Of all the prospective parents conceiving through assisted reproduction, those in surrogacy arrangements often face the most difficult legal issues. The surrogate and usually also her husband will be treated as the child’s legal parents at birth, leaving the commissioning parents with no legal connection with their child whatsoever, even where both are the biological parents.

There is a special remedy available called a parental order. This is an order made by the family courts which reassigns parenthood after surrogacy, extinguishing the responsibility of the surrogate parents and transferring it to the commissioning couple. The process takes place post-birth: the application must be made within the first six months of the child’s life (though the surrogate’s consent is ineffective until after the first six weeks) and typically takes many months to be processed by the courts. At present, only married couples can apply, but as from 6 April 2010, unmarried and same sex couples will also be eligible.

The Department of Health (DH) is currently consulting on new draft regulations which prescribe the detail of this court process, and which will replace existing regulations that have been in place since 1994. The consultation closes on 23 November.

What is in the draft regulations?

Like the existing regulations, the proposed revised regulations apply provisions of adoption law to the parental order application process, setting out court procedure and giving a surrogate child broadly the same legal status as an adopted child. Adoption law has itself been overhauled substantially in recent years, and this is reflected in the wording of the new regulations. However, as part of the general updating, there are some important revisions being made to the existing parental order system which need to be looked at carefully.

For example, a court considering whether to grant an adoption order now has to first consider the ‘welfare checklist’, a prescriptive list of considerations which includes ascertaining the child’s wishes and feelings and considering his or her relationship with the birth family. The new parental order regulations incorporate this checklist into the parental order process. However, it does not seem appropriate for the court to have to address all these issues in surrogacy cases, given that the child will inevitably be less than six months old, and will be already living with the applicants (at least one of whom is his or her biological parent).

Importing the new adoption law without amendment fails to adequately take account of the special nature of surrogacy arrangements, and there may be a risk that this could make the process of applying for a parental order even more onerous than before. While a parental order is similar to an adoption order (in the sense that it transfers legal parenthood from one person to another), surrogacy is very different from adoption. Because a surrogate child (or at least those to which parental orders can apply) is biologically connected to at least one of the commissioning parents and is almost invariably in their care from birth, the dynamic of the family is perhaps closer to donor conception than to adoption. Adapting adoption law is therefore a difficult task, and one which we think could be handled more carefully by the regulations.

The parental order system

Even though a more fundamental review may not be within the power of these regulations, it seems impossible to look at any legislation relating to parental orders without making the point that the whole system is problematic. Parental orders were introduced as a late amendment to the Human Fertilisation and Embryology Act 1990 in response to a specific surrogacy case. At the time, surrogacy was viewed as very rare and something which occurred largely on the fringes of the law and ethical acceptability. The 1990 rules on legal parenthood clearly prioritised donor conception (making the carrying mother the legal mother, and her husband the legal father), and parental orders were designed as a limited remedy – a ’sticking plaster’ – in respect of the awkward application of legal parenthood rules in surrogacy situations.

As all those working in this field know, things have changed radically since then. Surrogacy as a form of fertility treatment has blossomed, both in the UK and abroad, and no longer affects just a small number of altruistic inter-family arrangements. Indeed, the Human Fertilisation and Embryology Act 2008 itself has endorsed this, by legalising non-profit making surrogacy agencies like Surrogacy UK and COTS and extending the categories of couples eligible to apply for parental orders. We are also seeing growing numbers of fertility patients travelling abroad for surrogacy, which brings even more complex legal challenges.

The current system, which came about by historical accident rather than a concerted policy decision, fails to meet this increased demand, and is inadequate from almost every perspective. The surrogate and her husband (who, in the vast majority of cases do wish to surrender the child) remain legally and financially responsible for the child for up to a year after the birth, and may have no legal redress against intended parents who refuse to assume responsibility. The intended parents often have no status in respect of their child for many months, including no right to make decisions or to consent to immunisations, no right to transmit inheritance or citizenship rights automatically and the intending mother has no rights to maternity leave (though this is the subject of another current campaign), leaving children very vulnerable during the early months of their lives.

The system is not an effective guardian of public policy against commercial surrogacy, since the check on payments comes at the end the process (by which time any payments have already been made) and the only sanction available to the court is a refusal to grant an order, which is almost impossible to enforce since this would prejudice the welfare of a newborn child. And, most importantly of all, these problems mean that surrogate children lack even basic protection. The problems are highlighted most starkly in foreign surrogacy cases. For example, in the landmark case of Re X and Y (foreign surrogacy) [2008], the law left surrogate twins born abroad to a British couple stateless and parentless. Such children risk being abandoned to foreign state care in the absence of complex and expensive legal intervention – surely this is an outcome which the law has an obligation to avoid at all costs.

