IVF- guide to effectiveness

In July 1978 Louise Brown was hailed as the world’s first “test-tube baby”, born through the fertility treatment IVF.

In July 1978 Louise Brown was hailed as the world's first "test-tube baby", born through the fertility treatment IVFBut how has IVF effectiveness improved compared with modern IVF procedures?

Louise’s birth was cloaked in secrecy. Even her father John’s first visit to see her in Oldham General Hospital was under the eye of police officers, who lined the corridor outside.

She was the first to be born through in-vitro fertilisation (IVF), a process in which an egg is removed from the woman’s ovaries and fertilised with sperm in a laboratory, before being implanted into the uterus.

It is a treatment used to enable couples with a range of fertility problems to conceive a child, and now allows same sex couples and single mothers to have children too.

Technological advancements mean – according to 2013 estimates – more than five million people worldwide have been born through IVF.

But in 1978 it was highly experimental, and Dr Mike Macnamee, chief executive at the world’s first IVF clinic – Bourn Hall in Cambridge – believes Louise “really was a miracle”.

The two men who pioneered the treatment – gynaecologist Patrick Steptoe and Nobel Prize-winning physiologist Robert Edwards – “had gone through hundreds of embryo transfers before Louise was conceived”, he adds.

The pair had joined forces a full 10 years earlier, with skills that perfectly complemented one another – Edwards having developed a way to fertilise human eggs within the laboratory and Steptoe having devised a method for obtaining the eggs from the ovaries.

When Louise’s mother Lesley was put in contact with Steptoe by her doctor, she was warned there was a “one in a million” chance of success.

So when it worked, it was such a momentous scientific advancement that the birth had to be filmed – under agreement with the government – to give documented evidence that Louise was indeed her mother’s.

This is a far cry from modern procedures, which – owing much to the work of Bourn Hall in the 1980s – follow a refined and well established clinical process.

“Once Steptoe and Edwards worked out how to fertilise the egg, they very soon wanted to restrict the number of embryos they transferred into women – so they didn’t have too many multiple births,” Dr Macnamee explains.

“Development of the freezing technique in the mid-80s meant they could implant one or two embryos into the would-be mother and then freeze other embryos for future use, saving her the uncomfortable procedure of having the eggs removed again.”

Progress can also be seen in the modern use of ultrasound imaging to harvest the eggs under a mild sedation, rather than the form of keyhole surgery known as laparoscopy that was previously employed.

Techniques developed in the late 1980s also made a big difference in treating male infertility by injecting single sperm directly into the egg.

These, and other, small incremental steps mean the success rate for each round of IVF has grown from 10% to 40% since the early 80s, when Dr Macnamee’s first role included the hands-on task of mixing the eggs and sperm in a petri dish.

The chances of successfully conceiving through IVF decline with age, but the process is now more effective per cycle than natural reproduction. It does not, however, have approval from all quarters.

Dr Macnamee thinks the chances of women conceiving through IVF will only increase in future – and says he hopes to see a 60% success rate in IVF cycles before he retires.

One prominent area of research is aimed at exploring the way in which embryos interact with the lining of the womb when they are implanted.

Many believe it is when the two fail to engage with each other that the IVF cycle can prove unsuccessful.

Progress is slow – as there is no model to undertake tests in the lab – but Dr Macnamee believes this line of research could be key. “If we understand that better, it’d be the next big breakthrough,” he says.

Drinking alcohol when pregnant- what are the risks?

Women who drink alcohol and are pregnant at the time are seeking abortions under the misapprehension their babies will suffer foetal alcohol syndrome (FAS).
Drinking alcohol when pregnant- what are the risks?The British Pregnancy Advice Service (BPAS) says there is “no need” for an abortion in such cases, as there is “minimal” damage to babies from isolated episodes of binge drinking by their mothers.

FAS is a rare but serious condition that can cause:

  •     facial deformities
  •     restricted growth
  •     learning and behavioural disorders
  •     a poor memory or short attention span

Statistics for the incidence of the disorder in the UK are not available, but in America, experts say 0.2 to 1.5 cases occur for every 1,000 live births in certain areas of the country.

BPAS says this risk is incredibly small and women should not needlessly fear their behaviour has damaged their baby.

A Danish study in 2012 of more than 1,600 women suggested low-to-moderate drinking was not linked to adverse neurological effects in five-year-olds, but heavy, weekly drinking was associated with a lower attention span in the children.

What are the guidelines for drinking alcohol during pregnancy?

