IVF News

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In a controversial documentary for the Discovery Channel aired last week, Dr Panayiotis Zavos, a notorious US fertility doctor, claimed to have successfully created and implanted cloned human embryos with the intention of producing live human clones. Scientists and medical ethicists have unanimously condemned him for his actions, both questioning the truth of his claims and denouncing the performance of any such experiments.

Dr Zavos, who heads fertility clinics in the US and Cyprus, his place of birth, announced that he created 14 human embryos, 11 of which he implanted into four women, although none of these resulted in a viable pregnancy. Human cloning is illegal in the UK and many other countries, and the experiments were reportedly carried out in laboratories in a secret location in the Middle East. Dr Zavos has been widely criticised for using a technique that has been deemed too risky and too poorly understood for use in humans, and for neglecting to consider the moral and ethical implications, or the psychological effects on the potential parents and the cloned child.

Cloning experiments have been successful in many different animal species since the much-publicised birth of the first ever cloned mammal, Dolly the sheep. However, cloned embryos often have genetic defects and frequently result in miscarriages, still births or deformed offspring. The reasons for this are not known. Professor Azim Surani, professor of reproduction and fertility at Cambridge University, UK, said: 'This whole affair shows a complete lack of responsibility. If true, Zavos hasÖfailed to observe the universally accepted ban on human cloning, which was agreed because most of the resulting embryos from such animal experiments are abnormal'.

In addition to the creation and implantation of human clones, Dr Zavos has also announced the successful creation of animal-human hybrid embryos where human nuclear DNA was implanted into cow eggs. The resulting embryos would contain more than 99 per cent human DNA but the DNA in the mitochondria, which are the power-houses of cells, would come from the cow eggs. Dr Zavos stated that he had no intention of implanting such embryos, but created them only in order to study the cloning process. Nonetheless, he openly claimed to have created hybrid embryos using the DNA from a ten-year-old girl who died in a car crash and whose parents had expressed an interest in having a new child cloned.

Dr Zavos' scientific integrity has also been called into question, as none of these experiments have been published in a peer-reviewed scientific journal and so no other scientists have examined his methods or results. Professor Robert Winston, emeritus professor of fertility studies at Imperial College London said: 'I do not know of any credible evidence that suggests Dr Zavos can clone a human being. This seems to be yet another one of his claims to get repeated publicity'.

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New research detailing the UK public's views on IVF and related fertility issues has been published. The research was carried out by YouGov on behalf of the UK charity Progress Educational Trust in October 2006, in the form of two online survey questionnaires, to which a random nationally representative sample of 7,697 GB adults aged above 18 was invited. There were 4,012 respondents.

When asked whether all people have a right to have a child of their own, one third of those surveyed (32 per cent) strongly agreed, with a further 23 per cent agreeing 'a little'. However, there seemed to be no strong opinion among the respondents about whether society should make it easier for people to have children earlier in life. Under a third (28 per cent) of respondents agreed with this statement, 33 per cent gave no opinion and 31 per cent said that they neither agreed nor disagreed, while 37 per cent disagreed with this statement. Nevertheless, two thirds of those surveyed (66 per cent) agreed that modern lifestyles are forcing people to delay starting a family for too long - many were aware that having children at a later age was a common factor in the cause of infertility (76 per cent). However, 69 per cent of respondents said that they felt that women should accept that choosing a career over children may mean they cannot conceive naturally.

Other causes of infertility were thought to be medical conditions and treatments (85 per cent), alcohol and drug misuse (80 per cent) and genetic factors (76 per cent). When asked to pick the single most common factor in infertility, 17 per cent chose medical conditions, 16 per cent chose genetic factors and 14 per cent chose age. The survey also showed that 19 per cent of UK adults believe that one in 20 couples are affected by infertility, and the same percentage thought the figure was one in 10.

When asked about their knowledge of fertility treatments available, 37 per cent said it was 'poor or non-existent', compared to only 22 per cent who said it was 'good or better'. The majority (57 per cent) agreed that modern science should help infertile people to have a child of their own, although 70 per cent said that alternatives to fertility treatment should be promoted more widely. And just under half of the respondents said that too much money is ploughed into IVF research when we should be investing in educating people about the avoidable factors that lead to infertility. Respondents' knowledge of the cost of IVF was shown to be fairly good. Twenty-eight per cent said that they thought a single cycle of IVF costs between ?2,500 and ?4,999 and a further 13 per cent said they thought it cost between ?5,000 and ?7,499.

