IVF News

A Tunisian woman in her 30s who earlier this month claimed to be pregnant with 12 babies, has been exposed by the country's health ministry as a fraud. The woman, from the town of Gafsa told hospital workers that she was expecting six boys and six girls.

‘Our staff interviewed her at length, but her pregnancy appears to be in her imagination', said a spokesman in Tunis. ‘She's claiming to be nine months pregnant...but there's absolutely nothing about her appearance which indicates this. The woman has point blank refused to undergo a medical examination. She's gone into hiding'. 

Australia’s Labor government is heading for a showdown with other members of the federal coalition, the Opposition, the Greens and some independent senators over proposals to cap reimbursements under the Medicare scheme. The cap will cover services such as obstetrics and the provision of IVF, where the Government says doctors are charging excessive fees. However, the Coalition, which maintains a Senate majority, is threatening to delay the Bill on the grounds that it will deny access to treatment to those on lower incomes and that the fiscal details have not been thought through. 

Federal Health Minister Nicola Roxon says the Health Insurance Amendment (Extended Medicare Safety Net) Bill 2009 will save millions of dollars over the next few years which can be then used to fund a much awaited electronic health scheme. She insists it will not have a negative impact on patients and will provide an incentive to doctors to lower their prices for fertility treatment. 'It is in the hands of those specialists who can still make very, very good incomes to make a decision whether they want patients to pay for this, or whether they are prepared to moderate their fees,' she said. 'The changes to the extended Medicare safety net measure have been designed to cap doctors' fees where there is clear evidence they are excessive.'

Peter Dutton, health spokesman for the Opposition, said the Government must produce further details of the proposal before the measure is voted upon. 'If the government can stand by its guarantee that patients won't be worse off under these changes, then release the detail and we can have a proper chat about it,' he said. The Opposition has been attacked by Labor for reneging on a promise to back the proposals. 'The opposition has today indicated they are backing away from this commitment and in doing so they have displayed complete disregard for fiscal responsibility,' said Roxon. 

The IVF Medical Directors group and the Australian Medical Association have also criticised the proposal for a lack of detail, while the latter said the Government has failed to account for rising costs in the sector which will prevent doctors from reducing their fees. Independent Senator Nick Xenophon said the Government will create a situation whereby people on lower incomes will not be able to afford fertility treatment. 'We'll have a situation where there's IVF for the rich and infertility for everyone else,' he said. 'That's why it's very important, particularly in relation to the IVF changes, that they not go through,' he added. 

The Bill is currently being debated in the Senate.

 CRi Oosight™ Imaging System a Key to Breakthrough Gene Replacement Method 

With Potential To Prevent Inherited Mitochondrial Diseases 

-Study Reported in Nature- 

August 27, 2009, Woburn, MA— U.S. researchers using CRi’s Oosight™ imaging 

system have developed a gene transfer technique that has potential to prevent inherited 

diseases passed on from mothers to their children through mutated DNA in cell 

mitochondria. The research, which demonstrated the technique in rhesus monkeys, 

appears in the Aug. 26 issue of the journal Nature. 

The group, headed by Dr. Shoukhrat Mitalipov of the Oregon National Primate Research 

Center and the Oregon Stem Cell Center, extracted the nuclear DNA from the mother’s 

egg, guided by the Oosight system, and transplanted it into another egg that had the 

nucleus removed. The technique allowed the mother to pass along her nuclear genetic 

material to her offspring without her mitochondrial DNA. The eggs were fertilized and 

transplanted into surrogate mothers, resulting in the birth of four apparently healthy 

monkeys. Defects in DNA of mitochondria, the cell’s “power plants,” are associated with 

a wide range of human diseases. 

The Oosight system solved a key problem in avoiding damage to the nuclear DNA during 

the transfer procedure by providing a non-invasive imaging technique for visualizing the 

genetic material. Traditional visualization methods employ a stain or involve exposure to 

ultraviolet light, either of which can damage DNA.  The Oregon team had used the 

Oosight system in previous research, published in Nature in 2007, that provided a 

foundation for the current study. In that research, they cloned rhesus monkey embryos 

and used them to create embryonic stem cells.  

The Oosight system uses polarized light to generate high-contrast, real-time images of 

biological features such as the spindle apparatus housing the chromosomes and other 

filamentous structures within the egg, such as the multi-layer zona pellucida, without the 

addition of toxic stains or labels, while simultaneously generating useful quantitative data 

of their structural composition. Two of the four offspring, Spindler and Spindy, were 

named after the spindle, which is what the Oosight system is used to visualize. 

“This study underscores the potential of the Oosight system to advance reproductive 

medicine and highlights the enabling capabilities or our polarized light technology,”  

 said George Abe, president and CEO of CRi.   