Up until the 1980s, pregnant women were advised to drink stout to boost their iron levels. Official advice today is somewhat different.

Pregnant women should avoid alcohol altogether, says the British government. And if alcohol really must be consumed, it should be limited to the equivalent of one small glass of wine, once or twice a week, it adds.

This advice is mirrored by the Royal College of Obstetricians & Gynaecologists, (RCOG), which says the safest option for women is not to drink at all for the first 12 weeks and then minimal amounts per week after that.

Meanwhile, national guidelines from the National Institute for Health and Care Excellence say women should not drink for the first three months of their pregnancy, to minimise the risk of miscarrying.

And after that, it says pregnant mothers should drink only one to two units a week.

Alcohol can disrupt the baby’s normal development in the womb, its health at birth, susceptibility to illness in infancy, childhood, teenage years and later life, warns the RCOG.
Woman and man drinking Binge drinking during pregnancy tends to have an “all or nothing” effect, says the RCOG

It says the effects of drinking are “most harmful” just before pregnancy, due to the way alcohol hampers fertility, in both men and women – the mechanism of which is largely unknown.

Later in pregnancy, the shared blood supply between the mother and her baby via the placenta means that any alcohol that is consumed could easily reach the baby.

Before this – soon after conception and often prior to the woman finding out she is pregnant – could be a different matter.

There is limited evidence about how alcohol affects the baby before there is a direct line between the mother and baby’s blood supply, which happens about week four of pregnancy, the point at which a woman might be aware of missing her period and suspecting she is pregnant.

Understandably, it is ethically difficult to study. This uncertainty means experts often err on the side of caution when providing advice

The jury is largely out about exactly how much alcohol can be drunk during pregnancy, and when.

New draft guidelines from the government are expected to be released in the middle of next year – until then, the Department of Health suggests anybody concerned they have drunk too much alcohol during pregnancy should contact their doctor.

Obese women restricted in NHS IVF treatments

New NHS IVF treatment rules have been drawn up in Scotland.
Obese women restricted in NHS IVF treatmentsCouples who need help conceiving will be guaranteed two free infertility treatments from 1 July, however the treatments will only be available to those under 40, and it will not be offered to women who are obese.

In addition, couples need to have been in a stable relationship for two years and neither partner can smoke for three months before treatment begins.

Both partners also need to be methadone-free for a year before IVF starts

If either partner smokes they will need to have stopped before treatment is commenced

Women aged between 40 and 42 will be eligible for one cycle of fertility treatment if they have never previously undergone the procedure.

The new IVF criteria has been approved by the Scottish government.

The guarantees came as the National Infertility Group published a report with recommendations on new criteria.

The eligibility criteria for free fertility treatment in Scotland currently includes a female age limit of 39; the patient must not already have a child living at home; and they must have had less than three previous funded embryo transfers.

Scotland’s Public Health Minister Michael Matheson said the government was committed to “providing fair, reliable and faster access to IVF treatment”.

He insisted that it was important to end the different approaches across the country and to offer “equity”.

“We are investing £12 million over three years to help drive down waiting times for IVF treatments, and waiting times are already reducing in a number of NHS board areas.

“We also have to be responsible about the effects of smoking and obesity on pregnancy and beyond. Smoking not only reduces the effectiveness of IVF, but also doubles the risk of pregnancy loss.

“NHS boards will offer patients the support needed to make the lifestyle changes demanded of the new criteria.

“The safety of mother and baby is of utmost importance and the recommendations will ensure healthier outcomes for both families and babies born as a result of IVF treatment.”

Local maternity wards top the list of pregnant womens’ priorities

Pregnant women list the proximity of their local hospital or birthing centre as their top priority in their birth experience, according to a survey.Local maternity wards top the list of pregnant womens' prioritiesA quarter of British mothers listed the location of the birthing unit as their top priority when asked to identify the most important thing about their experience of giving birth.

The importance of the proximity to the hospital increased as women prepared to give birth to second (26 per cent) and third (30 per cent) children.

But while women see local maternity care as their top priority, the NHS is considering closing maternity units across the country in order to cut costs. A report published last year by the Royal College of Obstetricians and Gynaecologists recommended merging services into super-units.

Also high on the list of priorities for first-time mothers were: having a private room (14 per cent); access to a birthing pool (10 per cent); and having space for a partner stay overnight (nine per cent). As women prepared to give birth to second or third children, pools and partners, in particular, dropped in popularity, with only five per cent of women listing pools as a priority, and only four per cent citing an over-night stay by their partner as a key consideration.

