IVF News

Dr Carole Gilling-Smith, from the Chelsea and Westminster Hospital in London, has called for the UK government to support the use of a 'sperm washing' technique for HIV patients. The technique, which involves the use of fertility treatments, may enable HIV positive men to have children with less risk of passing on the virus to either their partners or their children. Dr Gilling-Smith wants it to be available to couples on the National Health Service (NHS).

The sperm washing technique was pioneered in Milan, Italy, in 1988. The latest research, carried out by Dr Gilling-Smith's team at the London hospital, involved 53 couples in which the male partner is
affected by HIV. The partners of 16 of the HIV positive men became pregnant after using the technique.

The technique itself is 'simple'. The HIV virus is thought to be present in seminal fluid, while sperm do not carry HIV. The sperm are
first centrifuged to separate them from the semen, then 'washed' several times to remove the remaining fluid. The remaining sperm are placed in a substitute fluid which is then inseminated into the woman.

Dr Gilling-Smith has called for the procedure to be available on the NHS because it would, in the long run, lower costs by lowering the number of mothers and children who need treatments for HIV.
'Nothing is 100 per cent safe in life' she said, adding 'what we try to do is reduce that risk. Until this was available, couples had no
option but to risk unprotected sex, or to resort to donor sperm - or to live a life without children'.
[ Full Article ]

World congress on Practical infertility management & Human Reproduction

Dates: 19,20 &21? November 2004

Hotel Grand Hyatt(7 star) Mumbai, India

Conference Chairman: Dr Hrishikesh Pai MD
Conference organizing secretaries: Dr Nandita Palshetkar MD & Dr Rishma Dhillon Pai MD

Jointly organised By: Lilavati Hospital IVF centre(Babies And Us Fertility Centre) + Mumbai Obstetrics & Gynaecological Society + Genetics-Food,Drugs & Medicosurgical equipment ?perinatology committee of Federatiion of Obstetrics & Gynaecological societies of India.

National Faculty : Nearly 100 leading Infertility-ART consultants-embryologists-scientists? from all over India will be participating in the congress

International Faculty: Dr John Macbain (Australia). Dr Penny Foster (Australia),Dr Chrisyopher Keck, Dr Olaf Naether (Germany),Dr Azim Kurjak(Coratia),Dr Rajat Goswamy(UK),Dr Pankaj Srivastav(Dubai),Dr Reena Agarwal(UK), Dr Vishwanath Karande(USA), DR Salil Khandwalla (USA), Dr Meena Nerurkar(USA), Dr H Ingol Neilson (Denmark), Dr Alpesh Doshi(UK), Dr Alka Goyal (Canada),Dr Raj Raghupathy(Kuwait)? ,Dr Stefano Bettochi(Italy),Dr Herman Tournaye (Belgium)

Pre Congress workshops:
1. Hysteroscopy hands on Workshop on animal organs :Conducted at the ethicon institute ? Total participants restricted to 20.Course Chair : Dr Hrishikesh Pai MD
2. Hysteroscopy Live demonstration workshop Conducted at the Nair Hospital & T N M Medical School. Various operative hysteroscopy procedures will be shown live. Lectures & videos? will be shown. Course Chair : Dr Steafano Bettochi MD
3. Colour Doppler , 3 D & 4 D workshop conducted at the Sion Hospital &? LTM Medical School. This workshop is a Diplomat certificate course jointly organized with the Ian Donal School of? Ultrasound Croatia. Course Chair : Dr Azim Kurjak ?MD, Dr Narendra Malhotra, Dr P K Shah & Dr Shaunak Khandwalla.
4. Andrology ?Update workshop: This is a detailed andrology & impotence workshop specially meant for Infertility specialist dealing in male infertility Course Chair: Dr Herman Tournaye & Dr Rupin Shah
5. ART workshop: Conducted at the Lilavati Hospital. This is a live demo workshop,demonstrating the various Art procedures.? Course chair : Dr Olaf Naether MD & Dr Nandita Palshetkar MD
6. Ovulation Induction & IUI workshop : Conducted at Lilavati Hospital This is live demo cum interactive workshop (with 8 ?IUI workstations), Course Chair: Dr Colin Howles & Dr Rishma Dhillon Pai

Congress: The congress is spread over 2 days with simultaneous sessions in 3 halls covering almost all aspects of Infertility, endoscopy, ultrasound.menopause & Genetics.There is a continuous video session going on in one of the halls. Additionally there is a specialized? embryology video session? on In vitro maturation (conducted by Dr H Ingol Neilson)? & Blastocyst culture(conducted by Alpesh Doshi) .

