IVF News

Barcelona, Spain: Research into the effect of age and the number of times women undergo assisted reproduction technology (ART) shows that for younger women, the overwhelming majority achieve a pregnancy within the first two attempts, whereas women over the age of 40 had a more consistent, but lower, pregnancy rate of about 20% throughout their first four attempts.

Mr Simon Hong told the 24th annual meeting of the European Society of Human Reproduction and Embryology in Barcelona today (Tuesday): "The purpose of this study was to try to identify, at least in our practice, if a patient in a certain age group should repeat a cycle and how many. We found that the overwhelming majority of women who became pregnant (96%) achieved pregnancy by their second attempt, although the probability of a pregnancy after the third and fourth attempts remains encouraging. These results confirm that there is negative correlation between achieving pregnancy and increasing the number of attempts. Nonetheless, for all patients undergoing ART treatment, failure of the first attempt justifies at least one additional cycle."

Mr Hong is a researcher at the Center for Reproductive Medicine and Infertility, Cornell University (New York, USA), which is headed by Professor Gianpiero Palermo who pioneered the intracytoplasmic sperm injection (ICSI) technique.

Mr Hong and his colleagues analysed 8,970 ICSI cycles carried out in 6,719 patients treated between September 1993 and December 2007. The women were categorised into three groups: those aged 35 or younger, those aged 36-39, and those aged 40 and over. The average age was 36.5. Mr Hong examined the number of women achieving pregnancy at each attempt in each age group.

"The overall pregnancy rate, regardless of the mothers' age, was 39.2% - 3,515 pregnancies out of 8,970 cycles. The highest number of ART attempts was eight, but only a handful of patients had six or more attempts," said Mr Hong.

Among all patients of all ages who achieved a pregnancy, 79.7% were successful in their first attempt, 16% in their second, and 3.4% in their third. When Mr Hong looked at the different age groups, those aged 35 and under had an overall pregnancy rate of 50.8%. In this age group, 53.7% of women became pregnant at their first attempt, and this decreased to 43%, 33%, 23% and 18.2% at the second, third, fourth and fifth attempts, respectively. There were no successful pregnancies beyond the fifth attempt.

In the 36-39 age group, the overall pregnancy rate was 39.5%. Again, there was a steady decrease from 41.5% at the first attempt to 25% at the fourth attempt. In women aged 40 and over, the overall pregnancy rate was 24.1%, ranging from 24.6% to 18.5%, and there were no significant differences in the proportion of women becoming pregnant between the first and the fourth attempts.

Mr Hong said: "We observed a more consistent pregnancy rate in the older age groups starting at 36 years. This is probably because older women have a lower pregnancy rate from the time of their first attempt, and this rate remains consistent thereafter. It is possible that the incidence of embryo aneuploidy in this age group is the over-riding factor affecting pregnancy outcome in this age group.

"For the group aged 36-39, the pregnancy rate was 25% at the fourth attempt; however, it only includes four pregnancies out of 16. The large majority of pregnancies were evenly distributed between the first three attempts. For the group aged 40 and over, a consistent pregnancy rate of about 20% throughout the first four attempts was observed. From this, it seems that for the older age groups, the number of attempts that provide a consistent pregnancy rate extends from two to four. 

"An ART cycle is financially burdensome, but most importantly an emotional endeavour. It also requires exposure to medications and to, although minor, a surgical procedure. From our findings, it appears that younger patients undergoing two ART attempts benefit from the highest chances of pregnancy. While women in the higher age groups (aged 36 and older) may benefit from a successful outcome when undergoing a third or perhaps fourth attempt."

Mr Hong concluded: "It is difficult to determine at which attempt a patient should end her pursuit to conceive through assisted reproduction. We feel that couples should be given all available information to make the most informed decision possible. Therefore, we believe that couples should be offered counselling that describes the chances of a successful pregnancy at each individual ART attempt for their specific age group."

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We are currently planning to help the first British couple have a baby free from the risk of developing early-onset Alzheimer's disease (EOAD). Preimplantation genetic diagnosis (PGD) for this disease, which affects individuals in middle age (40s and 50s) - rather than the more common Alzheimer's whose effects are suffered considerably later (over 65) - was first carried out five years ago in the US. We anticipate the usual controversy loosely bundled together under the banner of 'designer babies'. More specifically, objections may include concerns over the severity of the disease, age of onset and treatability.

