Willem Ombelet - Academia.edu (original) (raw)
Papers by Willem Ombelet
Human Reproduction Update, 2018
BACKGROUND: IUI with or without ovarian stimulation (OS) has become a first-line treatment option... more BACKGROUND: IUI with or without ovarian stimulation (OS) has become a first-line treatment option for many infertile couples, worldwide. The appropriate treatment modality for couples and their clinical management through IUI or IUI/OS cycles must consider maternal and perinatal outcomes, most notably the clinical complication of higher-order multiple pregnancies associated with IUI-OS. With a current global emphasis to continue to decrease maternal and perinatal mortality and morbidity, the World Health Organization (WHO) had established a multi-year project to review the evidence for the establishment of normative guidance for the implementation of IUI as a treatment to address fertility problems, and to consider its cost-effectiveness for lower resource settings. OBJECTIVE AND RATIONALE: The objective of this review is to provide a review of the evidence of 13 prioritized questions that cover IUI with and without OS. We provide summary recommendations for the development of global, evidence-based guidelines based upon methodology established by the WHO. SEARCH METHODS: We performed a comprehensive search using question-specific relevant search terms in May 2015. For each PICO (Population, Intervention, Comparison and Outcomes) drafted by WHO, specific search terms were used to find the available evidence in MEDLINE (1950 to May 2015) and The Cochrane Library (until May 2015). After presentation to an expert panel, a further hand search of references in relevant reviews was performed up to January 2017. Articles that were found to be relevant were read and analysed by two investigators and critically appraised using the Cochrane Collaboration's tool for assessing risk of bias, and AMSTAR in case of systematic reviews. The quality of the evidence was assessed using the GRADE system. An independent expert review process of our analysis was conducted in November 2016. OUTCOMES: This review provides an assessment and synthesis of the evidence that covers 13 clinical questions including the indications for the use of IUI versus expectant management, the sperm parameters required, the best and optimal method of timing and number of inseminations per cycle, prevention strategies to decrease multiple gestational pregnancies, and the cost-effectiveness of IUI versus IVF. We provide an evidence-based formulation of 20 recommendations, as well as two best practice points that address the integration of methods for the prevention of infection in the IUI laboratory. The quality of the evidence ranges from very low to high, with evidence that may be decades old but of high quality, however, we further discuss where critical research gaps in the evidence remain. WIDER IMPLICATIONS: This review presents an evidence synthesis assessment and includes recommendations that will assist health care providers worldwide with their decision-making when considering IUI treatments, with or without OS, for their patients presenting with fertility problems.
Facts, Views & Vision in ObGyn, 2016
Originated as a mainly social group of befriended colleagues, the VVOG has evolved over the past ... more Originated as a mainly social group of befriended colleagues, the VVOG has evolved over the past 55 years to become a truly professional society facing successfully such diverse challenges as organizing scientific congresses, postgraduate training, ethical debates, hands-on training courses, social events, interactions with national and international sister societies but also with the industry, insurers, the government, politicians and patient organisations.
Reproductive biomedicine online, 2016
According to a number of high quality studies intrauterine insemination (IUI) with homologous sem... more According to a number of high quality studies intrauterine insemination (IUI) with homologous semen should be the first choice treatment in case of unexplained and moderate male factor subfertility. IVF and ICSI are clearly over-used in this selected group of infertile couples. The limited value of IUI in infertility treatment as mentioned in the 2013 NICE guidelines was surely a premature statement and should be adapted to the actual literature. More evidence-based data are becoming available on different variables influencing the success rates after IUI. It can be expected that these findings may lead to a better understanding and use of IUI in the near future.