We need a better and more planned approach to surrogacy. Of course, there are difficult and sensitive issues to be handled in creating new law. Surrogacy arrangements are among the most ethically and humanly complex in assisted reproduction, with three or even four adults involved throughout the process of conception, pregnancy and birth, and possibly third party gamete donors as well. The respective interests, protection and independence from exploitation of all these adults and, most importantly, the resulting child, need to be adequately balanced and protected by the law.
It is disappointing that such issues were not properly addressed during the government’s overhaul of assisted reproduction law last year. Although the Minister indicated that surrogacy was a sensitive issue which would be looked at separately, no firm commitment for this review, or a date, has yet been set – and it seems, given the current ’status’ of surrogacy – odd to continue treating it separately. In order to ensure that our law can cope with the demands of modern surrogacy practice, and to ensure that vulnerable children are protected, we urge the government to take a fresh look, not only at the regulations, but at the law itself.

By Natalie Gamble and Louisa Ghevaert
Partners with specialist fertility law firm Gamble and Ghevaert LLP

The MOGS FPAI Dr Avabai Wadia Memorial Workshop on Contraception was held on 26 September 2009. Cases were conducted at the Lokmanya Tilak Municipal General Hospital, Sion and relayed live to the Regus Convention Center, Bandra Kurla Complex, Mumbai.

There was healthy interaction between the faculty in the Operation Theatre and the chairpersons and audience at the Convention Center. The operation theatre was coordinated by Dr Niranjan Chavan and Dr Shailesh Kore. The sessions were chaired by Dr V D Patkar, Dr Mukesh Gupta and Dr Abha Bhat in the morning and Dr Asha Dalal and Dr Vipin Checker in the afternoon. The organizing secretaries were Dr Sulbha Arora, Dr Raju Nagarkatti, Dr Vipin Checker and Dr Parikshit Tank.

The MOGS – FPAI Avabai Wadia Conference on Contraception was held on the 27^th of September 2009 at ITC Grand Central, Parel. There were 100 delegates for this event including 12 postgraduate students. The Israeli Faculty included Dr Asher Shushan and Dr Motti Hallak. Dr Gautam Allahbadia, MOGS President welcomed the Israeli Faculty, the MOGS members and delegates from all over India. The national anthems of both the countries ie India and Israel were played to commemorate the MOGS Indo-Israeli year of Academic Exchange. Dr Usha Krishna, President FPAI and Dr Anjali Sen, Regional Director International Planned Parenthood Federation, addressed the audience. The program began with the Avabai Wadia Video Film Festival on Reproductive Health Technologies, where 8-minute videos were presented on Tubal Ligation and its reversal, Vasectomy and its reversal, Manual Vacuum Aspiration and Hysteroscopic Permanent Sterilization. This was followed by a Panel Discussion on Repositioning Family Planning Leading to Population Stabilization. The panel was expertly moderated by Dr Usha Krishna. The panelists included the Israeli Faculty as well as renowned doctors & family planning practitioners from India. The Indian Demographic scenario, the role of the Government & NGOs, factors having positive & negative influence, and advantages / disadvantages of the available methods were discussed. The Avabai Wadia Memorial Oration was delivered by Prof RP Soonawala on The Indian Contraception Story: Lessons Learnt and Future Challenges. The wonderful talk outlining the evolution of contraception over the last 3000 years with fascinating stories and personal experiences was enjoyed by all. Post Lunch we had four sessions of Invited Lectures on four different aspects of Family Planning. The Hormonal Contraception Session was sponsored by Wyeth, and covered lectures on Low Dose Oral Contraception, Modern Trends in Contraception and Injectable Contraception. The MTP Session included Medical Methods, Implications and Amendments of the MTP Act and Emerging Trends in Second Trimester MTP. The session on Surgical Approach covered the areas of Non Scalpel Vasectomy, Trials & Tribulations of Female Sterilization and Hysteroscopic Sterilization. Lastly we had a session on Contraception in Special Groups such as Adolescents, the HIV Positive and women with Medical Disorders. The day concluded with the MOGS Dr Bhanuben Mahendra Nanavati Golden Jubilee Oration, which was delivered by Prof Suneeta Mittal from New Delhi on Contraception Acceptance: Gaps and Promises. This excellent oration was founded on years of experience, data, images and personal insights. The tireless efforts of the Organizing Committee ensured that the conference was a success in all aspects – the acquisition of knowledge, free exchange of ideas with audience interaction and experts’ opinion on all aspects of family planning.

