This study examined fertility treatment decision-making participation preferences among Chinese women following a recent unsuccessful IVF cycle. Most participants prefer to share decision-making than handing over this task to their doctors or make decisions themselves. In agreement with Deber and colleagues [16] the preference for sharing rather than handing over decision-making tasks was higher for a specific health condition (i.e. fertility treatment) than a general health condition (i.e. mild chest pain). Previous studies have reported that couples experiencing infertility are keen to search for treatment-related information and share this with their healthcare professionals in order to maximizing the chances of successful treatment [4, 32]. As our participants were not completely new to IVF, they were likely to be more knowledgeable about fertility treatment than a dubious chest pain.

Despite the greater power distance between patients and healthcare professionals that characterises Chinese culture compared to Canadian culture [33], we documented a greater preference for Shared roles (and a lower preference for a Passive role) in our Hong Kong sample than in the Canadian study. In fact, no Canadian participants chose Autonomous roles, while a minority of our participants did so. While a direct comparison was not feasible, our participants were in fertility treatment for an average of 4.0years (+/2.5) and had completed at least one IVF cycle, while their Canadian counterparts were in treatment for 2.3years (+/2.6) only. The longer duration of fertility treatment may have led to greater self-efficacy in sharing treatment decision tasks. However, the effect of previous clinical experience (e.g. years of infertility, years of ART) did not result in a significant difference in preferences in the Hong Kong sample, after controlling for other demographic, clinical and well-being factors. Nonetheless, our findings serve to demonstrate the variety of possibilities regarding cultural differences in healthcare decision-making and the multi-factorial nature of patients preferences.

Our findings reveal several demographic and clinical factors related to decision-making participation preferences in the doctor-patient relationship. First, in agreement with previous studies, participants with a religious affiliation tended to be more passive than those without a religious affiliation, possibly due to a greater tendency to trust authorities [34]. Due to the small cell sizes and the lack of existing literature on the effect of different religions on the fertility experience of the Chinese population, by the principle of parsimony, we only dichotomized the sample into those who reported and those who did not report a religious affiliation. However, future research may explore the nuances of the impact of different religions on the experience of fertility treatment among East Asian patients. Passivity in treatment decision-making was also related to the diagnosis of secondary infertility, rather than primary infertility. Participants diagnosed with secondary infertility may have greater difficulties making sense of their current fertility problems as they have previously achieved a clinical pregnancy, irrespective of the outcome (live birth, ectopic pregnancy, or miscarriage). Hence, with greater uncertainty and complications regarding their reproductive potential, they may exhibit a higher tendency to rely on healthcare professionals for treatment decision-making. Likewise, relative to women confronting infertility of mixed causation, women with female factor only infertility tended to be more autonomous in fertility treatment decision-making. This greater autonomy could have been encouraged by the greater certainty of attributing the cause of infertility to oneself, and subsequently greater perceived responsibility for the condition and its treatment.

Nonetheless, in spousal relationships, nearly half of our sample preferred to hand over both PS and DM to their husband. The percentage of participants who preferred to share decision-making tasks dropped from 92% in the doctor-patient relationship to 52% in the spousal relationship. Being autonomous, however, remained a minority choice. The options postulated to be theoretically implausible by Deber and colleagues [16] were rare in the spousal context.

Several factors were related to the tendency to hand over rather than share decision-making tasks in the spousal relationship. Having controlled for the womans age, a higher husbands age was related to a greater tendency to hand over rather than share decision-making tasks. The larger spousal age gap, especially when the husband is the older spouse, may have enlarged the power imbalance between a couple, leading to a greater preponderance of the husbands view as regards infertility and its treatment. This could be particularly pertinent in Chinese culture where the child bears only the paternal family surname and bloodline. Higher anxiety in women was also related to a greater tendency to entrust the decision-making tasks to their husband. Anxiety may have fuelled a womans wish for her husband to shoulder the psychological burdens of decision-making.

In contrast to the shared decision-making model [7], according to which patients enjoy better adjustment with active engagement in the treatment decision-making process, in this study Passive roles in both the doctor-patient and spousal relationships were related to higher marital satisfaction. Our study cannot clarify the direction of causality between marital satisfaction and decision-making participation preferences. However, several explanations are possible. First, entrusting the tasks to a knowledgeable outsider, such as a doctor, may avoid relational conflicts, especially when the couple are divided in their views over infertility and its treatment. Active involvement or even handing over key tasks in treatment decision-making to the husband may foster mutual trust and commitment and enhance relational quality in fertility treatment where husbands are often side-lined [35]. Hence, handing over the decision-making tasks to doctors and husbands may enhance relational quality. On the other hand, higher relational quality may increase the tendency to hand over decision-making tasks to doctors or husbands. Inviting the husband to PS and DM requires pre-established trust that the couple are on the same page and share similar views about treatment.

Our participants had experienced a recent unsuccessful IVF cycle. Relinquishing treatment decision-making to a trusted partner at this emotionally difficult time may reduce the pressure on the woman on the one hand, but is also a precarious move on the other, especially if the husband does not share his wifes views or knowledge about the treatment. Thus, among couples where the wife has chosen to hand over PS and DM, there could be a high level of consensus and pre-established trust in fertility-related issues, which are impetuses for harmonious relationships. Higher marital satisfaction may also reduce the womans distress and enable her to place greater trust in and be more open to suggestions from the healthcare team. Hence, a high level of marital satisfaction could be the antecedent for handing-over decision-making tasks to husbands and doctors, rather than its consequence. Fertility treatment decision-making epitomizes how marital and doctor-patient relationships interact and influence each other. Future studies are encouraged to examine the interactions of these relationships in a contextualized and dynamic manner.

