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Wang A.Y.,University of Technology, Sydney | Dill S.K.,Access Australia | Bowman M.,Genea | Sullivan E.A.,University of Technology, Sydney
Australian and New Zealand Journal of Obstetrics and Gynaecology | Year: 2016

Background Information on gestational surrogacy arrangement and outcomes is limited in Australia. Aims This national population study investigates the epidemiology of gestational surrogacy arrangement in Australia: treatment procedures, pregnancy and birth outcomes. Materials and methods A retrospective study was conducted of 169 intended parents cycles and 388 gestational carrier cycles in Australia in 2004-2011. Demographics were compared between intended parents and gestational carrier cycles. Pregnancy and birth outcomes were compared by number of embryos transferred. Results Over half (54%) intended parents cycles were in women aged <35 years compared to 38% of gestational carrier cycles. About 77% of intended parents cycles were of nulliparous women compared to 29% of gestational carrier cycles. Of the 360 embryo transfer cycles, 91% had cryopreserved embryos transferred and 69% were single-embryo transfer (SET) cycles. The rates of clinical pregnancy and live delivery were 26% and 19%, respectively. There were no differences in rates of clinical pregnancy and live delivery between SET cycles (27% and 19%) and double-embryo transfer (DET) cycles (25% and 19%). Five of 22 deliveries following DET were twin deliveries compared to none of 48 deliveries following SET. There were 73 liveborn babies following gestational surrogacy treatment, including 9 liveborn twins. Of these, 22% (16) were preterm and 14% (10) were low birthweight. Preterm birth was 13% for liveborn babies following SET, lower than the 31% or liveborn babies following DET. Conclusions To avoid adverse outcomes for both carriers and babies, SET should be advocated in all gestational surrogacy arrangements. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Source

Koch J.,IVF Australia | Rowan K.,Genea | Rombauts L.,Monash University | Yazdani A.,University of Queensland | And 2 more authors.
Australian and New Zealand Journal of Obstetrics and Gynaecology | Year: 2012

Endometriosis is common in women with infertility but its management is controversial and varied. This article summarises the consensus developed by a group of Australasian subspecialists in reproductive endocrinology and infertility (the Australasian CREI Consensus Expert Panel on Trial evidence group) on the evidence concerning the management of endometriosis in infertility. Endometriosis impairs fertility by causing a local inflammatory state, inducing progesterone resistance, impairing oocyte release and reducing sperm and embryo transport. Medical treatments have a limited role, whereas surgical and assisted reproductive treatments improve pregnancy rates. The role of surgery for deep infiltrative endometriosis and repeat surgery requires further evaluation and there is insufficient evidence for the use of anti-adhesives to improve fertility. Intrauterine insemination (IUI) and in vitro fertilisation (IVF) improve pregnancy rates but women with endometriosis have lower pregnancy rates than those with other causes of infertility. The decision about whether to operate or pursue assisted reproduction will depend on a variety of factors such as the patient's symptoms, the presence of complex masses on ultrasound, ovarian reserve and ovarian access for IVF, risk of surgery and cost. Some women with infertility and endometriosis may benefit from a combination of assisted reproduction and surgery. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Source

Russell P.,GynaePath | Russell P.,University of Sydney | Sacks G.,IVF Australia | Tremellen K.,Repromed | Gee A.,Genea
Pathology | Year: 2013

