IVF News

Abstaining from sex does not enhance a man's fertility and may lower the chances of a successful conception for couples undergoing fertility treatment, according to new research presented at the annual conference of the European Society of Human Reproduction and Embryology in Madrid last week.

Fertility experts at the Soroka and Ben-Gurion Universities in Israel looked at sperm samples from around 6,000 men who had abstained from sex for up to two weeks, and found that the quality of the sperm declined after four days abstinence in men with normal sperm counts, and sooner in men with low sperm counts. The findings contradict current World Health Organisation guidelines, which recommend abstinence of between two and seven days before collecting semen for fertility treatment.

The researchers tested more than 7,200 semen samples from 6000 men who had abstained from sex for between two days and two weeks, 4,500 of which had normal sperm counts, while the remainder had a reduced sperm count. They found that in men with normal sperm counts, the proportion of healthy, strong-swimming (motile) sperm rose to a peak after four days of abstinence, before starting to drop. But in men with a low sperm count, the proportion of motile sperm fell after just two days, suggesting that any benefit to fertility gained by boosting the volume of semen following abstinence is cancelled out by a decline in sperm quality.

UK scientist Lyn Fraser said the results made good biological sense, adding that most men with low sperm counts have testes that are not producing sperm at full capacity and, when numbers are low, the quality is low. 'That means that if you abstain from sex for a long time, you?ll be ejaculating sperm that are old and necrotic', she explained.

'Our data challenge the role of abstinence in male infertility treatments' said team leader Elahu Levitas, saying that the results were most relevant for patients undergoing intrauterine insemination, for which the best quality sperm was needed. 'For these patients we recommend minimal abstinence ? ideally no more than two days' he advised.
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Scientists from the Sahlgrenska Academy at Goteborg University in Sweden have announced that they have successfully achieved births from mice that had undergone uterus transplants. The research was reported at the European Society of Human Reproduction and Embryology (ESHRE) annual conference in Madrid, Spain, and follows an earlier report of successful pregnancies in mice in August 2002. The researchers hope that the technique may be able to be developed for use in humans, for example in women who are born without a uterus or who have had it surgically removed after cancer, infection or emergency operations. They believe that it would have advantages over adoption or surrogacy, the only ways a woman without a uterus could currently have a child, because 'with transplantation, the mother will be the social mother, the gestational mother and the genetic mother'.

Dr Mats Brannstrom and his colleagues transplanted uteruses into 12 mice that were 99 per cent genetically identical to the donors, placing them alongside their existing uteruses in order to compare them. Later, up to six embryos were implanted into each uterus. According to the research team, the number of pregnancies achieved in the transplanted uteruses was comparable to that which would be achieved normally, and the mice that were born from the transplants developed as well as any other mice, some of them going on to mate and have pups naturally. 'These are the first true uterus transplants to produce live births', Dr Brannstrom said.

Further uteruses were transplanted into other mice that were not genetically matched, but these were rejected after a week. Dr Brannstrom suggested that, if the technique is to be used in humans, the risk of rejection could be minimised by transplanting uteruses from close family members, although immunosuppressant drugs would still need to be taken. But, following further research on mice and pigs, Dr Brannstrom said that research will begin in humans. 'We hope to do this in two to three years', he said.
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Men undertaking IVF treatment with their partners may be able to store their sperm at home, rather than in a laboratory, say researchers. Scientists from the Erfan and Bagedo Hospitals in Jeddah, Saudi Arabia, have created a way of 'air-drying' sperm which allows it to be stored at room temperature rather than in frozen storage.

To be 'air-dried', washed sperm is smeared onto a sterilised glass slide and left to dry in a cabinet for two to three hours. Filtered air is passed through the cabinet to ensure no contamination of the sample. When the sperm is needed for use in fertility treatment, it is re-suspended in a biological solution similar to that which surrounds human eggs in ovarian follicles. Although this process was seen to cause some damage to the tail and bodies of the sperm, the DNA contained inside appeared to be intact, therefore intracytoplasmic sperm injection (ICSI) was used in order to fertilise an egg. This means that a single sperm was extracted from the solution and being injected directly into an egg.

