Tag Archives: Donor Eggs

Birth of first UK baby screened for genetic breast cancer

The first baby to be screened for alterations in the breast cancer-causing gene, BRCA1, was born last week. The child was at risk from inheriting the gene from her father, who has women in three generations of his family who have been diagnosed with breast caner in their twenties as a result of inheriting the defective gene.

breast_cancer22 Paul Serhal, the fertility expert who treated the couple at the Assisted Conception unit of University College Hospital, London, said: ‘This little girl will not face the spectre of developing this genetic form of breast cancer or ovarian cancer in her adult life. The parents will have been spared the risk of inflicting this disease on their daughter. The lasting legacy is the eradication of the transmission of this form of cancer that has blighted these families for generations.’

The BRCA1 gene, when properly functioning, can help prevent breast cancer, but abnormal variations can significantly increase the risk of developing breast cancer. Females born with the affected gene face a 50-80 per cent risk of contacting breast cancer and a 40-60 per cent chance of developing ovarian cancer.

In 2006 the UK’s Human Fertilisation and Embryology Authority (HFEA) permitted fertility clinics to perform pre-implantation genetic diagnosis (PGD) – a procedure whereby embryos are tested for various conditions, the healthy ones are re-implanted and those that are affected are discarded – to test for this type of gene that makes carriers susceptible to a disease but that does not necessarily lead to disease in all cases. BRCA1 and BRCA2 account for around five per cent of breast cancers and it is thought that roughly 37,000 women in the UK carry BRCA1.

pgd1The couple concerned, who wish to remain anonymous, underwent IVF despite being fertile. A single cell was removed from the 11 embryos created when they were at the eight-cell stage and tested for the defective BRCA1 gene, revealing that only five of the embryos were free from the gene. Two of these were implanted into the mother’s womb, of which one, a girl, pgd21 successfully implanted to develop until birth.  The remaining three healthy embryos were frozen in case the parents want more children in the future. The six embryos carrying the defective BRCA1 gene were discarded.

Given that the breast cancer is increasingly curable and that carriers of the gene do not necessarily develop the disease (and vice versa), questions have been raised over the ethics of the procedure. Josephine Quintavalle, of the campaign group Comment on Reproductive Ethics (Core), told the BBC that she believes the procedure is a step too far, as it gives the message that ‘you are better off dead, than being born with this gene’. She added: ‘I hope 20 years down the line we will have eradicated breast cancer – not eradicated the carriers’.

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The success rates of gestational surrogacy cycles

In India, especially in Mumbai, gestational surrogacy is helping many couples have children, which may not have been possible in the past.

At Rotunda, we have tripled our gestational surrogacy cycles in 2008, in conjunction with achieving exceptionally high success rates. Our success rates with fresh surrogacy cycles average around 50% per embryo transfer, and are as high as 70% per embryo transfer in cases where eggs from our young healthy donors are used.

Results of last six months’ surrogacy cycles at Rotunda:

Month (2008)

No. of Cycles

No. of Pregnancies

Pregnancy rate per transfer (%)

May

8

5

62.5

June

8

3

38.0

July

15

9

60.0

August

14

5

36.0

September

11

5

45.5

October

11

8

72.7

 

surrogacy-cycles

We understand that when a couple fails to achieve a pregnancy with surrogacy, the situation can be quite overwhelming due to the high expectation of success and the substantial drain on financial resources. Our team is always cognizant of these realities and every attempt is made to work with couples in the event of failure to help them realize their goal of building families.

Since there are potentially significant legal, financial, ethical, and psychological issues with surrogacy, couples should work with centers that have experience in selecting surrogate mothers and provide the infrastructure to deal with these issues. 

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France: Woman, 59, is oldest mother of triplets

A 59-year-old Frenchwoman has given birth by Caesarian section to two boys and a girl, who are in good health, the Paris hospital treating her said on Monday last.

“Everything went smoothly,” said a spokesman at Cochin hospital where the triplets were born overnight Saturday.

The woman, of Vietnamese origin, is thought to have resorted to a private Vietnamese clinic willing to overlook the age limit for egg donation and in vitro fertilisation (IVF), set at 45 in Vietnam, according to press reports.

Egg donations are authorised in France but most fertility clinics here set a maximum age limit of 42 for would-be mothers.