Half of those surveyed support IVF, whereas 14 per cent generally opposed it and one per cent said they would never countenance it for any reason. Half said that they agreed with the use of IVF by people who wish to avoid having a child with a genetic condition. Almost half (48 per cent) said that the media gives the impression that IVF has a high success rate and 51 per cent agreed that the media seems to show that that anyone can get IVF if they want it. Sixty-nine per cent of respondents, when told the true success rate of IVF, felt that this was not well publicised by the media when reporting on IVF - 25 per cent were surprised by the figure.

When people were asked if they would use IVF themselves, only 45 per cent said they would consider it, compared to 17 per cent who said they would not. Generally, the respondents thought that fertility treatments should primarily be available to married couples (85 per cent) and unmarried couples who had been together for more than three years (57 per cent). The majority also said that IVF patients should be evaluated before being accepted for treatment, particularly if public funds were used. Factors such as patients' age, mental health, relationship status and whether they had any existing children were the main things respondents thought should be taken into account, with over two thirds citing them. However, just over one third (36 per cent) thought that patients' sexuality should be taken into account.

When looking at more specific uses of IVF, 46 per cent of respondents said that they supported the use of IVF and related technologies by couples who wish to have a healthy child to help cure a sick sibling. Even so, this support (and the counter-point) did appear to be conditional upon the new baby being wanted for its own sake. Surprisingly, only eight per cent said that they would support the use of IVF and sex-selection for 'family balancing' purposes, with 74 per cent saying they would oppose this use, the main reason given in opposition being that the attitude was 'selfish' and that 'all children are a blessing'. Only three per cent said that they would support the use of IVF to select physical or other characteristics for a child. A large majority (79 per cent) were against the use of IVF by people aged over 50.

Seventeen per cent of people surveyed thought that 'fertility tourism' should be allowed, whereas 39 per cent opposed it. The main reason they felt this way was the feeling that people should be able to take advantage of more affordable treatment in other countries (78 per cent said this). However, some said that it is wrong to package treatment abroad to make money out of people and others that clinics abroad offer unacceptable treatments such as IVF for older women (58 per cent and 56 per cent respectively).

In terms of what to do with surplus embryos created in IVF, only 16 per cent said that they thought embryo freezing should not be allowed, 60 per cent of these saying it was because creating babies in this way is 'not natural'. Fifty-four per cent said that they consider an embryo to be a human life and it should therefore not be frozen. Support was lower for embryo freezing if it was to be used to delay having a family rather than for those couples who may become infertile through illness or treatment.

Using embryos for research was generally considered to be acceptable by those surveyed. Half of the respondents agreed with the statement 'it is better to freeze spare embryos and use them for research than to discard them', whereas 32 per cent disagreed. Roughly equal proportions (about one third) of the respondents considered an embryo to be a life, not to be a life or neither agreed nor disagreed that it was, and 41 per cent thought that 'spare' frozen embryos should be used for medical research, with 35 per cent saying that they should be donated to other couples undergoing treatment. Another 35 per cent thought that spare embryos should be discarded.

In relation to the use of donated gametes, 71 per cent thought that it is acceptable for a man to donate his sperm to infertile couples compared to only 33 per cent who approved of donation to 'non-traditional' families (for example, single women or female same-sex couples). Similar figures were found in relation to egg donation. Without more knowledge of the situation, a third of respondents believed that egg and sperm donors should be paid - and this figure increased to 40 per cent when the participants were told there was a shortage of donors in the UK and that payment may help to alleviate this. Twenty-eight per cent thought that donor anonymity should not be allowed compared to 58 per cent who thought it should. Respondents were told that recent changes to the law - meaning that donors can no longer be anonymous - appears to have caused a decline in the numbers of people becoming sperm and egg donors; upon hearing this, slightly more people felt that the right to anonymity should be available (63 per cent).

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A controversial new technique to improve the quality of eggs from older women undergoing IVF is being developed by Japanese scientists. Because the procedure involves using eggs from two women to create a single viable egg for fertilisation, it has sparked a media furore over the potential creation of what have been inaccurately dubbed 'three-parent embryos'.

The success rate of IVF declines dramatically as the age of the woman undergoing the procedure increases. One of the reasons for this is thought to be the accumulation of abnormalities in the cytoplasm (the jelly-like substance that surrounds a cell's nucleus) of eggs from older women. Researchers at the St Mother Hospital in Kitakyushu, Japan, took the nucleus out of an egg cell from an older woman undergoing IVF and transplanted into an egg donated by a younger woman (under the age of 35) which had first had its nucleus removed. The resulting egg had the nucleus from the older woman but the cytoplasm from the younger woman.

