IVF News

Anti-depressants may be linked to male infertility, say researchers at the Cornell Medical Center in New York. Results of a study reported in the New Scientist this week reveal that males taking anti-depressants - also known as selective serotonin reuptake inhibiters (SSRIs) - could be damaging their sperm. The study was performed by Peter Schlegel and Cigdem Tanrikut on 35 health male participants who were given paroxetine, which is marketed as Paxil or Seroxat by GlaxoSmithKline. After four weeks of taking the medication, it was found on average the proportion of sperm that became fragmented (damaged) nearly doubled, rising from 13.8 percent to 30.3 percent.

Sperm damage has been linked to male infertility and it is believed may also contribute to a decrease in embryo viability, although in itself the results do not mean males taking SSRIs will encounter fertility problems. In an abstract of the study made available to Reuters, the authors said: 'The fertility potential of a substantial proportion of men on paroxetine may be adversely affected by these changes in sperm DNA integrity.' In 2006, nearly two million prescriptions for peroxetine were issued.

Doctors have warned that the study should not prevent individuals with depression from seeking or stopping medical intervention. 'Patients shouldn't stop their antidepressants, but those who are depressed and experiencing fertility difficulties may wish to discuss this with their GP,' said Steve Field, chairman of the UK's Royal College of General Practitioners. Other experts have questioned the significance of the findings because, although they may seem alarming, the clinical significance may be low. Dr Allan Pacey, Senior Lecturer in Andrology at the University of Sheffield, said that further research is needed. 'It is a shame that the authors appear not to have conducted a randomised controlled trial which would be the most scientific way to investigate the drugs' effects, but I agree that the results are of concern and need to be investigated further,' he said. 

Glaxo told Reuters that it was reviewing its own findings on the drugs, as the study was not mandated by the company. A Glaxo spokeswoman said: 'These medicines remain an important option, in addition to counselling and lifestyle changes, for treatment of depression and this study should not be used to cause unnecessary concern for patients.' Other medical experts have highlighted that risks are in inherent part of taking medication. '[Anti-depressants] are powerful drugs, so in a sense it is no surprise that research is discovering more about their impact on the body,' said Dr Andrew McCulloch, of the Mental Health Foundation. 

The research will be presented in full at the annual conference of the American Society for Reproductive Medicine in November.

New laws to regulate assisted reproductive technology in India will be introduced to Parliament later this year. The text of the Assisted Reproductive Technology (Regulation) Bill 2008 was published last week by the Indian Council of Medical Research (ICMR) for public comment. The bill aims to regulate surrogacy arrangements in the country where regulation is lacking, in addition to other technologies including pre-implantation genetic diagnosis (PGD) and research on embryos. 

The bill will set up a National Advisory Board for Assisted Reproductive Technology to oversee the delivery of the services in the country. A regulatory body, the Registration Authority, will grant licences to fertility clinics to store gametes and offer fertility services. Embryo research must be performed on embryos donated for research and not stored beyond 14 days. Researchers must apply for a licence from the Registration Authority to perform research on embryos. The bill will also make it a criminal offence to perform sex-selection procedures except to prevent or treat a sex-linked disorder or disease. 

Media reports last August about a baby girl, Manyi Yamada, showed inadequacies in India's regulation of surrogacy, which was legalised in 2002. Manyi was born to an Indian surrogate mother, but the Japanese couple who arranged the surrogacy split up prior to the birth of the child. The child's biological father sought parental rights over the child but Indian laws were not clear on the status of foreign parents involved in surrogacy arrangements within its borders and the matter had to be decided in the courts. The new bill will clarify this area by making a surrogate child the legitimate child of a separated or divorced couple. Foreigners seeking surrogacy arrangements in the country will be required to register with their embassy and will have to state with whom the child should be looked after in the event of one of the parent's death. 

Following surrogacy, the child's birth certificate will show the names of both genetic parents. The bill also forbids women under 21 from entering into surrogacy arrangements and from having more than three live births in their lifetime. Once a surrogate child attains the age of 18, they may apply for information about their surrogate parent. 

India's Health Ministry does not keep official statistics on the number of surrogate births in the country but it is believed to be low. Media reports suggest that surrogacy arrangements in India can attract surrogate fees of between $12,000 to $30,000, with the industry being worth around $445m. The bill does not ban offering surrogate mothers compensation for their services.

Dr P M Bhargava, a member of the ICMR who helped draft the bill, told the Times of India that, 'considering all the news about surrogacy, including the recent case of the Japanese child, we realised that the new law addresses all the problem areas'.

