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Catalini L, Fedder J, Nørgård BM, Jølving LR. Assisted Reproductive Technology Results Using Donor or Partner Sperm: A Danish Nationwide Register-Based Cohort Study. J Clin Med 2023; 12:jcm12072571. [PMID: 37048654 PMCID: PMC10095571 DOI: 10.3390/jcm12072571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
This was a nationwide cohort study based on Danish health registers focusing on assisted reproductive technology (ART) treatments in women using donor or partner sperm from 2007 to 2017. Women using donor sperm were subdivided into groups based on relationship status: women with male partners, single women, or women with female partners. The live birth adjusted odds ratios (aORs) after the IUI treatments in women using donor sperm compared with women using partner sperm were 1.48 (95% CI: 1.38–1.59) in women with male partners using donor sperm, 1.20 (95% CI: 1.13–1.28) in single women, and 1.46 (95% CI: 1.32–1.62) in women with female partners. The live birth aORs after IVF treatments in women using donor sperm compared with women using partner sperm were 1.16 (95% CI: 1.02–1.32) in women with male partners using donor sperm, 0.88 (95% CI: 0.80–0.96) in single women, and 1.20 (95% CI: 1.00–1.44), in women with female partners. The use of donor sperm was associated with a higher chance of a live birth after the IUI treatments, but there was no difference after the IVF treatments. Our study invites healthcare professionals to increase their attention toward the different needs and fertility issues of all women attending fertility clinics.
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Affiliation(s)
- Laura Catalini
- Centre of Andrology and Fertility Clinic, Odense University Hospital, 5000 Odense, Denmark
- Research Unit of Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
- Correspondence:
| | - Jens Fedder
- Centre of Andrology and Fertility Clinic, Odense University Hospital, 5000 Odense, Denmark
- Research Unit of Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, 5000 Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Line Riis Jølving
- Center for Clinical Epidemiology, Odense University Hospital, 5000 Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
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Diego D, Medline A, Shandley LM, Kawwass JF, Hipp HS. Donor sperm recipients: fertility treatments, trends, and pregnancy outcomes. J Assist Reprod Genet 2022; 39:2303-2310. [PMID: 36089627 PMCID: PMC9464617 DOI: 10.1007/s10815-022-02616-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To report fertility treatment use and outcomes among patients who use donor sperm for intrauterine insemination (IUI), in vitro fertilization (IVF), and reciprocal IVF (co-IVF). Methods This is a retrospective review of patients who used donor sperm at an urban, southeastern academic reproductive center between 2014 and 2020. Results Among the 374 patients presenting for care, 88 (23.5%) were single, 188 (50.3%) were in a same-sex female partnership, and 98 (26.2%) had a male partner with a diagnosis of male factor infertility. Most patients did not have infertility (73.2%). A total of 1106 cycles were completed, of which there were 931 IUI cycles, 146 traditional IVF cycles, and 31 co-IVF cycles. Live birth rates per cycle were 11% in IUI, 42% in IVF, and 61% in co-IVF. Of all resulting pregnancies, hypertensive disorders were most commonly experienced (18.0%), followed by preterm delivery (15.3%), neonatal complications (9.5%), gestational diabetes (4.8%), and fetal growth restriction (4.8%). Of the 198 infants born, fifteen (8.3%) required admission to the neonatal intensive care unit and three (1.7%) demised. Pregnancy and neonatal complications were more likely to occur in older patients and patients with elevated body mass index. Conclusion The use of donor sperm for fertility treatment is increasing. These data show reassuring live birth rates; however, they also highlight the risks of subsequent pregnancy complications. With the expansion of fertility treatment options for patients, these data assist provider counseling of patients regarding anticipated cycle success rates and possible pregnancy complications.
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Affiliation(s)
- Daniela Diego
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA.
| | | | - Lisa M Shandley
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory Reproductive Center, Atlanta, GA, USA
| | - Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory Reproductive Center, Atlanta, GA, USA
| | - Heather S Hipp
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory Reproductive Center, Atlanta, GA, USA
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Brandão P, Ceschin N, Cruz F, Sousa-Santos R, Reis-Soares S, Bellver J. Similar reproductive outcomes between lesbian-shared IVF (ROPA) and IVF with autologous oocytes. J Assist Reprod Genet 2022; 39:2061-2067. [PMID: 35819575 PMCID: PMC9474973 DOI: 10.1007/s10815-022-02560-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare reproductive outcomes of the ROPA method (reception of oocytes from partner) to IVF with autologous oocytes. To study the impact of the absence of a genetic link between the embryo and its recipient in reproductive outcomes. METHODS Retrospective multicentric cohort study performed from January 2011 to December 2020 in 18 fertility clinics in Spain. A total of 99 ROPA (73 couples) and 2929 non-ROPA cycles (2334 couples or single patients) of women younger than 38 years old with no known female fertility disorder were included. Clinical outcomes were compared between both groups and included positive pregnancy test, clinical pregnancy, miscarriage, ectopic pregnancy, pre-term birth, live birth, weeks of gestation at birth, and newborn weight at birth. RESULTS No differences were found between groups in clinical outcomes. The total clinical pregnancy rates per embryo transfer were 57% and 50.2% (p = 0.15) and the live-birth rates were 46.1% and 40.9% (p = 0.14) for the ROPA and non-ROPA groups, respectively. When adjusted to age and BMI of donors and recipients, there were also no differences in live-birth rates between both groups. The cumulative live-birth rate per ROPA cycle was 73.7% and the cumulative live-birth rate per couple was 78.3%. CONCLUSION Clinical outcomes following the ROPA method and IVF with autologous oocytes were found to be similar. These findings suggest no impact of the absence of genetic ties between the embryo and the uterus on reproductive treatments' outcomes. Data regarding the outcomes of the ROPA method are reassuring.