Post Congress workshop:

This will be conducted at Lilavati Hospital. The total participants would be restricted to 24 .This is a 2 day Live demo-video & hands on workshop in basic ART techniques.All the various techniques of ART would be demonstrated live from the lab. The participants would be divided into 4?? groups for hands on training. Hands on training would be given in Basic culture techniques, semen analysis, semen washing, egg handling, ICSI & semen freezing. The candidates would also be trained in setting up ART units.Chair: Dr Hrishikesh Pai, Dr H Ingol Neilson , Dr Alpesh Doshi. & Dr RFeena Agarwal

Web site: www.infertilityindia.com
Email: [email protected]
Tel: 00919820057722
Secretariat: Dr Hrishikesh Pai
c/o Varriance
[ Full Article ]

Introduction

Many young adults expect that they will one day become parents; it is a social expectation in many cultures. However, one in six couples will have difficulty in achieving this goal (Burnett & Panchal, 2008; Dayus, Rajacich, & Carty, 2001).

According to the American Society for Reproductive Medicine (ASRM), infertility is a disease of the reproductive system that impairs the body’s ability to conceive a child; infertility is typically diagnosed when couples have been unsuccessful in becoming pregnant after 1 year of unprotected intercourse. The prevalence of infertility varies throughout the world from less than 5% to over 30% in certain regions, while its incidence is increasing in general (WHO, 2003).

The high incidence of this condition has increased the development and use of innovative technologies in IVF, such as ICSI, improved cryopreservation strategies and preimplantation genetic diagnosis/screening methods. However, the growing attention for the medical, biological and genetic aspects of the infertile patients has  not been followed by a parallel attention to  the emotional problems that affect those couples. The risk is to neglect the difficulties of psychological nature that often characterize childless couples. In this area, the role of psychology is not to determinate the factors that may cause infertility, such as some psychological theories sustained (Leiblum SR et al.1988), but to locate and operate on the psychological problems that come from the difficulty of conceiving and from the emotive stress often associated with ART. Indeed, the view on psychosocial factors in infertility has changed. At first, the "psychogenic infertility model" (infertility caused by psychological factors) dominated the research in this field. Nowadays, there are no studies providing evidences of distress as the cause of infertility, rather it is the psychological effects of infertility and of the reproductive treatment that are the focus of research ("psychological consequences model").

The double infertility psychological impact on couples: what does it mean “I’m  infertile”

It is well known that the experience of infertility can be devastating for the couple desiring a child. For women, pregnancy and motherhood are developmental milestones that are highly emphasized by our culture and the society and family pressure is often very hard to deal with. The experience of being unable to achieve a pregnancy may be described as a source of anxiety, fear, sadness, frustration and anger for couples who desire children ( Serafini P et al. 2000; Farinati DM et al. 2006; Cousineau TM et al. 2007; Cwikel J et al. 2004 ), causing feelings of worthlessness and important distress symptoms ( Farinati DM et al. 2006; Wichman CL et al. 2011; Moreira SNT et al. 2006). Infertility may be felt as a stigmatizing condition (Trindade ZA et al. 2002), being described by those who experience it as the most distressful event in their lives (Freeman EW et al. 1985).

Although both men and women are emotionally impacted by their infertility, they typically experience and cope with this loss in different ways. Whereas women are distressed by the infertility itself, men are more likely to be impacted by the relationship fallout and the sadness of their wives (Shapiro, 2009).

In women, the mood response to the diagnosis of infertility has been linked to models of bereavement or grief (Christie, 1997;), depression (Syme, 1997), and anxiety or stress (Mori, 1997). Infertile women are significantly more depressed than their fertile counterparts, with depression and anxiety levels equivalent to women with heart disease, cancer, or HIV-positive status.