The bill is timetabled to be debated by the Indian Parliament in the winter session.

The UK's High Court has ruled that it may have been unlawful for a widow to have removed her dead husband's sperm. Despite UK law requiring valid written consent for the storage and use of sperm, the 42-year-old widow obtained emergency Court permission to have sperm collected from her 31-year-old husband's body hours after he unexpectedly died from complications with a routine operation to remove his appendix in June 2007. She now seeks authorisation to undergo IVF abroad using his sperm. Giving the judgment, Mr Justice Charles said: 'I am not satisfied it is possible to lawfully remove sperm from a dead person who has not given effective advanced consent'. 

The mother-of-one pleaded that the couple had wanted another child, discussed their desire with family and friends and had sought information regarding IVF together. She explained that they had not thought to have him provide written permission because they had not feared that the minor surgery would be fatal. While the attempt to construct retrospective consent with evidence of his intentions holds little legal weight in light of the clear statutory provisions, her lawyer also argued that disposal of his sperm would contravene her human right to establish a family (protected under article 8 of the European Convention on Human Rights, enshrined in UK law by the Human Rights Act 1998). Because fresh sperm will lose viability over time, the Court authorised the emergency sample collection pending later legal resolution. Upon closer examination at the hearing, Mr Justice Charles questioned the decision. 

The final decision now resides with the Human Fertilisation and Embryology Authority (HFEA), which regulates gamete storage and its use. If permission is denied, then the HFEA decision will likely be legally challenged as was done by Diane Blood in a similar case in 1997. HFEA chair, Lisa Jardine, commented that the organisation sympathises with these 'difficult' situations but 'must operate within the legislation'. 

This case, like the landmark Blood case, may turn on the statutory loophole that provides the HFEA discretionary powers to dispense with the consent requirements for the sperm to be exported - in accordance with an EU citizen's right to receive health treatment in another member state. 

Diane Blood ultimately won a protracted legal battle through the English Courts in 1997 and was able to conceive two sons using her late husband's sperm. The Bloods attempted to start a family but Stephen Blood contracted meningitis and lapsed into a coma - his sperm was collected shortly before he died in 1995. The HFEA refused Mrs Blood authorisation to use the sperm as she did not have written consent from her husband. The High Court upheld the authority's decision because the HFE Act does not provide discretionary powers to waive domestic consent requirements. The Court of Appeal agreed but also decided that the authority could have used a statutory discretion to allow the transport of Blood's sperm to Belgium for treatment.

In Blood's case, Lord Hoffman noted that the sperm's storage was unlawful without the requisite written consent. However, given the unprecedented circumstances, he realised it was necessary for the clinic to store the sperm first and decide the legality later. He commented that he did not foresee the Courts would consider the legality of exporting unlawfully stored sperm again. A decade later, posthumous sperm has unlawfully been stored pending resolution of new legal arguments and Mr Justice Charles has likewise declared the case a 'novelty' in the law. 

Following the Blood case, the Government held a review of the law. The 1998 report concluded that the 'written consent' requirement should remain. Coincidentally, on the same day last week, MPs in the lower house of Victoria, Australia passed a package of reproductive law reforms which included a controversial clause to allow women to conceive using their partner's posthumous gametes provided she has prior written consent.

New figures release last week by the UK's Human Fertilisation and Embryology Authority (HFEA) show that two clinics run by fertility expert Mohammad Taranissi - the Assisted Reproduction and Gynaecology Centre (ARGC) and the Reproductive Genetics Institute (RGI) - are the most successful in the country in terms of 'live birth rates' (the number of babies born compared to the number of IVF cycles carried out). Meanwhile, the High Court has ruled that the BBC must pay half a million pounds towards Mr Taranissi's ongoing libel action over an undercover 'Panorama' documentary programme in which police-assisted HFEA teams unlawfully raided his two clinics.

Out of more than 100 clinics offering IVF in Britain, the ARGC achieved double the national average for live births following IVF or intracytoplasmic sperm injection (ICSI), where the sperm is injected directly into the egg. Figures for 2006, the most up-to-date available, show a live birth rate of 61 percent for the ARGC compared to 31 percent nationally.

The figures were published as the BBC was ordered by the High Court to pay £500,000 to Mr Taranissi after its lawyers took the decision to drop a 15-month-old defence to his claim that the allegations about his techniques, aired in 'Panorama', were not defamatory but part of 'responsible journalism' and thereby made in the public interest. The decision was allegedly taken to avoid revealing the sources for the programme. However, Richard Rampton QC, Mr Taranissi's counsel, accused the BBC of exaggerating the number of sources who contributed to the allegations.