While issues of comfort and personal, home-from-home care scored highest in the priorities of the women polled, a third of women said their top concerns were around the act of giving birth.

Fourteen per cent said their top priority was to have midwife-led care, whereas just 5 per cent of women polled said it was most important to them to have doctor led care. Another 11 per cent of women said that giving birth in a hospital with a good neonatal ward was their top priority.

“The fact that women want greater choice when it comes to giving birth is of little surprise; through our More Midwives campaign, WI members have been telling us that being able to make a choice about where and how they give birth is one of their greatest hopes,” said Ruth Bond, Chair of the National Federation of Women’s Institutes.

“Despite welcome commitments from the Government to overhaul maternity services, the number of midwives is not keeping pace with the ongoing the baby boom; this translates into fewer choices for women, and ultimately, an unsustainable strain on the system,” said Ms Bond.

The desire for midwife-led care comes days after the Royal College of Midwives gave warning that an extra 5,000 midwives were needed in England alone to deal with the highest birth rate in 40 years.

The poll, conducted by Bounty in conjunction with Ipsos/MORI, surveyed nearly 900 new mothers across Britain, exclusively for Telegraph Wonder Women.

From: http://www.telegraph.co.uk/Local-maternity-wards-top-list-of-womens-priorities-when-giving-birth

Number of mothers aged over 45 treble in a decade

The number of women having babies over the age of 45 has more than trebled in just over a decade as couples delay having children for career and financial reasons, according to official figures.The number of mothers aged over 45 treble in a decadeWhile the prevalence of teenage mothers has dropped dramatically since the 1990s, older mothers have reached the highest level seen in recent times.

A new analysis of birth records for 2011 published by the Office for National Statistics (ONS) confirms a major shift towards women having babies later in life, with even mothers in their early 20s becoming increasingly rare.

They show that less a quarter of births England and Wales in 2011 involved mothers under the age of 25 – half the proportion seen in 1970 and the lowest level since records began in 1938.

At the same time women over the age of 35 accounted for a fifth of the total in maternity wards, almost four times as many as in 1977, while those having babies over the age of 45 dramatically higher than a generation ago.

The ONS said the shift reflected a greater emphasis by women on building a career before having children couples with the impact of fertility treatment as well greater instability in relationships.

The figures also show the number of children born outside of marriage reaching a record high of 47.2 per cent.

Four out of 10 mothers over the age of 45 were also unmarried. Only 25 years earlier, almost eight out of 10 children were born to parents who had tied the knot.

But, significantly, the figures also hinted at major changes in the attitudes of fathers.

Birth registration records show that over the same period the number of men signalling a desire to play a part in the lives of children when they are not in a relationship with the mother has more than doubled.

Overall there were 723,913 live births in England and Wales in 2011, the most recent year for which figures are available.

A total of 1,832 babies were born to mothers over the age of 45 in 2011, almost three times the number as recently as the year 2000.

The figures bear witness to the impact of IVF, indicated by a marked rise in the number of women in their late 40s having twins or triplets.

In 1989, just three women in England and Wales had a multiple birth, a figure which was to increase more than thirty-fold in 20 years.

An analysis of birth registrations showed that almost a third of births were registered to couples living together but not married, up from only 10 per cent in 1986.

But more than one in 10 births were registered to parents who lived at separate addresses but were prepared to share responsibility.

That is three and a half time the level seen in the mid 1980s.

Men need to become match fit if they want to be fathers

Men have been warned they need to become ‘match fit’ if they want to be fathers, as a fertility study claims too much attention has been focused on mothers’ weight.Men need to become match fit if they want to be fathersWhile the health risks surrounding obesity and pregnancy have largely been centred on overweight mothers, the focus is now on men to lose weight.

Less efficient sperm results in smaller foetuses, poor pregnancy success and reduced placental development.

The discovery was made by reproductive experts from the University of Melbourne, Australia.

World Health Organisation figures show that a staggering 48 per cent of adult males are overweight or obese – making the findings even more of a worry.

The research was conducted by Professor David Gardner, Dr Natalie Hannan and PhD student Natalie Binder.

Prof Gardner, Head of the Department of Zoology, said: “A lot of men don’t understand they need to be healthy before conceiving. Sperm needs to be ‘match fit’ for the games of life and creating life is the biggest thing that we can do.”

The study used IVF to determine the effects of paternal obesity on embryo implantation into the womb and foetal development.

