Doctors have found the first clear evidence that overweight women face a heightened risk of miscarriage after undergoing IVF (in vitro fertilisation).
Obese women Women considering IVF should be counselled that being overweight or obese doubles their risk of miscarriage, say fertility experts

Overweight women are more than twice as likely to miscarry an IVF baby compared with those whose weight is healthier, fertility doctors say. The increased risk is so great they believe a warning should be included in counselling for couples before they embark on a course of fertility treatment.

Women who conceive naturally are known to have a greater chance of miscarrying if their body mass index (BMI) is 25 or higher, but the picture has been less clear for women carrying babies produced by in-vitro fertilisation (IVF), or another technique called intra-cytoplasmic sperm injection (ICSI).

“Overweight women wishing to get pregnant by spontaneous conception are already counselled to lose weight before trying for a baby,” said Tarek El-Toukhy, a fertility specialist who led the study at the assisted conception unit of Guy’s and St Thomas’ Hospital in London.

“Our findings have shown clearly that women undertaking ART [assisted reproductive technology] should be strongly encouraged to heed this advice in order that they can have the best possible chance of obtaining and maintaining a pregnancy,” he added.

Overweight mothers have a higher risk of developing other medical conditions that can threaten their pregnancy, including high blood pressure, pre-eclampsia, diabetes, premature delivery and post-partum bleeding.

El-Toukhy’s team examined the medical records of 318 women who each had one embryo implanted during fertility treatment at the clinic between January 2006 and December 2009. The women were divided into two groups: 185 had a healthy BMI between 18.5 and 24.9, while 133 had a BMI of 25 or above. Of the latter group, 19 were obese, defined as having a BMI of 30 or more.

The study, reported today at a meeting of the European Society of Human Reproduction and Embryology in Rome, found a miscarriage rate of 22% among women with a healthy BMI, compared with a 33% miscarriage rate for the overweight women.

After adjusting their data to take account of the women’s age, history of infertility and miscarriage, and lifestyle factors such as smoking, the researchers concluded that being overweight more than doubled the miscarriage rate.

“Although there is evidence that miscarriage rates are higher in overweight women who conceive spontaneously, there were conflicting views about the effect of increased weight on the outcome of pregnancies occurring after IVF and ICSI,” said Vivian Rittenberg, a fertility doctor who took part in the study.

Rittenberg said many studies that have examined the issue in the past have been hard to interpret, not least because doctors looked at miscarriage rates after implanting several embryos at once at different stages of development.

“We transferred only one embryo at a specific stage of development, and were therefore able to provide clear evidence of the deleterious effect of being overweight on the chances of miscarriage,” she said.

From: http://www.guardian.co.uk/science/2010/jun/28/overweight-doubles-risk-miscarriage-ivf

About one percent of IVF pregnancies are aborted every year, figures collected by the fertility watchdog show.The exact reasons for the terminations – which amount to an average of about 80 a year – are unclear, but will include medical problems with the foetus as well as social grounds, such as a relationship breakdown.

“Selective reduction” abortions, when one foetus is removed to improve the survival chances of another in a multiple pregnancy, are also included.

The figures from the Human Fertilisation and Embryology Authority, which regulates IVF clinics in the UK, were obtained as part of a Freedom of Information request.

They show that the proportion of foetuses aborted remained stable between 1991 and 2008, the last year for which data was available. In that year there were 65 terminations in 6,723 pregnancies.

The 18-34 age group saw the highest number of abortions, with 23 terminations, but they also had significantly more pregnancies than older IVF patients.

There was no information on the number of abortions of IVF pregnancies which had originally been funded by the NHS. Public provision of IVF is patchy, and many couples pay thousands of pounds to undergo fertility procedures privately.

Professor Bill Ledger, a member of the HFEA said: “I had no idea that there were so many post-IVF abortions and each one is a tragedy”, while former conservative MP Ann Widdecombe said some were treating babies like “designer goods”.

But Susan Seenan of the Infertility Network UK advised caution.

“Anyone who has undergone IVF knows what a long and difficult experience it can be. To make the decision to then terminate that pregnancy cannot be one that anyone takes lightly. I would imagine there are some pretty good reasons.”

Laura Riley, a spokesperson for the British Pregnancy Advisory Service, said: “Women and couples who have had donor insemination or IVF to become pregnant are unfortunately no more immune from the harsh vagaries of life than others who are lucky enough to be able to conceive naturally.

“Any woman can experience overwhelming life difficulties, such as intense relationship pressures or the diagnosis of a serious or lethal fetal medical problem. These may mean that she feels unable to continue with the pregnancy.”

From: http://news.bbc.co.uk/1/hi/health/10254133.stm

The rising rate of blunders in IVF treatment ‘may be systemic’, says leading patient safety expert

The number of reported mistakes a t the 138 fertility clinics in England and Wales nearly doubled in the year to April 2009, rising to 334 from 182 the previous year. One leading patient safety expert has now warned that blunders which have occurred as record numbers of women seek treatment, may be “systemic”.

The increase comes as one clinic, IVF Wales, is at the centre of a fresh scandal after losing the last two remaining embryos it had frozen for one of its patients. It is the second time in less than 12 months that a mix up at the centre, based at University Hospital of Wales in Cardiff, has left patients devastated.

The Cardiff-based couple has had their eight-year quest to have a baby put on hold as a result of the blunder, which followed an initial, unsuccessful course of IVF. The pair, identified only as Clare and Gareth, are suing Cardiff and Vale University Health Board, which last year paid out a five-figure sum in compensation for negligence after another mix up.

Guy Forster, a solicitor at the law firm Irwin Mitchell who is representing the couple, said the incident raised questions about the Government’s IVF watchdog, the Human Fertilisation and Embryology Authority.

“This raises concerns about the HFEA’s ability to regulate the IVF industry properly. I think it should be doing a lot more to follow up when an incident occurs, especially at a clinic with a poor track record,” he said, adding: “These problems appear to be on the rise.”

An official review last year found that the HFEA was failing to punish badly run fertility clinics by not using the “full range of sanctions” at its disposal. Professor Brian Toft, a patient safety expert at Coventry University, said: “If the HFEA fails to clamp down when something has gone wrong then things will continue to go wrong.”

He said the rise in reported incidents, uncovered by BBC Radio 5 Live, implied clinics were not learning from their mistakes, adding: “I have been told there are not enough qualified staff doing the work. HFEA do not make any recommendations for staffing levels per number of patients. If you have a lot of patients and not enough staff, this could account for an increase in errors. This problem may well be systemic.”

Professor Sammy Lee, an IVF expert, said the watchdog must ensure clinics comply with regulations. “They need to obtain staff that have experience of enforcement and are able to make sure that regulations are put into place,” he said.

An HFEA spokesman played down the increase in blunders, which he said was partly due to new rules requiring clinics to include incidents when patients suffered from ovarian hyperstimulation syndrome (OHSS). “The number of reported incidents has increased as the sector has responded positively to the opportunity to share lessons learned from incidents which have been reviewed and investigated,” the HFEA added in a statement.

From: http://www.independent.co.uk/errors-at-ivf-fertility-clinics-double-in-just-one-year