Aim: Abnormally functioning immunocompetent cells in the endometrium are thought to be responsible for at least some cases of recurrent reproductive failure [recurrent miscarriage or recurrent in vitro fertilisation (IVF) failure], but their detailed investigation has been hampered by a lack of a standardised protocol of counting such cells in study or control patients. The purpose of this study is to use a standardised protocol for the assessment of immune cells in the endometrial biopsies of a large cohort ofwomen with recurrent reproductive failure and establish relevant reference ranges. Method: In a recent study, we reported the presence and distribution of selected immune cells and macrophages in the endometria from 222 women who had a routine endometrial biopsy for investigation of recurrent miscarriage or IVF failure. Since the completion of that study, a further 1767 cases have been examined, using the same assessment parameters of the earlier study. Results: This updated analysis of 1989 endometrial biopsies provides reference ranges for CD8 +, CD163+, CD56+ and CD57+ cells for individual 'days' of a normalised menstrual cycle. CD8+ T-cells displayed a modest (50%) increase in numbers in the luteal phase and periglandular aggregation was a useful indicator of a subtle focal endometritis, possibly of infective origin, and generally not identified in H&E sections. A rapid accumulation of CD163+ macrophages occurs in the superficial stroma after day 22 of the cycle, while a significant number of cases displayed single or clustered macrophages within glandular lumens of the superficial endometrium in luteal phase, especially after day 20 of the cycle. The significance of this change is unclear but may relate to a macrophage response to abnormal glandular secretion or to bleeding occurring at the time of ovulation. CD56+ uterine natural killer (uNK) cells show such a dramatic rise in both absolute numbers and percentage of stromal cells from day 22 of the standardised 28 day cycle that this needs to be taken into account in all clinical studies or individual assessments of endometrial biopsies. CD57+ NK cells are seen in small numbers in most cases and cell counts of greater than 10 per mm2 are regarded as abnormal. Conclusions: This large database provides a daily range which is the most accurate survey yet of uNK cell numbers. Co-location of CD8+ T-cells and CD56+ uNK cells in perviascular aggregates has been demonstrated. © 2013 Royal College of Pathologists of Australasia. Source

Kwik M.,IVF Australia | Kwik M.,University of Sydney | Karia S.,Genea | Boothroyd C.,Greenslopes Private Hospital
Australian and New Zealand Journal of Obstetrics and Gynaecology | Year: 2015

Background Ovarian hyperstimulation syndrome (OHSS) is an uncommon but important iatrogenic condition associated with considerable morbidity and a small risk of mortality. This document gathers the consensus of a group of fertility subspecialists to aid health professionals in the development of protocols and guidelines for the management of women with OHSS. Aim To produce evidence-based consensus statements on the treatment of ovarian hyperstimulation syndrome (OHSS). Methods The CREI Consensus Group met in 2013 and 2014 and identified issues for inclusion and review. Review of the available evidence was conducted and consensus statements prepared. Areas of dissent of expert opinion and for further research were noted. Results There is a paucity of good data regarding the treatment of this condition, and much of the treatment is supportive in nature. Most of the management recommendations are based on good clinical practice points, rather than evidence from randomised trials. Conclusion OHSS is an uncommon but serious condition for which there are a number of proven preventative strategies. Once OHSS is present, the treatment of OHSS is mainly supportive, and more research is required to elucidate treatment options targeted specifically at the main causative factors, to better treat the condition. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Source

Robson S.J.,Australian National University | Campbell S.,City Fertility Center | McDonald J.,Primary IVF | Tremellen K.,Repromed | And 2 more authors.
Human Reproduction | Year: 2015

Although there is now considerable experience in obtaining sperm from a cadaver, there is little or no published data regarding pregnancy, birth and long-term childhood health and development outcomes when posthumous sperm is used in in vitro fertilisation (IVF). We report the results from treatment of four women undergoing IVF treatment using posthumously acquired human sperm from their deceased partners. In all cases, testicular tissue was obtained in a mortuary setting, and the duration from death to posthumous sperm retrieval ranged from 12 to 48 h. The age of women treated ranged from 31 to 41 years. Fertilization rates ranged from 40 to 100%. Singleton pregnancies were obtained for each of the four women. One pregnancy was complicated by preterm birth at 31 weeks; the other three delivered at term. One baby was growth restricted but morphologically normal; the other children had term birthweights in the normal range. All four children were have shown normal health and developmental outcomes, with the follow-up ranging from 1 to 7 years. © 2015 The Author 2015. Source

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