Questions such as the lack of spontaneity in sexual life, lack of control of one’s own life and social pressure to have children are some of the difficulties reported by infertile women( Benyamini Y et al. 2005), who may feel infertility as an insult to their self-esteem and femininity (Cwikel J et al. 2004).

The words from a woman experiencing infertility seem to summarize all of these findings:

 

I cannot conceive or bear children; I am infertile.

My infertility is a blow to my self-esteem, a

violation of my privacy; an assault on my sexuality,

a final exam on my ability to cope, an affront to

my sense of justice, a painful reminder that nothing

can be taken for granted. My infertility is a break

in the continuity of life. It is, above all, a

wound—to my body, to my psyche, to my soul.

The pain is intense” (Jorgensen, 1982)

 

While women may feel more able to express feelings and display sadness and anger directly, men may struggle with their own feelings and feel quite helpless in trying to comfort their spouse and be frustrated at not being able to solve their infertility (Monach, 1993; Zolbrod, 1993). For men, problems in fertility can be experienced as a “failure as a man” and therefore an assault on one’s masculinity. Men’s masculinity may be challenged and cause feelings of loss of power and potency, which may cause either occasional episodes of impotence or, conversely, promiscuity (Syme, 1997).

For couples, isolation is another aspect of coping with infertility (Salzer, 1991). Contact with the world, where signs of fertility are everywhere, is painful. Difficulties of attending social functions such as baby showers or family birthdays for children may prove to be impossible to bear, and even everyday activities of daily living such as seeing babies at the local market or office picnic can precipitate a strong emotional response. The social stigma of childlessness results in feelings of imperfections and a “spoiled identity” (Maill, 1986). There is a societal assumption that all couples have children. The topic is common in initial conversation when meeting someone for the first time. Some of the effects of dealing with the stigmatization of infertility include attempts toconceal the situation by denying the want of children, developing other interests, and avoiding social situations.

Stress on the couple is in part due to the insidious issue of guilt and blame (Menning, 1980; Zolbrod, 1993). Couples begin to experience tension and distance in their relationship. In two-thirds of the cases of infertility the problem will reside in one partner or the other; thus, guilt, blame, and shame enter in, particularly if either partner has a history of promiscuity, abortion, venereal disease, or drug or alcohol abuse. The partner who “owns” the causality may fear rejection by the fertile spouse. This is, of course, intensified if the specific answer for the infertility is unknown. Even if a medical condition is discovered the couple will feel punished. Couples have to cope with sexual problems that may arise after a prolonged period of unsuccessful attempts at pregnancy. Sex performed on demand is very different from recreational sex. Moreover, sexual urgency around ovulation may also interfere with the wife’s attainment of orgasm.

The psychological impact of starting an infertility treatment

Adding to the difficulties that come from the clinical condition of infertility are problems about the entrance of the couple in a specialized center for the assisted fertilization, in which the couple will have to satisfy the diagnosis program and treatment that often mean an ulterior source of stress.

Syme (1997) noted that in her clinical practice couples went through various phases when involved in infertility treatments. The first was Numbness, when the person described feeling “zombie like,” a reaction that was validated by Jones (1995). During this time of dissociation the dominant thought is that it cannot be true, and actual physical signs such as loss of appetite, difficulty concentrating, and problems with memory may occur. The second phase is that of Yearning, a phase that is accompanied by feelings that they are alone in their infertility. During Yearning it is particularly painful to see babies, so the couple will avoid social situations where children are present. Also, feelings of jealousy and anger are common during this phase. Anger is directed at both the self and others. It may be difficult not to be angry if the cause of the infertility rests with the other partner. This anger may be accompanied by feelings of regret about marrying his or her spouse. The third phase is that of Disorganization and Despair, the longest phase, lasting a minimum of six months. Anger and guilt from the prior phase continue and outbursts of rage will increase. There is concern about being out of control, as the person experiences nightmares, and the fear of being alone as his or her social activities continue to be limited in order to avoid the sight of babies and pregnant women. This phase may be accompanied by feelings of the helplessness and hopelessness most often associated with depression. The final phase of Reorganization is hallmarked by acceptance and reordering of one’s life. It can take couples anywhere from 2–5 years (Syme, 1997) to reach such a state of equilibrium.