The OSS and Ho Chi Minh, May 9, 2019
At the start of a new year it is time to look back over the past 12 months, as well as to look fo... more At the start of a new year it is time to look back over the past 12 months, as well as to look forward. 2015 has been one with a sad farewell to two very good friends, Dr Howard Jones Jr (see Fact Views Vis Obgyn, 2015, 7:149-152) and Professor Jan van der Merwe whose obituary appears in this issue. The past year has seen some very interesting and stimulating papers, not to forget about the most original 2015 cover designed by Koen Vanmechelen. The March issue was almost entirely dedicated to the second International Ovarian Tumour Analysis (IOTA) congress, held in Leuven, Belgium. We published eight outstanding papers linked to the different topics of the meeting and written by world experts in the field. I’d like to thank Professor Dirk Timmerman for helping us with the work-out and the content of this issue. In the June issue special attention has been paid to sperm donors and the related problems caused to the offspring and the children’s family. The editorial written by Professor Guido Pennings reflected on the ongoing debate about sperm anonymity in Belgium. In the September issue, Professor Wiebren Tjalma tackled the reimbursement for bone loss prevention in women and the discrepancies between reimbursement policies for women and men. Professor Geeta Nargund wrote a viewpoint paper describing the urgent need for fertility education in schools, a hot topic in the United Kingdom. In the fourth issue of 2015 we noticed two very interesting reviews. In the first systematic review (Vandendriessche et al.) the authors examined the value of old and new promising techniques in directing more effective adjuvant therapy for breast cancer. The second review by Datta et al. showed us that many additional interventions used in assisted reproduction are being practiced with little justifiable evidence. They only make IVF treatment more expensive with questionable actual advantage. In this issue we are very happy with an extremely interesting review on the religious aspects of assisted reproduction written by Professor Hassan Sallam from Alexandria, Egypt. I really believe that this paper should be a regarded as a one of the best reviews ever, describing the influence of religion on the human response to new developments such as assisted reproduction. I sincerely hope that the future will remain exciting with a lot of interesting debates, original scientific work, strong opinions and unexpected viewpoints. On behalf of the editorial board and the publisher I would like to thank all those who were involved in Facts, Views & Vision in ObGyn in 2015, our contributors, referees, secretarial team, the staff at Universa Press, our artistic reviewer and, of course, our readers ...
Reproductive BioMedicine Online, 2003
This is the first report of an intrauterine pregnancy following timed coitus, resulting from tran... more This is the first report of an intrauterine pregnancy following timed coitus, resulting from transperitoneal sperm and/or oocyte migration as the oocyte originated from an ectopic (undescended) ovary. The patient was treated in the infertility clinic after a history of primary infertility for 2 years. Diagnosis of a moderate teratozoospermia and the presence of a unicornuate uterus with one right-sided normal ovary was made. During the first intrauterine insemination (IUI) treatment cycle with clomiphene citrate stimulation, a discrepancy between oestradiol concentrations and follicular growth was observed. Magnetic resonance imaging (MRI) was carried out because the presence of an ectopic ovary was suspected. The diagnosis of a left-sided undescended ovary was made, containing several follicles, the largest measuring 16 mm in diameter. Because of a spontaneous LH surge 2 days later without substantial follicular growth in the normal right-sided ovary, IUI was cancelled and timed intercourse was planned. Surprisingly, and although the largest follicle in the normally located ovary reached a maximum diameter of only 12 mm on repetitive ultrasound monitoring, this patient became pregnant and gave birth to a healthy baby boy.
Facts, Views & Vision in ObGyn, 2016
The epidemic of iatrogenic multiple births as a result of infertility treatment are responsible f... more The epidemic of iatrogenic multiple births as a result of infertility treatment are responsible for an unacceptable high incidence of maternal, perinatal and childhood morbidity and mortality. Healthcare costs due to infertility therapy are too high and this may lead to social and political concern. The introduction of single embryo transfer (SET) was a real breakthrough, but was only accepted in most European countries and Japan. The United States, Latin America and most developing countries still have high multiple pregnancy rates. The most common argument for not performing SET are the high costs associated with ART procedures. Competition between ART centres to achieve and publish the highest success rates is another major factor. But things have changed: vitrification methods for cryopreservation are responsible for a better survival and increased success rate with frozen-embryo transfer, our knowledge to select the best embryo for SET is increasing and the growing concern of h...
