IVF News

Research published last month in the journal Reproductive BioMedicine Online indicates that a new freezing technique to store human eggs is safe. The study, led by Dr Ri-Cheng Chian, of McGill University, Montreal, Canada, looked at children conceived using eggs frozen by vitrification, and showed that the rate of birth defects was the same as in natural or IVF pregnancy. The study may lead the way for women to freeze their eggs to postpone motherhood.

Vitrification involves removing water from the eggs, adding an agent that acts as an 'anti-freeze', followed by very rapid cooling. This process avoids ice crystals forming which can damage the egg's structure. When this is done, 95 per cent of eggs survive the thawing process compared to 50-60 per cent of eggs frozen using previous techniques.

The new study looked at 200 children born after the technique was used, and found that only 2.5 per cent had birth defects, which is comparable to rates in natural or IVF pregnancy. The average birth weight was also no different in children conceived using vitrified eggs compared to children conceived naturally or using IVF. The freezing of eggs is not currently routinely available, as the freezing of sperm and embryos is, due to safety fears.

A woman's fertility rapidly declines after the age of 35, and there are both social and medical reasons why women may wish to freeze their eggs before this time, for later IVF treatment. Social reasons include wanting to delay motherhood to develop a career, or find the right partner. In addition, the freezing of eggs may be more acceptable to those who have ethical objections to freezing embryos. Medical reasons for freezing eggs include doing so before facing treatment that may reduce fertility, such as cancer therapy.

Currently this is the only large-scale study looking at the effects of vitrification on birth defects. Dr Allan Pacey, secretary of the British Fertility Society (BFS), said that more, similar studies are needed to verify the safety of the technique.

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."

Barcelona, Spain: New figures on assisted reproduction technology (ART) in Europe show that there has been an explosion in the use of ICSI (intracytoplasmic sperm injection) to treat infertility, the 24th annual meeting of the European Society of Human Reproduction and Embryology (ESHRE) in Barcelona heard today (Wednesday). Researchers believe that some countries may now be using the procedure too often.

In 2005 - the most recent year for which data have been collected - there were 203 329 ICSI cycles. This was nearly double the figure for standard IVF cycles, which was 118 074 for the same year.

The distribution of IVF and ICSI has undergone a complete reversal from 65.3% for IVF and 34.75 for ICSI in 1997 (when ART data first started to be collected for Europe), to 36.7% for IVF to 63.3% for ICSI in 2005.

ICSI was first developed in 1992 as a way of treating infertility caused when a man either had a very low sperm count or poor sperm motility. Individual sperm are collected and injected directly into the woman's egg, thereby ensuring fertilisation. However, Professor Anders Nyboe Andersen, chairman of the ESHRE's European IVF monitoring consortium, said the current shift from IVF to ICSI could not be explained by a corresponding rise in the proportion of couples seeking treatment for male-related infertility.

"More than half of all ICSI cycles are now done in couples without a diagnosis of severe male factor infertility. It is being used increasingly when couples are classified as having mixed causes of infertility, unexplained fertility or because they are older - in their late 30s or early 40s," said Prof Nyboe Andersen.

"Nor is it the case that performing ICSI provides a better pregnancy rate per embryo transfer than IVF. For 2005, the pregnancy rates were almost exactly the same: 30.4% for IVF and 30.3% for ICSI. More importantly, clinical trials have shown that ICSI does not produce more pregnancies compared to IVF for indications other than those for severe male infertility."

As ICSI is a more complicated procedure than IVF, it is also more expensive. Different studies have reported that ICSI is between 10% and 30% more expensive than IVF.

Prof Nyboe Andersen said: "Huge differences in the rates of ICSI and IVF exist between countries, but we don't know why this should be. The Nordic countries, The Netherlands and the UK used ICSI to a low extent (40-44%); Austria, Belgium and Germany used it much more frequently (68.5-73%); and the southern European countries, such as Greece, Italy and Spain, used ICSI the most frequently (66-81%).