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Affiliation(s)
- Pedro Brandão
- IVI-RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain.
- Faculty of Medicine, University of Porto, Porto, Portugal.
| | | | - Fábio Cruz
- IVI-RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain
- IVI Foundation, Valencia, Spain
| | | | | | - José Bellver
- IVI-RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain
- Faculty of Medicine and Odontology, Valencia, Spain
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Brandão P, Ceschin N, Gómez VH. The Pathway of Female Couples in a Fertility Clinic. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:660-666. [PMID: 35668678 PMCID: PMC9948101 DOI: 10.1055/s-0042-1744444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The present study aims to describe the main characteristics of female couples resorting to a fertility clinic, to understand whether these patients have clear previous plans concerning procreation and how they end up completing their family planning, and to briefly describe the main outcomes of the recepción de ovocitos de pareja (ROPA, in the Spanish acronym: in English, reception of partner's oocytes) method. METHODS This is a descriptive retrospective study of the pathway and outcomes of female couples in a fertility clinic during a 2-year period. RESULTS A total of 129 couples were treated. Only one third of the couples had no condition potentially affecting fertility or advanced age. Most couples were decided to undergo artificial insemination or in vitro fertilization and the majority kept their plans, as opposed to 38% of the couples who decided to the ROPA method (lesbian shared in vitro fertilization) who changed plans. Live birth rates per treatment (including frozen embryo transfers) for artificial insemination, 58% for in vitro fertilization, 80% for treatments with donated oocytes or embryos, and 79% for ROPA. Four in five couples achieved live births. CONCLUSION The present study highlights the importance of a thorough medical workup in same-sex couples resorting to assisted reproduction. Despite the higher-than-expected rates of fertility disorders, the outcomes were good. Most couples end up in a single parented method. Furthermore, the results of the ROPA method are reassuring.
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Affiliation(s)
- Pedro Brandão
- Department of Reproductive Medicine, Instituto Valenciano de Infertilidad, IVIRMA Global Valencia, Valencia, Spain.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Nathan Ceschin
- Department of Reproductive Medicine, Feliccità Instituto de Fertilidade, Curitiba, PR, Brazil
| | - Victor Hugo Gómez
- Department of Reproductive Medicine, Instituto Valenciano de Infertilidad, IVIRMA Global Valencia, Valencia, Spain
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Live birth, cumulative live birth and perinatal outcome following assisted reproductive treatments using donor sperm in single women vs. women in lesbian couples: a prospective controlled cohort study. J Assist Reprod Genet 2022; 39:629-637. [PMID: 35106694 PMCID: PMC8995219 DOI: 10.1007/s10815-022-02402-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/13/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Assisted reproductive technology (ART) treatments with donor sperm have been allowed for women in lesbian relationships (WLR) since 2005 in Sweden, but for single women (SW), these became approved only recently in 2016. This study was conducted to compare the outcomes of ART treatments in SW vs. WLR. Methods This is a prospective controlled cohort study of 251 women undergoing intrauterine insemination (D-IUI) or in vitro fertilization (D-IVF) using donor sperm between 2017 and 2019 at the department of Reproductive Medicine, Karolinska University Hospital. The cohort comprised 139 SW and 112 WLR. The main outcomes included differences in live birth rate (LBR) and cumulative live birth rate (cLBR) between the groups. The SW underwent 66 D-IUI and 193 D-IVF treatments and WLR underwent 255 D-IUI and 69 D-IVF treatments. Data on clinical characteristics, treatment protocols and clinical outcomes were extracted from the clinic’s electronic database. The outcomes of D-IUI and D-IVF were separately assessed. Results The cohort of SW was significantly older than WLR (37.6 vs. 32.4 years, P < 0.001), and more commonly underwent IVF at first treatment (83% vs. 29%, P < 0.000). Conversely, WLR underwent more frequently D-IUI as a first treatment (71% vs. 17% of SW, P < 0.001) and more often in the natural cycle (89.9% vs. 70.8%, P = 0.019), respectively. There was no statistically significant difference in the main outcome LBR between the two groups, or between the two different types of treatment, when adjusted for age. Perinatal outcomes and cLBR were also similar among the groups. Conclusions SW were, on average, older than WLR undergoing treatment with donor sperm. No significant differences were seen in the LBR and cLBR when adjusted for age between the two groups and between the two types of treatment (D-IVF vs. D-IUI). Trial registration ClinicalTrials.gov NTC04602962.
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Johal JK, Gardner RM, Vaughn SJ, Jaswa EG, Hedlin H, Aghajanova L. Pregnancy success rates for lesbian women undergoing intrauterine insemination. F S Rep 2021; 2:275-281. [PMID: 34553151 PMCID: PMC8441558 DOI: 10.1016/j.xfre.2021.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To compare the pregnancy outcomes of lesbian women undergoing donor sperm intrauterine insemination (IUI) with that of heterosexual women undergoing IUI using partner or donor sperm. Design Retrospective cohort analysis. Setting Two academic fertility practices. Patient(s) All IUI cycles between 2007 and 2016. Intervention(s) None. Main outcome measure(s) Primary outcomes included clinical pregnancy (CP) rates and live birth/ongoing pregnancy (LB) rates. The baseline characteristics and cycle characteristics were compared between the two groups using absolute standardized differences (ASDs). To account for the correlation between cycles per patient, a generalized estimating equation method for multivariable logistic regression was used. Results A total of 11,870 IUI cycles were included, of which 393 were in lesbian women using donor sperm and 11,477 were in heterosexual women with infertility using either partner or donor sperm. The CP rates were similar between the lesbian and heterosexual groups (13.2% vs. 11.1%, respectively, ASD = 0.06). In addition, the LB rates were similar between the two groups (10.4% vs. 8.3%, respectively, ASD = 0.10). After implementing the generalized estimating equation in a multivariable logistic regression, the lesbian group had an overall higher odds of CP (adjusted odds ratio 1.40, 95% confidence interval: [1.04–1.88]) and LB (adjusted odds ratio 1.59, 95% confidence interval [1.15–2.20]) compared with the heterosexual group. The clinical miscarriage rate was higher in the heterosexual group compared with that in the lesbian group (23.8% vs. 15.4%, respectively, ASD = 0.21). Conclusion Although the unadjusted rates were similar between the two groups, the adjusted CP and LB odds were significantly higher for lesbian women undergoing IUI for procreative management than those for heterosexual women undergoing IUI for infertility.