Journal of Magnetic Resonance Imaging, 2016
To prospectively evaluate and compare the junctional zone (JZ) and outer myometrial thickness in ... more To prospectively evaluate and compare the junctional zone (JZ) and outer myometrial thickness in infertile and healthy nulliparous women at different locations in the uterine wall during the menstrual cycle by magnetic resonance imaging (MRI). Material and methods: We performed pelvic 1.5T MRI (T 2-weighted turbo spin echo sequences) on 28 infertile women: 5 with infertility of unknown origin, 12 anovulating and 11 on ovarian stimulation therapy (mean age 28.5, 30.8 and 29.3 years, respectively); and a control group consisting of 18 healthy nulliparous volunteers (mean age 26.4 years). The women with unknown infertility origin and the control group underwent MRI investigations during their follicular, ovulatory and luteal phase. The JZ and outer myometrial thicknesses were measured at six locations in the uterine wall: anterior and posterior wall of the isthmus, midcorpus and fundus. Results: The JZ in the anovulating women at the posterior wall of the isthmus (4.2 mm) was significantly thicker compared to the control group (3.2, 3.0 and 2.9 mm, in respectively the three menstrual phases) (p=0.027). The outer myometrium in the anovulating women was significantly thicker at all measured locations (average 11.5 mm) in comparison to the control group (8.1, 8.0 and 8.5 mm, in respectively the three menstrual phases) (p<0.050). The infertile women on ovarian stimulation therapy showed a significantly thicker outer myometrium at the anterior wall (isthmus, midcorpus and fundus) (p<0.050). Conclusion: The results indicate that a thickened JZ, and especially a thickened outer myometrium might be associated with infertility.
Facts, views & vision in ObGyn, 2016
Although the increased risk for perinatal morbidity and mortality of babies born after ART is lar... more Although the increased risk for perinatal morbidity and mortality of babies born after ART is largely attributed to a higher rate of multiple gestations, a significantly worse perinatal outcome for singleton pregnancies following ART compared to pregnancies after natural conception has been reported as well. Most studies only include IVF/ICSI pregnancies; studies describing the perinatal outcome of pregnancies after non-IVF assisted reproduction are scarce. Population-based cohort study with three exposure groups: a study group of pregnancies (1) after ovarian stimulation (OS), with or without artificial insemination (AI), (2) after IFV or ICSI and (3) a naturally conceived (NC) comparison group. Data from the regional registry of all hospital deliveries in the Dutch-speaking part of Belgium during an 18-years period from January 1993 until December 2010 were used. The perinatal outcome parameters were prematurity, low birth weight, perinatal mortality and morbidity including neonat...
Facts, Views & Vision in ObGyn, 2016
The main objective of the Walking Egg non-profit organization is the implementation of good quali... more The main objective of the Walking Egg non-profit organization is the implementation of good quality and affordable infertility centres in resource-poor countries. Three levels of assistance are suggested: A level 1 infertility clinic is a basic infertility clinic capable of offering semen analysis, hormonal assays, follicular scanning, ovulation induction and intrauterine inseminations. Level 2 infertility clinics are supposed to perform simplified IVF as well. Level 3 infertility clinics capable of offering ICSI, cryopreservation and operative endoscopy are not part of the Walking Egg Project in the initial phase. A high quality but affordable service delivery with special attention to the prevention of complications and unnecessary interventions should be the trademark of this project.
Facts, Views & Vision in ObGyn, 2016
We honour the life of Robert Schoysman a pioneer and visionary in reproductive medicine, internat... more We honour the life of Robert Schoysman a pioneer and visionary in reproductive medicine, internationally renowned gynaecological surgeon and one of the pioneers of in vitro fertilization (IVF) in Belgium. From the early sixties he was interested in different options of male infertility treatment, including surgery and donor insemination. He was the pioneer of microsurgical epididymal sperm aspiration (MESA) and SUZI (subzonal sperm injection) in the early nineties. For those who were privileged to have worked with him he was a friend, a dedicated mentor and an enthusiastic teacher with vision and endless imagination.