PhD candidate Natalie Binder generated embryos from both normal weight and obese male mice.

She said: “We found development was delayed in the foetuses produced from obese fathers.  Furthermore, placental weight and development was significantly less for embryos derived from the sperm of obese males.

These findings indicate that paternal obesity not only negatively affects embryo development, but also impacts on the successful implantation into the womb.

“This then results in a small placenta which impairs fetal growth and development with long term consequences for the health of the offspring. Our study provides more information about the impact of obesity in men and their ability to start a family and the need to shed kilos in preparation to conceive.”

The findings were presented at the Annual Scientific Meeting of the Endocrine Society of Australia and the Society for Reproductive Biology 2012.

From: http://multi-vitamins.eu/men-need-to-become-match-fit-if-they-want-to-be-fathers

Maternity units must be closed to make childbirth safer

Maternity units must be shut and merged in to big new ‘super-units’ to help women give birth safely experts say.Maternity units must be closed to make childbirth saferThe NHS maternity system is “unsustainable” and its out of hours care, which is “propped up by junior doctors”, is often poor, according to a new report RCOG release: Education and training of specialists to radically change published by the Royal College of Obstetricians and Gynaecologists.

The college recommended that services be merged into super-units providing specialist, round-the-clock cover with consultants working nights and weekends.

A “flexible workforce” must be created by giving doctors new training, so that more patients can be treated in community hospitals, local clinics, and even mobile health units, the report said.

The college argues that wards can only continue to be staffed by fully trained doctors through a process of downgrading or the merger of many local units, so that women with more complex problems can be moved on to a larger centre.

The report said: “The college is adamant that the obstetric delivery suite needs fully qualified specialists available at all times, 24 hours a day, seven days a week – more than half of all births, after all, take place ‘out of hours’.

“That requires more specialists which raises the issue of affordability. This may mean fewer acute obstetric units so that for the more specialised obstetric care women may have to travel farther as the service applies the logic that care should be ‘localised where possible, centralised where necessary’.”

Patient deaths in London were halved when services from hospitals were streamlined into only eight specialised units.

According to one recent study, babies born “out of hours” are a third more likely to die than those born during the working week.

Dr Wendy Reid, vice-president of the Royal College, said: “When you have a baby you deserve the same quality of care at 3am as at 3pm. We cannot go on running the NHS in our specialty propped up by junior doctors.

She added: “My focus has to be on patient safety because if you don’t get that right, you don’t have much of a right to comment on anything else.

“That’s why we’re pushing for specialists available on the labour ward, because that’s the high risk time. But that isn’t to the exclusion of interaction with the team all along the pregnancy so that you pick up as many people as potentially high risk before it happens.”

Gonorrhoea cases jump 25pc in a year

Cases of gonorrhoea have jumped by 25 per cent in onee year, new official figures show- prompting criticism of the Government’s ‘safe sex’ message for teenagers.Gonorrhoea cases jump 25pc in a yearThe new statistics from the Health Protection Agency show there were almost 21,000 new diagnoses of the disease in England in 2011, up from just under 17,000 in 2010.

Dr Gwenda Hughes, head of surveillance of sexually transmitted infections (STIs) at the HPA, said the figures showed that “more must be done to encourage safer sexual behaviour through health promotion and ensuring easy access to sexual health services and screening.”

Most new cases are in gay men but, amongst heterosexuals, more than half of new cases of gonorrhoea (57 per cent) are in 15-to-24-year-olds, HPA figures show.

At the moment gonorrhoea – which can lead to infertility in women, and pregnancy complications in those who do get pregnant – is the second most common bacterial STI in Britain, after chlamydia, which is far more widespread.

In a statement the HPA also advised: “To combat the continuing high rates of STI transmission in England, and the growing risk of gonorrhoea treatment resistance it is essential to always use a condom when having sex with casual and new partners.”

But Professor David Paton, of Nottingham University, a long-standing critic of successive governments’ safe sex policies, said the HPA’s advice failed to mention that having lots of sexual partners was a risk in itself.

He said: “The advice says nothing about reducing the number of sexual partners or the dangers of having sex at too early an age.  It implies that, as long as you use a condom, it’s ok. But having lots of sexual partners is a high risk activity in itself.”

He argued this was flawed because condoms sometimes failed.

Peter Greenhouse, a consultant in sexual health and spokesman for the British Association for Sexual Health & HIV (BASHH), said gonorrhoea was “highly concentrated” in certain populations in Britain – particularly gay men.