Alzheimer disease is characterized by adult-onset progressive dementia and typically begins with subtle memory failure that becomes more severe and eventually incapacitating. Other common symptoms include confusion, poor judgment, language disturbance, agitation, withdrawal, hallucinations, seizures, Parkinsonian features, increased muscle tone, incontinence, and mutism. About 5-6 per cent of sufferers of this debilitating mental wasting disease develop EOAD in middle age, thus it is known as a late-onset condition even though this particular rare form is early-onset by comparison. Of these cases, about 60 per cent, equivalent to 25,000 patients in Britain, are genetic.

In the couple we hope to treat, the man has a family history of EOAD with a number of affected relatives who all died from the condition in their 40s. Their aim is to select embryos free from the mutant gene predisposing the children to the condition, in an attempt to rid their family of the tragedy of Alzheimer's. If he carries the mutation, the condition is dominant and 50 per cent of his children are likely to be affected.

From the clinic's perspective, the PGD process will involve an application to the Human Fertilisation and Embryology Authority (HFEA) for a licence to perform the treatment in Britain after first ensuring that appropriate genetic markers are available to use in a single cell test. The case is further complicated by the fact that the couple wish to screen their embryos using a process known as 'exclusion' testing. This involves analysis of carefully selected genetic markers based on the man's family history allowing 'unaffected embryos' to be definitively selected without revealing the presence or absence of the mutation in the man himself. In this way, he can continue his life normally without any specific knowledge regarding his own genetic status with respect to EOAD.

The prospect of a successful licence application is high since one condition (of a growing number) already screened at our clinic includes Huntington's disease. This is quite similar to EOAD in that it represents another late-onset condition for which 'exclusion' testing has also been licensed.

Why not perform PGD for all Alzheimer's cases? The simple answer is that it would difficult to screen embryos for genes that predispose to late-onset Alzheimer's at present, because a number of different genes are involved and the presence of a mutation does not always result in disease. Furthermore, a disease that may not become apparent until person reaches their seventies or eighties (approaching normal life expectancy in the UK at present) is not a compelling candidate for PGD. However, EOAD affects patients in their forties and fifties (just exceeding the halfway point for life expectancy projections for 2031 according to the UK's Office of National Statistics (1) and, in specific families a single causative mutation is known and highly penetrant (meaning that inheritance of the mutation virtually guarantees the disease). Together, these facts make PGD a realistic way to prevent the disease in such families, rather than having only half a life worth living.

Following the recent report of this family's decision to choose PGD, Dr David King, Director of Human Genetics Alert, was sympathetic but opined: 'We can confidently expect science to find a cure for Alzheimer's in the next 40 years'. We welcome the prospect of cures for currently incurable diseases such as Alzheimer's. Whether or not his confidence is justified may be irrelevant for this couple who simply wish to remove the genetic problem from their family. Perhaps they don't wish to take the risk that there won't be a cure.

In addition, Dr King resurrects the philosophical position with respect to PGD that it is rarely better to have not been born at all. Many would agree that the choice between never being born and having 45 healthy years is a no-brainer both practically and philosophically speaking. Unfortunately, this thesis is simply a philosophical position. The real-life situation is very different. The couples actually face a more sophisticated array of options. Not only can they choose between childlessness and the risk of having a child with a significant chance of developing Alzheimer's as they themselves grow older and less able to provide support for the middle-aged 'child', PGD allows them select from a cohort of eight-cell embryos those free from the disease that has blighted several generations of their family.

Within the framework of PGD, the public considers the severity of genetic disease as subjective and opinions vary widely (2). Perception of the severity of a condition should properly be the domain of the primary care providers (that is, the parents). Furthermore, the HFEA Ethics and Law Committee concludes that diseases that are treatable and later-onset may still be considered 'serious' genetic conditions. In any case, the fact that a condition is treatable does not necessarily preclude PGD. Being ill and the vast physical, emotional and financial resources required to support those who suffer should not simply be ignored by individuals considering PGD.

PGD is all about choice for individual patients at risk of transmitting genetic disease to help prevent suffering for their families. PGD is not about discrimination against people with genetic disease, cancer or disabilities. Neither should PGD be viewed as diverting resources away from or removing the need for research into developing cures for genetic disease. The goal of PGD is to prevent the disease...not the cure.

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Quality Control and Risk Management in the IVF laboratory: from theory to practise.