Intrauterine inseminations (IUI) are easier to perform, less invasive and less expensive than oth... more Intrauterine inseminations (IUI) are easier to perform, less invasive and less expensive than other methods of assisted reproduction. The rationale for the use of artificial insemination is to increase gamete density at the site of fertilisation. It is generally accepted that IUI with homologous semen should be preferred as a first choice treatment above more invasive and expensive techniques of assisted reproduction in case of cervical, unexplained and moderate male factor subfertility. Scientific validation of this strategy is difficult because the literature is rather
Facts, Views & Vision in ObGyn, 2015
Artificial insemination with homologous (AIH) or donor semen (AID) is nowadays a very popular tre... more Artificial insemination with homologous (AIH) or donor semen (AID) is nowadays a very popular treatment procedure used for many subfertile women worldwide. The rationale behind artificial insemination is to increase gamete density at the site of fertilisation. The sequence of events leading to today’s common use of artificial insemination traces back to scientific studies and experimentation many centuries ago. Modern techniques used in human artificial insemination programmes are mostly adapted from the work on cattle by dairy farmers wishing to improve milk production by using artificial insemination with sperm of selected bulls with well chosen genetic traits. The main reason for the renewed interest in artificial insemination in human was associated with the refinement of techniques for the preparation of washed motile spermatozoa in the early years of IVF. The history of artificial insemination is reviewed with particular interest to the most important hurdles and milestones.
Facts, Views & Vision in ObGyn, 2019
The Walking Egg non-profit organization (npo) was founded in 2010 by scientists and an artist. Fr... more The Walking Egg non-profit organization (npo) was founded in 2010 by scientists and an artist. From this unusual blend, a unique objective came forth: to implement accessible infertility programmes in resource-poor countries. Our project aims to raise universal awareness about the issue of childlessness and to make, in all its aspects, infertility care including assisted reproductive technologies (ART), available and accessible worldwide. This can only be achieved when good quality but affordable infertility care is associated with effective family planning and safe motherhood programmes. To be successful, a global project to tackle the socio-cultural, ethical, economical and political differences hindering access to fertility care must happen.
Facts, Views & Vision in ObGyn, 2016
Background Although the increased risk for perinatal morbidity and mortality of babies born after... more Background Although the increased risk for perinatal morbidity and mortality of babies born after ART is largely attributed to a higher rate of multiple gestations, a significantly worse perinatal outcome for singleton pregnancies following ART compared to pregnancies after natural conception has been reported as well. Most studies only include IVF/ICSI pregnancies; studies describing the perinatal outcome of pregnancies after non-IVF assisted reproduction are scarce. Methods and Materials Population-based cohort study with three exposure groups: a study group of pregnancies (1) after ovarian stimulation (OS), with or without artificial insemination (AI), (2) after IFV or ICSI and (3) a naturally conceived (NC) comparison group. Data from the regional registry of all hospital deliveries in the Dutch-speaking part of Belgium during an 18-years period from January 1993 until December 2010 were used. The perinatal outcome parameters were prematurity, low birth weight, perinatal mortali...
Facts, Views & Vision in ObGyn, 2020
Although the consequences of infertility are often severe in LMIC (Low and Middle Income Countrie... more Although the consequences of infertility are often severe in LMIC (Low and Middle Income Countries), national and international health strategies have always focussed on reducing total fertility rates while infertility care has received no attention at all. Access to infertility care can only be achieved when good quality but affordable infertility care is linked to more effective family planning programmes. Only a global project with respect to socio-cultural, ethical, economical and political differences can be successful. The 2020 WHO fact sheet on infertility cannot be misunderstood; global access to high-quality services for family planning including fertility care is one of the core elements of reproductive health. Different strategies are presented.