"It would appear that some countries are using ICSI excessively compared to IVF, despite the lack of medical evidence that it is beneficial to patients. As ICSI does not give higher pregnancy rates than IVF in couples where the infertility is not caused by male factors, and as it is more expensive, infertile couples and society may benefit from a less frequent use of ICSI in some of these countries."

Prof Nyboe Andersen said that one possible explanation for the increase in ICSI might be because doctors felt under pressure to show couples that they had tried every available procedure, including the most advanced, to achieve a pregnancy. "This is understandable, but except in cases of male factor infertility, ICSI is unnecessarily complicated and more expensive."

This is the ninth year that the ESHRE consortium has reported data on ART in Europe and in this time the number of cycles has more than doubled. Thirty countries contributed data for 2005, with 14 giving complete data from all their clinics. In 2005 there were 419 037 cycles of ART performed in Europe - a 14% increase on 2004 when 367 056 cycles were reported.

France (71 278), Germany (53 378), the UK (41 911), Spain (41 680) and Italy (34 541) perform the most number of cycles. In addition to the figures for IVF and ICSI, there were 79 140 cycles of frozen embryo transfers, 11 469 cycles of egg donation and 5 137 cycles of pre-implantation genetic diagnosis (PGD).

Scientists looking at pregnancy rates in women who have previously had IVF treatment say that lifestyle factors play a large part in whether a woman will go on to achieve a natural pregnancy or not. Speaking at the annual meeting of the European Society of Human Reproduction and Embryology (ESHRE) in Barcelona, Dr Ame Lintsen, from Radboud University in Nijmegen, the Netherlands, said that maintaining a healthy lifestyle after IVF treatment maximized the chances of a subsequent natural pregnancy.

The research team found all women who had undergone IVF treatment in the Netherlands between 1983 and 1995 (in the OMEA project) and asked them to answer a questionnaire on their lifestyle and reproductive history; 8669 women responded to the survey. The scientists were looking to find out the rate of the first natural conception after cessation of IVF treatment according to a woman's maternal age, pregnancy history, duration and cause of subfertility, the number of IVF cycles previously attempted, Body Mass Index, smoking and alcohol and caffeine intake. They found distinct patterns in the rate of subsequent pregnancies and the lifestyle of the women concerned.

The researchers found that 1349 of the women (16 per cent) had conceived naturally after stopping IVF treatment (in a maximum timeframe of 13 years). Forty-five per cent of these had conceived within 6 months after their last IVF cycle. However, they also discovered that smoking more than one cigarette a day made a woman 44 per cent less likely than average to conceive naturally; drinking more than four cups of coffee (or other caffeine drinks) a day made a woman 26 per cent less likely to do so, consuming alcohol on more than three occasions per week made her 26 per cent less likely to conceive and being significantly overweight reduced the chances of a subsequent natural conception by 29 per cent.

Similarly, increasing maternal age and having had more than four previous IVF attempts also appeared to reduce the chances of a subsequent natural conception, said the researchers, as did the original cause of a woman's subfertility. If this was due to uterine, cervical or ovarian problems or subfertility in their male partners, the women had a significantly greater chance of achieving a successful natural pregnancy after stopping IVF. However, if the woman's subfertility was 'unexplained' or the problem was with tubal pathology, her chances of a natural pregnancy greatly decreased.

Commenting on the findings, Dr Lintsen said that the results showed that 'women can influence their natural fecundity with healthy lifestyle choices'. Professor Bill Ledger, Professor of Obstetrics and Gynecology at Sheffield University in the UK, said that 'lots of women drink 20 cups of coffee a day and get pregnant falling off a log'. But, he added, 'it doesn't have a massive effect, but if you are already infertile, it could just tip you over the edge. You don't have to stop, just drink less'.