Embryolab Academy is pleased to announce a new and exciting Workshop on Quality Control and Risk Management in the IVF laboratory: from theory to practise. The Workshop will take place on the 21^stand 22^nd of March 2014 in Thessaloniki, Greece. Reproductive scientists, embryologists, quality managers in IVF, clinicians as well as ART Unit managers who desire to improve their knowledge and understanding of all the recent advances in Quality and Risk Management for ART laboratories are invited to join our Workshop.

Theoretical sessions will give an overview of recent advances in Quality and Risk Management for ART laboratories. In the ‘Hands-on’ sessions, different experts will focus on methodologies and techniques to standardise, measure, validate, and control different parameters like temperature, pH, air quality etc. In the ‘Brains-on’sessions delegates are invited to present a specific problem/trouble/issue they have or are encountering in their laboratories. In an interactive way, the expert team and the participants will investigate the problem and design a route for solving and preventing this (and other) problems in the future.

For more details on the program and registration, we would like to invite you to visit our website www.embryolab-academy.org or mail to [email protected].

 

Hoping to meet you soon in Thessaloniki!

Kind regards

Martine Nijs      Alexia Chatziparasidou       Nikos Christoforidis

Workshop Directors

Course website: http://www.embryolab-academy.org  

Contact: Martine Nijs

Address: Embryolab Academy
173-175 Ethnikis Antistaseos 
Thessaloniki 
Greece

Phone: Contact +302310 475718    

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The mother of a UK woman who died giving birth to another couple's child has said she intends to fight for custody of the baby. Marilyn Caltabiano says she wants the commissioning parents to hand over the baby boy so that she can give him to a younger, childless couple. Natasha Caltabiano, a 29-year-old mother of two, suffered a ruptured aorta and died from a heart attack 90 minutes after the child was born, at St Michael's hospital, Bristol. Natasha had developed high blood pressure during the pregnancy. The baby was handed over to the commissioning parents a week after the surrogate's death, and returned with them to their home in Northern Ireland.



Ms Caltabiano became a surrogate after hearing from a friend's sister, who had also done it. She designed a website advertising her willingness to help another couple, through which she made contact with the commissioning parents. The 52-year old father visited her a number of times throughout 2003 and 2004, to donate sperm with which she artificially inseminated herself. The man and his 48-year-old wife already have five children from previous relationships. Now, Natasha's mother says she wants the baby to go to another couple. 'This was Natasha's first surrogacy. I feel it was a complete waste of my daughter's life to give the baby to an older couple who already have children', she said.



After her daughter's death, Marilyn Caltabiano attacked the system of surrogacy, which she says encourages women to put themselves through the risks of pregnancy. Surrogacy UK, the agency that had helped with the arrangement, said that was 'doing all it can to provide support for everyone involved'. Following Surrogacy UK's rules, the commissioning couple had taken out a life insurance policy on Ms Caltabiano, which is payable to her next of kin. This will be used to buy a home for the existing children, said Ms Caltabiano's mother. According to newspaper reports at the time, the couple are refusing to pay the bulk of the ?8,850 promised as expenses payments to the surrogate. They say that they have incurred huge legal bills because of Ms Caltabiano's death.



Under UK law, Natasha Caltabiano would have been the child's legal mother, and her partner, if he consented, would have been its legal father. To become a child's legal guardians, commissioning parents must adopt a baby born to a surrogate mother. Alternatively, the surrogate mother and her partner must transfer their parental rights to the commissioning parents, when the baby is aged between six weeks and six months old. According to newspaper reports, Natasha's long-term partner Paul Brazier is currently estranged from the Caltabiano family, so the five-week old baby apparently has no legal guardians at present.
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The House of Commons 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. After a lengthy debate, MPs voted 292 to 217 against the amendment, a majority of 75. MPs also rejected the need for 'supportive parenting and a father or male role model' by 290 to 222 votes. The Prime Minister Gordon Brown, who rejected the amendment, gave Labour MPs a free vote on the issue. Under the new legislation, fertility clinics will only need to consider the child's need for '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.

Under the Human Fertilisation and Embryology Authority (HFEA) 2005 'Tomorrow's Children' guidelines, refusal of fertility treatment on the basis of sexual orientation is prohibited. The guidelines currently propose primarily taking into account factors in the medical and social history of the patient that may cause 'serious harm' to the child - such as criminal convictions relating to child harm, serious violence within the family, drug or alcohol abuse - and any risk of medical conditions to the child, prior to IVF treatment, but not 'broader social factors'.