Human Reproduction Update, 2018
BACKGROUND: IUI with or without ovarian stimulation (OS) has become a first-line treatment option... more BACKGROUND: IUI with or without ovarian stimulation (OS) has become a first-line treatment option for many infertile couples, worldwide. The appropriate treatment modality for couples and their clinical management through IUI or IUI/OS cycles must consider maternal and perinatal outcomes, most notably the clinical complication of higher-order multiple pregnancies associated with IUI-OS. With a current global emphasis to continue to decrease maternal and perinatal mortality and morbidity, the World Health Organization (WHO) had established a multi-year project to review the evidence for the establishment of normative guidance for the implementation of IUI as a treatment to address fertility problems, and to consider its cost-effectiveness for lower resource settings. OBJECTIVE AND RATIONALE: The objective of this review is to provide a review of the evidence of 13 prioritized questions that cover IUI with and without OS. We provide summary recommendations for the development of global, evidence-based guidelines based upon methodology established by the WHO. SEARCH METHODS: We performed a comprehensive search using question-specific relevant search terms in May 2015. For each PICO (Population, Intervention, Comparison and Outcomes) drafted by WHO, specific search terms were used to find the available evidence in MEDLINE (1950 to May 2015) and The Cochrane Library (until May 2015). After presentation to an expert panel, a further hand search of references in relevant reviews was performed up to January 2017. Articles that were found to be relevant were read and analysed by two investigators and critically appraised using the Cochrane Collaboration's tool for assessing risk of bias, and AMSTAR in case of systematic reviews. The quality of the evidence was assessed using the GRADE system. An independent expert review process of our analysis was conducted in November 2016. OUTCOMES: This review provides an assessment and synthesis of the evidence that covers 13 clinical questions including the indications for the use of IUI versus expectant management, the sperm parameters required, the best and optimal method of timing and number of inseminations per cycle, prevention strategies to decrease multiple gestational pregnancies, and the cost-effectiveness of IUI versus IVF. We provide an evidence-based formulation of 20 recommendations, as well as two best practice points that address the integration of methods for the prevention of infection in the IUI laboratory. The quality of the evidence ranges from very low to high, with evidence that may be decades old but of high quality, however, we further discuss where critical research gaps in the evidence remain. WIDER IMPLICATIONS: This review presents an evidence synthesis assessment and includes recommendations that will assist health care providers worldwide with their decision-making when considering IUI treatments, with or without OS, for their patients presenting with fertility problems.
Facts, Views & Vision in ObGyn, 2016
Originated as a mainly social group of befriended colleagues, the VVOG has evolved over the past ... more Originated as a mainly social group of befriended colleagues, the VVOG has evolved over the past 55 years to become a truly professional society facing successfully such diverse challenges as organizing scientific congresses, postgraduate training, ethical debates, hands-on training courses, social events, interactions with national and international sister societies but also with the industry, insurers, the government, politicians and patient organisations.
Reproductive biomedicine online, 2016
According to a number of high quality studies intrauterine insemination (IUI) with homologous sem... more According to a number of high quality studies intrauterine insemination (IUI) with homologous semen should be the first choice treatment in case of unexplained and moderate male factor subfertility. IVF and ICSI are clearly over-used in this selected group of infertile couples. The limited value of IUI in infertility treatment as mentioned in the 2013 NICE guidelines was surely a premature statement and should be adapted to the actual literature. More evidence-based data are becoming available on different variables influencing the success rates after IUI. It can be expected that these findings may lead to a better understanding and use of IUI in the near future.
