IVF NewsNews: Egg Freezing and Ovarian Tissue Cryopreservation are Safe for Offspring and Offer Advantages for Patients
ASRM 17 October 2007
Washington, DC- Freezing eggs or ovarian tissue offers advantages to women undergoing ART who have extra eggs but prefer not to create and freeze extra embryos and to women at risk of losing ovarian function as a consequence of treatment for cancer. Today, at the 63rd Annual Meeting of the American Society for Reproductive Medicine, researchers presented new experimental data on the safety and success of different techniques for oocyte and ovarian tissue cryopreservation.� In a prospective, randomized clinical study, Dr. Gary Daniel Smith and his colleagues found that eggs frozen quickly using the vitrification (V) technique survive freezing and thawing better than eggs frozen using a slow-rate freezing (SR-F) technique. In addition, embryo development and clinical pregnancy rates were better with vitrified eggs than with slow frozen eggs. Couples going through IVF and having more than 9 eggs retrieved were given the opportunity to freeze their extra eggs which were randomly assigned to V or SR-F. If the fresh IVF cycle did not result in a pregnancy, the couples could return to use their cryopreserved eggs for a later attempt at pregnancy. Eggs were frozen in 165 cases; in 63 of these cases, patients chose to use their frozen eggs. Vitrified/warmed eggs survived at a rate of 73% compared with slow frozen/thawed eggs at 66%. Fertilization was accomplished through ICSI. Although the number of embryos transferred between the two groups was similar, clinical pregnancy rates were higher for V eggs versus SR-F eggs (34% vs. 18%). The number of frozen eggs required to establish a clinical pregnancy was 21 vitrified/warmed eggs versus 45 slow-rate frozen/thawed eggs. In order to determine whether egg freezing has any detrimental effects on the babies born from embryos created with frozen eggs, researchers in Bologna, Italy collected data on 105 babies conceived with eggs that had been frozen using a slow-freezing, rapid thawing technique. Of the 149 pregnancies they observed, 89 resulted in the births of 105 babies. Fifty-nine of the deliveries were by cesarean section. Average gestation was normal- 38.9 weeks, and the babies’ average weights were normal– 3.35 kg for singletons and 2.6 kg for twins. Thirty-five of the pregnancies resulted in miscarriage and one pregnancy was aborted because the fetus had a trisomy 21. Twenty-three pregnancies were on-going. Of the 105 babies born, two had malformations; the researchers noted that their fathers had suffered from severe male factor infertility.� Additional reassuring data on the development of children conceived with frozen eggs comes from Dr. Ilan Tur-Kaspa and his colleagues in Chicago. Their retrospective study surveyed the literature on oocyte cryopreservation and found 272 clinical pregnancies from embryos created with frozen eggs up to July 2006. The results of genetic testing were, for the most part, normal with 93.8% normal results for eggs that had PGD of the second polar body and karyotyping after fertilization. The 272 clinical pregnancies resulted in 51 miscarriages, 2 tubal pregnancies, 156 deliveries of 197 babies and 63 ongoing pregnancies. Health status at birth was reported for 69.5% of the babies and of those, 99.3% were healthy. Follow-ups at six months to three years were reported for 31% of the children and all continue to develop normally. Only one twin was born with a congenital anomaly. Ovarian cryopreservation has been used for a decade at the Weill Medical College of Cornell University to preserve the possibility of fertility for women being treated for many different cancers. To obtain a perspective on the long-term storage and use of banked ovarian tissue, 55 who had undergone ovarian tissue cryopreservation between May 1997 and March 2007 were surveyed by telephone. Fifty women responded. The patients were treated for a variety of different conditions and were an average of 28 years old when their ovarian tissue was frozen. The patients ranged in age from 4 to 44 (average = 28 years old) at the time of ovarian tissue cryopreservation and were treated for a variety of different conditions. All of them had at least one ovary removed and 73% stopped menstruating regularly after their treatment. At the time of the survey, the average time their tissue was in storage was four years and only three had undergone transplantation. Of the three, one had her tissue transplanted back to the location of her ovary and two had their tissue transplanted elsewhere- one of these two failed to become pregnant after an embryo transfer; the other became pregnant twice spontaneously, losing one pregnancy and then giving birth to a healthy child.�
“These data will be reassuring to patients who need to freeze eggs or ovarian tissue to preserve their fertility,” Steven J. Ory, MD, President of the American Society for Reproductive Medicine remarked. “Although more frozen eggs are required to establish a pregnancy than fresh eggs, frozen eggs that fertilize, develop into viable embryos and implant are as likely to result in healthy children as fresh eggs.”