'It's Alice in Wonderland stuff', he told the Times newspaper, adding that 'one of the so-called medical experts was actually an administrative assistant'. He also criticised Panorama for 'misleading' viewers, which the BBC has denied.

The BBC still denies libel. Its QC, Adrienne Page, said the payment of costs should wait until the case had finished. She said: 'All this order can do is create the very real and substantial risk that there will be an injustice to the BBC in the event, which the court must assume is a real possibility, that they succeed in the justification defence'.

The case will be brought to a close in January when Mr Taranissi's claim is due to be tried by a judge sitting without a jury.

A woman in Taiwan has used the frozen sperm of her cancer-survivor husband to conceive and give birth to healthy twins. The woman's husband, surnamed Chen, was diagnosed with testicular cancer whilst studying at university aged 23. He cryogenically preserved samples of his sperm at Taipei's Medical University Hospital sperm bank, before undergoing chemotherapy which would potentially leave him infertile. Chen overcame the cancer but ceased to produce sperm. After getting married earlier this year, 36 year-old Chen and his wife decided they wanted their own child and so asked doctors to assist them using Chen's preserved sperm.

'The birth is a record in Taiwan' said Tseng Chi-jui, head of the Centre for Reproductive Medicine and Sciences at Taipei Medical University's College of Medicine. 'Never before has a case involving such a long period of time between the freezing of male sperm and procreation been reported in Taiwan'. 

Tseng used IVF to extract four eggs to be fertilised with Chen's unfrozen sperm and only two of the four re-implanted successfully into his wife's womb. As sperm tend to lose motility (the number of sperm active or moving) after defrosting, the fertility expert used intracytoplasmic sperm injection (ICSI) technology to ensure precise fertilisation with Mrs Chen's eggs. 

Improvements in cryogenics and assisted reproductive technologies have the potential to assist those with serious illnesses facing treatment which may render them infertile, Tseng said. Sperm cryopreservation enables such patients to 'save' their sperm for future procreation.

Mrs Chen gave birth to healthy twin boys at 37 weeks, one weighing four pounds six ounces, and the other weighing six pounds.

Earlier this year, a UK couple conceived a second baby using sperm frozen 19 years ago at St Mary's Hospital in Manchester. Emmanuel and Zoe Iyoha received IVF treatment using sperm preserved on Mr Iyoha's behalf in 1989, before he underwent successful treatment for cancer. In 2004, doctors at St Mary's hospital reported the birth of baby conceived using sperm that had been frozen for 21 years, believed to be the longest reported storage period for sperm successfully used for treatment.

A new method of assisted conception has been hailed as a safer and equally effective alternative to IVF for certain groups of women undergoing treatment. The Oxford Fertility Centre revealed this week that of the 40 women they treated between February 2007 and March 2008 with in-vitro maturation (IVM), the nine successful cases were all among the 27 women under 35; a success rate of 33 per cent. Conventional IVF has a 31 per cent success rate for this group of women. 

IVM does not require the powerful hormonal drugs used in IVF which stimulate the ovaries to produce mature eggs; instead, immature eggs are removed without the use of drugs and matured in the laboratory before being fertilised. As fewer drugs are used, the cost of IVM would be significantly less than IVF, £1,700 compared with around £4,300.

The IVM process promises to be safer than IVF because it does not risk the potentially fatal ovarian hyperstimulation syndrome (OHSS), a build up of fluid in the lungs and abdomen sometimes triggered by the hormonal drugs involved. This news will be particularly welcome to women with polycystic ovary syndrome (PCOS), which affects 10 to 20 per cent of women, and who are at higher risk of developing OHSS. 

'Unstimulated IVM treatment is a viable alternative to standard IVF for women under 35 years of age who have ovaries of a polycystic morphology', said Dr Tim Child, of the Oxford Fertility Centre, who presented the research at the American Society of Reproductive Medicine conference in San Francisco. 'IVM avoids the potentially fatal complication of OHSS in this at-risk patient group.' Dr Child attributed the significant improvement in success rates for IVM to better laboratory procedures and patient selection. 'I'm not sure we will ever get better than IVF but the aim is to achieve the same success rate', he said.

Another patient group who may benefit from IVM is cancer patients due to undergo chemotherapy. Tumours can be worsened by the hormonal drugs used in IVF, whereas the removal and storage of immature eggs in the IVM process would not adversely affect cancer patients and enable them to use their stored eggs once in remission.