The OSS and Ho Chi Minh, May 9, 2019
At the start of a new year it is time to look back over the past 12 months, as well as to look fo... more At the start of a new year it is time to look back over the past 12 months, as well as to look forward. 2015 has been one with a sad farewell to two very good friends, Dr Howard Jones Jr (see Fact Views Vis Obgyn, 2015, 7:149-152) and Professor Jan van der Merwe whose obituary appears in this issue. The past year has seen some very interesting and stimulating papers, not to forget about the most original 2015 cover designed by Koen Vanmechelen. The March issue was almost entirely dedicated to the second International Ovarian Tumour Analysis (IOTA) congress, held in Leuven, Belgium. We published eight outstanding papers linked to the different topics of the meeting and written by world experts in the field. I’d like to thank Professor Dirk Timmerman for helping us with the work-out and the content of this issue. In the June issue special attention has been paid to sperm donors and the related problems caused to the offspring and the children’s family. The editorial written by Professor Guido Pennings reflected on the ongoing debate about sperm anonymity in Belgium. In the September issue, Professor Wiebren Tjalma tackled the reimbursement for bone loss prevention in women and the discrepancies between reimbursement policies for women and men. Professor Geeta Nargund wrote a viewpoint paper describing the urgent need for fertility education in schools, a hot topic in the United Kingdom. In the fourth issue of 2015 we noticed two very interesting reviews. In the first systematic review (Vandendriessche et al.) the authors examined the value of old and new promising techniques in directing more effective adjuvant therapy for breast cancer. The second review by Datta et al. showed us that many additional interventions used in assisted reproduction are being practiced with little justifiable evidence. They only make IVF treatment more expensive with questionable actual advantage. In this issue we are very happy with an extremely interesting review on the religious aspects of assisted reproduction written by Professor Hassan Sallam from Alexandria, Egypt. I really believe that this paper should be a regarded as a one of the best reviews ever, describing the influence of religion on the human response to new developments such as assisted reproduction. I sincerely hope that the future will remain exciting with a lot of interesting debates, original scientific work, strong opinions and unexpected viewpoints. On behalf of the editorial board and the publisher I would like to thank all those who were involved in Facts, Views & Vision in ObGyn in 2015, our contributors, referees, secretarial team, the staff at Universa Press, our artistic reviewer and, of course, our readers ...
Reproductive BioMedicine Online, 2003
This is the first report of an intrauterine pregnancy following timed coitus, resulting from tran... more This is the first report of an intrauterine pregnancy following timed coitus, resulting from transperitoneal sperm and/or oocyte migration as the oocyte originated from an ectopic (undescended) ovary. The patient was treated in the infertility clinic after a history of primary infertility for 2 years. Diagnosis of a moderate teratozoospermia and the presence of a unicornuate uterus with one right-sided normal ovary was made. During the first intrauterine insemination (IUI) treatment cycle with clomiphene citrate stimulation, a discrepancy between oestradiol concentrations and follicular growth was observed. Magnetic resonance imaging (MRI) was carried out because the presence of an ectopic ovary was suspected. The diagnosis of a left-sided undescended ovary was made, containing several follicles, the largest measuring 16 mm in diameter. Because of a spontaneous LH surge 2 days later without substantial follicular growth in the normal right-sided ovary, IUI was cancelled and timed intercourse was planned. Surprisingly, and although the largest follicle in the normally located ovary reached a maximum diameter of only 12 mm on repetitive ultrasound monitoring, this patient became pregnant and gave birth to a healthy baby boy.
Facts, Views & Vision in ObGyn, 2016
The epidemic of iatrogenic multiple births as a result of infertility treatment are responsible f... more The epidemic of iatrogenic multiple births as a result of infertility treatment are responsible for an unacceptable high incidence of maternal, perinatal and childhood morbidity and mortality. Healthcare costs due to infertility therapy are too high and this may lead to social and political concern. The introduction of single embryo transfer (SET) was a real breakthrough, but was only accepted in most European countries and Japan. The United States, Latin America and most developing countries still have high multiple pregnancy rates. The most common argument for not performing SET are the high costs associated with ART procedures. Competition between ART centres to achieve and publish the highest success rates is another major factor. But things have changed: vitrification methods for cryopreservation are responsible for a better survival and increased success rate with frozen-embryo transfer, our knowledge to select the best embryo for SET is increasing and the growing concern of h...