Rotunda achieved its first pregnancy with Cryoshipped Vitrified embryos from USA and transferring them into a surrogate mother.

Till now, we have received frozen embryos from many countries and successfully transferred them into surrogate mothers at Rotunda. Most of these embryos were frozen by the slow freezing process. As vitrification is becoming popular as a method of choice for freezing gametes, we have started receiving vitrified embryos from world over. Our first case of cryoshipped, vitrified blastocyst transfer has resulted in a pregnancy.

A short history lesson:

In 1972 preimplantation mammalian embryos were first successfully cryopreserved. The method was very time consuming. Slow cooling was used (1 degree/min or less) to about -80 degrees Centigrade. Then the embryos were placed in liquid nitrogen.

The embryos also needed to be thawed slowly and a cryoprotectant added and removed in many gradual steps. This was a lot of work.

The first reported pregnancy in humans from frozen embryos was in 1983.

Most of the research has been done on mouse embryos. Development of frozen thawed mouse embryos, in vitro and in vivo, is not statistically reduced as compared to their nonfrozen counterparts.

Research continues in this area and human embryo freezing and thawing protocols have improved tremendously over the past 25 years. Hopefully, the newer vitrification technique will prove to have equivalent success rates with human blastocyst embryos transferred fresh or after freezing and thawing.

What is the difference between slow freezing and vitrification?

Patients who undergo IVF may have several eggs collected. The eggs are then fertilized with a sperm and checked for fertilization. Fertilized eggs are called embryos. A patient may have multiple high quality embryos eligible for embryo transfer back to the uterus. A certain number of embryos are chosen for embryo transfer, and the surplus of high quality embryos can be cryopreserved for future use.

Previously, embryos were cryopreserved using a slow freeze method. Embryos were run through different solutions of media todehydrate the cells of water and replace it with cryoprotectant. Then the cryoprotected embryos were individually labeled and stored in cryopreservation straws, which were put in special freezers. These freezers slowly (-0.3 degrees Celsius per minute), cooled the embryos to -35 degrees Celsius using liquid nitrogen. They were then stored in liquid nitrogen (-196 degrees Celsius). At that extremely cold temperature, cellular activity is essentially brought to a halt, allowing the embryos to remain viable indefinitely.

When patients decide to use their cryopreserved embryos to try for a pregnancy, the embryos are removed from the liquid nitrogen, warmed and run through solutions of media to remove the cryoprotectant and rehydrate the cells with water. During cryopreservation, the formation of intracellular ice crystals can damage the cells of the embryo, decreasing future viability. Therefore, new methods were developed to improve cryopreservation techniques.

Recent technical advancement in the field of cryobiology has opened up various options for freezing gametes and embryos at different developmental stages. The tendency of the IVF world to switch over to natural cycle IVF and to elective single-embryo transfer has put cryotechnology in the forefront of IVF. Vitrification method is gaining popularity as the method of choice for gamete/embryo cryopreservation.

Vitrification is a new process for cryopreserving embryos. Through vitrification, the water molecules in an embryo are removed and replaced with a higher concentration of cryoprotectant than in the slow freeze method. The embryos are then plunged directly into liquid nitrogen. This drastic (-12,000 degrees Celsius per minute) freezing creates a glass transition temperature, commonly called a “glass” state, and the embryos are vitrified. This quick freezing reduces the chance for intercellular ice crystals to be formed, thus decreasing the degeneration of cells upon thawing for embryo transfer.

In 1998, it was shown that vitrification using an EG-based vitrification solution (EFS40) (Kasai et al., 1990) with conventional cryo-straws was effective for human embryos at the 4- to 8-cell stage (Mukaida et al., 1998). The effectiveness of vitrification was confirmed for human embryos at the 8- to 16-cell stage (Saito et al., 2000) and the morula stage (Yokota et al., 2001b), also using EG-based solutions.

Many studies show survival rates of vitrified embryos to be far higher than survival rates of slow freeze embryos. Thus far at Rotunda, vitrification results are very encouraging, and we are excited to offer this cutting edge technology to our patients.

For more information about vitrification, ask to speak to the embryologist at your center.