But nothing prevents couples from seeking fertility treatment abroad and in 2001 a 62-year-old Frenchwoman gave birth to a child conceived through IVF, in the Riviera town of Frejus.

Earlier this year, an Indian woman said to be 70 years old gave birth to twins after receiving IVF treatment.

The baby girl weighed in at 2.42 kilograms (5.34 pounds) as did one brother, while the second boy weighed 2.32 kilograms.

The birth of triplets by a mother in her late 50s was unprecedented in France and possibly a world first.

But the news raised eyebrows among French health professionals concerned that science was pushing the limits of motherhood too far.

“Having children at that age is dangerous in terms of child development,” said child psychiatrist Nicole Garret-Gloanec.

Women of child-bearing age are able to “draw the link between their own childhood and their baby,” she said.

This case raises questions as to “how you can help a child grow, in educational terms and development,” said Dominique Ratia-Armangol, president of the national association of early childhood psychologists.

She said a child born to an older woman can become confused about the role of grandmother and mother.

Garret-Gloanec suggested that the mother’s late-in-life desire to have children was “a denial of ageing and of death.”

“It’s unhealthy, to project onto children your own anxieties about death,” she said.

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Equal access to IVF for lesbian couples and single women

New laws that grant lesbian couples and single women equal access to IVF have been passed by MPs voting in Victoria’s Parliament. The Assisted Reproductive Treatment bill was approved by 47 votes to 34, in a three day debate that lasted in the early hours. It will now be debated in the Upper House before it can become law. 

MP’s were given a free conscience vote on the bill, which included measures to permit the posthumous use of gametes – such as using a dead partner’s sperm – with many opposing the bill on grounds of the welfare of the child. Labor MP Marlene Kairouz, who voted against the bill, told MPs: ‘Bringing a child into the world without ever having the opportunity to meet both its parents shows disregard for its wellbeing, its needs and dignity.’

The reform comes after a four-year review conducted by the Victorian Law Reform Commission in to the current artificial reproductive technology (ART) laws in Victoria contained in the Infertility Treatment Act, which the new bill will repeal. ‘This is about updating our laws, bringing them into the 21st century but ensuring that the interests of children born of these arrangements are absolutely paramount,’ said the Attorney-General, Rob Hulls, before last week’s debate. It will also mean Victorian laws meet federal discrimination legislation by ensuring all women have equal access to fertility treatment. At present, lesbians and single parents have to travel to other states to receive fertility treatment. The bill also give greater parental rights to gay couples and parents of surrogate children. 

Rainbow Families Council spokeswoman Felicity Marlowe expressed her support for the proposed measures. ‘What we’d be really wanting to see is that people understand that the spirit of this bill is that the rights and best interests of children are upheld and we believe that voting in favour of it in the upper house will ensure that our children are not second class citizens,’ she said. 

The Attorney-General dubbed the bill ‘good reform’. He said, ‘When we’re dealing with social reform and particularly, obviously, conscience votes there are always passionate views that are held on both sides of the house.’

Posted by: Goral Gandhi, MSc

                  Laboratory Director

                  Rotunda – The Center For Human Reproduction

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Prognosis ‘encouraging’ after total fertilization failure in IVF and ICSI

More than 40 percent of patients who experience total fertilization failure after an IVF cycle have a baby at a later attempt, researchers report.

Total fertilization failure after IVF or ICSI can be very frustrating for patients and clinicians alike.

Little information has been available about patients’ chances of success in the future or how changes in treatment could improve the likelihood of fertilization in later cycles.

To investigate, Donna Kinzer (Boston IVF, Waltham, Massachusetts, USA) and colleagues conducted a retrospective analysis of data for 555 couples who experienced total fertilization failure during conventional IVF or ICSI.

They found that 44 percent of IVF patients who chose to continue treatment eventually gave birth. This equated to a delivery after 25 percent of embryo transfers and 22 percent of cycles.

After ICSI, 36 percent of couples had a child, after 23 percent of their embryo transfers, in 18 percent of their cycles.

Results also showed that fewer mature oocytes were used in the transfers that ended in complete fertilization failure, compared with earlier or later transfers, Kinzer et al report.

They say these results suggest that “total fertilization failure is not related to sperm parameters but rather is a result of suboptimal response to ovarian stimulation.