He warned that resistance to a new antibiotic called ceftriaxone was growing so fast that “in five years we are going to be in real trouble”.

From: http://www.telegraph.co.uk/Gonorrhoea-cases-jump-25pc-in-a-year

Abortions raise risk of premature births next time

Women who abort their first pregnancy are at significantly greater risk of having subsequent premature births a study has found.Abortions raise risk of premature births next timePrevious studies suggested that multiple abortions could result in complications in future pregnancies, but a new paper suggests that the risk after one termination is just as great.

Researchers from Aberdeen University studied the health data of more than 600,000 Scottish women whose second pregnancy came after either an induced abortion, a live birth or a miscarriage.

Speaking at the British Science Festival in Aberdeen, Prof Siladitya Bhattacharya said: “We found that women who had had a previous induced abortion had a higher risk of a spontaneous pre–term birth in their next ongoing pregnancy, compared with women who had never been pregnant before.”

“Abortion is common; most people know somebody who has undergone an abortion. The statistics for Scotland are compelling. In the last five years, 12 to 13,000 women have had abortions every year, and 40% of those are women under the age of 25.

Women who aborted their first pregnancy were 37 per cent more likely to have a subsequent premature birth than those in their first pregnancy, the study found.

However, they were 15 per cent less likely to have a subsequent pre–term birth than women who had previously suffered a miscarriage, according to the paper, which was published in the BMJ Open journal last month.

From: http://www.telegraph.co.uk/Abortion-raises-risk-of-premature-birth-next-time

Women can delay menopause indefinitely with ovary transplants

Women can remain fertile indefinitely after successful ovarian transplants lead to births and delay the menopause doctors have told a conference.Women can delay menopause indefinitely with ovary transplantsA technique to remove pieces of ovary, store it for decades and then replace it with delicate surgery could effectively put a woman’s menopause ‘on ice’, doctors said.

The only thing preventing them from having babies into their old age would be their physical ability to carry a pregnancy, they said.

The controversial notion would allow career women peace of mind with a fertility insurance policy so they can find a partner, settle down and become financially secure before starting a family.

By delaying the menopause they could also avoid the increased risk of osteoporosis and heart disease that come with the end of their fertile life but may raise the risk of breast and womb cancer.

A conference heard how 28 babies have been born worldwide to patients who either had their own ovarian tissue removed before treatment that would have left them infertile and replaced afterwards or twins where one donated tissue to the other.

Most of the children have been conceived naturally without the need for IVF for drugs.

Dr Sherman Silber, an American surgeon, has been involved in transplants for 11 women at St Luke’s Hospital in St Louis, Missouri, US, said: “A woman born today has a 50 per cent chance of living to 100. That means they are going to be spending half of their lives post-menopause.”

“But you could have grafts removed as a young woman and then have the first replaced as you approach menopausal age. You could then put a slice back every decade.  Some women might want to go through the menopause, but others might not.”

That would mean women would not have to “watch their body clocks”, he said, and would only be physically limited by their ability to carry a baby and give birth.

Transplants carried out eight years ago are still working showing the technique is ‘robust’ and it should no longer be considered experiemental, he said.

One transplant from one 38-year-old to her identical twin, has lasted seven years so far without failing.  In that time the recipient has had two healthy baby boys and a baby girl, all without IVF, conceiving the last aged 45.

Originally it was thought the transplants would only last months, or a few years at most, giving the women just a brief chance of conceiving. But Dr Silber said early hopes had been surpassed.

In Belgium, a woman has given birth after her ovarian tissue was frozen for decade, and in Italy a woman has just had a healthy baby girl after her tissue was frozen for seven years.

He and European colleagues have presented their findings this week at the European Society for Human Reproduction and Embryology (ESHRE) in Istanbul.

They wrote: “All modern women are concerned about what is commonly referred to as their ‘biological clock’ as they worry about the chances of conceiving by the time they have established their career and/or their marriage and their financial stability.

“Most of our cured cancer patients, who have young ovarian tissue frozen, feel almost grateful they had cancer, because otherwise they would share this same fear all modern, liberated women have about their ‘biological clock’.”

The first operation, conducted on Oudara Touirat in Belgium in 2003, led to a pregnancy and successful birth a year later.

Strips of her ovarian tissue were removed before chemotherapy for Hodgkin’s lymphoma and were replaced after she was given the all clear.

The majority of women who have undergone the procedure have had cancer but doctors said it is now time to extend it to others.