"With this advance, the Oosight imaging system, which is already widely used in fertility 

clinics, has offered new insights and possibilities into reproductive health and medicine," 

said Gary Borisy, director and CEO of the Marine Biological Laboratory (MBL) in 

Woods Hole, MA. The Oosight system is based on imaging technology originally 

developed by MBL scientists Rudolf Oldenbourg and Michael Shribek, working in 

collaboration with David Keefe, M.D., of the University of South Florida College of 

Medicine. 

In In Vitro Fertilization (IVF) the Oosight system is used as an aid to intracytosplasmic 

sperm injection (ICSI). The system not only provides assurance that the genetic material 

is not damaged by the injection needle, but it can also be used as a measurement tool to 

assess egg viability in both fresh and frozen eggs. Data show that an egg with a weak or 

malformed spindle and inner layer zona as measured with the system is much less likely 

to result in pregnancy. 

Other scientists have welcomed news of the advance. Mitochondria-expert Douglas 

Wallace of the University of California, Irvine, said “results were exciting” and the 

technique is “potentially very interesting.” Although he did caution that “there are safety 

issues that are going to need to be addressed before one could think about it in humans.” 

The Nature article reported that 15 embryos were transplanted into nine surrogate 

mothers; three became pregnant, one with twins, and four offspring were born (only three 

of these offspring have been reported in the Nature paper) The success rate is similar to 

that of conventional in vitro fertilization.  

A sample movie of the enucleation process that Dr. Mitalipov used is available at 

http://www.cri-inc.com/multimedia/Oosight_SCNT_Enucleation_Rhesus_Monkey.avi, 

(movie courtesy Dr. Mitalipov, OHSU). 

Contact CRi at [email protected] for more details. 

-- 

Cambridge Research & Instrumentation, Inc. (CRi) is a leader in biomedical imaging, 

and is dedicated to providing comprehensive solutions that analyze disease-specific 

information from biological and clinical samples in the combined physiological, 

morphological, and biochemical context of intact tissues and organisms for a variety of 

applications. With over 80 patents pending and issued, CRi’s award-winning innovations 

are being utilized around the world to enable our customers to perform leading research 

and provide better healthcare. 

For more information contact: 

Cathy Boutin 

Marketing Manager 

Cambridge Research & Instrumentation, Inc. (CRi) 

Tel. 781-935-9099 x180 

Email: [email protected] 

Leading fertility and adoption experts have called upon the Canadian government to fund three cycles of IVF for women under 42 in the state of Ontario. The Ontario Expert Panel on Fertility and Adoption, which released its report last week, recommended the province should fund IVF as well as including proposals to reform the adoption system.

The report acknowledged that cost was the major obstacle for those seeking treatment with one cycle costing around $10,000. ‘These recommendations will go a long way toward helping couples face infertility issues - their implementation will make both infertility treatment and adoption more accessible and affordable,' said Beverly Hanck, Executive Director of the Infertility Awareness Association of Canada. Supporters said it was only ‘equitable' to fund fertility treatment as with other medical interventions. ‘What we're advocating is that when your doctor prescribes it, because it is medically necessary, that it should be paid for equitably, not for some and not others,' said Mr. Attaran, professor of law and medicine at the University of Ottawa.

The report also recommended that IVF clinics should be accredited and as part of this be obliged to reduce the multiple birth rate to 15 per cent in five years time and ten per cent within ten years. The multiple birth rate following IVF was 27.5 per cent in 2006. Multiple births pose a risk of health to the mother and baby and the authors of the report said that the high cost of IVF was putting pressure on patients to opt for multiple embryo transfer in the belief this would increase the chances of pregnancy.

In addition, the report estimated that the province could save between $400 to $500 million over the course of the next ten years by reducing the frequency of multiple births. ‘Over a period of years, the savings from those multiple birth incidents would more than cover the cost of public funding of three cycles of IVF,' said the chairman of the panel and president of the University of Waterloo, David Johnston.

A similar postcode lottery in access to IVF treatment exists in the UK, where a report published last month showed that 8 out 10 Primary Care Trusts are failing to provide couples with the full three cycles of IVF treatment recommended by the National Institute for Health and Clinical Excellence (NICE).

A year ago the British Fertility Society (BFS) and the Association of Clinical Embryologists (ACE) introduced new guidelines advising all UK clinics to adopt a single embryo transfer (SET) policy for all women under 37. The move is aimed at reducing the number of risky multiple births amongst IVF patients in the UK.

Atlanta, GA - Data released today at the American Society for Reproductive Medicine Annual Meeting in Atlanta compares ART trends in the US with those around the world. Using data collected through the International Committee Monitoring ART (ICMART), investigators examined data from 2000- 2004. They found that delivery rates in the US were stable at 31% while they improved in Europe from 16% to 22%.