Evidences of a couple’s emotional distress can be found looking at the high discontinuation rate of infertile couples before achieving a pregnancy. Brandes and colleagues (2009) found that about half of the infertile couples discontinued fertility care before any treatment was started and nearly two-thirds discontinued before IVF or ICSI was started. Overall, the main reasons for withdrawal from fertility treatment are emotional distress and poor prognosis. So awareness of the motives for discontinuation could optimize fertility care and make it more patients centered, for instance by improving psychological care, or focusing on prevention of emotional distress.

Psychological interventions for infertile couples

Over the last few years, psychological research has demonstrated that, contrary to previous assumption, childless couples cannot be assigned to any psychopathologically defined class (Hammer Burns & Covington, 1999). However the attention to the emotional distress as a consequence of infertility and its treatment has led worldwide to the recommendation to provide psychosocial interventions for infertile couples. Indeed about 15% to 20% of all couples experience reproductive medicine as so stressful that they require psychological counselling (Boivin & Kentenich 2002).

Various types of psychological interventions already exist for infertile patients. Individually, these interventions focus on specific therapeutic approaches.

They vary from the provision of information (Daniluk, 1988; Takefman, 1990) to emotion- and problem-focused interventions (McQueeney et al., 1977) or supportive group interventions (Ferber, 1995), to psychological and sexual counselling (Sarrel and DeCherney, 1985), couple therapy (Diamond et al.,1999; Stammer et al., 2002), cognitive–behavioural therapy (Tuschen-Caffier et al., 1999), and mind–body therapy (Domar et al., 1992b).

Generally, the psychological interventions for childless couples can be divided into two types, individual therapy or group therapy, and three basic categories can be selected from several studies: (1) counselling interventions; (2) focused educational interventions, and (3) comprehensive educational programmes ( J. Boivin 2003). The feature that distinguished educational programmes (focused or comprehensive) from counselling is the therapeutic objective. If the main aim of the intervention is to impart knowledge or provide skills training, then the intervention classes is educational. If, in contrast, the main aim of the intervention is emotional expression and support, and/or discussion of thoughts and feelings related to infertility (as cause or consequence), then the intervention classes is counselling. The difference between focused and comprehensive interventions is in the range of information or skills training provided to participants with focused interventions providing one main skill (e.g., coping or relaxation training) and comprehensive programmes providing a range (e.g., coping and relaxation training).

Another category is educational but it consists of comprehensive and structured educational psychosocial interventions. For example, the Behavioural Medicine Program for Infertility (BMPI, also known as the mind/body program) (Domar, Seibel, & Benson, 1990) is a 10-week group program that includes, for example, cognitive-restructuring, methods for emotional expression, relaxation training, nutrition and exercise.

It has been demonstrated that psychosocial interventions are more effective in reducing negative affect than in changing interpersonal functioning (e.g., marital and social functioning). Pregnancy rates are not affected by psychosocial interventions. Moreover, group interventions which emphasise education and skills training (e.g., relaxation training) are significantly more effective in producing positive change across a range of outcomes than counselling interventions which emphasise emotional expression and support and/or discussion about thoughts and feelings related to infertility. Men and women benefit equally from psychosocial interventions. (J.Bovin, 2003).

Conclusion

Several studies recommending psychosocial interventions for childless couples have been reported in the few last years. However, only a few papers met minimum requirements for good quality studies and they are not empirically supported (Boivin, 2003). One of the few attempts to integrate the different knowledge and scientific evidence on psychological intervention for infertile couples was made in 1991 by experts from seven countries. Discussions in this and subsequent meetings produced a document entitled "Guidelines for Counselling in Infertility" aiming to describe key issues for the counselling of individuals using assisted reproduction (J.Bovin et al., 2001). They are based on the current best practice and are a valid proposal for a counselling framework to improve the care of infertile patients.

