The Poly-Parent Households Are Coming

The Poly-Parent Households Are Coming

The Poly-Parent Households Are Coming.  Consider the following scenario: Anna and Nicole, 36 and 39 years old, have been close friends since college. They each dated various men throughout their twenties and thirties, and had a smattering of romantic relationships that didn’t quite work out. But now, as they approach midlife, both women have grown weary of the merry-go-round of online dating and of searching for men who might — or might not — make appropriate fathers for the babies they don’t yet have. Both Anna and Nicole want children. They want to raise those children in a stable, nurturing environment, and to continue the legacy of their own parents and grandparents. And so they decide to have a baby — a baby that is genetically their own — together.Poly-Parent Households

Such an idea may sound fantastical. But technologies that could enable two women (or two men, or four unrelated people of any sex) to conceive a child together are already under development. If these technologies move eventually from the laboratory into clinical use, and the history of assisted fertility suggests they can and they will, then couples — or rather, co-parents — like Anna and Nicole are likely to reshape some of our most fundamental ideas about what it takes to make a baby, and a family.

To date, most major advances in assisted reproduction have been tweaks on the basic process of sexual reproduction. Artificial insemination brought sperm toward egg through a different, nonsexual channel. I.V.F. mixed them together outside the woman’s body. Little things, really, in the broader sweep of life.

And yet even these have had profound consequences. Humans are reproducing in ways that would have been truly unimaginable just several decades ago: Two men and a surrogate. Two women and a sperm donor. An older woman using genetic material from a much younger egg.

Each turn of the technological screw has been generated by the same profound impulse — to allow people to conceive babies they desperately want, and to build families with those they love. Each development has, in many ways, been deeply conservative, intended to extend or re-create life’s most basic process of production. But as these technologies have expanded and evolved, their impact has become far more revolutionary; they’ve forced us to reconceptualize just what a family means, and what it can be.

For most of human history, after all, families across the Western world were defined in largely biblical terms: one man, one woman, with children conceived through sex and sanctified by marriage. Everyone else was just a bastard.

NYTimes.com, August 12, 2020 by Debra L. Spar

Click here to read the entire article.

No Significant Difference in Frozen Embryo v. Fresh Embryo Viability

No Significant Difference in Frozen Embryo v. Fresh Embryo Viability

No significant difference was found in Frozen Embryo v. Fresh Embryo viability.  Sacha Stormlund, M.D., Ph.D., from Hvidovre University Hospital in Copenhagen, Denmark, and colleagues compared the ongoing pregnancy rate between women randomly assigned to assisted reproductive technology treatment with a freeze-all strategy with gonadotropin releasing hormone agonist triggering or a fresh transfer strategy with human chorionic gonadotropin triggering. The 460 women (aged 18 to 39 years) had regular menstrual cycles and were treated at one of eight outpatient fertility clinics in Denmark, Sweden, and Spain.No Significant Difference in Frozen Embryo v. Fresh Embryo Viability

The researchers found that the ongoing pregnancy rate did not differ significantly between the freeze-all and fresh transfer groups (27.8 versus 29.6 percent; risk ratio, 0.98; 95 percent confidence interval, 0.87 to 1.10; P = 0.76). There were also no significant differences between the groups for the live birth rate (risk ratio, 0.98; 95 percent confidence interval, 0.87 to 1.10; P = 0.83). From The BMJ:

Abstract

Objective To compare the ongoing pregnancy rate between a freeze-all strategy and a fresh transfer strategy in assisted reproductive technology treatment.

Design Multicentre, randomised controlled superiority trial.

Setting Outpatient fertility clinics at eight public hospitals in Denmark, Sweden, and Spain.

Participants 460 women aged 18-39 years with regular menstrual cycles starting their first, second, or third treatment cycle of in vitro fertilisation or intracytoplasmic sperm injection.

Interventions Women were randomised at baseline on cycle day 2 or 3 to one of two treatment groups: the freeze-all group (elective freezing of all embryos) who received gonadotropin releasing hormone agonist triggering and single frozen-thawed blastocyst transfer in a subsequent modified natural cycle; or the fresh transfer group who received human chorionic gonadotropin triggering and single blastocyst transfer in the fresh cycle. Women in the fresh transfer group with more than 18 follicles larger than 11 mm on the day of triggering had elective freezing of all embryos and postponement of transfer as a safety measure.

Main outcome measures The primary outcome was the ongoing pregnancy rate defined as a detectable fetal heart beat after eight weeks of gestation. Secondary outcomes were live birth rate, positive human chorionic gonadotropin rate, time to pregnancy, and pregnancy related, obstetric, and neonatal complications. The primary analysis was performed according to the intention-to-treat principle.

Results Ongoing pregnancy rate did not differ significantly between the freeze-all and fresh transfer groups (27.8% (62/223) v 29.6% (68/230); risk ratio 0.98, 95% confidence interval 0.87 to 1.10, P=0.76). Additionally, no significant difference was found in the live birth rate (27.4% (61/223) for the freeze-all group and 28.7% (66/230) for the fresh transfer group; risk ratio 0.98, 95% confidence interval 0.87 to 1.10, P=0.83). No significant differences between groups were observed for positive human chorionic gonadotropin rate or pregnancy loss, and none of the women had severe ovarian hyperstimulation syndrome; only one hospital admission related to this condition occurred in the fresh transfer group. The risks of pregnancy related, obstetric, and neonatal complications did not differ between the two groups except for a higher mean birth weight after frozen blastocyst transfer and an increased risk of prematurity after fresh blastocyst transfer. Time to pregnancy was longer in the freeze-all group.

Conclusions In women with regular menstrual cycles, a freeze-all strategy with gonadotropin releasing hormone agonist triggering for final oocyte maturation did not result in higher ongoing pregnancy and live birth rates than a fresh transfer strategy. The findings warrant caution in the indiscriminate application of a freeze-all strategy when no apparent risk of ovarian hyperstimulation syndrome is present.

August 6, 2020 – DoctorsLounge.com