The delivery rate was maintained in the US even as the number of embryos transferred declined from 3.0 to 2.7 embryos per transfer, and the US triplet rate was cut in half from 4.3% to 2.6%. Only Sweden saw a marked reduction in its twin rate over the period, going from 21.8% to only 5.6%. 

The same investigators used 2004 data to examine how economic factors influence the risk and benefit calculations of patients and physicians. They found that in countries where government provides free access to ART treatment, the utilization rate for those treatments is much higher. For example, in France there were 2,008 cycles for every million inhabitants, while in the US there were only 357 cycles per million people. Improved access not only raises the utilization rate, but changes outcomes, as well. The number of embryos transferred per cycle and the resulting high order multiple births are highest in those countries that do not provide free access.

This relationship was seen within countries, as well. In the USA, individual states with mandatory insurance coverage for IVF treatments saw different results than states without such a mandate. Researchers at the Yale University School of Medicine found that the number of embryos transferred per cycle, cancellation rate, twin rate and multiple live birth rate were all higher in mandated states than in non-mandated ones.

“These studies make it clear that policies that promote access to infertility treatment also promote making those treatments safer and more effective,” stated Elizabeth Ginsburg, MD, President of the Society for Assisted Reproductive Technology (SART).

A study conducted by researchers at the Harvard Medical School, US, has suggested that consumption of alcohol may be detrimental to chances of success in IVF (in vitro fertilisation) treatment. Consumption of just six units of alcohol a week by both partners reduced the probability of conception by 26 per cent. The study particularly singled out apparent detrimental effects to drinking white wine in women and drinking beer for the male partners. In those women whose partner drank beer daily, a 30 per cent decrease in the chance of having a baby was identified.

The study, presented at the annual conference of the American Society for Assisted Reproduction (ASRM) in Atlanta this week, questioned 574 couples who underwent more than 5,300 cycles of IVF. Of these, half of the women questioned drank less than one alcoholic drink a week. The leader of the study, Dr Brooke Rossi, said of the findings that 'there are many factors why IVF fails and most of these patients have no control over. But how much they drink is something that they can change.'

The President of the UK's Royal College of Physicians, Professor Ian Gilmore, who is also Chair of the Alcohol Health Alliance, commented on the study: 'Emerging results from this large cohort of couples undergoing IVF underline the pervasive dangers of alcohol in relation to conception and pregnancy. They lend weight to the importance of giving clear and unambiguous advice to women who are pregnant, or hoping to become so, that they should avoid drinking alcohol. If there are difficulties in achieving conception this advice should apply to their partners as well.'

The finding provides further evidence that drinking alcohol may make it harder to conceive for couples even without a specific fertility issue. As Tony Rutherford, President of the British Fertility Society, told the press: 'For any lifestyle factor that affects IVF, it would be unusual for it not to also have an impact on couples trying naturally for a baby.' He added that 'these findings probably reinforce 'good practice' advice to drink no more than one or two drinks a week if you are worried about having a healthy baby. But it may be that if you are trying for a baby with IVF and want to maximise your chances of success, you may want to 'play safe' and not drink at all.' It appears from this study that this advice may apply to both partners.

Transferring only one embryo during IVF (in vitro fertilisation) treatment significantly reduces the risk of multiple births without considerably altering a woman's chances of conceiving and having a baby, report Swedish researchers.

In a study published in the New England Journal of Medicine, comparing single with double embryo transfer, 53 per cent of the women who had a single embryo implanted had a live baby, compared with 57 per cent of women who were implanted with two embryos.

The study involved 660 women, 330 of whom were implanted with a single fresh embryo. If that treatment cycle failed, a second embryo was implanted which had been frozen then thawed before use. The remaining 330 women were implanted with two fresh embryos.

Dr William Gibbons, the president of the American Society for Reproductive Medicine, said that these findings 'should provide comfort for those who want to perform single-embryo transfers that the pregnancy rates are equivalent'.

The study also showed that the rate of multiple births among women first implanted with a single fresh embryo was significantly lower, at just 2.3 per cent. Of the women implanted with two fresh embryos, 27.5 per cent gave birth to more than one baby.

IVF treatment has routinely involved the implantation of multiple embryos in order to increase a woman's chances of having a child, but as IVF procedures have become more advanced, doctors have been able to implant fewer embryos, with equally successful results. However, multiple births are a common result, and incur health risks for both the mother and baby. Gestational diabetes, bleeding and pre-eclampsia, are all a risk for the mother, and the baby is at increased risk of cerebral palsy, birth defects and developmental delays.