However, the theoretical framework of the counselling models described in the literature to date varies, including psychodynamic psychotherapy, cognitive-behavioural techniques, solution-focused psychotherapy, crisis intervention and process-experiential grief counselling (Applegarth, 1999). This issue can lead counsellors to adopt a variety of perspectives to guide their work with infertile couples. Difficulties can arise when the counselling approach adopted by the counsellor is incompatible with the needs or personality of the patient. Indeed, it has never been demonstrated which is the best psychological intervention for infertile patients. Furthermore, this heterogeneity does not assure with certainty the use of a standard and shared approach. Thus, in the IVF field, a gold standard for childless couples' psychological intervention has not yet been identified. Therefore, a future objective might be to attempt to spot among the different existing approaches the one that is mostly efficient for the infertile couples undergoing IVF, strictly evaluating some outcomes that are determinant for the psychological wellness of the single persons (man or woman) and of the couples with the ultimate aim of  improving the quality of their life. Only in a second step, the role of psychology in IVF might be dedicated to the analysis of different psychological factors that may influence the pregnancy rate or that can beset the causes of the infertility.

What we really need at present in IVF is an integrated and pragmatic psychological approach that may efficiently act to reduce the embarrassment and enrich the life of the individual, by increasing his or her list of possibilities to a more complete personal and couple realization.

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Only nine out of 151 primary care trusts (PCTs) in England are funding the recommended three cycles of IVF for infertile couples, according to the UK Department of Health. The latest figures reveal that despite guidance issued over four years ago, four trusts are still offering no IVF treatment at all, and 94 per cent are not providing the full three cycles recommended. The failure to fully fund IVF treatment could jeopardise a new drive to cut the number of multiple births after fertility treatment, say experts.

The survey, which does not include data from Scotland, Wales or Northern Ireland, was published on the Department of Health's website in response to a parliamentary question. It found that just seven PCTs currently offer three cycles of NHS-funded IVF treatment: Heywood, Middleton and Rochdale, Bury, East Lancashire, Stockport, Tameside and Glossop, Trafford, and Blackburn with Darwen. According to the Times newspaper, the four PCTs that have suspended free IVF treatment are North Lincolnshire, North Staffordshire, North Yorkshire and York, and Stoke on Trent, though the latter has since resumed provision.

The National Institute for Health and Clinical Excellence (NICE) recommended, in February 2004, that three cycles of IVF should be offered to all infertile couples, subject to certain clinical criteria, to end the 'postcode lottery' of provision. Shortly afterwards, the then health secretary, Sir John Reid, announced that all infertile couples where the woman was aged between 23 and 39, and fitting certain other additional criteria - including having no other children living with them - should be given just one free cycle of IVF on the NHS from April 2005, with a view to increasing provision further in time.

Dr Mark Hamilton, chairman of the British Fertility Society (BFS), called the current IVF funding 'very patchy' across England. He said that it was 'imperative that the funding issues around IVF' were addressed in collaboration with the launch of a new strategy urging clinics to cut the number of multiple pregnancies after IVF. 'The funding issue is very, very important', he stressed.

Even where IVF treatment is funded, there is wide variation in the eligibility criteria set by different PCTs. For example, across the whole of South Central - which includes Oxfordshire to Portsmouth, Milton Keynes and the Isle of Wight - only women aged between 36 and 39 are eligible and only if neither partner has any children from a previous relationship. Meanwhile, in East Riding, Yorkshire, men over the age of 46 will not be treated on the NHS. In many areas women under the age of 25 cannot have free IVF, while in Bath and North East Somerset women will not be treated until they reach the age of 35.

Susan Seenan, of the charity Infertility Network UK (I N UK) said: 'It's a disgrace, it is so unfair. It is ridiculous that some PCTs are forcing women to wait until they are over 35 when their natural fertility has declined and the chance of a successful outcome is much less'. She added 'What we need is a set of standard centrally agreed criteria which the PCTs have to work with and then we will have a level playing field and everyone treated equally'.

