IVF News

Single French women and those in same-sex partnerships will be able to access IVF and other fertility treatments. 

New legislation aims to extend access to fertility treatment, making it free under the country's public healthcare system, ending the exclusion of women who do not have a male partner. 

Health minister Olivier Véran said he expected the law to come into force next month and promised that female couples would be able to enrol in assisted reproduction treatment programmes as soon as September.

Until now, French law has only allowed heterosexual married couples to access fertility treatment. Every year thousands of lesbian and single women from France travel to other countries, such as Spain and Belgium, to access fertility services, but this option comes at a significant financial cost.

The much-delayed reform fulfils a promise made by President Emmanuel Macron to legalise IVF for single women and lesbian couples in his 2017 election campaign. The reform was threatened early this year when, supported by right-wing politicians and the Catholic church, senators voted to remove single and lesbian women from the new bioethics bill.

However, the majority of French people appear to be in favour of extending access to fertility treatment, and LGBTQ groups protested the senate's decision.

'We demand, among other things, anonymous assisted reproduction by default, free and reimbursed for all, without any conditions,' said Lea Haurie-Hontas, a spokeswoman for Les Collages Lesbiens, who held a march in April protesting the senate's change to the bill.

Ultimately President Macron's party and their allies have a majority in the lower house and were able to override the senate. The passing of this legislation in France means they join ten other European states that currently fund fertility treatment for single women and lesbian couples. 

The bill does not cover fertility treatment for trans people, and will not help male same-sex couples become parents, as surrogacy remains illegal in France.

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The Scottish Government and NHS Scotland have launched their first campaign to encourage people to become sperm and egg donors. The initiative is being launched alongside four NHS fertility centres in Scotland: Aberdeen, Dundee, Edinburgh and Glasgow.

New research suggested that almost half of people in Scotland would consider donating gametes to those who need help to conceive. Hence, the initiative was launched to encourage these people to donate. Currently, the demand for egg and sperm donors exceeds their availability, with more than 200 people waiting for a donor in Scotland, therefore a drive in the number of altruistic donations would help a large number of families.

'Hundreds of people in Scotland need the help of egg or sperm donors to give them the chance to become parents and the gift of starting a family,' Maree Todd, the minister for public health, women's health and sport in Scotland said. 'Donating your eggs or sperm is an important decision and this campaign aims to highlight the options available to people who have carefully considered doing so… Demand for egg and sperm donations through the NHS remains high – altruistic donations provide the potential to give the joy of starting a family to others.'

Sixty-eight percent of those who said they would consider donating had said they believed it is a kind thing to do – however, over a quarter of these (27 percent) felt that they were not informed enough about donation or they would not know how to donate.

Other reasons people gave for considering donation included wanting to help others become parents, wanting to create new life and knowing friends and family who have had fertility issues of their own.

To be eligible to donate eggs, the donor must be aged between 18 and 35, and to donate sperm it is 18 to 45. All donors must also be healthy, non-smokers, and have no significant illness or inherited diseases. A biological family history is also required. Egg donors must be able to commit to the programme for about three months and sperm donors must be able to make regular donations.

Gwenda Burns, chief executive of the charity Fertility Network UK said: 'Scotland currently leads the way in the UK offering the gold standard of up to three full NHS IVF cycles, including access for couples where one partner has no biological child. The NHS donor campaign will further ensure equitable and fair access to treatment for patients who require donor treatment. We are proud and delighted to be involved in the campaign.'

She added, 'Raising awareness about the campaign is vital and whether you know someone who has had a personal struggle to conceive, or you just want to help others, becoming a sperm or egg donor for the NHS is an incredible act of generosity.'

The campaign adverts will run on a number of platforms throughout Scotland, including posters in gyms, audio adverts on Spotify, social media and YouTube and other digital channels to help raise awareness. The campaign can be followed on social media with the hashtag #JoyLoveHope.