Vitrification, a cutting edge technology for cryopreservation of embryos, is now available at Rotunda – Center for Human Reproduction.

Shalom & Namaskaar! The MOGS Indo-Israeli Year is well on its way with the second clinical meeting creating waves in the Ob-Gyn community in India. We had a star-studded faculty from both India & Israel. Prof Israel Shapiro is the President of the Israel Society of Ultrasound in Obstetrics & Gynecology. He is the Coordinator of the Scientific Meetings of the Society. He is also the Chairman of the Academic School of Ultrasound in Obstetrics & Gynecology. He is attached to the Department of Obstetrics & Gynecology at the Bnai-Zion Medical Center, Haifa. He has vast experience in Industrial Counseling and is currently the Consultant of General Electric (GE Healthcare) in developing ultrasound equipment.In fact, he developed the first transvaginal probe prototype with Elscint in Israel eons ago!Prof Shlomo Lipitz was awarded his MD degree in 1984 from The Hebrew University, Jerusalem and thereafter completed a Clinical Fellowship at The Fetal Medicine Unit, Department of Obstetrics & Gynecology, University College Hospital, London. He is now the Director of The Fetal Medicine Unit at The Sheba Medical Center, Israel. His areas of interest are Amniocentesis, Chorion Villus and Fetal Blood Sampling, Intrauterine Fetal Blood Transfusions, Shunts, Multifetal Pregnancy Reductions, Laser Therapy in Twin-Twin Transfusion Syndrome and Bipolar Coagulation in Monochorionic Twins.Prof Reuven Achiron is the Director of the Ultrasound Unit at the Department of Obstetrics & Gynecology at the Chaim Sheba Medical Center, Tel Hashomer. He has been invited to the World Congress of Ultrasound in Obstetrics & Gynecology thirteen times. He is a Member of the International Ultrasound Society and has been on the Editorial Board of the journal Ultrasound in Obstetrics & Gynecology. He has published six monographs and over 130 original articles on Obstetric Ultrasound & Fetal Diagnosis.Dr Chander Lulla is one of the pioneers of ultrasound in India and is the most-sought after interventional sonologist in this part of the world. He is affiliated to the Nowrosjee Wadia Maternity General Hospital as well as to the Jaslok Hospital in Mumbai. The formidable four were all set to showcase their skills to an eager audience sitting in two different auditoriums; the PG students in the Main Lecture Theatre at KEM hospital & the practicing gynecologists at the ITC Grand Central which is a kilometer away.

The Indo-Israeli workshop on fetal diagnosis and intervention organized by the Mumbai Obstetric and Gynecological Society and Seth G.S. Medical College, KEM hospital (Department of Obstetrics & Gynecology) was held on 6th June 2009 in the department of Obstetrics & Gynecology, KEM hospital. The workshop equipment was provided by Wipro GE Healthcare. Prof Reuven Achiron , Prof Shlomo Lipitz and Dr. C.P. Lulla demonstrated live 2-D and 3-D fetal ultrasound all through the day from 9am to 5pm with a short Lunch break! Live scanning of eleven cases was performed with detailed interaction with the audience. Normal first, second and third trimester ultrasounds, malformation scans, 3-D ultrasound and an interventional procedure of placental biopsy as a prenatal diagnostic technique in a case of thalassemia were demonstrated. Various congenital malformations including cranial, cardiac, pulmonary, renal, skeletal and gastrointestinal were demonstrated. The correct methodology for anomaly detection and the management protocols were discussed. The postgraduate students and the delegates at ITC Grand Central found the workshop very informative and useful for clinical practice.
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The Conference on Fetal Diagnosis and Intervention was held the next day -the 7th June 2009, Sunday at the ITC Grand Central, Parel, Mumbai. There were 145 registrations for this event. The opening session was on free communications. Dr Shailesh Kore was awarded the prize for the best paper. His subject was prediction of preeclampsia by placental laterality. This was followed by a session on the journey of a fetus from the womb to the pediatric operation theatre. It was a collaborative effort by Dr Nitin Chaubal and Dr Sanjay Oak.The Israeli Faculty were thoroughly impressed with this presentation & congratulated both the speakers (see video). Prior to the Key-note addresses, we played the National Anthems of both countries. This was a truly emotional moment for our invited guests. The international faculty presented the Keynote Addresses on Applications of current ultrasound in fetal medicine (Professor Reuven Achiron) and Diagnosis and treatment of complications of monochorionic twins (Professor Shlomo Lipitz).