Journal of Magnetic Resonance Imaging, 2016
To prospectively evaluate and compare the junctional zone (JZ) and outer myometrial thickness in ... more To prospectively evaluate and compare the junctional zone (JZ) and outer myometrial thickness in infertile and healthy nulliparous women at different locations in the uterine wall during the menstrual cycle by magnetic resonance imaging (MRI). Material and methods: We performed pelvic 1.5T MRI (T 2-weighted turbo spin echo sequences) on 28 infertile women: 5 with infertility of unknown origin, 12 anovulating and 11 on ovarian stimulation therapy (mean age 28.5, 30.8 and 29.3 years, respectively); and a control group consisting of 18 healthy nulliparous volunteers (mean age 26.4 years). The women with unknown infertility origin and the control group underwent MRI investigations during their follicular, ovulatory and luteal phase. The JZ and outer myometrial thicknesses were measured at six locations in the uterine wall: anterior and posterior wall of the isthmus, midcorpus and fundus. Results: The JZ in the anovulating women at the posterior wall of the isthmus (4.2 mm) was significantly thicker compared to the control group (3.2, 3.0 and 2.9 mm, in respectively the three menstrual phases) (p=0.027). The outer myometrium in the anovulating women was significantly thicker at all measured locations (average 11.5 mm) in comparison to the control group (8.1, 8.0 and 8.5 mm, in respectively the three menstrual phases) (p<0.050). The infertile women on ovarian stimulation therapy showed a significantly thicker outer myometrium at the anterior wall (isthmus, midcorpus and fundus) (p<0.050). Conclusion: The results indicate that a thickened JZ, and especially a thickened outer myometrium might be associated with infertility.
Facts, views & vision in ObGyn, 2016
Although the increased risk for perinatal morbidity and mortality of babies born after ART is lar... more Although the increased risk for perinatal morbidity and mortality of babies born after ART is largely attributed to a higher rate of multiple gestations, a significantly worse perinatal outcome for singleton pregnancies following ART compared to pregnancies after natural conception has been reported as well. Most studies only include IVF/ICSI pregnancies; studies describing the perinatal outcome of pregnancies after non-IVF assisted reproduction are scarce. Population-based cohort study with three exposure groups: a study group of pregnancies (1) after ovarian stimulation (OS), with or without artificial insemination (AI), (2) after IFV or ICSI and (3) a naturally conceived (NC) comparison group. Data from the regional registry of all hospital deliveries in the Dutch-speaking part of Belgium during an 18-years period from January 1993 until December 2010 were used. The perinatal outcome parameters were prematurity, low birth weight, perinatal mortality and morbidity including neonat...
Facts, Views & Vision in ObGyn, 2016
The main objective of the Walking Egg non-profit organization is the implementation of good quali... more The main objective of the Walking Egg non-profit organization is the implementation of good quality and affordable infertility centres in resource-poor countries. Three levels of assistance are suggested: A level 1 infertility clinic is a basic infertility clinic capable of offering semen analysis, hormonal assays, follicular scanning, ovulation induction and intrauterine inseminations. Level 2 infertility clinics are supposed to perform simplified IVF as well. Level 3 infertility clinics capable of offering ICSI, cryopreservation and operative endoscopy are not part of the Walking Egg Project in the initial phase. A high quality but affordable service delivery with special attention to the prevention of complications and unnecessary interventions should be the trademark of this project.
Facts, Views & Vision in ObGyn, 2016
We honour the life of Robert Schoysman a pioneer and visionary in reproductive medicine, internat... more We honour the life of Robert Schoysman a pioneer and visionary in reproductive medicine, internationally renowned gynaecological surgeon and one of the pioneers of in vitro fertilization (IVF) in Belgium. From the early sixties he was interested in different options of male infertility treatment, including surgery and donor insemination. He was the pioneer of microsurgical epididymal sperm aspiration (MESA) and SUZI (subzonal sperm injection) in the early nineties. For those who were privileged to have worked with him he was a friend, a dedicated mentor and an enthusiastic teacher with vision and endless imagination.
