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.

Three IVF cycles a minimum treatment requirement

A charity is calling for couples who need help conceiving to have access to three cycles of IVF instead of two.

Three IVF cycles a minimum treatment requirementIn 2013 a working group, set up by the Scottish government, recommended eligible couples should be offered up to three treatments. But that would only be after health boards had reduced IVF waiting times.

Infertility Network UK said it was a “no-brainer” there should now be three cycles as waiting times have fallen.

New IVF criteria was introduced in July 2013, following recommendations by the National Infertility Working Group.

The changes were designed to standardise fertility treatment across Scotland to prevent a “postcode lottery”.

Giving evidence to Holyrood’s health committee, the charity’s chief executive Susan Seenan said: “The group recommended three cycles and said that once the waiting times were down to below 12 months, at the latest early 2015, they would consider moving to three cycles.

“It just doesn’t seem to be happening as fast as we would like it to. We just think now that the waiting times are down, that it is a no-brainer – we should move to offering everybody who is eligible three cycles.”

IVF treatment guidelines

  • A guaranteed two full cycles of IVF, as well as unlimited frozen transfers for eligible couples until the woman’s 40th birthday
  • Women aged between 40 and 42 will be offered one full cycle of IVF provided they meet all necessary criteria
  • From 31 March, 2015, all eligible couples will start treatment within 12 months of being accepted for IVF treatment
  • Obese women – those with a Body Mass Index (BMI) over 30 – will have to lose weight and have a BMI of 29.9 or less before treatment
  • If either partner smokes, they will need to have stopped before treatment is started

Susan Seenan added: “Everybody in the group was agreed that…three cycles was the best possible way to move forward for patients.

“Why anybody would not want to move forward with that, I have no idea, unless it is finance related.”

Fertility treatment is currently available to those under 40, and is not 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.

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

HIV care at risk from NHS changes

HIV care is at risk from the changes to the health service in England specialists are warning.
HIV care at risk from NHS changesAs part of NHS reorganisation, sexual healthcare became the responsibility of local authorities, while HIV care remains within the NHS.

The British HIV Association says many specialists feel the split has worsened patient care, and worry the situation will deteriorate even further.

The government said the NHS and local authorities should work together.

A survey by BHIVA, released to mark World Aids Day on Sunday 1st December, found a third of the 100 HIV specialists questioned thought care for people with HIV was poorer since the reorganisation in April this year. In addition two thirds thought care was set to deteriorate further.

In the past, HIV and genitourinary medicine (GUM) services were integrated, sharing staff and resources.

But the reorganisation transferred responsibilities for tackling public health issues such as obesity, smoking prevention and sexual health – but not HIV care – to local councils.

Around 100,000 people in the UK live with HIV.

Dr David Asboe, chair of BHIVA and a consultant in HIV medicine at the Chelsea and Westminster Hospital, said: “Key to the concerns uncovered in this survey are fears about the separation of HIV care from broader genitourinary medicine.”

Dr Janet Wilson, president of the British Association for Sexual Health and HIV (BASHH), said: “Sexual health clinicians have been sounding the warnings around restructuring since the introduction of the government’s health reforms.

“We are already hearing about tendered GUM services being prevented from undertaking partner notification on people newly diagnosed as HIV-positive even though this is the most effective public health intervention for identifying undiagnosed HIV infection.”

She added: “We need government, national and local agencies to urgently work together to prevent HIV and GUM care going backwards.”

Dr Steve Taylor, lead consultant in HIV Services at Birmingham Heartlands Hospital, said there was an issue with staff who had worked for joint HIV and GUM services in the past moving to a new sexually transmitted infection centre and being lost to the HIV services: “The way the system has been created has made an artificial divide between classic GUM services and HIV.

And he suggested anything not in the GUM service contracts risked being lost or downgraded, such as contact tracing to find current and former partners, data collection and training.

Dr Taylor added: “It’s about who is going to pick up the responsibility for all of those things that appear to be falling in the middle of what’s being covered by NHS England and by local authorities.”

A Department of Health spokesman said: “Public Health England’s report on HIV care last year reported an increase in people being diagnosed and prompt integration into care. However, the NHS and local authorities should work together to make sure that sexual health services are convenient and work for patients.”

