Monthly Archives: September 2009

Accelerated fertility treatment leads to shortened time to pregnancy and cost savings

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.”

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Lord Winston, Labels Egg Feezing As “Expensive Confidence

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.

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Baby Oliver is now a Beacon of Hope for IVF patients

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.”Picture 1

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US company offers celebrity ‘look-a-like’ sperm

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.

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