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.

During the debate, Labour MP George Howarth asked Mr Duncan Smith if he agreed that not all fathers had a positive influence in a family. The Liberal Democrat science spokesman Evan Harris also asked if he considered lesbian couples to be 'broken families'. Emily Thornberry said to Mr Duncan Smith, 'you will not, as a result of this amendment, bring any more fathers into any more families'.

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.
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Women who attended a mind and body course shortly before undergoing IVF demonstrated increased pregnancy rates compared with those that did not, a US study has found. The findings suggest that stress relief may increase the likelihood of becoming pregnant from IVF. 

'Women who are in fertility treatment do report huge amounts of stress', said Dr Courtney Lynch, head of reproductive epidemiology at the Ohio State University, commenting on the study. 'One of the reasons IVF is not as effective as we'd like it to be is that some couples don't make it to cycle two and cycle three because they're so stressed out'.

Around 140 women seeking IVF were originally recruited to the study and were divided into two groups. Around half were asked to attend weekly sessions of a mind and body program designed to reduce stress levels. Ninety-seven women underwent their first cycle of IVF resulting in a combined pregnancy rate of 43 percent. By the end of the second cycle, 52 percent of women in the group that attended the classes fell pregnant, compared with 20 percent of women in the group that didn't.

The difference in the pregnancy rates between the two IVF cycles might be because over half of the women on the mind and body program had not been to any of their classes by the start of their first cycle and therefore did not have the chance to acquire new relaxation skills, the authors of the study said. In contrast, by the time of their second IVF cycle, 76 percent had attended at least half of their mind and body classes.

The effect of stress on IVF remains unclear, however. Although some interventions have previously been shown to be an effective stress management approach, a recent review of 14 studies that used various ways of measuring anxiety or depression and included women undergoing several kinds of fertility treatments concluded stress does not affect IVF success rates.

Although many women undergoing fertility treatments appear to experience higher levels of stress, 'we don't know if the infertility caused the stress or the stress caused the infertility', said Dr Lynch. 

The study was conducted by researchers from Boston IVF and Harvard Medical School. It waspublished in the journal Fertility and Sterility.

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Indian Society of Assisted Reproduction and Mumbai Obstetric & Gynecological Society,would like to jointly announce Medical conference "The Ovary Unraveled” from December 11 to 13, 2009 in Mumbai,India.

It will be an exciting & wide ranging programme designed to engage all delegates on topics of vital importance related to the ovary.The event will be the perfect occasion for the international experts to share their leading edge knowledge on innovation and technology balanced by critically important insight into their practical application.

It will offer perfect opportunity for all attending Gynecologist & Obstetrics at Medical conferences to Meet,hear and learn from International Faculty Dr.Bruno Lunenfeld,Dr.Denny Sakkas,Dr.H.R.Tinneberg,Dr.Jan Gerris,Dr.Jose Remohi,Dr.Liselotte Mettler,Dr.Marco Filicori,Dr.Martina Ribic Pucelj,Dr.Paul Devroey,Dr.Paul Gassner,Dr.Roy Homburg,Dr.Robert Casper,Dr.Robert Norman,Dr.S.L.Tan,Dr. Sadhana Desai,Dr.Gautam Allahbadia,Dr.Abha Majumdar,Dr.Mridubhashini Govindrajan,Dr.Ameet Patki,Dr.Nalini Mahajan,Dr.Asha Rao,Dr.Nandita Palshetkar,Dr.B.N. Chakravarthy,during the workshop and scientific program at event.

The Ovary Unraveled,Medical conference,Global Health Congress promises to match that sentiment and, at the same time, provide even more networking for this international gathering. The conference will feature up to 1,500 attendees, up to 200 speakers, and over 40 exhibitors.

Ovary2009.org is there website where you can find more details about medical events and conference,Letter of Invitation,Certificate of Attendance,Delegates Registration,scientific program,pre and post congress workshops,GUIDELINES FOR SUBMISSION OF ABSTRACTS.

Save the date today by going to the medical Congress webiste ovary2009.org and register for this event, and accomplish in 3 days what would otherwise take you years to accomplish.

Venue of the conference "The Ovary Unraveled”:
The Renaissance Mumbai Hotel.