The post lunch session was a visual treat with twelve videos from invited faculty.Prof. Shapiro’s video was the run away winner of this Video film session (see video). This was followed by invited lectures by Dr C P Lulla, Dr Aniruddha Badade and Dr Sameer Dikshit.

The Dr M Y Raval Oration was delivered by Professor Israel Shapiro on the subject of “Three Dimensional Ultrasound: Gimmick or Breakthrough”. This 100 minute oration was founded on years of experience, data, images and personal insights. It was laced with the right dose of humor and received a standing ovation from the audience (see video).

The chairpersons ensured that the sessions were interactive and kept the program running on schedule. The venue was well-appointed and hospitable. Once again, on behalf of MOGS we would like to express our thanks to the superlative Banqueting team at the ITC Grand Central. I would also like to mention that the success of this meeting was shaped in a large way with the untiring efforts of the hands-on conveners Dr Sulbha Arora & Dr Parikshit Tank. The MOGS office staff ensured that the Registration Desk & other admin formalities purred on smoothly like a BMW engine! Thank you delegates – We had delegates from Arunachal, Bihar, Haryana, Gujarat, Maharashtra & Sri Lanka too! I am still receiving positive feedback on this meeting from doctors who were not present , but have heard about this meeting from registered delegates. This is really heartening & we look forward to the Late Dr Avabai Wadia Workshop & Conference on Contraception in September 2009. Before I pen off, I would like to express my gratitude to the supporters of MOGS who were present in the exhibition hall on both days. Thank you Danny for making our Indo-Israeli dream a reality. Lakhaim!

For many couples, being infertile no longer means having to go through life without children. Modern science and continued research in this direction has helped millions of couples all over the world become parents to a healthy child. Even issues that were once thought to make it impossible to conceive a child can now be overcome. One such female fertility problem is having a lack of eggs available for fertilisation.

What is Egg Donation

So what is a woman to do if her eggs have been found to be of poor quality or low quantity? Using an egg donor can significantly increase your chances of pregnancy. Compared to a your own eggs, using donor eggs are typically a better option when you do not have a very good ovarian reserve.

Ovarian reserve is the quantity and quality of eggs present in a woman’s body and this number differs for from every woman. In some cases, in spite of a high number of follicles, a woman may not have her eggs mature due to issues like premature ovarian failure. Other women may have eggs that are incapable of being fertilised or implanting on the uterine wall due to structural defects.

On the whole, donor eggs may be a better option when:

- Premature ovarian failure due to genetic or auto-immune disorders has been diagnosed or has occurred due to radiation therapy or artificial removal of the ovaries

- A woman is over 40 and is going through or has already gone through menopause

- There has been no response to fertility drugs

- There is a high level of FSH in the blood (FSH is a hormone that stimulates follicles to mature into eggs. If its level is too high in the blood, it signifies fewer eggs present in the body.)

- A woman cannot conceive in spite of repeated IVF cycles

- There is a risk of transferring genetic disease, like haemophilia, to the child from the mother

Physical Considerations

Doctors recommend that if a couple is opting for donor eggs, the mother should undergo a detailed medical analysis to check whether her body is suitable for pregnancy or if she is at a health risk. This particularly becomes important for women aged 40 years or more.

The uterus is also checked for deformations such as fibroids and scarred tissues that may not allow the egg to implant.

Psychological Considerations

The decision of using an egg that is not yours is a difficult one. The choice of the donor, her being known or anonymous, the ethical or religious aspects, the choice of telling the child, the involvement of relatives and friends and most importantly the parents’ firm will to use donor eggs are some aspects of the issue that have to be dealt with.

Psychological counseling can be very helpful for couples in this regard to make a concrete decision.

Selection of Donor

Choosing a donor is a crucial aspect. She might be a family friend, relative or a person known to you. There are also many organisations and online sites that provide a list of donors who are willing to donate eggs. If you are already attending a fertility clinic, they too may have a pool of egg donors from which you can choose. Some couples have also successfully advertised for donors, though this may not be a safe approach, as the person’s background cannot be sufficiently verified.

Depending on how you locate your donor, the donor may remain anonymous. For instance, if your infertility clinic offers an egg donor program, you will likely be able to read about a donor’s health history, physical traits, education level, possibly profession and other general information. However, you will not learn the donors name, address or any other information that will allow you to identify them.

In general, women between the ages of 18 and 35 who are physically healthy, non-smokers, with no hereditary or sexually transmitted diseases and who are psychologically fit are most suited to become donors.