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Affiliation(s)
- Jasmyn K Johal
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, Stanford, California
| | - Rebecca M Gardner
- Quantitative Sciences Unit, Department of Medicine, Stanford School of Medicine, Stanford, California
| | - Sara J Vaughn
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, Stanford, California
| | - Eleni G Jaswa
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Franciso, California
| | - Haley Hedlin
- Quantitative Sciences Unit, Department of Medicine, Stanford School of Medicine, Stanford, California
| | - Lusine Aghajanova
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, Stanford, California
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Bortoletto P, Willson S, Romanski PA, Davis OK, Rosenwaks Z. Reproductive outcomes of women aged 40 and older undergoing IVF with donor sperm. Hum Reprod 2021; 36:229-235. [PMID: 33432330 DOI: 10.1093/humrep/deaa286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/21/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Do women ≥40 years old without a male partner who utilize donor sperm have the same reproductive outcomes as those who utilize their partner's sperm? SUMMARY ANSWER After controlling for relevant confounders, women ≥40 years old using donor sperm for IVF have significantly higher odds of having a live birth compared to those utilizing their partner's sperm. WHAT IS KNOWN ALREADY Women who are unpartnered or in same-sex relationships are by definition not infertile, but may choose to conceive using donor sperm. It is not known how IVF outcomes are affected with the use of donor sperm compared to women utilizing their partner's sperm, particularly at very advanced maternal ages. STUDY DESIGN, SIZE, DURATION This is a retrospective cohort study conducted at a university-affiliated center of women undergoing IVF with fresh embryo transfer between 2008 and 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients were divided into two groups based on the ejaculated sperm source utilized: donor or partner sperm. Live birth rate was the primary outcome. Pregnancy rate was the secondary outcome. Multivariable logistic regression was performed and adjusted for age, the developmental stage of the embryo, and the number of embryos transferred. Unadjusted odds ratio (OR) and adjusted OR (aOR) with 95% CI for pregnancy and live birth were estimated. Statistical significance was denoted by P < 0.05. MAIN RESULTS AND THE ROLE OF CHANCE A total of 3910 cycles in women ≥40 years old were analyzed, of which 307 utilized donor sperm and 3603 utilized their partner's sperm to conceive. In the univariate analysis, patients utilizing donor sperm were found to have similar pregnancy rates as those utilizing partner sperm (41.0 vs 39.8%, OR: 0.95, 95% CI: 0.75-1.20). After adjusting for age, the number of embryos transferred and the developmental stage of the embryos, the model estimates did not vary (aOR: 1.22, 95% CI: 0.95-1.56). Similarly, the univariate analysis for live birth did not demonstrate a difference between groups (19.2 vs 17.8%, OR: 0.91, 95% CI: 0.67-1.22). However, after a similar adjustment was made for confounders, the use of donor sperm was associated with statistically significant increased odds of live birth (aOR: 1.38, 95% CI: 1.01-1.88). LIMITATIONS, REASONS FOR CAUTION As with any retrospective study, the potential for residual confounding exists, despite attempts to control for this with regression modeling. WIDER IMPLICATIONS OF THE FINDINGS Women ≥40 years old who are unpartnered or in same-sex relationships can be counseled that their odds of a live birth are slightly better than women in heterosexual relationships utilizing their partner's sperm. These findings serve to further refine and individualize counseling on the expected IVF outcomes for women in this population. STUDY FUNDING/COMPETING INTEREST(S) No funding was sought for this study. The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- P Bortoletto
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, NY, USA
| | - S Willson
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - P A Romanski
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, NY, USA
| | - O K Davis
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Z Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, NY, USA
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Balcells L, Fabra P, Polo A, Calaf J. Putting reproductive rights into practice. The profile of the demand in a publicly sponsored ART program for single or female partner women in Catalonia. EUR J CONTRACEP REPR 2021; 26:279-283. [PMID: 33724129 DOI: 10.1080/13625187.2021.1891410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the size and characteristics of the demand for a newly established, publicly sponsored, program of assisted reproduction for single women (SW) and women with a female partner (FP) in a European country. MATERIALS AND METHODS We analysed the application forms received during the first two years and structured interviews with 300 successive non selected applicants. RESULTS The mean sustained size of the demand was of 52.6 applications per month (sd 14) and corresponded to 0.06 % of the target population. Data from 237 applicants was evaluable. 119 (50.2 %) were SW and 118 (49.8 %) were FP. The median age was 36 years, 36.5 years for SW and 34 years for FP (p < 0.001, Mann-Whitney). Clinically 18.6 % of women presented irregular cycles, and 17.8 % of women had undergone hysterosalpingography (HSG), with a 14.3% prevalence of tubal dysfunction. CONCLUSIONS A publicly sponsored program for Assisted Reproduction for SWFP should establish clear inclusion criteria, especially as regards to age, ovarian reserve, techniques offered, and the number of cycles to obtain the maximal efficiency. Further research specific for this group is required to ensure that they receive adequate care and ultimately to fulfil their reproductive rights.
