Tag Archives: Success rates

Vitrification of Cleavage Stage Embryos

Freezing Cleavage-stage Embryos by Vitrification Improves Outcome July 9, 2009 Embryo cryopreservation is known to offer several advantages during ART cycles, including enhancing cumulative pregnancy rates, preventing ovarian hyperstimulation syndrome, reducing multiple pregnancy rates, and lowering treatment costs. After the vitrification technology for cryopreservation was developed, several studies have compared the slow freezing technique and vitrification method in relation to post-thaw survival, implantation, and live-birth rates. Now, a new retrospective study published in the Journal of Assisted Reproduction and Genetics highlights the efficacy of cleavage-stage embryo vitrification in improving the survival rate, post-thaw embryo morphology, and pregnancy outcomes, compared to the slow-freezing technique. Mojtaba Rezazadeh Valojerdi and colleagues, from the Embryology Department, Royan Institute, Iran, compared the effect of vitrification against slow-freezing of cleavage-stage embryos with regard to post-thaw survival rate, embryo morphology, and clinical outcomes. Cleavage-stage embryos of 305 patients were either subjected to vitrification (n=153) or slow-freezing (n=152) procedures. The following results observed during the study demonstrated that vitrification is a better cryopreservation technique compared to the slow-freezing method. Variables Vitrification (%) Slow-freezing (%) Odds Ratio Survival rate 96.9 82.8 6.607 Morphology with intact blastomeres 91.8 56.2 8.769 Clinical pregnancy rate 40.5 21.4 2.427 Implantation rate 16.6 6.8 2.726 Previously, Loutradi et al (Fertility and Sterility, 2008) conducted a systemic review and meta-analysis to compare post-thaw survival rates following vitrification and slow-freezing of human embryos. The investigators analyzed four studies, including three randomized controlled trials, comprising of 7,482 vitrified and 1,342 slow-frozen human blastocysts/cleavage stage embryos. A substantially higher cleavage stage embryo survival rate was observed in the vitrification group as compared to the slow-freezing group (OR=15.57; random effects model). Post-thaw survival rate of blastocysts was also found to be considerably greater in the vitrification group than the slow-freezing group (OR=2.20; fixed effects model). The conventional cryopreservation, by means of the slow-rate freezing protocol is associated with disadvantages such as osmotic shock, cryoprotectant toxicity, and mainly intracellular ice formation that can damage the cell wall and structure. In contrast, vitrification, the ultra-rapid cryopreservation method, eliminates the formation of ice crystals, thereby reducing the chances of cellular damage. The superiority of vitrification over slow-freezing for embryo preservation has been documented by several authors. Balaban et al (Human Reproduction, 2008) demonstrated that vitrification has a lower effect on embryo metabolic rate, compared to slow-freezing; as evident by the higher survival rate and subsequent in vitro development. Apart from the potential advantages of embryo vitrification, the ultra-rapid technique of cryopreservation has also shown its superiority in oocyte and sperm cryopreservation, and is hence becoming a more favorable procedure in comparison to the slow-freezing technique. In a more recent review study, Kolibianakis and colleagues (Current Opinion in Obstetrics and Gynecology, 2009) noted that vitrification was significantly better than slow-freezing with regard to post-thaw survival rates and embryo development of cleavage-stage embryos and blastocysts. However, the clinical pregnancy rates per transfer were comparable between the two groups. Although there seems to be ample evidence from retrospective studies and meta-analyses on the potential benefits of vitrification compared to the conventional freezing techniques, further prospective, randomized controlled trials are mandated for validating these findings and also to assuage the concerns of embryo toxicity due to the cryoprotectants used for vitrification.

References:
1. Rezazadeh Valojerdi M, Eftekhari-Yazdi P, Karimian L, Hassani F, Movaghar B. Vitrification versus slow freezing gives excellent survival, post warming embryo morphology and pregnancy outcomes for human cleaved embryos. J Assist Reprod Genet. 2009 Jun 10. [Epub ahead of print]
2. Loutradi KE, Kolibianakis EM, Venetis CA, et al. Cryopreservation of human embryos by vitrification or slow freezing: a systematic review and meta-analysis. Fertil Steril. 2008 Jul;90(1):186-93.
3. Balaban B, Urman B, Ata B, et al. A randomized controlled study of human Day 3 embryo cryopreservation by slow freezing or vitrification: vitrification is associated with higher survival, metabolism and blastocyst formation. Hum Reprod. 2008 Sep;23(9):1976-82.
4. Kolibianakis EM, Venetis CA, Tarlatzis BC. Cryopreservation of human embryos by vitrification or slow freezing: which one is better? Curr Opin Obstet Gynecol. 2009 Jun;21(3):270-4.

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Egg Donation

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.

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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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UK survey reveals that three-quarters of infertile patients would consider treatment abroad

An overwhelming majority of infertility patients in the UK said they would contemplate travelling abroad for fertility treatment, according to the first comprehensive study on the strength and motivations behind the fertility tourism industry. Among the 339 infertile patients who responded to an online poll conducted by Infertility Network UK, 76 per cent stated they would be willing to seek fertility treatment outside the UK with 70 per cent citing their reasons would be to avoid higher costs and long wait-lists at UK clinics. Infertility Network UK performed the survey for this year’s National Infertility Day on Saturday, 19 July 2008, when it announced its findings at a conference in central London.

 Other popular reasons provided by the patients for why they might prefer to receive fertility treatment abroad were high success rates (61 per cent) and the greater availability of donor eggs and sperm (54 per cent). The UK has suffered a decline in the number of egg and sperm donors since removing donor anonymity by law in 2005. The 24 per cent opposed to treatment in overseas clinics were commonly concerned about lower standards, lack of regulation and language-barrier difficulties.

 Clare Brown, Chief Executive of Infertility Network UK, blames the current ‘appalling’ difficulties – such as ‘postcode lottery’ arbitrary provision – that infertile couples face in Britain in order to access fertility assistance: ‘If the NHS funded three full cycles of treatment as recommended by NICE, many couples would not be forced to consider going abroad for treatment’, she said. She warned that regulations can be totally different for foreign fertility clinics and it is ‘absolutely vital’ for individuals to do ‘thorough research beforehand’.

 Yet the study revealed an 88 per cent level of satisfaction from those who received treatment abroad, reportedly not only due to lower costs, shorter waiting-lists and successful pregnancy rates but also due to general staff attitude, atmosphere and state of the facilities. Clare Brown added that she hopes ‘that clinics in the UK take into account the findings of this survey and learn from the good experiences many couples have had at clinics abroad’.

 Among those who were dissatisfied, 47 per cent experienced problems due to language and communication difficulties and 37 per cent due to unregulated practice. Prime Minister Gordon Brown stated, ‘The Government is working directly with Infertility Network UK, as well as experts in the NHS to ensure the needs of people with fertility problems are recognised and addressed’.

 25 July 2008 marked the 30th birthday of Louise Brown, who was the world’s first IVF-conceived child born in England. Thirty years onward, roughly 3.5 million IVF-assisted babies have been born worldwide, averaging at least 200,000 annually. However, infertile individuals in the UK are among the least likely in the developed world to receive IVF with one of the lowest annual IVF performance rates in Europe – under 700 per million Britons.

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