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The oocyte retrieval procedure has undergone a substantial evolution over almost forty years moving from the abdominal to vaginal approach. Ultrasound- guided oocyte retrieval is performed now as a routine procedure worldwide.
A scientific rationale for the use of acupuncture during in vitro fertilization (IVF) treatment is lacking, but theoretically focuses mainly on its potential role in enhancement of uterine receptivity through increased blood flow and quiescence. A perceived reduction in anxiety and stress after acupuncture has often been cited as an additional justification. Five randomized controlled trials (RCTs) have reported IVF outcome when acupuncture was performed at the time of oocyte retrieval. Four of these five studies were designed to assess the analgesic effect of acupuncture used at the time of oocyte retrieval compared to conventional analgesia and only one study reported pregnancy rate as a primary outcome. Studies involving acupuncture around the time of embryo transfer involved those that performed acupuncture only on the day of the embryo transfer and those that performed acupuncture on the day of embryo transfer and repeated again two to three days later.
Preliminary studies, as well as the authors' own experience over a number of years, suggest a favorable role for immunotherapy using intravenous immunoglobulin (IVIG) and Humira in improving the success rate of in vitro fertilization (IVF) treatment in women suffering from recurrent implantation failure. IVIG down regulates in vivo and in vitro natural killer (NK) cell activity and modifies NK cell cytokine production profile. Compared to the literature on the application of IVIG in recurrent implantation failure patients, studies evaluating the use of the tumour necrosis factor-α (TNF-α) blocker Humira are scarce. The optimum method to prove the efficacy of therapeutic interventions is through conducting adequately powered and well-designed randomized controlled trials. Although the safety profile of immunotherapy has been demonstrated in several uncontrolled studies, further and larger studies including cost-effectiveness evaluation of the proposed interventions will need to be carried out.
Preimplantation genetic diagnosis (PGD) is a complex process comprising many stages and involving a multidisciplinary team of healthcare professionals. PGD allows a couple to conceive pregnancy that is biologically their own and is unaffected by the genetic condition in the family. Embryos are created by using assisted reproductive technology (ART) and are tested for the relevant genetic condition by polar body, blastomere or trophectoderm biopsy. It is important to distinguish the difference between PGD and preimplantation genetic screening (PGS) for sporadic chromosome aneuploidy. PGS is distinct from PGD and it is mainly used within the ART arena as an adjunct to fertility treatment with the aim of improving in vitro fertilisation (IVF) outcome. The potential use of PGD to select embryos with desirable nonmedical traits such as intelligence, beauty or longevity perhaps represents a more distant future for PGD.
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