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Newly released guidance from the UK Competition and Markets Authority (CMA), would allow couples to initiate legal proceedings against IVF clinics that have falsely guaranteed their success rates.

The guidance, drawn up with the Human Fertilisation and Embryology Authority (HFEA), sets out consumer law rights for those considering/undergoing fertility treatments. The document sets out the legal obligations of clinics to the consumers, and specifically requires that: 'Clinics should not be advertising misleadingly low headline prices to attract patients.' Further, clinics cannot 'cherry-pick' their success rates by using a particularly good year rather than the most recent one or selectively sampling patients who had better results. If a clinic breaches any legal guidelines in promoting their services, then patients may seek compensation through legal proceedings.

'Buying fertility treatment is a big decision - it can be complicated, stressful and very expensive, with no guarantee of success. All patients deserve to have the information they need to make the right choices for them and be treated fairly,' said Louise Strong from the CMA. 'Our guidance should help clinics understand their legal obligations. In six months, we will be reviewing compliance in the sector and we will be ready to take enforcement action if businesses are breaking the law.'

In February 2020 the CMA had announced it would investigate possible 'mis-selling of services' and misleading claims about success rates of fertility treatments by clinics.

HFEA chair Julia Chain said the guidance 'is a major step forward for fertility patients as it provides added protection by ensuring that all clinics adhere to consumer and advertising law in addition to our regulatory requirements.'

The guidance also creates an obligation for clinics to present accurate data so that consumers can properly investigate and compare each clinics' costs and success rates. This protection extends beyond the treatment itself, to any guarantees made by clinics about 'add-ons', or the 'non-compulsory extras supplied by some clinics' which can cost up to £2500 per cycle.

Sarah Norcross, director of fertility charity Progress Educational Trust (PET), said: 'This is a wake-up call for fertility clinics that they are not exempt from consumer law. Sadly, too many patients struggling with infertility are unaware that they are consumers as well as patients and that they have rights.'

She continued, 'This is important when they are choosing a clinic and when they are offered treatment add-ons to IVF cycles as they can easily face financially ruinous bills for fertility treatment which should be available on the NHS... That's why PET welcomes this comprehensive guidance for both patients and clinics from the CMA; it will hopefully be a beacon of light for patients trying to navigate what is often a murky and tricky process at an emotionally difficult time, and a warning light for clinics of the practices to beware of.'

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Some of the faulty embryos currently ruled out for use in IVF can self-correct and lead to healthy pregnancies, research has revealed. The finding that embryos exhibiting chromosomal abnormalities are more viable than previously thought could change our approach to IVF and increase success rates.

Currently, some IVF clinics check embryos for chromosome number before transferring them into the mother's womb. This test, known as preimplantation genetic testing for aneuploidy (PGT-A), screens out so-called aneuploid embryos – those with an incorrect number of chromosomes. It is meant to help reduce the chances of miscarriage. Now US researchers have found that aneuploid embryos have an in-built ability to self-correct and the potential to develop into healthy babies.

Dr Ali Brivanlou, head of the laboratory of synthetic embryology at Rockefeller University, New York, said, 'This is going to revolutionise how IVF moves forward. This test is obsolete and should be replaced with more precise technology to assess in vitro-fertilised embryo quality'.

In the first set of tests, the scientists transferred embryos that had failed the PGT-A screen into women who had given their consent. When the women underwent genetic tests a few months later there were no longer any signs of aneuploidy. The rate of live births and miscarriages was also similar in women who had received embryos that had passed the screening, with an 18 percent pregnancy and 12 percent live birth rate at age 40. 

Next, the team wanted to understand how the faulty embryos were still able to develop. Using human embryonic stem cells, they generated artificial human embryos in the lab and then studied how they developed.

They found that the proportion of aneuploid cells decreased as the embryos developed. They also found that aneuploid cells are removed from the part of the embryo that goes onto become the fetus. But interestingly, they saw that aneuploid cells remain in the outer layer of early embryos – the part that eventually becomes the placenta.