Typically, sperm samples mixed with a protective chemical are frozen in large liquid nitrogen tanks. These have to be carefully programmed to ensure that the sperm is not damaged or destroyed by cooling too fast or too slowly. The protective chemical also has to be separated from the sperm before it can be used. 'These methods are time-consuming and cumbersome compared to our simple technique of air-drying' said Dr Daniel Imoedemhe, leader of the research team. He added 'the process can be further simplified by allowing patients to take responsibility for storing their air-dried sperm at home'.

Presenting their findings at the annual conference of the European Society of Human Fertilisation and Embryology in Madrid, Spain, this week, the scientists said they had successfully created human embryos using this method. Previous experiments had been carried out successfully in mice.
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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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New research has added to the growing body of evidence that children fathered by older men may face some physical health problems. A British and Swedish research team based at Oxford University, UK, has found that an inherited condition called Apert syndrome is more likely to develop in the children of older men. Apert syndrome causes children to be born with distorted skulls and often to have webbed fingers or toes.

In Apert syndrome, mutations in a gene called FGFR2 are passed from the father (who is unaffected) to the child. The mutations 'are associated with increased paternal age', say the researchers, who have published their findings in the journal Science. The majority of the one in 700,000 children born with the condition in the UK are born to older fathers, which suggested that the gene mutation that causes the condition occurs more frequently in men as they age. However, the researchers found no increased incidence of the FGFR2 mutation. Instead, they found that the mutation itself was very infrequent, but, when it did occur, it had a great effect on the way sperm was produced. Professor Andrew Wilkie said that this was similar to the effect of cancer, 'with rogue cells multiplying and producing sperm with the mutated gene'.

However, the researchers also found that the gene mutation, although it causes Apert syndrome in children if a sperm carrying it fertilises an agg, is actually beneficial to the sperm itself, as it helps it to survive longer in the testes.

In 2001, a study showed that older fathers produce children with a much higher risk of developing schizophrenia: this too was thought to be caused by mutations in sperm that increased with paternal age. Then, researchers pointed to 'strong evidence' that men, like women, have a 'biological clock' when it comes to having children, challenging commonly held beliefs that while older women risk having babies with birth defects, men can safely father children whatever their age.
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This weekend, the Daily Mail newspaper broke a story that a British government agency is considering a proposal to offer six IVF cycles to women under 40 years of age on the National Health Service (NHS). If NICE, the National Institute for Clinical Excellence, ends up publishing what are at present draft proposals, it could spell the end of the 'postcode lottery' in IVF provision, in which access to service depends upon where you live, rather than whether you need treatment. It could also mean an end to the dominance of the private sector which currently provides treatment to 80 percent of couples undergoing IVF.

Not everyone thinks this proposal is a good one. Stephen Pollard, writing in the Independent, suggests that if the NHS were to start funding IVF in this way, it would undermine its policy of funding only essential services. This, according to Pollard, is 'redefining the purpose of the NHS to include the provision of all treatments, rather than just those that are clinically necessary.' However, the NHS already provides non-essential services which are not clinically necessary to patients. One such service is family planning. Pregnancy is not a disease (though, in fact, infertility often is a result of disease) and having a baby is not life threatening, yet contraceptive advice and services are provided free of charge - and so they should be.

That is not to say that NHS provision of family planning services is guided by an enlightened view of women controlling their fertility. Early adoption of such services was probably motivated at least in part by a desire to limit the number of babies born to single women or to families on low incomes. But regardless of the reason for the introduction of family planning services, they are now part of our health system and few would argue that they ought to be removed. The point remains that whilst preventing conception is seen as a legitimate service for the NHS to provide, assisting conception is regarded by some as unworthy of government funding.