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Women who use fertility drugs may be at increased risk of developing cancer of the uterus. Dr Ronit Calderon-Margalit and colleagues at Hadassah-Hebrew University in Jerusalem studied 15,000 women who gave birth 30 years ago. They found that those who used fertility drugs were more likely to develop uterine cancer - cancer of the womb - than women who had not used fertility drugs, but the risk was still low. 

Of 567 women who took fertility drugs, 5 had developed uterine cancer in the past 30 years, three times the incidence of women who had not used fertility drugs. For women who had used the drug Clomiphene, the risk was four times greater.

The study, published in the American Journal of Epidemiology, also found smaller increases in the risk for other cancers: melanoma, breast cancer and non-Hodgkin's lymphoma. The researchers did not find an increased risk of ovarian cancer with fertility drug use, a link which has been identified in previous studies.

Jodie Moffat, health information officer at Cancer Research UK, said the study had several limitations, and it was difficult to draw any firm conclusions about the link between fertility drugs and uterine cancer. 'The study didn't include a detailed history of fertility drug use, and the number of women who developed uterine cancer was very small', she said.

Richard Kennedy, consultant at the Centre for Reproductive Medicine at University Hospital Coventry, and spokesman for British Fertility Society, also said that 'there have been a high number of studies that have failed to find a conclusive link. It is important to remain vigilant about these things but the broad message must be reassurance'.

Fertility drugs are used by women who are undergoing IVF treatement, egg donation, or to facilitate conception. They act by inducing ovulation, stimulating more egg production or, like Clomiphene, by blocking the hormone estrogen.

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Gay and lesbian couples in the UK will get easier access to fertility treatments following a review of the existing law governing the area, it is reported. The 1990 Human Fertilisation and Embryology Act is currently under review by the House of Commons Science and Technology Committee, whose comments will feed into a second review and consultation, due to be undertaken next year by the Department of Health (DH).

According to an article in the UK's Observer newspaper, the DH is apparently planning to make the changes to the law in light of the Civil Partnerships bill, which is currently passing through parliament, and 'changes in societal attitudes' since the 1990 Act was passed. Currently, the law states that fertility doctors should make treatment decisions taking into account the welfare of the child to be born, including the 'need of a child for a father'. Many clinics have refused to provide fertility treatments to lesbian couples on this basis.

However, the passage of the Civil Partnerships bill would mean for the first time that lesbian and gay couples wishing to have their relationship legally recognised could apply to do so. Entering a formal 'civil partnership' will give same-sex couples similar rights and responsibilities to those currently enjoyed by married couples. What this means, suggests the DH, is that other legislation drawn up with heterosexual couples in mind may also need updating.

The Observer reported that a DH submission to the Commons Committee review panel claims that changes in the way the law is framed could lead to legislation that can 'better recognise the wider range of people who seek and receive assisted reproduction treatment in the 21st century'. Professor Alison Murdoch, chair of the British Fertility Society, said that she favoured extending the provision of fertility services to same-sex couples. 'We have to stand back from it and say, what is the evidence that there is any harm to anybody from them having a child', she said. She added: 'Children need to be brought up in a loving, caring environment - it's the loving care that's important, not the sexuality of the parent'.

Single women and lesbian couples in Victoria, Australia, will now be able to inseminate themselves thanks to a loophole in the law found by Victoria's Infertility Treatment Authority (ITA) and Melbourne IVF. While clinical reproductive services in Victoria are legally limited to women who are 'medically infertile' (rather than 'socially infertile'), allowing women to take screened sperm samples home from clinics for self-insemination does not breach the prohibition. Dr John McBain, chairman of Melbourne IVF, said 'It is not a reproductive service if we're not performing it'. If self-insemination has failed four times, then the woman can be classed as medically infertile and can receive full access to IVF procedures.
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Research published in the journal Fertility and Sterility has shown that the quality of parenting and psychological adjustment of egg donation families is generally on a par with that of donor insemination (DI) and IVF families. Mothers and children from 17 families created by egg donation, 35 families created by DI and 34 IVF families were interviewed as the children approached adolescence.