Conference Date:
11th December 2009 to 13th December 2009.

Deadlines for submission of Abstracts:
October15,2009.

Last date for accommodation requests:
November1, 2009.

Deadlines for conference Registration:
15th November 2009.

Spot registration for the conference will be done at Venue Subject to availability.

For further information and registration Please contact them:
CONTACT PERSON:
Mr.Vivek Jayant Kank
Phone:- +91 9321992764
Secretariat-Address:
Flat 23 A,2ndfloor,ElcoArcade,Hill Road,Bandra(W), Mumbai 400050.India.
Fax: +91 22 26456488
EMAI:[email protected]
http://ovary2009.org/default.asp

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Following its initial approval in July 2003, the Spanish government has ruled that research will be allowed to take place on frozen-thawed human embryos, as long as they are donated for research purposes after being left over from fertility treatments. The Spanish parliament made a ruling on 16 October that will amend a law governing assisted reproduction passed in 1988. It is estimated that there are tens of thousands of embryos in frozen storage in Spain, because the law there has required clinics to keep supernumary embryos for five years, but has never specified what can be done with them after that time. Advocates for embryo research pushed for a change in the law so that these embryos could be used by scientists.

The new Spanish provisions will only allow research to take place on embryos stored in clinics before the newly-passed law comes into effect. Any embryos frozen and stored after this time will, according to the new law, remain frozen 'throughout the full fertility period of the woman'. Additionally, it will limit both the number of eggs that can be fertilised per cycle, and the number of resulting embryos that can be transferred, to three. IVF experts have criticised the new law on two grounds: that the number of successful IVF pregnancies is likely to be lower because of the limit on eggs that can be fertilised, and because the reforms will encourage fertility clinics to store as few embryos as possible. But Ana Pastor, the Spanish health minister, believes the new law will reduce the number of multiple pregnancies.

The new Spanish law also says that a national bank will be established to 'manage and store' embryonic stem (ES) cell lines derived from the left over embryos. But last week, Francesco Vallejo Serrano, head of the health department of the Andalucian government, announced that the autonomous region (one of 17 in Spain) intends to set up its own bank of human ES cell lines using any embryos that have been stored for more than five years. He says this is possible because of a loophole in the 1988 law, which only bans research on 'viable embryos'. Serrano argues that embryos stored for more than five years are not viable and should therefore be accessible to researchers. Regional legislation was passed on 9 October to this effect. The Spanish national health ministry is challenging the regional legislation on the grounds that it is anticonstitutional.
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More and more IVF patients are using donor eggs, according to a study carried out in the USA.

Although the use of a patient's own eggs in IVF still remains the most popular means of assisted conception, there has been a considerable rise in the use of donor eggs in the last decade, especially in women over 35 years old.

The study, carried out by Emory University, Atlanta, and the Federal Centers for Disease Control and Prevention, also found that the chances of having a good birth outcome, defined as a single baby delivered at full term, for women aged over 35 years old is higher when they use donor eggs than when they use their own eggs in IVF.

Professor William Schlaff, chair of obstetrics and gynaecology at Thomas Jefferson University, Philadelphia, who was not involved in the research, affirmed that 'women not having success in becoming pregnant in their late 30s and 40s are more comfortable using donor eggs'.

Nevertheless, figures show that traditional IVF remains the most used method. 'For most people, the desire to have a child that is genetically from both parents is very strong', said Evan Myers, professor of obstetrics and gynaecology at Duke University, North Carolina.

The study also found that the percentage of single embryos used rose from less than one percent in 2000 to 14.5 percent in 2010. Professor Schlaff said that 'many patients are willing to take the risk of having twins to raise their chances of having at least one baby and to decrease costs'.

The average age of women using donor eggs remained at 41 years old, for whom a decline in egg quality is reported as a reason for using donor eggs. The average age of egg donors was 28. That fact that the rate of poorer birth outcomes did not increase with the age of egg recipients indicated that using eggs from younger donors can avoid age-related complications in pregnancy, explained Professor Myers.

However, 'researchers still need to find better ways to identify which embryos have the best chance of resulting in healthy babies', said Dr Jennifer Kawwass, lead author of Emory University's study.

The figures were obtained from data provided by 443 clinics, representing 93 percent of all US fertility centres. The results were published in the Journal of the American Medical Association and were presented at the annual conference of the American Society for Reproductive Medicine in Boston.

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