Pollard argues that the crux of the issue is whether 'there is any "right" to children, the absence of which is something that the state, through the NHS, has a duty to rectify'. He goes on to say that IVF treatment is provided largely by the private sector 'because the existing consensus is that there is no such right, and thus no such NHS duty'. Does such a consensus exist and, if it does, how was it arrived at? Until now, there has been no real public or political debate about NHS provision of fertility services. In truth, the current poor provision of IVF on the NHS is based not upon rational decision-making, but upon ethical reactions to IVF which are 25 years out of date. IVF grew up as a private service because the state was unwilling to fund what was regarded at the time by many influential people as an ethically dubious treatment. Times have changed and public attitudes have changed with them. Perhaps it's time that the health service's view caught up with the times.
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British fertility specialist Professor Lord Robert Winston has warned that more research into some fertility techniques associated with IVF needs to take place, in order to ensure the safety of patients and their children. Speaking at the British Association Festival of Science in Salford, Manchester earlier this week, he said that certain techniques ought to be better investigated, as they may be the cause of long-term health problems in IVF children.

Many fertility techniques, he claimed, have been introduced to clinics before enough research on their potential risks has been done. This leads to a situation in which couples seeking treatment are under-informed about the consequences of going ahead. Many concerns have simply been put aside, he said, because of the commercial nature of IVF. When asked whether he thought this meant IVF patients and children were part of a mass experiment, he said 'that's exactly what I'm saying'.

Professor Winston highlighted embryo freezing which, he said, may cause mutations in an embryo before its implantation into the uterus. He also said that research should be undertaken on the use of ovary-stimulating drugs, to assess their potential risk of causing chromosomal damage to the eggs produced. Both of these techniques, he claimed, may possibly be the cause of 'some of the phenomena which are not currently understood' in IVF. He added 'whilst the early reports of IVF were wholly reassuring in terms of the abnormality rate, there is now a lot of data out there which suggests that some procedures actually, under certain circumstances, might be quite dangerous'.

In response to Professor Winston's comments, the UK's Human Fertilisation and Embryology Authority (HFEA), which licenses and monitors IVF clinics, said that it was currently collaborating with the Medical Research Council on IVF research and safety. Confirming the partnership in October 2002, the HFEA said that a working group had been established, in response to various studies that expressed concern about IVF procedures and long-term health, to conduct a programme of research looking at potential health effects of IVF and related procedures. Suzi Leather, chair of the HFEA, said that the working group hopes to 'complete its review and decide on areas for additional research by the end of 2003'.
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This week the law in the UK has been changed to allow the name of men who have died before their child was conceived to appear on that child's birth certificate. It's not a radical change in the law or any great philosophical shift in the way that we regulate assisted reproduction, but for the handful of families affected by the change, it is hugely significant.

Before now, women undergoing IVF or artificial insemination whose partner died before or during treatment, were not permitted to enter their dead partner's name on the birth certificate. Instead, the father's name was left blank, suggesting that he was unknown. By contrast, if a man dies whilst his wife or partner is pregnant, his name can be entered on the child's birth certificate. Mothers of posthumously conceived children, including Mrs Diane Blood, have been campaigning for some years for a change in the law to correct this anomaly. Having given verbal support to the idea of allowing posthumous fathers' names to appear on birth certificates, the government finally delivered on its promise by backing the passage of the Deceased Fathers Bill through parliament. As it happens, the government had been forced to act, after an English court suggested that the law as it stood was incompatible with the European Convention on Human Rights. The bill received royal assent last week and will now amend the Human Fertilisation and Embryology (HFE) Act.

One important aspect of the bill is that it doesn't simply recognise the rights of biologically related fathers. Two clauses refer to couples (married or unmarried) where the embryo was created using donor sperm. This means that a man who would not have been biologically related to his child can now be recognised as the legal father if he died before the child were was. This mirrors the recognition given to social fathers in the HFE Act. This fact provoked some discussion during the passage of the bill, particularly at its second reading in the House of Lords in July. Baroness Warnock said 'I strongly believe that in any case of AID [artificial insemination by donor], the birth certificate of the child should bear the words, 'by donor'.' However, the Baroness conceded that this issued pertained to the question of donor anonymity in general and was a matter for separate discussion.

As the law stands, the social (rather than the biological) father of a donor conceived child is the legal father whose name appears on the birth certificate. This makes sense, particularly in the example of posthumous fathers, who had planned to become a father, but were prevented from doing so by their unfortunate and untimely death. After all, one of the most important aspects of being a parent is the decision to become one in the first place. Intending to have a child and embarking upon a method of realising that intention is of more significance than the method by which that intention is realised.
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Last week, the High Court ruled against two women seeking to use their frozen embryos against their ex-partners' wishes. One of them, Lorraine Hadley, said in a subsequent BBC interview that she may request her ex-husband to consent to donating their two embryos to another woman, so that the embryos may not be destroyed.