The research team, who at the time of the study were based at the Family and Child Research Centre at City University in London, compared the responses of the families to interviews and questionnaires. The participants are part of an on-going study into the development of children from families created by assisted conception, at three centres across the UK. The research team was assessing the parents' marital and psychological state, the quality of the parent-child relationships, the father's contribution to the parenting and the children's socio-emotional development. The team had previously interviewed the same participants when the children concerned were 4.5 years old, finding that egg donation was linked to greater parental psychological well-being compared to the other methods of assisted conception looked at, as well as adoption, and that none of the children had psychological or developmental problems.

In the latest study, the researchers - Doctors Clare Murray, Fiona MacCallum and Susan Golombok - found no differences between the children from egg donation and IVF families. Children from the families created by egg donation were 'well adjusted' socially and emotionally, and the parenting skills did not significantly differ between the groups. However, there were some differences between the egg donation and DI families, which the researchers anticipate reflect 'lower levels of sensitive responding of egg donation mothers toward their children compared with DI mothers'. They found that DI mothers had a tendency to become more 'emotionally over-involved' with their children than egg donation mothers. However, the differences in these factors was relatively small, suggesting that none of the mothers interviewed were functioning badly. While the children of these families were also all functioning well, the researchers did find that children born from DI were more likely than egg donation children to experience bullying at school. The team suggests that 'having a mother who is more likely to be over-involved might render children more vulnerable to negative reactions from their peers'.

In their conclusions, the researchers suggest that the differences between the different types of families may in some way reflect the different pattern of genetic relationships within them, or be linked to secrecy surrounding the use of donate gametes. Children lacking a genetic link to one or both of their parents, they found, were unlikely to be told of the method of their conception, with only 17 of the egg donation children and two of the DI children having been told of their origins. Children born following IVF using the parents' gametes were far more likely to have the method of their creation explained to them, with 26 of the 34 children being interviewed having been told. The researchers suggest that one reason egg donation and DI parents do not inform their offspring is perhaps because they themselves experience more social stigma or that they believe it would be harmful for the children to learn about their origins.

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Embryo culture media are routinely supplemented with antibiotics to prevent bacterial growth during embryo culture. The most commonly used antibiotics being Penicillin and Streptomycin. The anti-bacterial effect of penicillin is attributed to its ability to inhibit the synthesis of peptidoglycan, unique glycoproteins of bacterial cell wall. Since peptidoglycan is not synthesized by human cells, there is no apprehension about using penicillin as one would not expect it to have any detrimental effects on human embryos.

Streptomycin and gentamycin belong to the aminoglycoside group of antibiotics which exert their antibacterial effect by inhibiting bacterial protein synthesis, which incidentally are similar to mitochondrial proteins. Therefore, it is of concern on whether the antibiotics used in embryo culture media would have any detrimental effects on embryonic development. This issue has not been addressed despite the routine use of these antibiotics in culture media.

Recently, Lemeire et al (2007) tested the toxicity of streptomycin in four bio-assays: 1) follicle bio-assay (FBA), a multi-parametric long-term follicle culture system mimicking ovarian function, 2) in vitro fertilisation (IVF) of exposed oocytes enabling gamete quality determination through fecundability 3) the mouse embryo assay (MEA) which analyses pre-implantation embryo development, and 4) the embryonic stem cell test (EST) for post-implantation embryo-toxicity.

The FBA revealed a concentration-dependent decrease in mice oocyte nuclear maturation during continuous exposure starting with 50mug/ml streptomycin characterised by a significantly reduced first polar body-rate (40% vs. 92% in the control group). Oocytes that remained arrested in metaphase I had aberrant spindle formation. IVF of long-term exposed oocytes in the FBA to 50mug/ml streptomycin resulted in a significantly lower fertilization rate of 23% vs. 74% in the control group and were unable to develop to the blastocyst stage. The MEA revealed no effect on pre-implantation embryo development. The EST also did not demonstrate any post-implantation detrimental effect.

This study although done in mice indicates that one needs to be cautious before using streptomycin in human IVF and embryo culture media.

Lemeire K, Van Merris V, Cortvrindt R. (2007) The antibiotic streptomycin assessed in a battery of in vitro tests for reproductive toxicology. Toxicol In Vitro E-pub ahead of print.