Geeta Nargund from St George's Hospital in South London said that the technique is not appropriate for older women since fewer eggs remain in their ovaries. Many eggs fail to mature in the laboratory and so a higher number of eggs are needed to begin with.

One year ago we presented an IVF ethics questionnaire. The purpose of the questionnaire was to determine current opinion of many of the issues surrounding IVF and associated technology. Within 6 weeks we had over 600 responses from people in the field of IVF, patients and members of the general public from all around the world. Results from the questionnaire have been presented in major international conferences in the US (ASRM) and Europe (ESHRE). Results have also been featured in the New Scientist

We now have results of the questionnaire online.
They can be seen at http://ivf.net/survey/stats.php?sid=2

We welcome your comments below.

Please do not reproduce results or analysis of results without permission.

ASRM
http://www.asrm.org/Professionals/Meetings/sanfrancisco2008/Abstracts2008.pdf

O-181
‘WHEN DOES LIFE BEGIN?’ RESULTS OF AN ONLINE SURVEY.
T. A. Elliott, J. A. Friedman, E. T. Siegel, H. I. Kort, Z. P. Nagy.
IVF Laboratory, Reproductive Biology Associates, Atlanta, GA.

P-828
QUALITY OF LIFE AND WELFARE OF THE CHILD: RESULTS OF
AN ONLINE SURVEY. E. T. Siegel, T. Elliott, J. A. Friedman, D. L. Keenan, Z. P. Nagy.
Reproductive Biology Associates, Atlanta, GA

P-828
QUALITY OF LIFE AND WELFARE OF THE CHILD: RESULTS OF
AN ONLINE SURVEY. E. T. Siegel, T. Elliott, J. A. Friedman, D. L. Keenan, Z. P. Nagy.
Reproductive Biology Associates, Atlanta, GA.

ESHRE
http://posters.webges.com/eshre/e-poster

Opinions of embryonic stem cell use in IVF; results of an online survey
e-Poster: 419
J.A. Friedman, E.T. Siegel, T.H. Taylor, Z.P. Nagy, T.A. Elliott
Reproductive Biology Associates, Atlanta, GA.

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.

Clinical   Fellowship in Andrology and Reproductive Medicine.

Objectives: 

Train postgraduate students to establish and run an efficient, cost effective and ethical reproductive medicine unit.

At the end of the course, candidates will

1.be able to handle reproductive medical problems both in the male and female.

2.have good working knowledge in the field of infertility and reproductive laboratory services

Eligibility:

Postgraduate Degree or Diploma in Obstetrics and Gynecology, General surgery,urology and general medicine.

Duration:

1 year

Mode of Teaching:

Lectures, Power point presentations and interactive sessions

Practical demonstrations

Hands on – wherever applicable

Journal club every month

Frequent examinations conducted throughout the course. MCQ’s, Short notes and Essay type Questions.

The students will not receive any stipend or any other form of financial support from the institution. However they may utilize the existing infrastructure in the department and institution. Fellows enrolled will not be on call in the hospital in any other department.

The fertility clinic and IVF division, AMRI Hospital, Kolkata, India is organising a five day training programme in ICSI, Vitrification and advanced embryo culture technique. The dates of the programme are:

• First Batch   : May 30  -  June 3, 2011

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• Second Batch   : June 6 - June 10, 2011

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• Third Batch   : June 20 - June 24, 2011

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• Fourth Batch   : June 27 - July 1, 2011

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• Fifth Batch   : July 12 - July 16, 2011

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• Sixth Batch   : July 18 - July 22, 2011

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• Seventh Batch   : July 25 - July 29, 2011

Course Details: 

The Candidates will get theoretical and hands-on experience on step-by-step Micromanupulator Setup, ICSI Sperm selection, Sperm Catching, Oocyte injection, Technical Knowhow, Bench-top experience on Oocyte and Embryo Vitrification, Quality checks in IVF lab including online pH monitoring of culture media.

Course Fees: INR 20,000 ($ 500)*

* Limited Time Offer

We will accept only 3 Candidates in each batch....

For further details please contact..

Dr. Alex C Varghese, PhD

Scientific Director

AMRI IVF Division.

97A, Southern Avenue, Kolkata:700029

Cell No: +919748634082

Email : [email protected]

Website : http://www.amrihospital.com/clinic/ivf_centre/index.php

Youtube Video Link: http://www.youtube.com/user/AMRIIVF