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Affiliation(s)
- Laura Balcells
- Department of Obstetrics and Gynaecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Paula Fabra
- Department of Obstetrics and Gynaecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ana Polo
- Department of Obstetrics and Gynaecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Programa de Reproducció Assistida, Fundació Puigvert, Barcelona, Spain.,Medicine Faculty, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquim Calaf
- Department of Obstetrics and Gynaecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Programa de Reproducció Assistida, Fundació Puigvert, Barcelona, Spain.,Medicine Faculty, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract
The use of assisted reproduction among women in relationships with other women has increased in the United States over the past decade as a result of increased legal access and social acceptance. Despite this shift, limited studies currently exist to guide optimal fertility care for this growing patient population of women seeking assisted reproduction. In this Commentary, assisted reproduction will be meant to include ovulation induction, intrauterine insemination (IUI), and in vitro fertilization (IVF). Conflicting studies suggest that self-identified lesbian women may demonstrate an increased prevalence of polycystic ovarian syndrome. Most available studies find that a woman's sexual orientation does not affect the outcome of fertility treatment. Self-identified lesbian women undergoing donor sperm IUI and IVF have similar pregnancy and live-birth rates as heterosexual women. Better evidence regarding patient demographics and comorbidities, underlying etiologies of subfertility, and assisted reproductive outcomes among women building families with other women is needed to optimize care.
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Carpinello OJ, Jahandideh S, Yamasaki M, Hill MJ, Decherney AH, Stentz N, Moon KS, Devine K. Does ovarian stimulation benefit ovulatory women undergoing therapeutic donor insemination? Fertil Steril 2020; 115:638-645. [PMID: 33077237 DOI: 10.1016/j.fertnstert.2020.08.1430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/19/2020] [Accepted: 08/28/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare clinical and ongoing pregnancy after natural cycle (NC) intrauterine insemination (IUI) versus ovarian stimulation (OS) IUI in ovulatory women undergoing therapeutic donor insemination (TDI). DESIGN Retrospective cohort. SETTING Single infertility center. PATIENT(S) A total of 76,643 IUI cycles in patients treated with intrauterine insemination were examined. Women undergoing TDI in the absence of diagnosed female factor infertility were included. INTERVENTION(S) NC TDI or OS TDI with either clomiphene citrate or letrozole. MAIN OUTCOME MEASURE(S) Clinical and ongoing pregnancies were analyzed by generalized estimating equations adjusting for age, body mass index, total motile sperm at time of insemination and cycle number. Ongoing multiple gestations were examined as a secondary outcome. RESULT(S) Six thousand one hundred ninety-two TDI cycles from 2,343 patients (711 patients without repeated IUI cycles) met inclusion criteria and were available for analysis (3,837 NC and 2,355 OS). There was no difference in mean age between the two groups (NC, 34.2 years vs. OS, 34.3 years). Probability of clinical and ongoing pregnancy was higher in the OS cohort compared with the NC cohort (OS, 22.4% vs. NC, 18.7% and OS, 15.4% vs. NC, 14.9%, respectively). However, OS significantly increased ongoing multiple gestations (OS, 10.8% vs. NC, 2.4%). CONCLUSION(S) Ovarian stimulation in TDI cycles resulted in a <4% increase in clinical and <1% increase in ongoing pregnancy, and more than fourfold increase in ongoing multiple gestations. Natural cycle IUI should be considered as a first-line treatment for ovulatory women who need donor insemination.
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Affiliation(s)
- Olivia J Carpinello
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
| | | | - Meghan Yamasaki
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Micah J Hill
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Alan H Decherney
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Soares SR, Cruz M, Vergara V, Requena A, García-Velasco JA. Donor IUI is equally effective for heterosexual couples, single women and lesbians, but autologous IUI does worse. Hum Reprod 2020; 34:2184-2192. [PMID: 31711203 DOI: 10.1093/humrep/dez179] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/30/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Are there differences in the clinical outcomes of IUI among different populational groups (heterosexual couples, single women and lesbian couples)? SUMMARY ANSWER The outcome of donor IUI (D-IUI) is similar in all populational groups and better than that seen with autologous insemination. WHAT IS KNOWN ALREADY A vast body of literature on clinical outcome is available for counselling heterosexual couples regarding decisions related to ART. The reproductive potential of single women, lesbian couples and heterosexual couples who need donor semen is assumed to be better, but there is a scarcity of data on their ART performance to actually confirm it. STUDY DESIGN, SIZE, DURATION In this retrospective multicentric cohort study, a total of 7228 IUI treatment cycles performed in 3807 patients between January 2013 and December 2016 in 13 private clinics belonging to the same reproductive medicine group in Spain were included. Patients with previous IUI attempts were excluded from the study. Only 1.9% of cycles were lost to follow-up. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 5318 D-IUI cycles were performed in three different populational groups: heterosexual couples (D-HC, 1167 cycles), single women (SW, 2839 cycles) and lesbian couples (LC, 1312), while a total of 1910 autologous IUI cycles were performed in heterosexual couples (A-HC). This last one was considered the control group and was composed of cycles performed in couples with a male partner with sperm parameters equivalent to those requested from donors. In order to identify factors with an impact on clinical outcome, a multivariate logistic regression analysis was performed. Regarding live birth rate (LBR), mixed effect models were employed to control for the fact that different patients were submitted to different numbers of treatments. MAIN RESULTS AND THE ROLE OF CHANCE Parameters that were significant to the primary outcome (LBR) according to the multivariate analysis were the populational group (D-HC, SW, LC and A-HC) to which the patient belonged, female age and a diagnosis of low ovarian reserve. At the age range of good prognosis (≤37 years), LBR was similar in all groups that underwent D-IUI (18.8% for D-HC, 16.5% for SW and 17.6% for LC) but was significantly lower in the autologous IUI (A-HC) group (11%). For all these significant findings, the strength of the association was confirmed by P values <0.001. From 38 years of age on, no significant differences were observed among the populational groups studied, and for all of them, LBR was below 7% from 40 years of age on. LIMITATIONS, REASONS FOR CAUTION To the best of our knowledge, a smoking habit was the only known factor with a potential effect on ART outcome that could not be controlled for, due to the unavailability of this information in a significant percentage of the clinical files studied. Our study was not capable of precisely quantifying the impact of a diagnosis of low ovarian reserve on the LBR of both IUI and D-IUI, due to the number of cycles performed in patients with such diagnosis (n = 231, 3.2% of the total). WIDER IMPLICATIONS OF THE FINDINGS For the first time, a comparison among D-HC, SW, LC and A-HC was performed in a study with a robust sample size and controlling for potential sources of bias. There is now sound evidence that equivalent clinical outcome is seen in the three groups treated with donor semen (D-HC, SW and LC). Specifically, regarding the comparison between SW and LC, our findings rule out differences in LBR proposed by previous publications, with very similar clinical outcomes within the same age ranges. At age ranges of good prognosis (≤37 years), reproductive performance of D-IUI is significantly better than that seen in heterosexual couples undergoing autologous IUI, even when only cases of optimal sperm quality are considered in this last group. This finding is in agreement with the concept that, as a group, A-HC are more prone to have female factor infertility, even when their infertility assessment finds no contraindication to IUI. Age affects all these groups equally, with none of them reaching a 7% LBR after the age of 40 years. Our findings will be useful for the counselling of patients from the different populations studied here about ART strategies. STUDY FUNDING/COMPETING INTEREST(S) None.
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12
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Does empiric superovulation improve fecundity in healthy women undergoing therapeutic donor insemination without a male partner? Fertil Steril 2020; 113:114-120. [DOI: 10.1016/j.fertnstert.2019.08.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/12/2019] [Accepted: 08/29/2019] [Indexed: 01/25/2023]
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Double intrauterine insemination (IUI) of no benefit over single IUI among lesbian and single women seeking to conceive. J Assist Reprod Genet 2019; 36:2095-2101. [PMID: 31410635 DOI: 10.1007/s10815-019-01561-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To explore clinical benefit of performing two intrauterine inseminations (IUI) 24 h apart-a double IUI vs. a single IUI among lesbian and single women. METHODS Retrospective cohort study using electronic medical record review during a 17-year period (11/1999-3/2017). A total of 11,396 patients at a single academic-affiliated private practice were included in this study. All cycles with a single or double IUI were included. A sub-analysis of first cycles only (n = 10,413) was also performed. Canceled IVF cycles converted to IUI were excluded. T tests and Wilcoxon rank-sum tests were used for continuous data, and chi-square for categorical data. Multivariable logistic regression controlled for patient age, day 3 follicle-stimulating hormone (D3 FSH), body mass index (BMI), peak estradiol (E2), and post-wash total motile sperm counts to model the association between IUI number and ongoing pregnancy rate (OPR) according to sperm source (autologous vs. donor). Generalized estimating equations and mixed effect models accounted for multiple cycles from the same woman. Adjusted odds ratio (AOR) with 95% CI was determined. Sub-analyses of sexual orientation and partner status were performed to compare heterosexual couples with proven infertility to women with lesbian and single women. RESULTS During the study period, 22,452 cycles met inclusion criteria (single IUI 1283 vs. double IUI 21,169). Mean patient age and BMI were similar between groups. For couples using autologous sperm, OPR was significantly higher with double IUI (12.0% vs. 14.1%; p = 0.0380). A similar increase was observed for donor sperm OPR among heterosexual couples (14.4% vs. 16.2%), though this did not reach statistical significance (p = 0.395). A sub-analysis restricted to donor sperm demonstrates a clinical benefit of second IUI in heterosexual couples, 8.5% vs. 17.6% OPR (AOR 2.94; CI 1.00-10.99; p = 0.0496). When lesbian and single patients were evaluated, there was no difference (17.2% vs. 15.2%; AOR 0.99; CI 0.59-1.70; p = 0.0958). CONCLUSIONS Double IUI is associated with a significantly higher OPR for heterosexual couples using an autologous or donor sperm source. The benefit of a second IUI is less clear in patients with undocumented fertility status using donor sperm, such as single and lesbian women.