In addition to self-selection bias in recruitment, this cross-sectional study provides only a snapshot of the experience of women in IVF treatment and cannot infer the direction of causality. Decision-making participation preferences could change with increasing knowledge, treatment experience, and relationships with other decision-makers such as doctors and a partner. Future studies should adopt a longitudinal approach to examine changes in participation preferences and clarify the antecedents and consequences of these changes. We also only included women with experience of a recent unsuccessful IVF cycle. Their decision-making participation preferences could be different from women who have not initiated treatment, are in active treatment or who have already terminated treatment. Lastly, this study investigated participation preferences from the vantage point of the women rather than actual participation of the women, their partners and doctors. Future studies should investigate the perspectives of partners and doctors and develop means to improve the congruence of actual and preferred participation of all parties.

Despite the complexity of treatment decisions, our findings highlight that in partnership with doctors, women were keen to find solutions to their fertility problems as well as weighing various treatment options to arrive at a decision they deemed the best for them and their families. Echoing European Society of Human Reproduction and Embryology (ESHRE) guidelines [36] on psychosocial care in fertility treatment, our findings underscore the importance of providing information and decisional support to patients before, during and after a fertility treatment cycle. Not only is factual information about the pros, the cons and what to expect from different treatment and non-treatment options (e.g., adoption) important, decisional support in weighing different factors in relation to the unique situation of the woman and relational dynamics is also vital. The ultimate decision in fertility treatment is usually a trade-off among multiple factors that tend to be rather idiosyncratic and sometimes contradictory, including physical burden, psychological distress, social and familial expectations, desires for a biological child, financial affordability, etc. [5, 37]. A previous German study found that fertility patients were not well equipped to make informed treatment decisions because of their overwhelming desire for a child and insufficient information about the psycho-social-economic costs of treatment [5]. Counsellors should pay particular attention to these tangible and intangible costs and desires, screen for psychological and relational distress using validated measures and offer appropriate emotional and decisional support to couples throughout their treatment journey.

Unlike many other health conditions fertility treatment is marked by its relational nature [19]. Our findings highlight the significance of husbands involvement in decision-making from the viewpoint of their wives, and the associations between participation preferences and marital satisfaction. Chinese couples often face enormous stigma for being childless from both paternal and maternal families [24]. A husbands involvement has been found to be pivotal both for his wifes and his own adjustment [23, 38]. However, most husbands feel alienated in fertility treatment as many procedures and decisions concern their wife only [35]. Men are often involved in a typical IVF cycle at two points only consenting to the treatment and providing a semen sample. Previous studies found that husbands tend to perceive themselves as a stoic emotional rock to support their wife, an agent exercising a rational veto and responsibility, and/ or a biological necessity to provide semen [20, 39, 40]. The supportive role aside, the mere fact of infertility could be emasculating [41]. Guilt is commonly experienced, especially when witnessing the physical and emotional duress experienced by their partner because of their shared desire for a biological child [22], and is particularly salient in cases of male-factor infertility [42]. The prospect of involuntary childlessness is daunting for many men who have long aspired to be a father [43]. Under such threats to virility, the pressure to be strong and masculine escalates, making disclosure of distress and help-seeking even harder [44,45,46]. Hence, patient enablement and counselling in fertility settings should include husbands whenever appropriate and possible. To start with, healthcare professionals should acknowledge the construction of treatment preference as a multi-factorial and dynamic interplay between intuitive and deliberative mental processes of both the woman and her partner. To achieve a couple-oriented approach, healthcare professionals should ensure husbands are offered adequate emotional, informational, and decisional support in fertility treatment. Fertility treatment has long been positioned as a feminine discipline. Nonetheless, future research should examine how much and in what ways husbands expect to be engaged in fertility treatment and its decision-making, as well as their understanding of infertility, desire for fatherhood and experiences in ART (e.g., sperm extraction, sperm donation, etc). The knowledge generated by this study will build the evidence-base for gender-sensitive and couple-oriented psychosocial support.

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Preferred problem solving and decision-making role in fertility treatment among women following an unsuccessful in vitro fertilization cycle - BMC...

A same-sex couple have become the first in the world to carry the same baby in both their wombs as part of a landmark "shared motherhood" procedure.

The British couple Jasmine and Donna Francis-Smith welcomed their son, Otis, two months ago.

The baby was born via in vivo natural fertilization, which involves the eggs being incubated in the mother's body, rather than externally, as is the case with in vitro fertilization.

The AneVivo procedure, which was pioneered by the Swiss technology company Anecova and carried out at the London Women's Clinic, involved the eggs of the biological mother being placed inside a miniature capsule and inserted into her womb, where they were incubated.

After the incubation of the eggs, they were taken out of the first mother's womb and placed into the womb of the gestational mother, who carried the baby to term.

Lance Corporal Donna, from Nottinghamshire, told The Telegraph she and Jasmine felt "overwhelmed" by the attention their unique pregnancy story had received.

"You get a lot of same-sex couples where one person is doing the whole thing, and the one person is getting pregnant and giving birth, whereas with this we're both involved in a massive way," Donna said.

"It's definitely brought us closer together emotionally. We're a close couple anyway, but we both have a special bond with Otis as well which was helped by the way we've done it."

Baby Otis. Voxia

Donna explained that she incubated her egg for 18 hours before it was placed in Jasmine's body.