The scientists hope this finding will change practices in IVF clinics. Lead author Dr Norbert Gleicher, medical director at the Centre for Human Reproduction in New York, said, 'Thousands of good embryos are being discarded daily. We now have an opportunity to unlock the potential of this technology to help many more couples suffering from infertility.'    

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The International Society for Stem Cell Research (ISSCR) has published wide-ranging new guidelines, covering areas of research and clinical practice that range from the routine to the novel and contentious.

Previous guidelines issued by the ISSCR – a prominent body of researchers, clinicians, ethicists and others whose work involves stem cells– upheld the '14-day rule', prohibiting the culturing of human embryos in the laboratory for longer than 14 days from fertilisation. This has changed in the new guidelines, which for the first time allow for the possibility of culturing intact human embryos beyond 14 days, subject to special oversight.

The guidelines say: 'Given advancements in human embryo culture, and the potential for such research to yield beneficial knowledge that promotes human health and wellbeing, the ISSCR calls for... public conversations touching on the scientific significance as well as the societal and ethical issues raised by allowing such research. Should broad public support be achieved within a jurisdiction, and if local policies and regulations permit, a specialised scientific and ethical oversight process could weigh whether the scientific objectives necessitate and justify the time in culture beyond 14 days'.

The guidelines, while highly influential, will not change the legal status of such research in the UK, where the 14-day rule is enshrined in an act of parliament which would need to be changed before researchers and regulators could act.

A growing area of research addressed by the guidelines is entities that resemble embryos but have been created from stem cells, rather than being created by fertilisation. A number of different terms have been used for such entities in recent years, but the guidelines seek to standardise the terminology so that these entities are known collectively as 'stem-cell-based embryo models'.

The guidelines divide these models into two categories. 'Integrated' stem-cell-based embryo models contain not just embryo-like cells, but also cells resembling extra-embryonic material – for example, cells of the kind that develop into the placenta. 'Non-integrated' stem-cell-based embryo models do not have (and cannot develop) such additional cells, and resemble only the embryo proper (or a part of it).

The guidelines require greater oversight for integrated embryo models than for non-integrated embryo models. Furthermore, if an embryo model contains human cells, then – regardless of whether it is integrated or non-integrated – the guidelines prohibit any attempt to use it to establish a pregnancy.

Other potentially challenging areas covered by the guidelines include in vitro derived gametes (sperm and eggs made in the laboratory) and work that combines human and non-human material. Additionally, the guidelines seek to discourage people from offering or undergoing stem cell therapies that are not supported by robust evidence.

Published alongside the new guidelines are a number of papers in the journal Stem Cell Reports, discussing how and why the guidelines have been updated. An additional commentary by Professor Robin Lovell-Badge of the Francis Crick Institute, who chaired the task force that updated the guidelines, is published in Nature and says that 'applying the guidelines will demand extensive public engagement'.

Sarah Norcross, director of the Progress Educational Trust (the charity which publishes BioNews), said that 'these are exciting times for embryo and stem cell research' and 'the new guidelines from the ISSCR do an excellent job of addressing the ethically challenging areas'.

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Self-organising heart organoids using human pluripotent stem cells have been developed by researchers from the Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA).

These heart organoids the size of a sesame seed, known as cardioids, developed structures with a cavity resembling the structures that go on to form the atrium and ventricles of the human heart. The chamber-like structures could also beat after eight days of development and they contained an inner layer similar to the endothelial lining present in a developing heart that later contributes to the development of heart vasculature.

'Cardioids are a major milestone. Our guiding principle is that for an in vitro tissue to be fully physiological, it also needs to undergo organogenesis. We were able to achieve this, using the developmental principles of self-organisation – which makes it such an exciting discovery,' said Dr Sasha Mendjan, group leader at IMBA, Austria, who is a co-author of this research.