WE ARE GLAD TO ANNOUNCE THAT FIRST TIME IN ASSOCIATION WITH UNIVERSITY OF CALCUTTA AND EPPENDORF INDIA LIMITED, (India Subsidiary of Eppendorf AG, Germany) a 2 weeks intensive training program is going to be organised.

There will be 4 batches (Two Weeks each) from September to November 2008. The first batch of training will start on September 8th, 2008; in each batch the number of trainees will be restricted to three to give proper exposure to each trainee.

This hands on training in ICSI and advanced Molecular Biology techniques is offered by expert clinical embryologists and scientists.

For additional information, including accommodation facilities,course fee structure please get in touch with:
Prof. A. K. Bhattacharyya, PhD, DSc.
15A, Satyen Dutta Road,
Kolkata 700029,
WEST BENGAL, INDIA.

Cell :00919831016254
Tel : 0091-33-2466-1264 or 0091-33-2419-6198

Email : [email protected]

Alternate Email : [email protected]

Fertility 2009 is the 6th biannual conference of the UK Fertility Societies: the Association of Clinical Embryologists, British Fertility Society and the Society for Reproduction & Fertility.  The conference will take place at the EICC in Edinburgh on 7-9 January 2009.  The event will offer a cutting edge programme of scientific international speakers, specialist concurrent sessions and poster presentations as well as a large trade exhibition, attracting 400 plus experts in fertility, sexual health & reproductive biology.

The organisers are inviting submissions of papers for oral and poster presentation.  
Submissions must be made online at the conference website www.fertility2009.org no later than 14 September 2008. 

To register or further details or enquiries please visit www.fertility2009.org or contact the conference organisers on +4420 8832 7311 or email [email protected]

New Zealand's Advisory Committee on Assisted Reproductive Technology (ACART) has announced two proposals to legalise currently prohibited fertility practices. It has published two consultation documents proposing first, that women should be allowed to use frozen eggs that had been extracted and stored prior to chemotherapy treatment for cancer and, secondly, that existing regulations on the creation of 'saviour siblings' should be expanded, to include not just siblings but also other close members of the family and also to extend beyond purely inherited conditions to others that might be amenable to treatment using donor tissues.

ACART, an independent governmental advisory group, indicated in its first discussion document that the time had arrived to legalise the usage of frozen eggs. Although freezing of ova has been permitted in New Zealand since 2005, it is only more recently that robust evidence has existed to demonstrate the safety of the technique, prompting ACART to propose steps to legalise its usage.

Additional advantages mentioned in the document include that egg freezing avoids certain religious difficulties surrounding the freezing of embryos and that, whereas those who can source suitable sperm at the time of freezing are currently able to store frozen embryos for use, others are discriminated against by only being able to store eggs which they are, at the present time, unable to use.

On the matter of 'saviour siblings', in the second document, ACART suggested that there is insufficient justification for restricting 'saviour' tissues to siblings alone. It further argued that as the existing rationale that the donor sibling benefits from PGD by being genetic disease free is spurious, the practice need not be restricted to inherited conditions. Objections based on the commodification of the child and of the potential psychological damage consequent upon this commodification were rejected, as was the possibility of allowing the deliberate selection of an embryo which contained a genetic disorder, on the basis that there was a morally relevant difference in purpose between selecting an embryo with a genetic disorder and selecting one without.

Early resistance to the proposals has been shown by 'Family First NZ' who criticised ACART for endorsing the production of children as 'spare parts factories for relatives' and for, in theory, making it possible for a women to give consent for her frozen eggs to be used by a surrogate mother after her own death, creating 'a baby beyond the grave' which would never know its genetic mother.

The New Zealand Ministry of Health, however, backed the proposals, saying that the proposed changes could potentially help infertile cancer sufferers to have babies and also help treat very rare diseases. ACART's consultations on the proposal to legalise frozen egg usage and on the draft guidelines for extended use of PGD both remain open until 5 September.