Jasmine, a dental nurse from Northamptonshire, said the couple felt "really fortunate" that their first attempt at IVF was successful "because the reality is that it doesn't work first time for a lot of people."

Dr. Kamal Ahuja, the managing and scientific director of London Women's Clinic, said: "London Women's Clinic has been in the forefront of fertility treatment since 1985, and it's our great pleasure to report the first birth in the world with Shared Motherhood using Anecova's groundbreaking technology for in vivo natural fertilization."

Martin Velasco, the founder and CEO of Anecova, said the technology firm believed its AneVivo procedure had the "potential to bring significant value to London Women's Clinic's already well-established Shared Motherhood program, particularly since it enhances the emotional value for the couple."

The average cost of a cycle of in vitro fertilization is 5,000, or $6,520, the Human Fertilization and Embryology Authority says.

The success rate is approximately 29% for women under the age of 35, 23% for women ages 35 to 37, and 15% for those ages 38 to 39.

Earlier this year, a study found that the success rate for women undergoing IVF had peaked at one in four.

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A same-sex British couple have become the first in the world to carry their baby in both their wombs - INSIDER

Children and young adults these days have awide range of possibilities how to spend their leisure time. Some of us like to watch movies, some of us enjoy playing aflute and some of us prefer to go laboratories, put on a white coat and carry out an experiment. Zuzana Hudov, a15-year old student from Slovakia, fell into the category of teenagers who preferred going to labs and make experiments. Even though this is just onestory it once may be astory of hundreds of young aspiring students.

As alittle child Zuzanawas not much different from all the other kids in the kindergarten. Shewas playful, energetic and endlessly curious about the world surrounding her. However, curiosity diverted from the behaviour of her classmates. Most of the kids liked to explore the outside world, yet Zuzanawas more fascinated about the things that could not be understood by just looking at them. Shewould spend hours and hours browsing through an old Encyclopedia, looking at the pictures of human body, homogenesis phases and even insect behaviour. Her restless mind caused her agreat deal of problems in kindergarten since sheoften refused to go to bed during the afternoon sleep-time and, often, she would even take abook from the small kindergarten library and read it, hidden under the duvet, while other kids were sleeping. When Zuzana was five, her mother realised that the kindergarten was noplace for her daugther, and therefore, with the approval of experts, Zuzana was admitted to primary school ayear earlier than regular . That was where the real journey started, says Zuzana.

The competitive atmosphere of school brought Zuzanas ambitions and her desire to thrive to life. Even though shewas more than ayear younger than her classmates, she always perfomed very well and was one of the best pupils in her class. Although Zuzanastill preferred to read books, shefelt aresponsibility for the community and mediated with teachers and pupils about potential improvements to make; therefore she was electedclass representative.

Until the age of eleven her hobbies were pretty general: reading, playing the piano and dancing. Zuzanas interests changed when she was in sixth grade, as at that time, biology and chemistry classes were added to school curriculum. Zuzana was fascinated by the two new subjects and used to spend several hours each day to read popular science books and magazines. At the age of twelve sheperformed her first study about human body mass index (BMI) and obesity and took part in a local competition.

Due to her ambition and success in and outside school, she got the chance to study at GBAS Suany, aprestigious Slovak bilingual grammar school, where she started at the age of thirteen, and joined classes with classmates 3 years older than her.

During the biology classes, especially on the topics of neuroscience and genetics, Zuzana realised that although her desire for more knowledge was being fulfilled, her ambitions to do her own investigations and actuallycontribute to science were not satisfied. While looking for opportunities to collaborate with reasearch labs, she discovered that in many Western countries it is not uncommon for youngstudents to doscientific internships. She started contacting research institutions in Slovakia, but never was selected because of her young age. Consequently she started to applyoutside her home country and was eventually accepted as a summer intern at Masaryk University in Brno, Czech Republic at the Department of Histology and Embryology.

The laboratories that gave Zuzana this opportunity was lead by Mgr. Da Bohaiakov, Ph.D. and focused on neurogenesis research. The project she worked on was the immunofluorescent analysis of in vitro neural rosette formation from induced pluripotent stem cells (iPSCs). The aim of her research was to analyse the markers of neural rosette formation, which is a2D in vitro model of human neurogenesis. During the neurulation phase of embryogenesis there are many things than may go wrong, which can lead to neural tube defects (NTDs), such as spina bifida. NTDs are very dangerous and cause alot of pain and suffering in an individuals life. However, these days we are not only unable to treat these disorders, but we are not even able to observe the neurulation process non-invasively. That is why scientists are trying to developwith the in vitro solutions, which neural rosettes might potentially be.

Zuzanas first laboratory internship marked some new beginnings in her life such as the her first successfull research project, and afirst scientific work that won the 3rd place at the national Stredokolsk Odborn innos (High School Scientific Activity). At the age of 15 shewas the youngest participant in history.

The success of her first project was the incentive for Zuzanato participate in more scientific activities; therefore during the following term she launched abiology club at her school, took part in an international DNA essay contest where she finished among the top ten participants and carried out more work in a laboratory and completed one more internship.

In spite of all her success Zuzana still feels the responsibility for her community and she thinks that if shecould achieve all of this, why not any other student in the world? This is the reason why she decided to publish her story

Iam certainly no better than any other child, she says, yet Iwas lucky, Ihad an idea and enough passion not to give up, even though the circumstances were against me.