'Even if I can't have them maybe Wayne might consider that we donate them, so that it's not just destroying them' she said, 'so that someone else might benefit from it, even if it can't be me.'

According to UK rules, Lorraine Hadley would not be able to choose, or be made aware of, the identity of anyone seeking to become pregnant with the embryos created by herself and her former husband.

At the High Court, Mr Justice Wall refused Natallie Evans and Lorraine Hadley leave to appeal against his decision. However, the women can appeal directly to the Court of Appeal if they want to take the case further. They have been granted a 28-day stay on the destruction of their embryos that their former partners have requested, while they decide their next move.
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While one might have sympathy for Natallie Evans and Lorraine Hadley because the UK's High Court has ruled they cannot use the embryos they have in frozen storage, it is hard to criticise the legal decision in this case. Mr Justice Wall followed the letter of the law on consent. But he has also, like legal judgements made in two previous cases this year, highlighted legal parenthood following assisted reproduction treatments (ARTs) as a problematic area of the law.

Earlier this year, two courts in the UK made similar but different rulings about parenthood following ART. In February, the Court of Appeal said, reversing the decision of a lower court, that a man could not be regarded as the legal father of a child born to his ex-partner after IVF. In this case, the couple began IVF treatment together (although donated sperm was used), but they separated before the embryos were transferred. The woman later requested the transfer of the stored frozen embryos to her womb without informing the clinic of their separation. She became pregnant and had a baby girl.

In the second case, the High Court ruled in March that a black man was the legal father of mixed-race twins born to a white couple. The mistake occurred at an IVF clinic: his sperm was wrongly used to fertilise the eggs of a white woman undergoing treatment there with her husband.

In both these cases the courts struggled to fit definitions of parenthood - particularly those that do not arise from having children in the 'normal' way - to the situations they faced. Whatever one thinks of the ethical and emotional issues involved, it is possible to argue that both were wrongly decided. By this I do not necessarily mean that the judges involved misapplied the law: they in fact only put an interpretation on the (often rather strange) provisions of the Human Fertilisation and Embryology Act 1990 regarding legal parenthood after ART. Rather, the wrong decisions were reached precisely because of the legal definitions.

Perhaps a better determinant of legal parenthood in these situations (and for all ART treatments) is one based on the intention of the parties. Practically, what this would mean is that the man in the first case, despite not being the child?s biological father, would be the legal father and could apply for parental responsibility and contact with her. Judicial and political rhetoric in plenty of other cases would support the contention that it is better for the child to have this man - who, it must be remembered, intended her creation - recognised as her father rather than no man at all (given that sperm donors are rightly not legally recognised as such). In the second case, an intentional approach would mean that the man who underwent treatment with his wife, was with her throughout the pregnancy and will perform the role of social father, is also recognised as the legal father. Why make a man who did not intend those children to be born (and who will not raise them) the legal father by virtue of a biological link?

The difference in the cases of Ms Evans and Ms Hadley is that the women's former partners requested that the embryos be destroyed because they had no wish to be the fathers of any children born to the two women since their separation. Because they withdrew their consent, Mr Justice Wall had little option but to respect their choice. But had parenthood been defined by intention, all withdrawing consent might mean is that these men clarified that they had no intention to be the legal or social father of any resulting children. This might be an acceptable compromise.

If parenthood had been defined by intention, the men in question would, of course, be have been genetically related to children they didn't intend to father. However, so are many men, and it seems the law can treat them how it wants. Men who get a woman pregnant by having sex with them, but who don't intend to be the father, are still treated as such by the law, which makes them pay child support. Men who donate their sperm are exempt, legally and socially. Men whose sperm is accidentally used to fertilise another woman in an IVF clinic fall somewhere in between: a legal father in name only. Why can't this kind of legal halfway house be similarly applied to men who withdraw their consent? That way, the children can be born but these men will neither be their legal nor social fathers.

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