In their paper published in the journal Cell, the scientists report how they were able to guide the development of human stem cells into cardioids by establishing conditions that mimic the embryonic environment during early embryonic development. They aimed to produce the three layers of tissue observed in the human heart chamber and did this by putting the stem cells into concentrations of growth-promoting nutrients to encourage them to develop in the order they would in an embryo.

'Amazingly, this led to self-organisation of a heart chamber-like structure that was beating. For the first time, we could observe something like this in a dish. It is a simple, robust and scalable model, and does not require addition of exogenous extracellular matrix like many other organoid models,' said Dr Mendjan.

Hofbauer and colleagues were also able to generate cardioids that mimicked a condition observed in children known as Hypoplastic Left Heart Syndrome, through the modification of transcription factors associated with this syndrome. They also investigated the impact of injuring the cardioids through freezing which is a technique that mimics heart attacks in these self-organised heart organoids. This resulted in the accumulation of extracellular matrix proteins which is a hallmark of heart disease and regeneration.

Cardioids hold great potential as a tool for studying human heart diseases and testing potential therapeutics. Further studies will be conducted by the team in efforts to generate organoids with all four chambers of the human heart. 

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More single women and same-sex couples are opting for IVF as the success rate continues to improve, according to new data from the UK regulator. 

The Human Fertilisation and Embryology Authority (HFEA) examined trends in fertility treatment numbers and patient demographics from 1991 to 2019. As well as reporting an increase in IVF successes, the report revealed emerging trends in the patients seeking fertility treatment, and exposed large disparities in NHS funding.

HFEA chair Julia Chain summarised that there have been 'many positive changes in the treatment of patients', citing 'birth rates increasing, multiple birth rates falling and treatment becoming safer.' 

The report, published last week to mark thirty years since the establishment of the HFEA, analysed trends in assisted reproductive technologies such as IVF and donor insemination (DI). It found that since 1991, for all patient groups under the age of 43, the success rate of IVF and DI has increased – rising, for example, from six percent in 1991 to 25 percent in 2019, for patients aged 35 to 37. 

The multiple birth rate has dramatically declined, from 28 percent in 1991 to just six percent in 2019, improving treatment safety. The HFEA explained that this reflects a change in treatment practice, where now more usually one embryo is transferred back to the patient during treatment instead of multiple embryos. 

Notably, the number of single women choosing to undergo IVF has doubled to two percent of all IVF cycles. The number of same-sex couples undergoing IVF and DI has likewise more than doubled – 2345 IVF cycles involved a female patient with a female partner in 2019, a four-fold increase from 2009 alone. Despite this, the guidelines for provision of fertility treatment differs for same-sex couples and other family structures.  

Sarah Norcross, director of the Progress Educational Trust (which publishes BioNews), commented that the report shows 'the routes to family formation are changing', and called on the National Institute for Health and Care Excellence (NICE) to re-evaluate its guidelines. 

As well as analysing trends in fertility treatment, the report also highlighted the 'postcode lottery' of NHS funding across the UK. In Scotland, 62 percent of IVF cycles were funded by the NHS, while in some parts of England this was as low as 20 percent. 

Norcross said the figures demonstrate 'the harsh reality of more than half a decade of cuts to NHS-funded fertility services in England, with potentially more to come later this year in the north London area.'

She added: 'It is shocking that the East of England is now the worst place to live in the UK, with just 20 percent of treatment funded, when nearly a decade ago it was the best place to live.'
 

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Motile cilia are needed to transport ovulated eggs in the fallopian tube, according to new research.

The study, published in the Proceedings of the National Academy of Sciences (PNAS), used mice lacking motile cilia, which are little hairs found in the fallopian tube, to show that they are essential for transporting eggs from the ovary to the uterus. The study further clarified that smooth muscle, which was also thought to move eggs in the fallopian tube, is instead more important for moving sperm and embryos.

'We are very excited about solving this longstanding mystery,' said Dr Wei Yan, an investigator at the Lundquist Institute in Torrance, California, who led the study. 'It is now clear that both motile cilia and smooth muscle participate in the transport function, and motile cilia are required for egg pickup, whereas smooth muscle contraction is more important for sperm and embryo transport.'