Zuzana hopes that her story can motivate her fellow pupils and she urges parents to foster the curiosity and ideas of their children. Additionally she wants to send the message that is importnat to look outside your own surrounding and use the possibilities Europe of today gives to everyone.

By Zuzana Hudacova

Featured image credit: Zuzana Hudov

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Story of a 15-year old scientist: How it all began - EuroScientist

Hao Xu,1,2,* Sha-Jie Dang,3,4,* Yuan-Yuan Cui,1 Zhen-Yu Wu,1 Jun-Feng Zhang,2 Xiao-Peng Mei,5 Yu-Peng Feng,1 Yun-Qing Li1

1Department of Anatomy, Histology and Embryology, K.K. Leung Brain Research Centre, The Fourth Military Medical University, Xian, Shaan Xi, Peoples Republic of China; 2Institution of Basic Medical Science, Xian Medical University, Xian, Shaan Xi, Peoples Republic of China; 3Department of Anesthesiology, Shaanxi Provincial Cancer Hospital, Xian, Shaan Xi, Peoples Republic of China; 4The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xian Jiaotong University, Xian, Shaan Xi, Peoples Republic of China; 5Department of Anesthesiology, The First Affiliated Hospital of Xian Jiaotong University, Xian, Shaan Xi, Peoples Republic of China

*These authors contributed equally to this work

Correspondence: Yun-Qing Li; Yu-Peng FengDepartment of Anatomy, Histology and Embryology, K.K. Leung Brain Research Centre, The Fourth Military Medical University, Xian, Shaan Xi, Peoples Republic of ChinaEmail deptanat@fmmu.edu.cn; fengyp@fmmu.edu.cn

Background and objective: Thalidomide (Tha) has been shown to exert immunomodulatory and anti-inflammatory properties. Whether Tha can alleviate spinal nerve ligation (SNL)-induced neuropathic pain (NP) is still unclear. This study aimed to investigate the therapeutic effect of Tha on the SNL-induced NP and further explore the potential analgesic mechanisms of Tha.Methods: The effects of Tha on SNL-induced mechanical allodynia were assessed by pain behavioral testing. The expressions of the astrocyte marker glial fibrillary acidic protein (GFAP) and the microglia marker Iba1 in the spinal dorsal horn were evaluated by immunofluorescence histochemistry. Protein expressions of the tumor necrosis factor alpha (TNF-) in the spinal dorsal horn were tested by Western blot assay. Data were analyzed using one-way ANOVA or two-way ANOVA.Results: By the pretreatment with a single intraperitoneal injection, the PWMT in SNL+Tha group was significantly increased from day 1 to day 2 after SNL (P < 0.05 compared with SNL+Veh group). By the posttreatment with a single intraperitoneal injection, the PWMT in SNL+Tha group was also significantly increased from day 3 to day 4 after SNL (P < 0.05 compared with SNL+Veh group). By the posttreatment with multiple intraperitoneal injection, both the PWMT and the PWTL in SNL+Tha group were similarly significantly increased from day 3 to day 14 after SNL (P < 0.05 compared with SNL+Veh group). Furthermore, the GFAP and Iba1 expressions and TNF- levels of the ipsilateral spinal dorsal horn in SNL+Tha group were significantly weaker from day 3 to day 14 after SNL than those in SNL+Veh group (P < 0.05).Conclusion: Tha can significantly alleviate NP induced by SNL. The analgesic mechanism may be related to inhibition of astrocyte and microglia activation as well as down-regulation of TNF- levels in the spinal dorsal horn.

Keywords: Tha, neuropathic pain, Glia, TNF-, spinal nerve ligation

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License.By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Systemic Injection of Thalidomide Prevent and Attenuate Neuropathic Pa | JPR - Dove Medical Press

Pro-abortion Democrat presidential candidate Pete Buttigieg blasted pro-life laws during a campaign swing in Alabama this week. He attacked the pro-life legislators behind a law the state legislature approved this year that would protect women and unborn children from abortion.

In May, Gov. Kay Ivey signed a bill that bans abortion in Alabama. But, during a roundtable discussion with abortion activists and Democrat voters, Buttigieg went after the pro-life lawmakers behind the bill, falsely claiming they ignore science and just want to punish women.

Heres more:

Buttigieg criticized the law, saying the legislature was ignoring science, criminalizing abortion, and punishing women. The mayor said as president he would prevent state-level interference with abortion access and work to abolish the Hyde Amendment, which prevents the use of medical fund to pay for abortions. At a Fox News event around the time of the Alabama ban, Buttigieg said I trust women to draw the line on abortion, a line he repeated on Monday.

The law in question clearly doesnt ignore science since human life clearly begins at conception and a developing baby in the womb is just that, a baby. In fact a study by scientists earlier this year proves human life begins at conception.

To quote just one authoritative human embryology textbook: Human development begins at fertilisation when a sperm unites with an oocyte [ovum] to form a single cell zygote. This highly specialised, totipotent cell marks the beginning of each of us as a unique individual. (Moore, K.L., Persaud, T.V.N. & Torchia, M.G. (2015).The developing human: clinically oriented embryology(10th ed.).

The Alabama abortion ban also does not punish women. The law in question only punishes abortionists who violate the statute by killing unborn children in abortions.

PRO-LIFE COLLEGE STUDENT? LifeNews is looking for interns interested in writing, social media, or video creation. Contact us today.

Moreover, the Alabama abortion ban was sponsored by a woman and was signed into law by another woman. State Representative Terri Collins, a woman, helped sponsor the bill. Governor Kay Ivey, also a woman, signed the bill into law. In a statement, Gov. Ivey prioritized not only the protection of life, but also the enhancement of life.