Donor’s Check-Up

In order to ensure that a donor is physically, genetically and psychologically healthy for the donation, she has to undergo a number of tests. These may include:

- Blood tests to know the blood group, blood count and check for any infectious diseases might be passed on to the child

- HIV tests

- Hepatitis B and C tests

- Test for syphilis

- Medical history of the donor and her family to ensure that no hereditary problems are present

- The level of hormones present to know how fertile she is and whether her eggs are healthy enough

Psychological counseling is also advised to know her better as well as prepare her for the process.

The Procedure

Once you have decided to use donor eggs, the first step involves consultation with a physician or an organisation providing the donors. This helps in identifying your needs better and also answers any queries you might have regarding the procedure. The consultant also tries to find out your physical characteristics, likes, and dislikes to best match you with a donor.

After the selection of the donor comes the evaluation cycle phase.

Egg Donation Cycle

When the process of pregnancy takes place naturally, the uterus of the mother prepares itself by thickening the lining of the inner wall, while the body automatically produces an increase of hormones, like estrogen and progesterone, for the conception. But in the case of pregnancy with donor eggs, a mother’s body is not prepared for pregnancy and therefore the hormones have to be artificially induced.

A prospective mother will undergo an evaluation to determine the correct amount of estrogen and other hormonal supplements to be administered prior to transferring a fertilised donor egg. This is done by measuring your blood estrogen level and through ultrasound check ups to observe the uterine lining. The doctor may also give oral or estrogen injections to raise your hormone levels, which you may continue to take for a period of 10 to 14 days.

Then, the donor and the mother’s cycle are synchronized with the help of birth control pills. Once this has been done, the donor is given fertility drugs to promote a greater number of eggs being matured during her cycle. Meanwhile, you are given the appropriate dose of estrogen to prepare your uterus for the embryo.

A day before your donor under goes egg retrieval, you are given progestrone vaginally or with an injection. When the donors egg are retrieved, your partner will provide a semen sample that day so that his sperm can be combined that day with the freshly retrieved eggs. After 3 to 5 days, once the embryos have formed, two to three embryos will be transferred to your uterus as it normally would during an IVF procedure.

You will continue to receive estrogen and progestrone doses to help encourage a pregnancy. 10 to 11 days after the embryo transfer, a pregnancy test is carried out to check the success of the procedure.

Benefits

There are a number of benefits to using donor eggs:

- A donor egg from a younger woman increases the chances of conception to 50% as compared to 15% to 18% with your own eggs. This is because donor eggs are of better quality and there are more numbers of eggs available for fertilisation.

- As the donor egg provides a better chance of fertilisation, you may not have to undergo as many IVF cycles thereby saving yourself from the physical, mental, and financial anxieties associated with each cycle.

- Donor eggs provide an opportunity to conceive a child whose genetic make up resembles one of the parents.

- You are able to experience the process of giving birth when the fertilised egg is placed inside your uterus, which is not possible with an adopted child.

Risk Factors

A common fear of parents is that their child will be born with a genetic defect. Donors, however, are usually extensively checked for any signs of physical and genetic abnormalities. As a result, the chances of your child being affected by genetic problems caused by a donor are significantly reduced. However, they cannot be completely eliminated.

Unlike donor sperm, which is frozen and quarantined for at least six months, donor eggs are not frozen. This is because the freezing technique for eggs has yet to be perfected; in fact, freezing eggs typically damages the egg making it unusable. Therefore, fresh eggs must be used when you opt for donor eggs. Some infections, like HIV, may not produce a positive result until months after the infection, which means, although a donor may be tested, there is still a chance that she, and her eggs, could have a serious infection.

Other risks associated with this procedure include those associated with the IVF process itself as well as the chance of miscarriage if your body does not respond to the embryo. Furthermore, because two to three embryos are transferred, your risk of a multiple pregnancy occurring is increased.

Success Rate

Research has shown that there is about a 48% to 50% chance of conceiving using donor eggs. For women above the age of 40, who in general have a lower quality and quantity of eggs, the chances of conceiving with a donor egg is 5 times more than with their own eggs.

A major new trial recently published in the journal Fertility and Sterility shows that for couples beginning infertility treatments, an accelerated path to in-vitro fertilization (IVF) can offer a shorter time to pregnancy, cost savings of nearly $10,000, and a lowered risk of multiple births.