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Nazem TG, Chang S, Lee JA, Briton-Jones C, Copperman AB, McAvey B. Understanding the Reproductive Experience and Pregnancy Outcomes of Lesbian Women Undergoing Donor Intrauterine Insemination. LGBT Health 2019; 6:62-67. [PMID: 30848719 DOI: 10.1089/lgbt.2018.0151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The study purpose was to evaluate the reproductive experience, specifically cycle characteristics and treatment outcomes, of lesbian women. In addition, we aimed to determine whether there are differences in pregnancy outcomes when comparing lesbian women undergoing ovulation induction (OI) versus natural cycles with donor intrauterine insemination (IUI), as well as lesbian and heterosexual women undergoing the same assisted reproductive technology treatment. METHODS This was a retrospective cohort study including women who underwent an IUI with cryopreserved sperm between 2006 and 2018. The primary outcome of interest was clinical pregnancy (CP) rate. RESULTS A total of 216 lesbian women (451 natural cycles and 441 OI cycles) and 584 heterosexual women (1177 natural cycles and 1238 OI cycles) were included in the study. Thirty percent of lesbian women had a hysterosalpingogram as part of their initial workup. Approximately 40% of lesbian women who underwent OI/IUI had previously undergone at least one natural cycle/IUI. There was no significant difference in CP rate when comparing lesbian women and heterosexual women undergoing natural or OI/IUI, or when comparing lesbian women who underwent natural versus OI/IUI cycles. However, there was a significantly higher multiple gestation rate among lesbian women undergoing OI compared with those undergoing natural cycles (11.8% vs. 0%, p = 0.01). CONCLUSION This large study showed that while pregnancy outcomes were similar between groups, the multiple gestation rate was higher in lesbian women undergoing OI compared with lesbian women undergoing natural cycles.
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Affiliation(s)
- Taraneh Gharib Nazem
- 1 Reproductive Medicine Associates of New York, New York, New York.,2 Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sydney Chang
- 1 Reproductive Medicine Associates of New York, New York, New York.,2 Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph A Lee
- 1 Reproductive Medicine Associates of New York, New York, New York
| | | | - Alan B Copperman
- 1 Reproductive Medicine Associates of New York, New York, New York.,2 Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Beth McAvey
- 1 Reproductive Medicine Associates of New York, New York, New York.,3 Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai West, New York, New York
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Hodson K, Meads C, Bewley S. Lesbian and bisexual women's likelihood of becoming pregnant: a systematic review and meta-analysis. BJOG 2017; 124:393-402. [PMID: 27981741 PMCID: PMC5299536 DOI: 10.1111/1471-0528.14449] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Few data exist regarding pregnancy in lesbian and bisexual (LB) women. OBJECTIVES To determine the likelihood of LB women becoming pregnant, naturally or assisted, in comparison with heterosexual women SEARCH STRATEGY: Systematic review of papers published 1 January 2000 to 23 June 2015. SELECTION CRITERIA Studies contained details of pregnancy rates among LB women compared with heterosexual women. No restriction on study design. DATA COLLECTION AND ANALYSIS Inclusion decisions, data extraction and quality assessment were conducted in duplicate. Meta-analyses were carried out, with subgroups as appropriate. MAIN RESULTS Of 6859 papers identified, 104 full-text articles were requested, 30 papers (28 studies) were included. The odds ratio (OR) of ever being pregnant was 0.19 (95% CI 0.18-0.21) in lesbian women and 1.22 (95% CI 1.15-1.29) in bisexual women compared with heterosexual women. In the general population, the odds ratio for pregnancy was nine-fold lower among lesbian women and over two-fold lower among bisexual women (0.12 [95% CI 0.12-0.13] and 0.50 [95% CI 0.45-0.55], respectively). Odds ratios for pregnancy were higher for both LB adolescents (1.37 [95% CI 1.18-1.59] and 1.98 [95% CI 1.85, 2.13], respectively). There were inconsistent results regarding abortion rates. Lower rates of previous pregnancies were found in lesbian women undergoing artificial insemination (OR 0.17 [95% CI 0.11-0.26]) but there were higher assisted reproduction success rates compared with heterosexual women (OR 1.56 [95% CI 1.24-1.96]). CONCLUSIONS Heterosexuality must not be assumed in adolescents, as LB adolescents are at greater risk of unwanted pregnancies and terminations. Clinicians should provide appropriate information to all women, without assumptions about LB patients' desire for, or rejection of, fertility and childbearing. TWEETABLE ABSTRACT Review of likelihood of LB women becoming pregnant: LB teenagers at greater risk of unwanted pregnancies.
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Affiliation(s)
| | - C Meads
- Department of Health, Social Care and EducationAnglia Ruskin UniversityCambridgeUK
| | - S Bewley
- Division of Women's HealthWomen's Health Academic CentreKing's College London and King's Health PartnersSt Thomas’ Hospital CampusLondonUK
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16
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Robinson K, Galloway KY, Bewley S, Meads C. Lesbian and bisexual women's gynaecological conditions: a systematic review and exploratory meta-analysis. BJOG 2017; 124:381-392. [PMID: 27862853 PMCID: PMC5363366 DOI: 10.1111/1471-0528.14414] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Little is known about the gynaecological health of lesbian and bisexual (LB) women. OBJECTIVES To examine differences in incidence and/or prevalence of gynaecological conditions in LB compared with heterosexual women. SEARCH STRATEGY The systematic review protocol was prospectively registered (PROSPERO-CRD42015027091) and searches conducted in seven databases. SELECTION CRITERIA Comparative studies published 2000-2015, reporting any benign (non-infectious) and/or malignant gynaecological conditions with no language or setting restrictions. DATA COLLECTION AND ANALYSIS Inclusions, data extraction and quality assessment were conducted in duplicate. Meta-analyses of condition prevalence rates were conducted where ≥3 studies reported results. MAIN RESULTS From 567 records, 47 full papers were examined and 11 studies of mixed designs included. No studies directly addressing the question were found. Two chronic pelvic pain studies reported higher rates in bisexual compared with heterosexual women (38.5 versus 28.2% and 18.6 versus 6.4%). Meta-analyses showed no statistically significant differences in polycystic ovarian syndrome, endometriosis and fibroids. There was a higher rate of cervical cancer in bisexual than heterosexual women [odds ratio (OR) = 1.94; 95% CI 1.46-2.59] but no difference overall (OR = 0.76; 95% CI 0.15-3.92). There was a lower rate of uterine cancer in lesbian than heterosexual women (OR = 0.28; 95% CI 0.11-0.73) and overall (OR = 0.36; 95% CI 0.13-0.97), but no difference in bisexual women (OR = 0.43; 95% CI 0.06-3.07). CONCLUSIONS More bisexual women may experience chronic pelvic pain and cervical cancer than heterosexual women. There is no information on potential confounders. Better evidence is required, preferably monitoring sexual orientation in research using the existing validated measure and fully reporting results. TWEETABLE ABSTRACT Lesbians have less uterine cancer than heterosexual women; bisexuals have more pelvic pain and cervical cancer.