The costs of IVF often prohibit more people choosing single embryo transfer, particularly in countries such as the US where treatment is not covered by national healthcare providers or insurance.

Moreover, 'the stress and disappointment of a failed cycle is hard to put a value on' says Dr Laurel Stadtmauer, an associate professor of obstetrics and gynecology at the Jones Institute for Reproductive Medicine in Norfolk, Virginia, US. 'This research adds further evidence confirming the value of elective single embryo transfer in assisted reproductive technologies,' said Richard Kennedy, a spokesman for the International Federation of Fertility Services.

The World Health Organisation (WHO), in conjuntion with the International Committee for Monitoring Assisted Reproductive Technologies (ICMART), has formally recognised infertility as a disease in its new international glossary of Assistive Reproductive Technologies (ART) terminology. The jointly-prepared glossary appeared simultaneously in journals Fertility and Sterility and Human Reproduction.

According to the glossary, infertility is 'a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse'.

The move was described as 'a significant milestone for the condition' by the American Society of Reproductive Medicine (ASRM). 'We applaud the WHO for leading this important effort and for being so clear about the disease status of infertility', said Dr William Gibbons, ASRM President. He added: 'For too long those suffering from infertility have had their condition slighted or even ignored. Insurance companies don't pay to treat it, governments don't put adequate resources to study it and consequently patients suffer. We hope that this international recognition that infertility is, in fact, a disease will allow it to be treated like other diseases'.

The Supreme Court of the Republic of Ireland has ruled that a woman may not use her frozen embryos after her estranged husband, whose sperm was used to create them, refused consent. Mary Roche, 43, and her husband Thomas had one child in 1997. They then turned to IVF (in vitro fertilisation) treatment at the SIMS Fertility Clinic in Rathgar, Dublin, which produced six embryos. Three of the embryos were implanted, resulting in the birth of one child. The other three were kept frozen, but the couple separated not long after.

Mrs Roche began legal action to gain access to the other embryos. In 2006, the High Court stated the embryos were not protected by the Republic's Constitution. In December 2009, the five judges of the Supreme Court unanimously dismissed Mrs Roche's appeal. They stated that Article 40.3.3 of the Irish Constitution, derived from the 1983 referendum on the Anti Abortion Amendment, was put in place to prevent decriminilisation of abortion without the consent of the people as a whole. It protected the rights of the unborn child and of the mother in equal measure, but these rights did not extend to preimplanted embryos. The forms filled in by the couple at the clinic merely expressed consent to the medical procedures, but were not a binding contract that the embryos must be used.

Mrs Justice Denham stated that 'the question raised is whether the term 'unborn' in the Constitution includes the three frozen embryos in issue in this case', adding: 'This is not an arena for attempting to define 'life', 'the beginning of life', 'the timing of ensoulment'... or any other imponderable relating to the concept of life.'

The judges stated that the issue of when life begins was a matter for the Oireachtas (the Irish legislative body) and not the courts. They also said it was disturbing that four years after the Report of the Commission On Assisted Reproduction, there was no legislation put in place to regulate these issues. As a result of these criticisms, Health Minister Mary Harney has promised that her department will begin drawing up new legislation to begin addressing these matters.

Researchers in Switzerland have unravelled part of the mystery of dormant endogenous retroviruses (ERVs) found in our DNA (deoxyribonucleic acid) which, if woken, 'multiply, induce innumerable mutations' and kill embryos at an early stage of development, as reported by the publication Scientific Computing.

Previous research has revealed the existence of these 'viral squatters', however, how the body silences them to prevent the adverse consequences of their presence has been little understood until the current study. 'These data indicate that KAP1 has a crucial role in controlling ERVs during early embryonic development,' write Didier Trono and his team from Ecole Polytechnique Federale de Lausanne, in the journal Nature.

The team analysed early mouse embryos and embryonic stem cells, and found a master regulatory protein called KAP1 which 'can trigger permanent gene silencing during embryogenesis,' the researchers explain. When they removed the gene, the damaging mutations caused by increasing activity in the ERV receptors increased by more than 500 times, which caused the cells and embryos to die.

In mutating their host's DNA, these ERVs have the power to alter genes. However, over time, the human body has evolved to silence their effects. Trono notes that 'in our genome, we find traces of the last two major waves [of evolution]. The first took place 100 million years ago at the time when mammals started to develop, and the second about 50 million years ago, just before the first anthropoid primates.'

It has been suggested that the approach could be used as a potential target against AIDS. Where the AIDS virus lies dormant in infected red blood cells, if these ERVs were 'woken', they may be more susceptible to therapy. 'The work presented here opens new perspectives to explore ERV-mediated control of cellular genes in development and in adult tissues,' Trono and his team conclude.