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Women may release eggs more than once during their monthly cycle, a new study by a group of Canadian researchers suggests. Their findings could lead to improvements in fertility treatments, and could also explain many unexpected pregnancies. 'We are in the early phases of understanding it, but it is quite a significant departure from what we all thought was going on for the last 50 years or so' said team leader Roger Pierson, of the University of Saskatchewan, Saskatoon.

The scientists carried out daily ultrasound scans on 63 women with normal menstrual cycles aged between 18-40, and studied their developing egg follicles over six weeks. It was previously thought that at the beginning of a normal ovarian cycle, around 15-20 follicles begin to grow, and that one mature egg is released, roughly halfway through the cycle. But the researchers found that in most of the women, follicle development occurred not just once, but in two or three 'waves' throughout the cycle. Although most ovulated once, between the 11th and 17th day, six of the women ovulated twice, and seven not at all. In the remaining 50 participants, 40 per cent had more than one wave of follicle activity, which could potentially have resulted in ovulation. 'We don't know why some waves lead to ovulation and others don't' said Pierson, although he speculated that luteinising hormone, which is produced following ovulation, could inhibit the release of another egg. He added that for couples with fertility problems, it might be possible to harness some of the non-ovulating waves into releasing eggs.

Pierson said the results, published in the journal Fertility and Sterility, also showed exactly why the rhythm method of contraception (relying on a 'safe' time of the monthly cycle to avoid pregnancy) doesn't work. They could also explain the occurrence of non-identical twins with different conception dates, and why some women undergoing fertility treatment may not respond to ovary-stimulating medicines. 'We're probably giving at least some of these women drugs at the wrong time' says Pierson. The group are now planning longer-term studies, to see if the women's patterns are consistent from month to month.

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A 60 year-old woman has sparked controversy in Canada by travelling to India to receive fertility treatment after years of failed attempts to conceive naturally. Ranjit Hayer, originally from India, has become the oldest woman in Canada to give birth after receiving IVF at Dr Anoop Gupta's Delhi fertility clinic; her twin boys were delivered seven weeks prematurely by Caesarean section at the Foothills hospital in Calgary last week. 

Canadians are not usually eligible for fertility treatment above the age of 50, so Hayer travelled to what has been dubbed by one Canadian newspaper the 'salvation destination' amongst the global community of infertile; India, where 'unregulated reproductive technology makes anything possible'. Hayer is not the oldest woman to have given birth; a growing number of post-menopausal women have turned to fertility treatment in India where regulations have been minimal. In November 2008, a woman in the northern Indian state of Haryana gave birth to her first child at the alleged age of 70 years old. In 2006, Carmela Bousada of Spain was hailed as the oldest new mother after giving birth to twin boys at 66 years of age.

The case in Canada has not only raised ethical questions about older mothers and their ability to parent, but also about who pays for the treatment of patients who undergo medical procedures abroad. 'I very much object to the resources this woman has used in the health system. We have spent a lot of money on her' said Dr Cal Greene, medical director of a Calgary-based fertility clinic. Physicians in the state expressed concern that the cost of care for Hayer's twins could reach $6,000 a day, as resources are limited. Dr Greene would 'rather see those resources used in the normal age group'. However, Juliet Guichon, a bioethicist at the University of Calgary said it would be unethical for the medical system to turn away any patient in need.

Dr Gupta's clinic is one of an estimated 150 clinics in India offering an extensive range fertility treatments to patients such as Mrs Hayer who are either unable to access treatment in their home country, or cannot afford to. The lack of regulation has caused concern even within India: 'Total madness is prevailing', said Imrana Qadeer, a professor of public health at Jawaharlal Nehru University, a campaigner for regulated assisted reproduction. 'It is a totally unregulated thing... the doctors get away with a lot of things because people trust them and also there is a lot of ignorance about technologies... Women are vulnerable, they can be pressured'. Surrogacy in India is a big attraction for foreign patients, where the total cost is about $10,000 compared to $50-70,000 in the US. Yet surrogates tend to be poor, uneducated women often unable to read the contracts they sign. Egg donation is also widely desired by foreign patients, and according to Dr Gupta, has been on the increase since the economic downturn.

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