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Affiliation(s)
- K Robinson
- Division of Women's HealthWomen's Health Academic CentreKing's College London and King's Health PartnersLondonUK
| | - KY Galloway
- Division of Women's HealthWomen's Health Academic CentreKing's College London and King's Health PartnersLondonUK
| | - S Bewley
- Division of Women's HealthWomen's Health Academic CentreKing's College London and King's Health PartnersLondonUK
| | - C Meads
- RAND EuropeWestbrook CentreCambridgeUK
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Obajimi GO, Ogunbode OO, Adetayo CO, Ilesanmi AO. Acceptability of artificial insemination by donor among infertile women attending the Gynaecological Clinic of the University College Hospital, Ibadan. TROPICAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2017. [DOI: 10.4103/tjog.tjog_63_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Schwartz SR, Baral S. Fertility-related research needs among women at the margins. REPRODUCTIVE HEALTH MATTERS 2015; 23:30-46. [PMID: 26278831 DOI: 10.1016/j.rhm.2015.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/29/2015] [Accepted: 06/08/2015] [Indexed: 11/15/2022] Open
Abstract
Fertility-related research encompasses fertility intentions, preconception care, research amongst pregnant women, and post-partum outcomes of mothers and children. However, some women remain under-represented within this domain of study. Women frequently missing within fertility-related research include those who are already the most vulnerable to health disparities, including female sex workers, lesbian, gay, bisexual, and transgender women, women living with HIV, and women who use drugs. Yet characterization of the needs of these women is important, given their unique fertility-related concerns, including risks and barriers to care emanating from social stigmas and discrimination. This synthesis provides an overview of fertility-related evidence, highlighting where there are clear research gaps among marginalized women and the potential implications of these data shortfalls. Overall, research among marginalized women to date has addressed pregnancy prevention and in some cases fertility intentions, but the majority of studies have focused on post-conception pregnancy safety and the well-being of the child. However, among female sex workers specifically, data on pregnancy safety and the well-being of the child are largely unavailable. Within each marginalized group, preconception care and effectiveness of conception methods are consistently understudied. Ultimately, the absence of epidemiologic, clinical and programmatic evidence limits the availability and quality of reproductive health services for all women and prevents social action to address these gaps.
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Affiliation(s)
- Sheree R Schwartz
- Assistant Scientist, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Stefan Baral
- Associate Professor, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Tarín JJ, García-Pérez MA, Cano A. Deficiencies in reporting results of lesbians and gays after donor intrauterine insemination and assisted reproductive technology treatments: a review of the first emerging studies. Reprod Biol Endocrinol 2015; 13:52. [PMID: 26022418 PMCID: PMC4450473 DOI: 10.1186/s12958-015-0053-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/27/2015] [Indexed: 11/10/2022] Open
Abstract
At a time when increasing numbers of lesbians and gays consider parenthood using reproductive assistance in infertility centers, the present review aims to summarize the results obtained so far by lesbians after intrauterine insemination (IUI) and in-vitro fertilization (IVF) using donor spermatozoa (D-IUI and D-IVF, respectively) and gays entering into gestational-surrogacy programs. Data show that gays display normal semen parameters and lesbians exhibit no specific causes of female infertility except perhaps for polycystic ovary syndrome (PCOS) and some PCOS-related factors. Pair-bonded lesbians entering into D-IUI programs, tend to have higher pregnancy and delivery percentages following spontaneous or induced ovulation than single or pair-bound heterosexual women. The only single study reporting success percentages of lesbians after D-IVF provides, however, puzzling results. In particular, pair-bonded lesbians have lower pregnancy and live-birth percentages than pair-bonded heterosexual women in fresh D-IVF cycles but percentages are similar in frozen/thawed D-IVF cycles. Like in lesbians after D-IUI, surrogate women recruited by pair-bonded gays/single men tend to have higher pregnancy percentages and lower miscarriage percentages than surrogate women recruited by heterosexual couples. Notably, all the reports reviewed in the present study are methodologically flawed because of sampling bias, small sample sizes and inadequate use of statistical methods to control for the effects of influential covariates including age, smoking habits, previous gynecological problems, hormonal stimulation type and protocol, and number of prior treatment types and pregnancies/deliveries. Clinicians, reproductive biologists and editors of fertility/infertility journals should make efforts to prevent these deficiencies in future data reporting.
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Affiliation(s)
- Juan J Tarín
- Department of Functional Biology and Physical Anthropology, Faculty of Biological Sciences, University of Valencia, Burjassot, Valencia, 46100, Spain.
| | - Miguel A García-Pérez
- Department of Genetics, Faculty of Biological Sciences, University of Valencia, Burjassot, Valencia, 46100, Spain.
- Research Unit-INCLIVA, Hospital Clínico de Valencia, Valencia, 46010, Spain.
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, University of Valencia, Valencia, 46010, Spain.
- Service of Obstetrics and Gynecology, University Clinic Hospital, Valencia, 46010, Spain.