She urged members to find the best ways possible to foster a better Alabama in all regards, from education to public safety, exposing the lie that pro-lifers only care about the unborn. We must give every person the best chance for a quality life and a promising future.

And the citizens of Alabama, including women, are pro-life on abortion. According to Pew Research Center data from 2014, 58 percent of Alabama adults wanted abortion illegal in all or most cases. Forty-nine percent of those were men and 51 percent were women.

Meanwhile, in 2018, Alabama voters men and women approved a statewide amendment saying unborn babies have a right to life. Voters said yes by a 60-40 margin. The vote came despite the Planned Parenthood abortion business spending $1.5 million to defeat it.

Pete Buttigieg can support abortion if he thinks killing babies is a good thing, but hes not entitled to make up his own facts. The truth is his pro-abortion position is at odds with science, and women.

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Pete Buttigieg Slams Pro-Lifers: They Ignore Science and Just Want to Punish Women - LifeNews.com

A same-sex couple have become the first in the world to carry the same baby in both their wombs as part of a landmark "shared motherhood" procedure.

The British couple Jasmine and Donna Francis-Smith welcomed their son, Otis, two months ago.

The baby was born via in vivo natural fertilization, which involves the eggs being incubated in the mother's body, rather than externally, as is the case with in vitro fertilization.

The AneVivo procedure, which was pioneered by the Swiss technology company Anecova and carried out at the London Women's Clinic, involved the eggs of the biological mother being placed inside a miniature capsule and inserted into her womb, where they were incubated.

After the incubation of the eggs, they were taken out of the first mother's womb and placed into the womb of the gestational mother, who carried the baby to term.

Lance Corporal Donna, from Nottinghamshire, told The Telegraph she and Jasmine felt "overwhelmed" by the attention their unique pregnancy story had received.

"You get a lot of same-sex couples where one person is doing the whole thing, and the one person is getting pregnant and giving birth, whereas with this we're both involved in a massive way," Donna said.

"It's definitely brought us closer together emotionally. We're a close couple anyway, but we both have a special bond with Otis as well which was helped by the way we've done it."

Baby Otis. Voxia

Donna explained that she incubated her egg for 18 hours before it was placed in Jasmine's body.

Jasmine, a dental nurse from Northamptonshire, said the couple felt "really fortunate" that their first attempt at IVF was successful "because the reality is that it doesn't work first time for a lot of people."

Dr. Kamal Ahuja, the managing and scientific director of London Women's Clinic, said: "London Women's Clinic has been in the forefront of fertility treatment since 1985, and it's our great pleasure to report the first birth in the world with Shared Motherhood using Anecova's groundbreaking technology for in vivo natural fertilization."

Martin Velasco, the founder and CEO of Anecova, said the technology firm believed its AneVivo procedure had the "potential to bring significant value to London Women's Clinic's already well-established Shared Motherhood program, particularly since it enhances the emotional value for the couple."

The average cost of a cycle of in vitro fertilization is 5,000, or $6,520, the Human Fertilization and Embryology Authority says.

The success rate is approximately 29% for women under the age of 35, 23% for women ages 35 to 37, and 15% for those ages 38 to 39.

Earlier this year, a study found that the success rate for women undergoing IVF had peaked at one in four.

Read the rest here:
A same-sex British couple have become the first in the world to carry their baby in both their wombs - Business Insider

3-Dec-2019

Design and Build | Pharmaceuticals

In vitro fertilisation is a process that mimics nature and as such, the industry requires state-of-the-art facilities to control environmental conditions and prevent contamination of the product. Giles Palmer explains

From its humble beginnings in a small cottage hospital in Oldham (UK) to its acceptance in mainstream medicine and everyday life, the in vitro fertilisation (IVF) industry has evolved continuously, and is increasingly applicable not only with the treatment of a growing variety of fertility issues but also with challenges of todays society and lifestyle choices.

Globally, infertility affects seven million people: one in six couples have a problem in conceiving. Last year we celebrated the 40th anniversary of the first test-tube baby, Louise Brown, and in doing so the birth of clinical embryology as a profession.

Over the years, IVF success rates have increased. The introduction of hormonal stimulation produced more oocytes than the early natural cycle attempts leading to a more streamlined and controlled treatment cycle leading to a better choice of embryos to transfer, and the need to cryopreserve remaining embryos.

Originally designed for patients with tubal damagewhen the oocyte could not journey from the oviduct to the uterus to implantthe application of this science has been developed to include all forms of infertility, from hormonal disorders to severe male infertility. The shift has seen the opening of new possibilities that have been both morally, spiritual and socially questioned, such as the use of donor sperm and oocytes, sex selection, genetic screening and posthumous use.

These processes are manual manipulations in laminar flow hood with heated work surfaces, cultured in special low volume incubators

Embryologists working in the lab mimic nature, closely maintaining optimum conditions of temperature, pH and osmolarity; monitoring the development of embryos, and selecting the best embryo for transfer. These processes are manual manipulations in laminar flow hood with heated work surfaces, cultured in special low volume incubators.

Culturing outside the body close to physiological conditions has paved the way for new techniques, such as intracytoplasmic sperm injection (ICSI) and preimplantation diagnosis via embryo biopsy coupled with the ever-evolving science of molecular genetics.

Recent advances in cryobiology have also meant that frozen embryos have now succeeded in producing a viable pregnancy as fresh embryos (Thomson, 2019).