[ Full Article ] News: Restrictive fertility law forces Italian patients abroad
Dr Jess Buxton 12 December 2006
Thousands of Italians are being forced to travel abroad for assisted reproduction or preimplantation genetic diagnosis (PGD) treatment, because of Italy's highly restrictive legislation. The results of a new survey carried out by the Reproductive Tourism Observatory show that the number of couples travelling to other countries for such procedures has increased four-fold since the law was passed three years ago. The ban on PGD - testing embryos to identify those free from serious genetic disorders - was challenged unsuccessfully in a court case held earlier this year.
Italy's new law, said to be the most restrictive in Europe, was passed in December 2003 to counter the country's reputation for being the 'Wild West' of fertility treatments. The law restricts the provision of fertility treatments to 'stable heterosexual couples' who live together and are of childbearing age, and who are shown to be clinically infertile. Research using human embryos is prohibited, as is embryo freezing, gamete donation, surrogacy, and the provision of any fertility treatments for single women or same-sex couples. The law also says that no more than three eggs can be fertilised at any one time, and that any eggs fertilised must all be transferred to the uterus simultaneously. Italians are also banned from using PGD for any purpose.
The new survey, which gathered data from 27 centres in nine European countries and the US, compared the number of Italian couples who used the centres before and after the law came into effect. It revealed that the number of Italians seeking treatment rose from 1066 in 2003 to 4173 in 2005, with Spain the most popular destination. Data from seven Spanish clinics showed that the number of Italian couples they treated had jumped from 60 to 1365 - representing between 10-50 per cent of their patients. Other popular countries for treatment were Belgium and Switzerland, particularly the Italian-speaking canton of Ticino. The Reproductive Tourism Observatory was set up by Cecos, an association of private Italian fertility clinics. Its chairman, gynaecologist Andrea Borini, said that the law had also affected the outcomes of fertility treatment carried out in Italy: 'Compared with years before the new law, the number of cycles of treatment remained stable in 2005, as did success rates, except in women aged older than 40 years [in whom it fell], because of the limit of three fertilisable oocytes', he told the British Medical Journal (BMJ). 'On the other hand, among younger women we recorded an increase of multiple pregnancies, which have risen from 16 to 21 per cent of the total, while triplets have increased from 1.8 to 4.3 per cent, since the law insists that all fertilised embryos must be implanted in the womb', he added. Last month, the Italian Constitutional Court turned down an appeal from a couple at high risk of having a child with thalassaemia, who wanted to use PGD to ensure they did not implant an embryo affected by the genetic blood disorder. Gynaecologist Giovanni Monni told the BMJ that the woman being treated was 'so shocked about the law' that she didn't agree to have the embryo implanted without knowing whether it was affected by thalassaemia. 'She had already had two abortions in the past, after positive results for thalassaemia from chorionic villus sampling', he said.
In court, the couple argued that the law put womens' health in danger, because without PGD they are often exposed to the mental stress of prenatal diagnosis and abortion. After losing their case, the couple now plan to travel abroad to restart their treatment. The law does not set a penalty for women who refuse to have their embryos implanted - under these circumstances, doctors are allowed to freeze embryos for potential use in the treatment of another infertile couple. 'Sadly, the ban of preimplantation testing is favouring procreative tourism among the wealthiest and abortions among the poorest couples', Dr Monni said.
[ Full Article ] News: Europe struggles to meet the legal, ethical and regulatory challenges posed by more patients travelling abroad for PGD
Press releases ESHRE 2007 05 July 2007
Lyon, France: A new study has shown that increasing numbers of couples are travelling abroad for preimplantation genetic diagnosis (PGD), and that the main reason for this cross-border movement is the legal position in patients’ countries of origin.