They add: “If subtle improvements in oocyte yield can be effected, this may increase the chance of fertilization in subsequent cycles for these patients.”

Source: Fertility and Sterility 2008; 90: 284-8

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Ovarian stimulation before IVF ‘does not influence birthweight’

German investigators claim they have produced “robust” evidence that ovarian stimulation for IVF does not influence the birthweight of resulting babies.

Singleton children conceived through IVF have lower birthweights, on average, than their naturally conceived counterparts, and it has been hypothesized that ovarian stimulation could be a cause.

To find out, Georg Griesinger (University Clinic of Schleswig-Holstein) and colleagues analyzed data from a national IVF registry with 65-70 percent coverage. They retrieved information for all IVF cycles in women aged 25-35 years who underwent ovarian stimulation and had a live, singleton birth (n = 32,416).

On multivariate regression, the baby’s birthweight was significantly and independently predicted by each of maternal height, maternal weight, duration of infertility, and the number of embryos transferred.

However, none of the parameters of ovarian stimulation studied-including duration of stimulation, use of gonadotrophins, and the number of oocytes retrieved-significantly predicted birthweight.

“The present study provides robust evidence from a large sample of IVF singletons that ovarian stimulation and birthweight have no apparent quantitative (eg, dose-response) association,” say the researchers.

However, they caution: “Although this is reassuring to the clinician, it does not invalidate the need for studying the effect of ovarian stimulation on outcomes other than birthweight, such as epigenetic alterations, and associated health disorders.”

Source: Human Reproduction 2008; Advance online publication

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Intracytoplasmic sperm injection (ICSI)

Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg; this procedure is most commonly used to overcome male infertility problems. With conventional IVF, one can expect approximately 75% of the oocytes (eggs) to fertilize if they are healthy and the sperm parameters are not severely abnormal.

 

However, when there are severe sperm defects in count, motility or morphology, prolonged unexplained infertility, or abnormalities of the oocyte membrane , there may be severely reduced fertilization or none at all.

Fertilization involves a complex series of physical and biochemical events, which take place between the egg and sperm. Conventional IVF overcomes the need for the sperm to swim long distances to reach the egg. However, the sperm must still be able to secrete enzymes to enable it to move through the cumulus mass, which surrounds the egg, be able to attach to and drill through the protein coat (zona pellucida) which protects the egg, and to attach to the egg membrane. The egg must be able to engulf the sperm and to cause the sperm head to swell and become a male pronucleus. This will then combine with the female pronucleus to complete the process of fertilization. Failure of any of these steps will result in no fertilization.

Intracytoplasmic Sperm Injection (ICSI) is used to treat severe male infertility. Male infertility is a lowering of a male’s sperm count or sperm quality sufficient to reduce a patient’s chance of pregnancy. Male infertility is often classified as mild, moderate or severe based on the number of motile sperm and the number of normally-shaped sperm in a man’s semen. Men with fewer than five million sperm or fewer than 10 percent normally-shaped sperm are classified as having severe male infertility.

During IVF, patients who do not have male infertility have their eggs inseminated by a standard insemination procedure that involves placing a small volume of specially prepared motile sperm with the eggs in a dish. The process of fertilization is complex and requires sperm to function normally. The sperm from men with male infertility often do not possess normal sperm functions. Therefore, when sperm and eggs are simply placed together in a dish, as is done in the standard insemination procedure, the eggs often do not fertilize.

The ICSI technique was developed to assist the fertilization process in patients with severe male infertility. ICSI is a highly successful procedure that involves injecting one sperm directly into the egg using a microscope equipped with specialized micromanipulation equipment. The first step in ICSI involves selecting a normal-appearing sperm for injection into the egg. The sperm is then inserted into the egg using a micropipet.

The ICSI procedure can be used successfully to treat a wide array of male infertility disorders, such as low sperm counts, low sperm motility, or abnormally-shaped sperm. ICSI may also be used to treat a condition called azoospermia, which is the complete absence of sperm in the man’s ejaculate. When no sperm are present in the ejaculate, the sperm aspiration techniques, Epididymal sperm aspiration and Testicular Sperm Extraction (TESE) may be used to obtain sperm from the male’s reproductive tract. These sperm may then be used in conjunction with IVF and ICSI, donor egg IVF and ICSI, surrogacy.

Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd

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