Embryos are routinely cultured now to five- or six-day post insemination before being transferred to the intended mother when the embryo has reached the blastocyst stage. This ready-to-implant embryonic stage (previously difficult to achieve with suboptimal culture media) now has a success rate of 54%, according to London Womens Clinic data.

Giles Palmer, Senior Embryologist

The IVF lab is almost always adjacent to an operating theatre where procedures such as egg collection (by follicle aspiration) under sedation and embryo transfer are performed. The eggs and embryos are transferred hand-to-hand, literally, by a hatch (a passthrough you might say in the cleanroom industry) that must remain open for lengths of time up to 30 minutes.

Positive pressure and HEPA filters are commonplace in IVF laboratories, but industry standards are somewhat elusive: there is no consensus on what constitutes an IVF laboratory, and guidelines may differ greatly from country to country.

Only about 15% of IVF clinics are housed within a hospital, and currently may be designed within a medical centre, doctors offices and general buildings.

The IVF process also requires auxiliary rooms. An andrology laboratory (preferably in a separate room but not globally mandatory) is used to process the non-aseptic semen. A cryobiology room is then used to store the frozen samples. Plus, a medical gas room is also required.

Apart from gases used by the anaesthetists, mixtures of medical-grade gasses are required to produce the correct environment within the incubators for the developing embryo; typically 6% CO2 with low O2 tension.

The IVF industry might not manufacture a product, as many industries using cleanrooms, but it seems appropriate to measure success by an endpoint of the birth of a healthy child. Development and normal growth, however, can be limited in adverse air conditions. The entire IVF process is governed by the biology of sperm, egg and embryo, and we must optimise conditions to protect the product against exposure to adverse external factors. The problem lies in the lack of agreement of these conditions.

The human embryo is sensitive to light, temperature and other environmental conditions. Pollutants can settle on workspaces, and although embryos bathed in their culture media overlaid with a layer of light paraffin oil, attention has to be paid to the risk of toxins infiltrating the barrier because embryos lack an immune system to stave off harmful environmental contaminants.

It should be noted that disposables and new equipment can introduce hazards in the laboratory, too

Urban air can contain high levels of pollutants, such as carbon monoxide, nitrous oxide, sulphur dioxide and heavy metals. Indoor construction materials, such as MDF, PVC flooring, paints and adhesives, constitute the major source of volatile organic compounds (VOCs).

Once only anecdotal in the early days of IVF, studies emerged, showing the negative effect of poor air quality and ultimately, pregnancy outcome (Cohen 1997, Hall 1998, Mayer 1999, Boone 1999). It was shown that compressed gases that fed the incubators had high levels of VOCs (namely benzene, isopropanol and pentane) and it was not uncommon for the laboratory environment to have higher VOC concentrations than indoor air.

Particle monitors and VOC counters have also emerged in the IVF marketplace

The industry took notice and has produced ingenious ways to protect the embryos, from closed laminar flow hoods to improvements to filters systems with in-line gas filters and standalone portable air filtration units. Particle monitors and VOC counters have also emerged in the IVF marketplace (Forman, 2004).

It should be noted that disposables and new equipment can introduce hazards in the laboratory, too. Sterile plastic test tubes and dishes in packages need off-gassing. The polystyrene-based plastics can emit styrene (Sing, 2015), and it is good practice to open the consumables well before use and leave in a laminar flow hood. New equipment must also be burnt in (to release residual VOCs from the manufacturing process) in a separate room before use.

While health and safety authorities have safe limits for VOC exposure for humans, there is nothing documented for developing embryos. Industry guidelines were (and still are) vague, but both the European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine recognise air quality is a key factor to success (ASRM 2014, ESHRE 2004) yet without specific details.

In 2004, the IVF landscape changed in Europe with the announcement of the European Union Tissue and Cell Directive, which specified precise quality and safety requirements for the donations, procurement, testing coding and storing. A key point in this policy was clean air (EUCTD, 2004). It was meant to bring cell and tissue use on par with blood and organ handling.

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The inclusion of the IVF was both unexpected and fiercely debated (Mortimer 2005, Saunders and Pope 2005) because the original specifications would have been detrimental to in vitro embryo development.

The Directive stated: Where tissues or cells are exposed to the environment (...) an air quality of Grade A, as defined in the current European Guide to Good Manufacturing Practice, is required. The background must be demonstrated to guarantee the maintenance of Grade A in the tissue/cell manipulation while in use and unmanned. The document highlighted areas of improvements; there was little or no air management before this draft.

Where tissues or cells are exposed to the environment (...) an air quality of Grade A, as defined in the current European Guide to Good Manufacturing Practice, is required

It was argued that risk of infection is low and that the product cannot be sterilised. Equally, the cooling effects of maintaining airflow of a Grade A environment would have been detrimental to embryo culture and introduce vibrations not conducive to fine accurate manipulation needed in many techniques.

A second draft of the Directive stated a less stringent environment if Grade A was either detrimental or technically impossible, but did not define a level of air quality other than close to A.

In the UK, the Human Fertilisation and Embryology Authority (HFEA), a government watchdog, supported a Grade C working environment with a background of Grade D. From 2007, all manipulations must be within a Class II laminar flow hood. This regulation meant IVF labs at the very least had to make some adjustments to facilities and standard operating procedure. In the design of a laboratory, great care should be placed on location and adjacent rooms, so to avoid proximity to laundry, canteen or pathology labs emitting possible air contaminants. In a hospital environment, however, limited available space is always a problem.