Mr James Lawford Davies, a solicitor specialising in reproductive and genetic technologies, told the 23rd annual meeting of the European Society of Human Reproduction and Embryology today (Monday 2 July) that the main reason couples travelled to other countries was because PGD was banned in their own. However, this led to concerns over how referrals were made, whether or not the referral itself might be unlawful, and the quality (or even the existence) of counselling, medical advice, support, monitoring and follow-up for families and their children. Other reasons for travelling abroad included the quality of the treatment, test availability, expertise in certain diseases, cost and length of waiting lists in their home countries. This is the first EU-wide study of provision and regulation of PGD, a technique for testing embryos fertilised in the laboratory for specific genetic or sex-linked disorders such as cystic fibrosis or Duchenne muscular dystrophy. Only unaffected embryos are transferred to the woman’s uterus, thus avoiding the possible need for a pregnancy termination when the defect is picked up at a later stage. The study [1] was launched by the European Commission after a workshop organised jointly by the Institute for Prospective Technological Studies (IPTS) of the European Commission's Joint Research Centre (JRC), ESHRE and the European Society of Human Genetics (ESHG) revealed that little was know about the extent to which couples crossed national boundaries to gain access to treatment and what different regulatory frameworks for PGD existed in Member States. Mr Lawford Davies, who lectures in law and medicine at the Institute for Human Genetics at Newcastle University and is a visiting research fellow at Durham University Law School, UK, is a co-author of the report and he focused on the legal, ethical and regulatory aspects of the research in his presentation to the ESHRE conference. “Reproductive and genetic technologies are regulated in a wide variety of ways across Europe,” he said. “The free movement of people and goods around the EU is a welcome development, but there are disadvantages to such cross-border flow in relation to PGD where such treatment is prohibited in the family’s country of origin. “The evidence provided in this study suggests that doctors in Ireland, Switzerland and Germany – where PGD is prohibited – are concerned about providing information to patients about suitable PGD clinics in other countries. Formal referral is said to be prohibited in Germany and at least one Swiss clinic feared that even informing patients about PGD might be illegal. In Ireland, doctors’ fears about potential prosecution has led to a peculiar ‘inverted referral’ process whereby patients must contact PGD clinics in other countries themselves and these clinics then approach the Irish clinic for the relevant patient information. In situations where patients are left to identify clinics themselves, they are deprived of the benefit of medical advice, counselling and support at a vulnerable time. more/ “Secondly, the prohibition of PGD in their own country may complicate monitoring and follow-up. Self-referred patients, who may have identified clinics via the Internet or other means, may go unnoticed and clinics in their home countries could be reluctant to get involved in following up families and children born as a result of prohibited treatment. The evidence indicates some clinics are not deterred, whilst others do not see it as their responsibility. “Our research also revealed an apparent inconsistency in countries such as Germany, Switzerland and Ireland where, on one hand PGD is prohibited, but on the other hand, prenatal testing and pregnancy termination for serious genetic disorders is permitted – although the latter is not allowed in Ireland.” The report’s authors sent an on-line questionnaire to PGD and IVF clinics in Europe, and then conducted a more in-depth analysis of PGD practice and provision in 11 countries, which had been chosen to include countries with different approaches to regulation: Belgium, Czech Republic, France, Germany, Greece, Ireland, The Netherlands, Slovak Republic, Spain, Switzerland and the UK. The survey identified 53 centres offering PGD, most of them located in Spain, Belgium, The Czech Republic, Greece and the UK. Seventeen centres confirmed that they received tissue samples and 36 treated patients from abroad. The countries that received the most numbers of couples from elsewhere were Spain (332), Belgium (127), the Czech Republic (110), and Cyprus (150). Mr Lawford Davies said that the survey highlighted other areas of concern:
He said: “The rights and interests of patients seeking and receiving PGD in Europe are protected to a varied degree, but current policies by some Member States create a barrier to treatment which forces patients to travel abroad in circumstances which may compromise their interests. It is for individual Member States to decide how best to approach this problem, but options that they could consider could include harmonisation of regulation across Europe, or regulating rather than prohibiting PGD.” [ Full Article ] Announcement: IVF WITNESS ELIMINATES RISK OF MIX-UPS
W.R.Brown MBA 08 February 2008
A groundbreaking new device has been launched worldwide that takes the IVF process to a much higher level of safety. In a move that will reassure patients everywhere, a rapidly growing number of clinics in the UK, the US and elsewhere are adopting IVF Witness – a system which is revolutionising the IVF process by eliminating the possibility of mix ups. Developed by Research Instruments Ltd, IVF Witness uses radio frequency identification tags to track IVF samples through the fertilisation process and sets off an alarm if samples from different parents are brought into the same work area. Exhaustive tests have proved the RFID system to be absolutely safe. Overlake Reproductive Health in Bellevue, Seattle, is the first clinic in America to use IVF Witness. ‘I admit I was sceptical at first but, after using the system for the last four months, I am now a complete convert,’ said Shaun Kelly, Overlake’s Laboratory Director. ‘We still check everything visually because, if anything, the system makes you even more aware of the importance of vigilance. ‘The advantages are two-fold. Firstly, patients feel far more relaxed and confident about the procedure because they have an ID card which puts them in control and secondly embryologists are reassured by having an extra safety net. It tightens up the whole IVF process and makes it far more secure.’ Hull IVF Unit, a UK-based clinic that was recently given a five star rating in the latest ivfworld.com ratings survey, has also started using the new system. ‘We have chosen to install this system for two reasons,’ said Dr John Robinson, Hull IVF Unit’s Scientific Director. ‘Firstly, and most importantly, it greatly reduces the possibility of human error. Secondly, unlike the double witness process, it does not require two members of staff to operate – it allows embryologists to work safely and effectively, without frequent interruptions to witness with other colleagues. ‘In Hull we see about 350 IVF patients each year and the manual system becomes more difficult to manage, and potentially less reliable, the busier it gets. IVF Witness minimises human intervention and the system’s workstation won’t allow the wrong eggs and sperm to be used in the same location: very reassuring for both patients and staff. In effect, it is providing a continual and very robust safety check, independent, and additional to the many checks embryologists have to carry out while working.’ Bill Brown is the Managing Director of Research Instruments, based in the UK, which developed the device. ‘After looking at several possible alternatives, we chose to develop a Radio Frequency Identification (RFID) system because it is far more effective and reliable than anything else on the market,’ he said. ‘RFID continually monitors the whole work area so no transfer can take place between non-matching samples. It makes it impossible for a sample to be transferred to a non-matching patient without an alarm going off.’ For more information, visit www.research-instruments.com [ Full Article ] Announcement: Master of Clinical Embryology (MCE), Monash University Australia is now taking enrollment for 2009
Monash University Australia 20 September 2008
Master of Clinical Embryology (MCE), Monash University Australia is now taking enrollment for 2009 Class and Laboratory skills in clinical embryology and ART Requirements: Course website: http://www.monashinstitute.org/eprd/ Contact: Dr. Sally Catt Address: Course Coordinator Phone: Contact +61 3 95947360 Fax: Contact + 61 3 95947114
[ Full Article ] Article: Should HIV positive people become parents?
Juliet Tizzard 29 March 2003
This week's BioNews reports on a doctor's plea to make sperm washing for HIV positive men available on the National Health Service (NHS). Is it reasonable to ask that health authorities assist individuals or couples to become parents when they have such a serious health status?
Once upon a time, HIV positive people seeking to have a child would have been regarded as crazy. The HIV positive parent would not only have risked transmitting the virus to their child (and perhaps their partner), but the child would also be at risk of losing one of their parents at an early age. However, times have changed. Today, HIV is no longer regarded as an immediate death sentence. The average life expectancy of a person with HIV who has access to anti-retroviral drugs is 20 years. And for HIV-positive women, the risk of transmission to their baby can be as low as one or two percent, provided that certain precautions are taken. Added to these increased options for HIV people is sperm washing, which offers HIV positive men the opportunity of having a genetically related child whilst keeping to a minimum the risk of transmission to his partner and child. With advances in drug therapies for HIV and in medical intervention to minimise the risk of transmission through reproduction, having children may not seem like such a risky strategy for HIV positive adults today. HIV-positive people want to live their lives as normally as possible and, for many, that will include having a family - something that the rest of us can contemplate without too many worries. Unless they are unlucky enough to have difficulty conceiving naturally, HIV positive don't actually need assisted conception treatments to get pregnant. They could leave things to chance and hope that the HIV virus is not transmitted - and no-one would be able to stop them. Thankfully, medical science can help to stack the odds in favour of patients and their prospective children. It seems unfair not to help them do this. [ Full Article ] News: HFEA approves embryo tests for hereditary cancer
Dr Jess Buxton 16 May 2006
The UK's fertility treatment regulator has given the go-ahead for couples to test embryos to avoid passing on hereditary cancer. At its open meeting held on 10 May in Belfast, the Human Fertilisation and Embryology Authority (HFEA) accepted a recommendation from its ethics and law committee to allow licences to be granted for such procedures. People who know they have inherited genetic mutations that would confer a high risk of breast, ovarian or bowel cancer on their children will now be permitted to undergo preimplantation genetic diagnosis (PGD) treatment, to enable them to select IVF embryos that do not have the faulty gene. [ Full Article ] Announcement: NEW HFEA AUTHORITY MEMBERS APPOINTED
HFEA 07 September 2008
The Human Fertilisation and Embryology Authority has today announced the appointment of new Authority members by the Appointments Commission. Most of the new appointments will take effect from 1 September 2008 for a period of three years. Six new members have been appointed to the Authority. They are: Dr Mair Crouch, Ms Jane Dibblin, Ms Gemma Hobcraft, Ms Lillian Neville, Mrs Debbie Barber and Professor Lesley Regan. Biographies of the new appointees are available below. In addition, three current Authority members have been re-appointed for a further term. Ms Clare Brown, Professor Neva Haites and Professor Emily Jackson have been appointed for a further three years. Three members will step down from the Authority this year when their appointments come to an end. Ms Sharmila Nebhrajani will step down on 31 October 2008. Walter Merricks and Dr Maybeth Jamieson will step down on 30 November 2008. "Of course it is always sad to lose members who have served the HFEA as well as Sharmila, Maybeth and Walter have. They leave us knowing that they have made a contribution of the highest calibre and with our warm good wishes for the future." All appointments are made on merit and political activity plays no part in the selection process. However, in accordance with the original Nolan recommendations, there is a requirement for appointees' political activity (if any declared) to be made public. None of the new members has taken part in political activity over the last five years. The appointments have been made in accordance with the Office of the Commissioner for Public Appointments (OCPA) Code of Practice.