The research team presented their results at the American Society for Reproductiove Medicine meeting in Atlanta, Georgia in October 2009. Out of 31 eggs on which the procedure was performed, 25 appeared to have transplanted successfully and looked healthy and so were used for fertilisation. Out of these 25 eggs, seven (28 per cent) formed early-stage embryos after being injected with sperm. This was a dramatic improvement on the usual three per cent success rate for the fertilisation of eggs from older women.

In this case, the embryos were not implanted back into women, but team leader Dr Atsushi Tanaka told New Scientist magazine: 'If we could transfer these constructed new embryos, I believe the success rate would be high'.

Although the vast majority of human DNA is contained inside the nuclei of cells, a handful of genes - just 37 genes out of around 25,000 genes in total - are found in the mitochondria, tiny structures that exist in the cytoplasm and provide power to cells. The embryos created by Dr Tanaka and his team would inherit only these 37 genes from the younger donor of the empty egg and cytoplasm, and their remaining 25,000 or so genes from the woman who donated the egg's nucleus and the man who donated the sperm. For this reason, a similar technique of nuclear transfer has been proposed in order to enable women who have severe genetic disorders associated with mitochondrial genes to have children of their own without passing on their condition.

The use of this technique on eggs intended for implantation is currently banned in the UK. However, the new Human Fertilisation and Embryology Act recognises what it calls the 'devastating effects' of mitochondrial diseases and will allow for secondary legislation to sanction treatment of mitochondrial diseases should therapies be developed.

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Two studies of babies conceived using in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) were published in the New England Journal of Medicine last week. One of the studies reports that children have an increased risk of birth defects and the other shows that low birth weights are more common in these children.

In the first study, a team of researchers based at the University of Western Australia examined data from the births register, comparing 1138 babies born from assisted reproduction with 4000 naturally conceived children. They discovered that nine per cent of singleton IVF and ICSI babies not born prematurely had 'major birth defects', compared to just over four per cent of naturally conceived children. The birth defects include heart problems, Down's syndrome, club foot and cleft lips and palates.

The second study compared 42,463 American babies born between 1996 and 1999 following assisted reproduction techniques, with over 3 million other children. The researchers, from the Centre of Disease Control and Prevention in the US, found that six-and-a-half per cent of the assisted reproduction children had a low birth weight (below 5.8 pounds), more than double the number of low birth weights in naturally conceived children.

Dr Jennifer Kurinczuk, a lead author in the Australian study, called for more research into the findings, as previous studies have not produced such results. She said there could be a number of reasons why birth defects were more common in IVF and ICSI children, including genetic abnormalities in the parents, which may affect their fertility, or problems associated with the age of the parents. She did not rule out the possibility that they may be caused by the procedures themselves. But she said that the studies should not cause alarm, adding 'what we have to remember is that more than 90 per cent of babies are free of such major defects'.
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Researchers in South Korea have developed a new method for choosing the best sperm to use during ICSI (intracytoplasmic sperm injection) treatment - a variation of IVF in which a single sperm is injected directly into an egg. The team, based at the Chung-Ang University in Gyeonggi-Do, found that when placed in a solution that makes them swell up, genetically abnormal sperm tend to differ in appearance to healthy sperm. Study leader Myung-Geol Pang presented the findings at the annual European Society for Human Reproduction and Embryology conference earlier this month, New Scientist reports.

During natural conception, healthy sperm are much more likely to fertilise an egg than sperm containing major genetic faults. So any 'aneuploid' sperm - those which have chromosome errors that could affect normal development - are usually left behind. However, this selection process is bypassed in ICSI, a method used to help treat men with very low sperm counts. As Ulrik Kvist, of the Karolinska Institute's Andrology Centre in Stockholm, Sweden explains: 'It's a short cut to the egg, so better methods are needed to screen out the bad sperm from the good'.

In the latest study, the scientists used the 'hypo-osmotic swelling test' (HOST) to examine the appearance of normal and abnormal sperm, and stained the sperms' chromosomes using fluorescent dyes, to find out which were genetically normal. They examined more than 16,000 sperm cells from three fertile men and six with low sperm counts, and found that faulty sperm look different to their healthy counterparts when subjected to this analysis. Their results showed that when selected in this way, there was a 20-fold decrease in the numbers of aneuploid sperm in the samples taken from men with low sperm counts. According to Pang, 'this is much lower than the frequency of anueplidy in sperm taken from healthy men'.