Intrauterine inseminations (IUI) are easier to perform, less invasive and less expensive than oth... more Intrauterine inseminations (IUI) are easier to perform, less invasive and less expensive than other methods of assisted reproduction. The rationale for the use of artificial insemination is to increase gamete density at the site of fertilisation. It is generally accepted that IUI with homologous semen should be preferred as a first choice treatment above more invasive and expensive techniques of assisted reproduction in case of cervical, unexplained and moderate male factor subfertility. Scientific validation of this strategy is difficult because the literature is rather
Facts, Views & Vision in ObGyn, 2015
Artificial insemination with homologous (AIH) or donor semen (AID) is nowadays a very popular tre... more Artificial insemination with homologous (AIH) or donor semen (AID) is nowadays a very popular treatment procedure used for many subfertile women worldwide. The rationale behind artificial insemination is to increase gamete density at the site of fertilisation. The sequence of events leading to today’s common use of artificial insemination traces back to scientific studies and experimentation many centuries ago. Modern techniques used in human artificial insemination programmes are mostly adapted from the work on cattle by dairy farmers wishing to improve milk production by using artificial insemination with sperm of selected bulls with well chosen genetic traits. The main reason for the renewed interest in artificial insemination in human was associated with the refinement of techniques for the preparation of washed motile spermatozoa in the early years of IVF. The history of artificial insemination is reviewed with particular interest to the most important hurdles and milestones.
Facts, Views & Vision in ObGyn, 2019
The Walking Egg non-profit organization (npo) was founded in 2010 by scientists and an artist. Fr... more The Walking Egg non-profit organization (npo) was founded in 2010 by scientists and an artist. From this unusual blend, a unique objective came forth: to implement accessible infertility programmes in resource-poor countries. Our project aims to raise universal awareness about the issue of childlessness and to make, in all its aspects, infertility care including assisted reproductive technologies (ART), available and accessible worldwide. This can only be achieved when good quality but affordable infertility care is associated with effective family planning and safe motherhood programmes. To be successful, a global project to tackle the socio-cultural, ethical, economical and political differences hindering access to fertility care must happen.
Facts, Views & Vision in ObGyn, 2016
Background Although the increased risk for perinatal morbidity and mortality of babies born after... more Background Although the increased risk for perinatal morbidity and mortality of babies born after ART is largely attributed to a higher rate of multiple gestations, a significantly worse perinatal outcome for singleton pregnancies following ART compared to pregnancies after natural conception has been reported as well. Most studies only include IVF/ICSI pregnancies; studies describing the perinatal outcome of pregnancies after non-IVF assisted reproduction are scarce. Methods and Materials Population-based cohort study with three exposure groups: a study group of pregnancies (1) after ovarian stimulation (OS), with or without artificial insemination (AI), (2) after IFV or ICSI and (3) a naturally conceived (NC) comparison group. Data from the regional registry of all hospital deliveries in the Dutch-speaking part of Belgium during an 18-years period from January 1993 until December 2010 were used. The perinatal outcome parameters were prematurity, low birth weight, perinatal mortali...
Facts, Views & Vision in ObGyn, 2020
Although the consequences of infertility are often severe in LMIC (Low and Middle Income Countrie... more Although the consequences of infertility are often severe in LMIC (Low and Middle Income Countries), national and international health strategies have always focussed on reducing total fertility rates while infertility care has received no attention at all. Access to infertility care can only be achieved when good quality but affordable infertility care is linked to more effective family planning programmes. Only a global project with respect to socio-cultural, ethical, economical and political differences can be successful. The 2020 WHO fact sheet on infertility cannot be misunderstood; global access to high-quality services for family planning including fertility care is one of the core elements of reproductive health. Different strategies are presented.