The same deal of attention should be paid during and after laboratory renovation or build. The wrong materials can be the difference between a triumphant inauguration with great IVF success rates or failure with long-lasting effects.

Construction should involve using furniture free of VOCs, preferably stainless steel and low VOC materials and adhesives.

Lab improvements can help increase IVF success by implementing cleanroom standards

In a study following the VOC measurements during a renovation of a laboratory, I was able to show key VOC emissions, such as ethyl alcohol, acetone, hexane and toluene, at various point of construction phases, and ways to alleviate and eliminate the VOCs upon completion of the work (Palmer, 2010). This may be common knowledge to the cleanroom aficionados, but was something quite new a decade or so ago.

Other papers on air quality improvements followed, illustrating how lab improvements can help increase IVF success by implementing cleanroom standards.

Heitmann et al. in 2015, for example, described how a former lab with an unreliable HVAC system was transformed. The project used the strategy of pre-filter, photocatalytic irradiation and chemical filtration, by means of activated carbon, potassium permanganate, and finally HEPA filters. Implantation rates were drastically increased, and clinical pregnancy rate increased by 10%.

Still, as IVF resides predominately in the private healthcare sector, a great variety of different types of facilities exist, from renovated listed buildings of grandeur to purpose-built installations.

There was a clear need for clarity within the existing guidelines on optimal laboratory conditions, but in a recently published article, a survey of 36 clinics using an IVF quality control app globally, little conformity could be found (Palmer, 2019).

Laboratory temperatures varied from 17oC to 35oC, and humidity from 5% to 80%; only four laboratories measured air quality; and only two measured VOCs.

The implementation of stricter guidelines is not always welcome. The mere mention of my talk on this subject at Cleanzone Middle East on social media raised a quiet storm doubting the merits of cleanroom technologies. Those raising an eyebrow pointed to costs, increase in staff required and questioned the necessity. Needless to say, the feedback was from old school scientists who had clearly not read or approved of the recent Cairo consensus published in 2018.

The Cairo meeting of experts was set out in the wake of growing evidence for recommending technical and operational requirements, control of particulates, aspirational benchmarks, and help in laboratory commissioning in the future.

The mere mention of my talk on this subject at Cleanzone Middle East on social media raised a quiet storm doubting the merits of cleanroom technologies

The meeting listed the most common agents of contamination and compared a large number of older facilities with laboratories using cleanroom concepts:

In all, there were over 50 consensus points, and it was concluded that cleanroom design should be implemented in any new IVF laboratory builds.

The global fertility rate continues to decline. Main culprits of this trend are the increase in obesity, environmental factors and lifestyle as well as psychographic changes.

Based on 2019 figures, there are over 3,000 clinics worldwide, and the need for IVF is ever-growing. In the US, 1.5% of all children born are a result of assisted reproduction, while the number is 4% in Australia and Israel, and in Denmark 6.4%.

Several economic sources have valued the market to be approximately US$16 billion, with a compound annual growth rate (CAGR) of almost 10%. If this growth holds strong for the next five years, it would mean an industry worth nearly $40 billion by 2025.

Growth is similar in all areas of the globe and large corporations, backed by venture capitalists, are consolidating chains of clinics. Once a reserve of private consultants or small groups of doctors, IVF clinics have now gone big, resulting in chains of IVF clinics.

The success of freezing produces an ever-increasing inventory of cryo-stored embryos, and estimates from IVF research group TMR forecast 21 million people will have stored samples by 2025

The IVF industry has to invest in new facilities equipped with state-of-the-art technology to keep up with this demand and produce high and reproducible standards. The success of freezing produces an ever-increasing inventory of cryo-stored embryos, and estimates from IVF research group TMR forecast 21 million people will have stored samples by 2025. This is a huge capacity that will need significant infrastructure to back it up.

Driven by technological advances, especially in the field of fertility preservation, we will see IVF clinics even more widespread and frequently used than they are today.

Consulting on various projects, in the UK and abroad, I have seen a huge lack in understanding of what is required to construct and maintain a successful IVF facility. I welcome the introduction of cleanroom companies into the IVF industry, as many aspects of your work and products are applicable to our industry today.

The modular cleanroom initiatives, such as the Shellbe system, are particularly appealing for their capacity to produce a zero VOC laboratory customised to the clients needs.

I welcome the introduction of cleanroom companies into the IVF industry, as many aspects of your work and products are applicable to our industry today

Fickle and demanding, we embryologists may be about the conditions and the design of the IVF clinic, but I am often hampered by lack of local expertise (or material) in various places of the world. As real estate costs and availability become so prohibitive in many cities, the portable, adaptable modular lab can be designed, shipped and constructed like Lego and fit suitably in spaces that were previously unutilised.

With so much evidence and interest in our field, now is the time for the IVF industry to enter the biotechnology arena and be ready for cleanroom technology.

N.B. This article is featured in the December 2019 issue of Cleanroom Technology. Subscribe today and get your print copy!

The latest digital edition is available online.

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Cleanroom technology for the IVF industry - Cleanroom Technology

A new study by an international team of researchers, led by scientists from the University of Bristol and Nanjing Institute of Geology and Palaeontology, has discovered that animal-like embryos evolved long before the first animals appear in the fossil record.

Animals evolved from single-celled ancestors, before diversifying into 30 or 40 distinct anatomical designs. When and how animal ancestors made the transition from single-celled microbes to complex multicellular organisms has been the focus of intense debate.

