Tag Archives: Fertility Treatment

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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Freezing improves DNA integrity

Gamete cryopreservation could help improve the fertility of men whose spermatozoa show a high level of prefreeze DNA fragmentation, study findings indicate.

 Laura Thomson (Fertility First, Hurstville, Australia) and co-authors note potential cryoinjury of sperm from subfertile men is an issue of primary concern “considering that subfertile men form a very large proportion of the men requiring semen cryopreservation.”

The findings were observed during a study comparing different cryoprotectants used to store spermatozoa for fertility treatment. The study involved 320 men who presented for fertility investigations and provided semen samples.

Post-thaw sperm DNA integrity was unaffected by the type of cryoprotectant used during freezing, but showed a significant, negative correlation with the prefreeze level of DNA fragmentation. Among men with prefreeze sperm DNA fragmentation levels within the normal range, 89 percent showed an increase in fragmentation post-thaw. Conversely, 64 percent of those with very high levels of prefreeze fragmentation showed a decrease in fragmentation post-thaw.

The authors suggest that the result “gives rise to a possible novel method of reducing fragmentation in sperm used for assisted reproductive technology treatment cycles, in some cases without the need for invasive and expensive testicular sperm retrievals.”

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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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Widow claims human right to use dead husband’s sperm

 

The UK’s High Court has ruled that it may have been unlawful for a widow to have removed her dead husband’s sperm. Despite UK law requiring valid written consent for the storage and use of sperm, the 42-year-old widow obtained emergency Court permission to have sperm collected from her 31-year-old husband’s body hours after he unexpectedly died from complications with a routine operation to remove his appendix in June 2007. She now seeks authorisation to undergo IVF abroad using his sperm. Giving the judgment, Mr Justice Charles said: ‘I am not satisfied it is possible to lawfully remove sperm from a dead person who has not given effective advanced consent’. 

The mother-of-one pleaded that the couple had wanted another child, discussed their desire with family and friends and had sought information regarding IVF together. She explained that they had not thought to have him provide written permission because they had not feared that the minor surgery would be fatal. While the attempt to construct retrospective consent with evidence of his intentions holds little legal weight in light of the clear statutory provisions, her lawyer also argued that disposal of his sperm would contravene her human right to establish a family (protected under article 8 of the European Convention on Human Rights, enshrined in UK law by the Human Rights Act 1998). Because fresh sperm will lose viability over time, the Court authorised the emergency sample collection pending later legal resolution. Upon closer examination at the hearing, Mr Justice Charles questioned the decision. 

The final decision now resides with the Human Fertilisation and Embryology Authority (HFEA), which regulates gamete storage and its use. If permission is denied, then the HFEA decision will likely be legally challenged as was done by Diane Blood in a similar case in 1997. HFEA chair, Lisa Jardine, commented that the organisation sympathises with these ‘difficult’ situations but ‘must operate within the legislation’. 

This case, like the landmark Blood case, may turn on the statutory loophole that provides the HFEA discretionary powers to dispense with the consent requirements for the sperm to be exported – in accordance with an EU citizen’s right to receive health treatment in another member state. 

Diane Blood ultimately won a protracted legal battle through the English Courts in 1997 and was able to conceive two sons using her late husband’s sperm. The Bloods attempted to start a family but Stephen Blood contracted meningitis and lapsed into a coma – his sperm was collected shortly before he died in 1995. The HFEA refused Mrs Blood authorisation to use the sperm as she did not have written consent from her husband. The High Court upheld the authority’s decision because the HFE Act does not provide discretionary powers to waive domestic consent requirements. The Court of Appeal agreed but also decided that the authority could have used a statutory discretion to allow the transport of Blood’s sperm to Belgium for treatment.

In Blood’s case, Lord Hoffman noted that the sperm’s storage was unlawful without the requisite written consent. However, given the unprecedented circumstances, he realised it was necessary for the clinic to store the sperm first and decide the legality later. He commented that he did not foresee the Courts would consider the legality of exporting unlawfully stored sperm again. A decade later, posthumous sperm has unlawfully been stored pending resolution of new legal arguments and Mr Justice Charles has likewise declared the case a ‘novelty’ in the law. 

Following the Blood case, the Government held a review of the law. The 1998 report concluded that the ‘written consent’ requirement should remain. Coincidentally, on the same day last week, MPs in the lower house of Victoria, Australia passed a package of reproductive law reforms which included a controversial clause to allow women to conceive using their partner’s posthumous gametes provided she has prior written consent.

Posted by: Goral Gandhi, MSc

                  Laboratory Director

                  Rotunda – The Center For Human Reproduction

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Delaying motherhood and defying nature

The average age of women seeking fertility help in Australia has increased from 35.2 years old in 2002 to 35.6 years old in 2006, according to a report by the Australian Institute of Health and Welfare (AIHW). The report showed that record numbers of women over 40 were undergoing fertility treatment – rising from 14.3 per cent in 2002 to 16.2 per cent in 2006 – despite those over 45 having only a two per cent chance of becoming pregnant.