The team now wants to test whether sperm selected using the new method result in healthier embryos. 'If it works it would potentially be very beneficial', Alan Handyside of the Bridge Fertility Clinic in London told New Scientist.
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Researchers studying Australian groups of twins have established a link between heavy alcohol use and delayed pregnancy, in findings to be published in the journal 'Alcoholism: Clinical and Experimental Research'. 

Mary Waldron, assistant professor of psychiatry at Washington University School of Medicine and corresponding author of the research, wrote that this was the first study to look at the affect of alcohol on fertility. Both men and women were studied, but alcohol was found only to have an effect on women's fertility, with incidents expected to increase due to the higher rates of alcohol abuse currently seen in the young female population. 

Some experts voiced caution, as the correlation between alcohol abuse and later onset of pregnancy could relate to the fact that alcoholic women have more relationship issues which cause them to have children later, rather than the effect of alcohol on fertility. However, other experts still stressed the fact that even small amounts of alcohol could affect fertility, because reproductive hormones rely on cholesterol made by the liver. Steve Hillier, Professor of Reproductive Endocrinology, University of Edinburgh, urged that the study results be treated cautiously, but that, 'if nothing else they are valuable in alerting us to the potentially deleterious impact of alcohol abuse on the female reproductive system'. 

The study authors have warned women to consider the impact alcohol might have on their efforts to conceive, and that women attempting to become pregnant should consider not drinking at all. Mary Waldron cautioned, 'young women who drink alcohol may want to consider the long-term consequences for later childbearing. If drinking continues to increases to levels of problem use, their and / or opportunity to have children may be impaired'. 

Sharon Wilsnack, co-author of the study and professor of clinical neuroscience at the University of North Dakota School of Medicine & Health Sciences, warned that women already experiencing fertility problems should not use alcohol as a way to cope with the stress they might feel as a result of those problems. She said that, 'alcohol would likely make the reproductive problems worse as well as carrying risks of possible alcohol abuse or dependence'.

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Dear Colleagues and students,
Don’t miss the opportunity to attend to the Summer course in stem cell research at The Monash Immunology and Stem Cell Laboratories (MISCL) of Monash University, Melbourne Australia
Professor Alan Trounson, Director                                                     
 
Dates: January 7th – February 3rd, 2008
Attached you will find detailed information.
The application form and preliminary program are available upon request.         

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Summer course in stem cell research at The Monash Immunology and Stem Cell Laboratories (MISCL) of Monash University, Melbourne Australia
Professor Alan Trounson, Director                                                      

Dates: January 7th - February 3rd, 2008

A four week course at the Monash Immunology and Stem Cell Laboratories (MISCL) of Monash University, Melbourne, Australia, will be held in January 2008 and will include lectures and hands-on laboratory work. The course is suited for biology and biotechnology scientists who are seeking advance exploration of techniques associated with research in stem cells. Accommodation, social events and outings are included.

The course includes lectures and seminars by experts in the fields of embryology, stem cell biology, and biotechnology. The lectures will focus on human embryology, nuclear reprogramming, maintenance and differentiation of ES cells, and application to regenerative medicine, and ethics and business in the world of stem cells.

Practical sessions are held at MISCL. Participants will be involved in a weekly rotation in specified laboratories. Practical sessions will be introduced and guided by resident scientists, postgraduate students and staff members. Participants will be given a one on one tutoring. Practical work will include instructions of tissue culture techniques for embryos and stem cells, imaging and molecular analyses.

The course will be divided into 4 major sections:
1. Nuclear transfer and cell fusion. This part will include production of mouse embryos following enucleation and injection or fusion of somatic and ES cells.
2. Maintenance of mouse and human ES cells. This part will include culture of undifferentiated ES cells, and splitting and freezing ES cells.
3. Identification of ES cells. This part will include:  identification of specific markers for human and mouse embryonic stem cells by microscopic (immuno fluorescent antibodies) and molecular (RT-PCR) methods. 
4. ES cells differentiation:  This part will include formation of embryoid bodies and the identification of selectable markers for differentiated cells.

Laboratory work will be supplemented by seminars on the protocols used during the practical work. 