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Nordqvist S, Sydsjö G, Lampic C, Åkerud H, Elenis E, Skoog Svanberg A. Sexual orientation of women does not affect outcome of fertility treatment with donated sperm. Hum Reprod 2014; 29:704-11. [PMID: 24435777 PMCID: PMC3949497 DOI: 10.1093/humrep/det445] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is there a difference in fertility between heterosexual women and lesbians undergoing sperm donation? SUMMARY ANSWER Women undergoing treatment with donated sperm are equally fertile regardless of sexual orientation. WHAT IS KNOWN ALREADY Lesbians have an increased prevalence of smoking, obesity, sexually transmitted diseases and, possibly, polycystic ovary syndrome, all factors known to affect fertility. Previous studies on sperm donation inseminations (D-IUI) show conflicting results regarding pregnancy outcome. STUDY DESIGN, SIZE, DURATION This is a national study of 171 lesbians and 124 heterosexual women undergoing sperm donation both as D-IUI (lesbian n = 438, heterosexual n = 298) and as embryo transfers (ET) after IVF with donated sperm (lesbians n = 225, heterosexuals n = 230) during 2005-2010. PARTICIPANTS/MATERIALS, SETTING, METHODS All clinics in Sweden offering sperm donation recruited patients. Differences in patients' medical history, treatment results and number of treatments to live birth were analyzed using independent samples t-test, Pearson's χ(2) test or Fisher's exact probability test. MAIN RESULTS AND THE ROLE OF CHANCE 71.8% of heterosexuals and 69.0% of lesbians had a child after treatment. The mean number of treatments was 4.2 for heterosexual women and 3.9 for lesbians. The total live birth rate, regardless of treatment type, was 19.7% for heterosexuals and 19.5% for lesbians. For D-IUI, the live birth rate was 12.8% for heterosexuals and 16.0% for lesbians and the live birth rate for all IVF embryo transfers (fresh and thawed cycles) was 28.7% for heterosexuals and 26.2% for lesbians. There were no differences in live birth rate between the groups for each of the different types of insemination stimulations (natural cycle; clomiphene citrate; FSH; clomiphene citrate and FSH combined). Nor was there a difference in live birth rate between the groups for either fresh or thawed embryo transfer. There was no difference between the proportions of women in either group or the number of treatments needed to achieve a live birth. Heterosexuals had a higher prevalence of smokers (9.2%), uterine polyps (7.2%) or previous children (11.3%) than lesbians (smokers 2.8%, P = 0.03; polyps 1.8%, P = 0.03; child 2.5%, P = 0.003). LIMITATIONS, REASONS FOR CAUTION This study is limited to women living in stable relationships undergoing treatment with donated sperm in a clinical setting and may not apply to single women or those undergoing home inseminations. WIDER IMPLICATIONS OF THE FINDINGS These results may influence healthcare policy decisions as well as increase the quality of clinical care and medical knowledge of healthcare professionals. The data also have important implications for individuals regarding screening, infertility diagnostic procedures and treatment types offered to heterosexuals and lesbians seeking pregnancy through sperm donation. STUDY FUNDING/COMPETING INTEREST(S) Funding was granted by the Stiftelsen Familjeplaneringsfonden i Uppsala; the Swedish Research Council for Health, Working Life and Welfare; and the Marianne and Marcus Wallenberg Foundation. The authors report no conflicts of interest.
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Affiliation(s)
- S Nordqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala SE-751 85, Sweden
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Abstract
BACKGROUND Although pregnancy loss is a distressing health event for many women, research typically equates women's experiences of pregnancy loss to ‘married heterosexual women's experiences of pregnancy loss’. The objective of this study was to explore lesbian and bisexual women's experiences of miscarriage, stillbirth and neonatal death. METHODS This study analysed predominantly qualitative online survey data from 60 non-heterosexual, mostly lesbian, women from the UK, USA, Canada and Australia. All but one of the pregnancies was planned. Most respondents had physically experienced one early miscarriage during their first pregnancy, although a third had experienced multiple losses. RESULTS The analysis highlights three themes: processes and practices for conception; amplification of loss; and health care and heterosexism. Of the respondents, 84% conceived using donor sperm; most used various resources to plan conception and engaged in preconception health care. The experience of loss was amplified due to contextual factors and the investment respondents reported making in impending motherhood. Most felt that their loss(es) had made a ‘significant’/‘very significant’ impact on their lives. Many respondents experienced health care during their loss. Although the majority rated the overall standard of care as ‘good’/‘very good’/‘outstanding’, a minority reported experiencing heterosexism from health professionals. CONCLUSIONS The implications for policy and practice are outlined. The main limitation was that the inflexibility of the methodology did not allow the specificities of women's experiences to be probed further. It is suggested that both coupled and single non-heterosexual women should be made more visible in reproductive health and pregnancy loss research.
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Affiliation(s)
- Elizabeth Peel
- School of Life & Health Sciences, Aston University, Birmingham B4 7ET, UK.
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Sawyer N. Who's keeping count? The need for regulation is a relative matter. Fertil Steril 2009; 92:1811-7. [DOI: 10.1016/j.fertnstert.2009.01.099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 10/22/2008] [Accepted: 01/12/2009] [Indexed: 10/21/2022]
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Abstract
The objective of this review is to analyse and integrate into a semi-historical background the alternative treatments available for the alleviation of infertility. Data are presented on their causes and success, using compilations of data reported in the literature along with personal experience. Results are expressed as the outcome of endocrinological and surgical treatments for female and male infertility. Clinical pregnancy and delivery rates are reported as the measurements of effectiveness of in-vitro fertilization and related techniques. Detailed analysis of the most important considerations with respect to a number of infertility treatment options are provided, and show how the treatment of choice will always depend on the specific context and needs of each patient. New technologies are described briefly, and an ethical comment completes the review.
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