The increased risk of complications during pregnancy and at birth observed in babies conceived through assisted reproductive technology (ART) may be the result of parent's underlying infertility problems rather than the technology itself, a new study has revealed. In a report published in The Lancet, researchers found that children conceived through ART were born earlier, had a lower average birth weight and were more at risk of being still born than naturally-conceived children in the general population. However, their birth statistics were no different from those of their naturally-conceived siblings. This suggests that the problems associated with ART may in fact arise from the same inherent factors that cause the couple's infertility.

Between one and four per cent of babies born in Europe are conceived through ART, and it is well known that these children are more likely to have problems before, during and after birth. There has been concern that this is attributable to the technologies used - the techniques for storing sperm and eggs, fertilisation and implantation. The new study, led by Dr Liv Bente Romundstad from St Olav's University Hospital in Trondheim, Norway, sought to investigate this further by examining detailed records kept at the Medical Birth Registry of Norway. The researchers looked at more than 1.2 million births from January 1984 to June 2006 and compared 1,200,922 births following natural conception with 8,229 births after ART. They examined only single pregnancies, as twins and triplets are already known to have a greater risk of pre- and post-natal problems.

When the researchers compared the two groups as a whole, their analysis was in line with previous findings. Babies conceived through ART were on average 25 grams lighter, born two days earlier, and were at greater risk of having a low weight for their gestational age or dying in the period around birth. However, the researchers then narrowed their investigation to include only children born to 2, 546 women who had conceived at least one child naturally and at least one child through ART. They found that amongst these children, there was no difference in the likelihood of complications after ART compared to natural conception. Interestingly, babies conceived through ART were less likely to be still-born than their naturally-conceived siblings.

Dr Romundstad concluded that 'the adverse outcomes of assisted fertilisation that we noted compared with those in the general population could therefore be attributable to the factors leading to infertility, rather than to factors related to the reproductive technology'. Dr Allan Pacey of the University of Sheffield, UK, and the British Fertility Society commented to BBC News Online: 'It is reassuring to see that, in this study at least, the laboratory procedures [used in ART] were not contributing to adverse birth outcomes for those born'.

A woman in her early forties, who claims six years of unnecessary tests and waiting for IVF on the NHS has meant that she is now too old to use her own eggs, is suing the trust she claims is responsible. 

As reported last week in the Daily Mail, Greta Mason decided to sue Worthing and Southlands Primary Care Trust after she was placed on a waiting list for fours years and once gaining an appointment she was not treated for another two. By this time, Greta's eggs were too old to be used and she decided to use a egg donor instead. 

Greta told the Daily Mail that although she would love and care for her baby when it arrives, she was 'absolutely devastated that is not genetically mine.' She and her husband Chris eventually traveled to Spain to undergo private fertility treatment using donated eggs. The procedure cost £15,000 and the couple say they had to re-mortgaged their home to pay for the treatment. 

'I had always dreamed of having my own flesh and blood child who will inherit my genes so it was an absolutely shattering blow,' she told the newspaper. 'I always wanted a baby with my husband but the truth is that this baby is genetically another woman's, and at times during my pregnancy, because the baby is not related to me, I have simply felt like an incubator.'

Greta claims that as she neared the menopause her hormone levels should have been checked more regularly by doctors so that IVF could be performed using her own eggs. 'If this had been done, the doctors would have had an early warning that my eggs were getting too old to be used for IVF and they could have brought us in for treatment earlier,' she said.

Master of Clinical Embryology (MCE), Monash University Australia is now taking enrollment for 2009

Class and Laboratory skills in clinical embryology and ART

Requirements:
MCE is available to candidates with degrees from approved tertiary institutions in: Medicine, Science (with Honours) and Veterinary Science. Candidates with a Pass degree must have equivalent professional experience in embryology or reproductive biology.

 Course website: http://www.monashinstitute.org/eprd/  

Contact: Dr. Sally Catt

Address: Course Coordinator
27-31 Wright Street
Clayton VIC
Australia
3168

Phone: Contact +61 3 95947360 

Fax: Contact + 61 3 95947114