To apply contact course coordinator:
Dr. Orly Lacham-Kaplan, Senior Research Fellow, MISCL
[email protected]
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Embryo Talk, a quarterly journal, published by Hope Infertility Clinic & Research Foundation, India invites original articles and short incisive reviews or various aspects related to clinical embryology. All papers are peer-reviewed prior to acceptance. Those interested can contact the executive editor, Dr Rajvi Mehta on [email protected] for details.  

Those interested in subscribing can contact [email protected]

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On Thursday 14 December, UK Public Health Minister Caroline Flint announced the publication of the British Government's proposals for a major overhaul of the law on assisted human reproduction and embryo research. The proposals, contained in a new 'White Paper', follow an extensive public consultation exercise on the current law, the Human Fertilisation and Embryology (HFE) Act 1990.

The White Paper states that the statutory functions currently performed by the Human Fertilisation and Embryology Authority (HFEA) and the Human Tissue Authority (HTA) should be combined under one new body, the Regulatory Authority for Tissue and Embryos (RATE). In the run-up to RATE, Health Ministers propose to appoint a single individual to separately Chair the HTA and HFEA to move the Authorities further towards working as an integrated body. Launching the White Paper, Ms Flint said that 'the current law, which has served us well, is in need of revision', adding that 'technology has changed, and so have attitudes'.

One of the major proposals contained in the White Paper states that the 'need for a father' clause should be removed from the provisions of the law. Currently, the HFE Act stipulates that fertility treatment providers should take into account the welfare of the potential child to be born, including that child's need for a father. If the new proposals become law, it would mean that clinics would not be able to refuse treatment to single women or lesbian couples on that basis alone. In fact, it is also recommended that the parenthood provisions within the legislation are to be extended to include civil partners and other same-sex couples. However, the other welfare of the child checks should be retained, says the White Paper, even though this part of the existing law has faced heavy criticism since 1990, mainly because couples who can conceive naturally do not face similar checks or investigation into their suitability as parents.

It is also proposed that Internet sperm donor services be brought within the ambit of the regulation and that the use of sex selection techniques for 'social' reasons - either using pre-implantation genetic diagnosis or sperm sorting methods - be formally banned, even for the purpose of 'family balancing'. Deliberately 'screening in' a disease or disorder (for example if two deaf parents wished to have a deaf child) will also be banned, although the screening of embryos for serious genetic diseases, as well as to see if they could be a tissue match for an existing sick sibling, will continue to be permitted under licence. However, in terms of embryo research, the creation of chimeras will be banned, at least initially, although scientists will be allowed to alter the genetic structure of reproductive cells - though they will be banned from implanting such an embryo created using these into a woman in order to make a baby.

In relation to the use of donor sperm, eggs and embryos, no changes are proposed to the law - which was last changed in 2004 anyway - on the anonymity of donors. In fact, some of the recent changes are to be incorporated into and developed within the new law: donor-conceived children will be allowed to find out the name of their donor and also if they have sisters or brothers also conceived through donation, when they reach the age of 18. Donors will be informed if a donor-conceived child is seeking identifying information about them.

Following from some recent high-profile cases, such as that taken by Natallie Evans, the statutory storage period for embryos is to be extended from five to 10 years, while a 'cooling off period' of up to one year will be put in place if consent to embryo storage by one of the couple involved is withdrawn.

Comment on the proposals has tended to focus most on the welfare of the child provisions. Josephine Quintavalle, of Comment on Reproductive Ethics, criticised the removal of the 'need for a father reference' saying that it is 'a dreadful statement to make about the role of men' and adding that 'fatherhood is much more than the donation of sperm'. However, Liberal Democrat MP Dr Evan Harris welcomed the removal of the 'need for a father' clause, calling it 'unjustifiable, discriminatory and vindictive' and adding that 'it was also unsustainable in human rights and equality terms'. Anna Smajdor, researcher in medical ethics at Imperial College London, agreed, saying that the 'removal of the specific reference to a need for a father is on balance a good thing', but adding that 'it still remains utterly bizarre that fertility clinicians should be responsible for making judgements about the suitability of people to be parents'.

The HTA has welcomed the White Paper, saying that 'bringing all matters concerning human tissue, gametes and embryos under a single framework will ensure consistency of approach in these closely related areas'. Shirley Harrison, Interim Chair of the HTA said: "We have worked to establish the HTA as a regulator that uses a modern and creative approach. We are fully supportive of RATE and want to see the new Authority combine the best of both the HTA and the HFEA to become a model of better regulation'.

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