Until now, this question could only be addressed by studying living animals and their relatives, but now the research team has found evidence that a key step in this major evolutionary transition occurred long before complex animals appear in the fossil record, in the fossilized embryos that resemble multicellular stages in the life cycle of single-celled relatives of animals.

The team discovered the fossils named Caveasphaera in 609 million-year old rocks in the Guizhou Province of South China. Individual Caveasphaera fossils are only about half a millimeter in diameter, but X-ray microscopy revealed that they were preserved all the way down to their component cells.

Kelly Vargas, from the University of Bristols School of Earth Sciences, said: X-Ray tomographic microscopy works like a medical CT scanner, but allows us to see features that are less than a thousandth of a millimeter in size. We were able to sort the fossils into growth stages, reconstructing the embryology of Caveasphaera.

Co-author Zongjun Yin, from Nanjing Institute of Geology and Palaeontology in China, added: Our results show that Caveasphaera sorted its cells during embryo development, in just the same way as living animals, including humans, but we have no evidence that these embryos developed into more complex organisms.

Dr John Cunningham, another co-author, said: Caveasphaera had a life cycle like the close living relatives of animals, which alternate between single-celled and multicellular stages. However, Caveasphaera goes one step further, reorganizing those cells during embryology.

Co-author Stefan Bengtson, from the Swedish Museum of Natural History, said Caveasphaera is the earliest evidence of this most important step in the evolution of animals, which allowed them to develop distinct tissue layers and organs.

Maoyan Zhu, from Nanjing Institute of Geology and Palaeontology, said he is not totally convinced that Caveasphaera is an animal. He added: Caveasphaera looks a lot like the embryos of some starfish and corals we dont find the adult stages simply because they are harder to fossilize.

Co-author Dr Federica Marone from the Paul Scherrer Institute in Switzerland said, This study shows the amazing detail that can be preserved in the fossil record but also the power of X-ray microscopes in uncovering secrets preserved in stone without destroying the fossils.

Co-author Professor Philip Donoghue, also from the University of Bristols School of Earth Sciences, said Caveasphaera shows features that look both like microbial relatives of animals and early embryo stages of primitive animals. Were still searching for more fossils that may help us to decide.

Either way, fossils of Caveasphaera tell us that animal-like embryonic development evolved long before the oldest definitive animals appear in the fossil record.

Reference

Yin et al. (2019) The Early Ediacaran Caveasphaera Foreshadows the Evolutionary Origin of Animal-like Embryology. Current Biology. DOI: https://doi.org/10.1016/j.cub.2019.10.057

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Fossils Suggest the Egg Came Before the Chicken - Technology Networks

As a future social worker, I am fascinated that unborn humans are often left out of the rhetoric for equal and basic human rights.

The following statements are held to be true by all social workers who adhere to the National Association of Social Workers Code of Ethics:

Social workers strive to help meet the basic human needs of all people, and every human life has inherent dignity and worth.

Isn't the most basic, fundamental need the right to life?

Furthermore, the first principle of a widely accepted social work ethics guide states the social workers first priority is the protection of human life, which applies to all persons, both the life of a client and the lives of all others.

The science of embryology shows the unborn child is a distinct human life from the moment of fertilization. If the social worker recognizes that every human life has inherent worth and basic rights and has pledged to defend those rights, what is the social worker's responsibility to the unborn population?

One may respond by saying that social workers must respect the self-determination of their clients.

However, according to the NASW Ethical Standards, "Social workers may limit clients' rights to self-determination when . . . (their) actions pose a serious, foreseeable, and imminent risk to themselves or others."

What if ones actions are posing a death risk to the human in their womb?

When considering the defense of vulnerable populations, lets remember the unborn.

Originally posted here:
Letter to the Editor: Arguments for equal and human rights must include the unborn - Tulsa World

There is no dark side of moon | Former NASA scientist busts age-old myth through his animation

A research conducted by a team of scientists at Bristol University has found that animal embryos evolved before animals. Until now, the evolution of animals was studied by analyzing living animals and their relatives.

But now, the research team has found that fossilized embryos that resemble multicellular stages in the life cycle of single-celled relatives of animals, which indicates that animal embryos started evolving first.

During the study, researchers discovered these fossils from 609 million-year-old rocks in the Guizhou Province of South China. Scientists have named these fossils Caveasphaera, and they are just only about half a millimetre in diameter. X-ray analysis done on these fossils revealed that they were preserved all the way down to their component cells.

"X-Ray tomographic microscopy works like a medical CT scanner but allows us to see features that are less than a thousandth of a millimetre in size. We were able to sort the fossils into growth stages, reconstructing the embryology of Caveasphaera," said Kelly Vargas, a researcher at the University of Bristol's School of Earth Sciences in a recent statement.

Zongjun Yin, from Nanjing Institute of Geology and Palaeontology in China, who is the co-author of the study suggested that Caveasphaera sorted its cells during embryo development in just the same way as living animals that include human beings. However, he made it clear that there is no evidence that these embryos developed into complex organs.

"Caveasphaera had a life cycle like the close living relatives of animals, which alternate between single-celled and multicellular stages. However, Caveasphaera goes one step further, reorganizing those cells during embryology," said John Cunningham, co-author of the study.

Few months back, a study conducted by a team of experts at the University of Queensland and Neel Institute had solved the billion-dollar 'chicken or egg' paradox. After using various theories of quantum physics, researchers found that both the chicken and egg can come first. However, another study conducted in 2014 argued that chicken came first, as proteins found in the body of chicken are necessary to form an egg.

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Animals embryos evolved before animals, study reveals - International Business Times, Singapore Edition