The HFEA was set up in August 1991 as part of the Human Fertilisation and Embryology Act 1990. The HFEA's principal tasks are to license and monitor clinics that carry out in vitro fertilisation (IVF), artificial insemination (AI) and human embryo research. The HFEA also regulates the storage of gametes (eggs and sperm) and embryos. [ Full Article ] News: Clinic offers repeat IVF cycle in exchange for lifestyle improvements
Sarah Guy 30 November 2009
A central London fertility clinic is offering an IVF treatment package in return for patients signing up to a health and lifestyle improvement programme, which will require patients to stop smoking, drinking, and lose weight if necessary prior to commencing IVF (in vitro fertilisation) treatment. The treatment package - 'IVF Plus' - offered by Bridge clinic in turn will include all tests, scans and drugs, four months of folic acid supplements, counselling and stress relief, optional acupuncture, and a free second cycle of treatment should the first fail. IVF Plus costs just £4500. Furthermore, this package will include IVF treatment via the ICSI (intracytoplasmic sperm injection) method, where an individual sperm is actually injected into the egg cell, rather than being mixed with the egg in a dish. ICSI is more expensive and is generally only used when the male partner has fertility problems. At present, only patients with a good chance of success are being offered this treatment package. In order to be eligible for IVF Plus patients must be under 36 and of a healthy weight, not have experienced a failed IVF cycle or miscarriage, and both partners must be free of infectious diseases. However, after analysing the results of the first 50 treatments, Bridge clinic intends to revise and extend the programme to include those with a lower chance of success, such as older patients and patients facing other fertility problems The medical director of the Bridge clinic, Dr Mohamed Menabawey, commented that IVF Plus 'is a contract between us and the patient. The technology can go so far but the patient has to play their part.' He added: 'They have to agree to improve their lifestyle, stop smoking, stop drinking and lose weight if they need to and to undergo stress management. It is to make sure they are in the best shape they can be mentally and physically. We are very confident we will see good results.' This approach is encouraged by the Human Fertilisation and Embryology Authority (HFEA), in particular as it outlines the total cost to patients at the beginning of embarking on treatment. The cost of a cycle of IVF treatment can begin at £4000 and exceed £8000 and statistics show that between one in four and one in five cycles are successful. Bridge clinic's initiative in developing this package goes some way to addressing the issue of cost, as well as previous concerns over the lower chances of successful IVF treatment for women who are overweight. [ Full Article ] News: Women with Turner's syndrome using donor eggs carry a higher risk, claims study
Rosie Morley 16 May 2011
New research suggests that pregnancy via egg donation, in women with Turner's syndrome, carries an increased risk for both mother and child. Turner's syndrome is a condition, which affects around one in 2,500 women, where a woman is born with only one X chromosome, instead of the usual two. This can lead to a range of health problems, including short stature and an increased risk of heart disease. Women with this condition are often infertile, but may be able to have children using donor eggs. The study followed the pregnancies of 93 mothers with Turner's syndrome who had undergone egg donation. Thirty-eight percent of the mothers had pregnancy-associated hypertensive, high blood pressure, disorders. These included four women who had severe eclampsia, a potentially life-threatening complication of pregnancy characterised by seizures. In addition, 30 percent of the babies were found to have restricted growth pre-natally. Unfortunately, during the study two of the women died after giving birth, and another woman had a miscarriage following eclampsia. Overall only 40 percent of the pregnancies were defined as 'normal'. Professor Patrick Fénichel from the University of Nice, who led the research, said: 'My group and the French oocyte donation research group will now concentrate on understanding if eclampsia is linked only to Turner’s syndrome or also to egg donation itself'. 'We will also look at ways in which better monitoring during pregnancy, delivery and the immediate post-partum period in an appropriate hospital centre might improve the outcomes of pregnancy in Turner’s mothers'. The research was presented at the European Congress of Endocrinology, which was held in Rotterdam from 30 April to 4 May 2011. [ Full Article ] |