For the first time, these results demonstrate that the long held treatment combining fertility injections with insemination (IUI) does not have a place in infertility treatments today. This study also demonstrates that today’s infertility treatments are very successful. When fertility care is covered by insurance (or alternatively when couples can afford all needed treatment), the vast majority will have a baby, and the quickest way to get pregnant is to follow this new shortened protocol.

Elizabeth Ginsburg, President of the Society for Assisted Reproductive Technology, commented, “This is a very important study that will likely influence physicians to reduce the number of stimulated inseminations for patients with unexplained infertility. Adoption of such an accelerated course of treatment could result in many patients conceiving in less time with less expense.”

Lord Winston, emeritus Professor of Fertility Studies at Imperial College London and pioneer of IVF, has criticized fertility clinics for over-hyping egg freezing services. In an interview with the Daily Mail newspaper he accuses providers of creating false optimism in the effectiveness of the procedure particularly where signing up patients for purely ’social’ reasons. Before use of egg freezing grows further he calls for more research into both the effects of egg freezing on the ability to later conceive and into the long-term health implications for those born
from frozen eggs.
The comments come in response to calls, made at last week’s European Society for Human Reproduction and Embryology (ESHRE) annual conference, for greater availability of egg freezing as an option for women who are postponing pregnancy until later in their lives. Lord Winston’s comments partially mirror a joint statement made in February by the UK’s Royal College of Obstetricians and Gynaecologists and the British Fertility
Society (BFS) which also called for women not to freeze eggs for social reasons.
Lord Winston noted that the production of six to ten eggs for freezing involves both the risk of ovarian hyperstimulation syndrome for the woman and an increased likelihood of chromosome defects in the eggs produced. Producing such a quantity of eggs he sees as dangerous yet also inadequate to ensure a viable embryo is produced. The BFS has stated that the average chance of success for any individual frozen egg is six per cent and only four children have been born from frozen eggs in the UK to date.
Additionally, the lack of data on the long term health effects – the first children conceived with frozen eggs are only now five – is provided as reason enough for adopting a cautious approach towards increasing availability of egg freezing and makes encouraging those without a pressing need (such as impending cancer treatment) all the more dubious. Lord Winston states, in unequivocal terms, ‘in my view it is irresponsible [for clinics] to egg freeze until long-term animal research has been done’. The most detailed research to date is due to be published next month.
Describing the procedure as a ‘quick fix’, Lord Winston sees the best path forward for prolonging the ability to have a child, for social reasons, is to attempt to develop better means of postponing the menopause. Though the procedure can be justified for those with serious medical conditions it is not be encouraged as a means of delaying motherhood. The provision of egg freezing for social reasons, available for between £2,500 and £5,000 at 45 clinics in the UK, is in his view simply an ‘undesirable commercial activity’ and should not be encouraged.

A British woman has become the first in the world to give birth using a new IVF test that promises to improve the chances of parenthood for infertile couples.

A boy, named Oliver, was born in July to a 41-year-old woman who had tried 13 cycles of IVF without success. She conceived after her eggs were screened to select those that were the most viable.

The screening technique has the potential to raise IVF success rates significantly, particularly for women in their late 30s and 40s and couples with a history of failed fertility treatment or miscarriage. It could also be used in younger women to promote the use of a single embryo in IVF to guard against risky multiple births. If the test can pick the best eggs, one embryo could be transferred to the womb without reducing success rates.

Simon Fishel, managing director of the CARE Fertility Group in Nottingham, who treated the new parents, said: “Oliver’s birth is an important landmark in shaping our understanding of why many women fail to become pregnant.”

He said that older versions of the screening test have been shown to double the chances of IVF success for some couples with a poor prognosis, and that early results suggest that the new technique is at least as good, if not better.

Since the pregnancy that led to Oliver’s birth was announced in January, about five more women have conceived after taking the egg test, known as Array Comparative Genomic Hybridisation (Array CGH), out of about 20 treated.

All the patients treated had a poor prognosis, with multiple failed attempts at IVF, and Dr Fishel said that the early success rate of about 25 per cent was a considerable improvement. “I’d generally give these women about a 10 per cent chance of getting pregnant,” he said.

The effectiveness of Array CGH, however, has yet to be assessed in a randomised controlled trial — the gold standard for medical therapies — and other scientists were more cautious about its prospects. Several other quality tests for eggs and embryos have looked promising at first, but have been found wanting by randomised trials.