The figures may echo a growing trend in the number of couples delaying parenthood, says Peter Illingworth, a Sydney- based doctor and president of the Fertility Society of Australia .’The vast majority of couples we see who are over 40, for example, have only just met’, he told the Bloomberg Press. ‘It’s not that they have made a conscious decision to do it in their 40s, it’s that the opportunity to have children has only just arisen later on in a woman’s life’, he added.

The report highlighted a 4.6 per cent increase in the number of couples undergoing Assisted Reproduction Techniques (ART), rising from 46,481 in 2002 to 48,706 in 2006. In total 10,522 babies were born in Australia and New Zealand as a result of ART in 2006, with numbers rising at an average rate of 5 per cent per year between 2002 and 2006. Of these, 78 per cent were singleton births, reflecting the recent drive to make single embryo transfer (SET) the policy of all fertility clinics.

Professor Michael Chapman, Head of Women’s and Children’s Health at the University of New South Wales in Sydney told The Age that fewer women than ever were having multiple births, with fewer than one per cent of women having more than two babies.

‘The multiple pregnancy rate, which six or seven years ago was in the 20 per cent range, is now down to 11 per cent’, he said, adding: ‘It’s virtually halved from its peak and that’s good for the parents, it’s good for society, because many of them end up in special care units and with long-term medical problems’.

The aim of SET policy is to avoid the risks associated with multiple births, such as premature birth, low birth weight, an increased risk of death in the first week and an increased risk of cerebral palsy around four times that for singleton births. However, SET is not always considered the best policy. For example, some experts have criticised the recent decision to make SET part of UK fertility guidelines, pointing to the low success rates of IVF, the lack of state provision on the National Health Service and the high private fees.

Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd

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Fertility laws in UK drop “need for a father” in infertility treatment

Single women and lesbian couples will be able to seek fertility treatment without having to consider a father for their children. In May this year, the House of Commons in UK has rejected a proposed amendment to the new Human Fertilisation and Embryology (HFE) Bill, requiring fertility clinics to consider the ‘need for a father’ prior to IVF treatment. Under the new Human Fertilisation and Embryology Bill, women seeking fertility treatment will no longer have to take into account the role of a father figure. Instead, the rules will be replaced with references to “supportive parenting”.

Section 13 of the 1990 Human Fertilisation and Embryology (HFE) Act required IVF clinics to consider the ‘welfare’ of any child that may be created, including the ‘need for a father’, prior to IVF treatment. This requirement was debated in the House of Commons and reviewed by the parliamentary Science and Technology Committee in 2006. It was suggested that the requirement discriminates against lesbian couples and single women seeking IVF treatment, but noted that clinicians and fertility counsellors recommended retaining a reference to the parenting needs of the child.

The new Bill will reflect the HFEA guidelines and will be brought into line with the Human Rights Act. Health minister Dawn Primarolo said, ‘this is about ensuring that this law reflects current practices and family setups and current legislation referring to human rights’. Emily Thornberry, the Labour MP for Islington, reiterated, ‘the important point is to give legal rights to lesbian couples and single women.’

The amendment to retain the ‘need for a father’ in the new HFE bill was proposed by former Conservative leader Iain Duncan Smith, who argued that removing the ‘need for a father’ would send a message that ‘fathers are less important than mothers’ in parenting. Labour MP Geraldine Smith appealed to ‘common sense’ in the need for a father figure. Mr Duncan Smith and his supporters said that fathers play an important role in parenting, and pointed to evidence that children from single parent families were less likely to do well at school and more likely to abuse drugs and alcohol. In practice, they said, there was little evidence that lesbian couples and single mothers were being denied fertility treatment..

The latest psychological research, discussed at a public debate hosted by the Progress Educational Trust at the House of Commons in January 2008, suggests that children benefit when a father is active in parenting, and are adversely affected when a father leaves the family. There is also much evidence that ‘solo’ single mothers by choice and lesbian couples are highly committed to parenthood and able to provide supportive parenting.

The Bill will also allow both partners in a lesbian couple to be designated parents when they conceive with donated sperm. This reflects the situation of a heterosexual couple seeking fertility treatment with donor sperm, where the man is deemed the legal father despite having no biological relation to the child. The legislation represents the greatest extension to the family rights of homosexual couples since gay adoption.

Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd

 

 

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Septuplet joy for Egyptian couple

An Egyptian woman has given birth to seven babies in the northern city of Alexandria, doctors said. The mother, named as 27-year-old Ghazala Khamis, is said to be well and the septuplets – four boys and three girls – are reported to be stable. The babies are said to weigh between 1.45 and 2.8kg (3-6lb); the couple already have three girls.

They sought fertility treatment hoping to have a boy, and were said to be astonished at the multiple pregnancy. Since the introduction of in-vitro fertilisation (IVF) treatment 30 years ago, the number of multiple births has increased dramatically.

Health experts say septuplets are very rare, and it is even less common for all to survive. The seven were delivered by Caesarean section a month early, and all have been placed in incubators designed for premature babies. The woman’s brother said that the Egyptian health minister had promised free milk and nappies for the babies for two years, to help the family cope.

Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd

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