The cilia at the end of the fallopian tube nearest the ovary, picks up and transports ovulated eggs, called oocytes, to the widest part of the fallopian tube called the ampulla, in the middle of the fallopian tube. Here, an egg can be fertilised by sperm. A fertilised embryo is then transported further down the fallopian tube to the uterine cavity where it can eventually implant and grow. This process is achieved by cells which have motile cilia called multiciliated cells and smooth muscle cells. 

Motile cilia 'beat' and smooth muscle contracts to move objects, but which cell type drives the movement of ovulated eggs and embryos at different points in the fallopian tube has been unclear. Clarifying this mechanism is important, because disrupted transport can result in eggs being unable to be fertilised, or embryos being unable to grow or growing in the wrong place, which can lead to infertility and an ectopic pregnancy. 

The results of the study have resolved the mechanism underlying the transport of oocytes in the fallopian tube from the ovary to the ampulla, in the middle of the fallopian tube. Using mice that lacked motile cilia, Dr Yan's team showed that oocytes could not be picked up in the part of fallopian tube that connects to the ovary, called the infundibulum, and be transported to the ampulla for fertilisation. Thus, disruptions to either the structure or beating patterns of motile cilia lead to fertility loss.

The study also showed that motile cilia in other parts of the fallopian tube closer to the uterus facilitated sperm and embryo transport but were not essential for fertility. This is because embryos could also be moved due to smooth muscle contraction in that areas. Sperm were also able to reach the ampulla regardless of whether motile cilia were present or not, due to the contraction of smooth muscle.

According to the authors, these findings may contribute to developing non-hormone female contraceptives, and understanding the cause of ectopic pregnancies and other conditions.

'Knowledge derived from the present study helps us understand the causes of female infertility and ectopic pregnancy, and the molecules essential for motile cilial functions represent a good target for developing non-hormonal female contraceptives,' said Dr Yan.

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Changes to the three-dimensional (3D) structure of sperm chromosomes during sperm development can affect fertility in mice, it has been revealed.

Sperm and egg development, also known as gametogenesis, involves recombination, the shuffling of genes between chromosomes. This process is affected by the 3D structure of chromosomes – the way the DNA is packed, and which chunks of the genome are connected, and can affect sperm viability according to new research.

Dr Aurora Ruiz-Hererra from the Universitat Autònoma de Barcelona and lead author of the study, published in Nature Communications, explained: 'The study shows that both the dynamics of the genome organisation during the formation of gametes and the recombination is affected by the presence of chromosomal rearrangements'.

The team compared the rate of recombination in male mice between five wild-caught populations of mice and a population of common lab mice. Two of the wild mouse populations had a high prevalence of Robertsonian (Rb) fusions, a type of recombination where stray chunks of chromosome fuse together abnormally and can result in genetic conditions in humans such as Down's syndrome. 

They found that the mouse populations with a higher prevalence of these fusions exhibited a decrease in the rate of recombination which negatively impacted gametogenesis and the viability of the sperm. Higher levels of failed sperm development and immotile sperm were seen in these mice.

'The results point to the importance of the three-dimensional genomic context in which the recombination takes place, where factors such as chromosomal reorganisations can shape the genomic makeup of a given species' said Dr Covadonga Vara, co-author of the study.

The work showed that the observed effects could be partially explained by the fact that the presence of Rb fusions affected the 3D structure of the chromosomes. This change in structure alters how chromosomes interact with each other, and the expression of genes encoded on them.

The authors suggest that the presence of these fusions could have an evolutionary role in exposing parts of the genome to different regulatory mechanisms or enabling shuffling between genome regions which would not otherwise mix.

The findings of this work may lead to a greater understanding of adaptive processes as well as shine light on the mechanisms influencing fertility and genetic condition in humans.

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