Tony Rutherford, chairman of the British Fertility Society, welcomed the birth, but added: “It is absolutely essential that these new techniques are subject to further rigorous research; and should only be offered to patients within the context of a robustly designed clinical trial, carried out in suitably experienced centres.

“The widespread use of this technology should await the outcome of such research to ensure we know which patients might benefit. All too often we see ground-breaking news about techniques that seem to offer great hope, but fail to live up to expectations when applied in widespread clinical practice.”

Array CGH seeks to identify eggs that have the wrong number of chromosomes, which will generally fail to develop properly if fertilised with sperm. Such chromosomal abnormalities are difficult to detect in eggs or embryos by eye, and they are among the major causes of IVF failure.

Array CGH has two main advantages over other methods of screening: the first is “gene chip” technology that tests DNA very quickly, so that eggs or embryos do not need to be frozen while they are checked. The second is that instead of removing cells from embryos, which can damage them, it relies on testing the eggs, which are the cause of 85 per cent of chromosomal defects.

Healthy human cells have 46 chromosomes, 23 inherited from each parent. Before an egg is fertilised, it ejects half of its complement to leave space for the 23 paternal chromosomes carried by the sperm. The waste chromosomes are jettisoned in a structure called the polar body and are a mirror image of those left behind in the egg.

Array CGH checks that an egg’s polar body has 23 chromosomes: if it does not, its parent egg must have too many or too few. Doctors can then ensure that only normal eggs are fertilised to produce viable embryos for transfer to the womb.

Oliver’s mother produced eight eggs, of which only two were found to be normal and transferred to the womb. In several other cases Dr Fishel’s team has found no eggs suitable for transfer.

The test costs £1,950, on top of the £3,000 or so for IVF. It is not available on the NHS or at other private clinics.

Professor Peter Braude, of King’s College London, said: “I am delighted that this patient has achieved her positive outcome after so many years of trying. However we need to be cautious as to whether the new technique was responsible.

“I hope that this is not the case here and would love to see a positive outcome to rigorous analysis of this technique, but at the moment this can only be viewed as a potentially very lucky result.”

A California-based fertility company is offering prospective parents a range of celebrity ‘look-a-like’ sperm donors. Cryobank, which is also planning to offer services in New York, allows customers to search through a database according to characteristics such as ethinicity and eye colour without revealing donors’ photographs. In addition, the company has now added features that resemble celebrities such as David Beckham and David Blaine.

Cryobank’s introduction on its website reads: ‘Have you ever wondered if your favorite donor looks like anyone famous? You know how tall he is and his hair and eye color, but wouldn’t it be great to have an idea of what he really LOOKS like? Now you can find out with a click of your mouse!’

Scott Browne, a spokesman for Cryobank said that ‘the intention is not to suggest the child will look like one of the celebrities. It’s just to personalise the donor. I think in their heads they know the medical history is most important, but ultimately we’re all interested in what someone looks like. It’s what we do when we’re dating or meet someone. I didn’t ask my wife her medical history before I decided to marry her.’
Potential sperm donors are put through a rigorous screening process delving into their health and medical history before finding out which celebrity they most closely resemble. Browne says the process of deciding which donor resembles which celebrity is not easy: ‘There’s a lot that goes into it. It’s not just sitting in a room deciding who looks like Ben Affleck, what sounded really easy got complicated when we realised that people see people in completely different ways,’ he said. He added: ‘So we’re very concerned about misleading clients. One rule we made was that a donor never gets just one celeb. And one of our representatives can always get on the phone and explain.’

The company’s New York Park Avenue branch will not be open for a few months but from this week prospective parents can search the database online for celebrity look-a-like sperm.

Back in 1999, Pek Van Andel and three of his colleagues did a research study to take MRI images of a couple having sex. Now, the video is on the internet. Oh my.

It’s sure not the sexiest piece of footage I’ve ever seen, but it’s interesting. I guess? What’s great is that the researchers were pretty upfront about there being no real point to this study other than just seeing if they could do it. Look at their objective!

Objective: To find out whether taking images of the male and female genitals during coitus is feasible and to find out whether former and current ideas about the anatomy during sexual intercourse and during female sexual arousal are based on assumptions or on facts.

This is exactly the kind of thing we’d do if you gave us any kind of equipment—test the limits of it. Also, can you imagine trying to have sex in an MRI tube? That’s got to make the back seat of a compact car feel like a king-size bed by comparison.

Now that sex is done, we need to start the MRI on other bodily functions. Urination, defecation…I guess that’s it.