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.”

Bikini waxes and Brazilians- causes rise in STI warts

Bikini waxes and shaves are the cause for the explosion in the number of cases of a type of sexually transmitted infection that causes unsightly warts, doctors are warning.Bikini waxes and Brazilians- causes rise in STI wartsShaving the pubic region causes ‘micro-trauma’ of the skin, boosting the chance of a pox virus called Molluscum contagiosum, say the medical experts.

The virus causes water warts, small pink bubbles which can break out over the body. These warts are relatively common in children as the virus can be spread by normal skin-on-skin contact.

However, it is also passed on during sexual activity, and over the last decade the incidence of this type of infection has been on the rise.

Doctors wanted to know if this rise was linked to the growing fashion for ‘Brazilians’ and other forms of pubic hair removal.

They looked through records of visits to a private skin clinic from January 2011 to March 2012, and identified 30 cases of water warts infection. All but two of the 30 patients had undergone pubic hair removal. Twenty of the 28 had been shaved, five clipped and three waxed.

In four cases the warts had spread to the abdomen and in one they had spread to the thighs.

Their research Pubic hair removal: a risk factor for ‘minor’ STI such as molluscum contagiosum which was published in the journal Sexually Transmitted Infections, they warned: “Hair removal (especially shaving) could favour its acquisition, propagation and transmission by micro-traumatisms.”

They said the reason for opting for pubic hair removal remained “unclear”, “but may be linked with internet based pornography”.

“Another reason cited is an increased sexual sensation. There may also be psychological reasons, as an unconscious desire to simulate an infantile look or a desire to distance ourselves from our animal nature.”

The trend, they noted, was “also growing among men”. In fact, 24 of the 30 cases were in men.

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.

Sexual healthcare at risk from NHS changes

In April 2013 many health services are being put out to private tender – and will be overseen by amongst others the GP-led Clinical Commissioning Groups (CCGs).Sexual healthcare at risk from NHS changesBut CCGs will not commission sexual health or public health services such as obesity and smoking prevention.

This function will fall to local councils, and elected officials. The directors of public health who will advise on these decisions will need to be strong advocates for the disadvantaged and stigmatised.

HIV services, meanwhile, will be commissioned centrally by the NHS Commissioning Board.

This separation is fraught with difficulties: especially when both sexual health and HIV care are currently provided by the same healthcare professionals on the same premises.

It is similarly unclear who will pay for HIV prevention campaigns.

Over 85% of all people attending NHS sexual health clinics take up HIV testing, with referral and retention rates both excellent – resulting in world-class patient outcomes.

Currently, we are able to treat patients, map epidemiological trends (disease patterns in the population) and target our prevention campaigns in a manner which is the envy of the world.

Any private company tempted to bid for a contract from a local council, may have subtly different priorities.

There will certainly be a handsome profit to be made from delivering straight-forward tests for sexually transmitted infections and HIV.

But diagnosis, management and treatment of the more complicated cases or assiduous epidemiological data collection might not be such money-spinners.

Is the private sector willing to provide such expertise, to perform ‘contact-tracing’, the unique NHS service which helps us track the spread of pathogens and identify outbreaks?

The worried well are an easy market.

But will private companies really target the hard-to-reach populations who need the services most, such as prisoners, commercial sex workers and intravenous drug users?

The difficulty with splitting HIV service provision apart from sexual health provision will also begin to tell.

Relatively expensive HIV services may become untenable without the staff and stability offered by providing the two services together.

Instead, there is a very real risk that currently joined-up services will become fragmented, with huge variation in service.

From: http://www.bbc.co.uk/news/health-19991579

NHS bill for PIP breast implant scandal almost £2 million- and growing

The NHS is facing a bill of almost £2 million for the PIP breast implant scandal as thousands of women are being turned away by their private clinics.NHS bill for PIP breast implant scandal almost £2 million- and growingAround 47,000 British women are believed to have been given faulty implants manufactured by French company Poly Implant Prothese (PIP).

They were filled with non-medical grade silicone intended for use in mattresses and have been linked to ruptures and swelling in the body.

The latest data from the Department of Health (DoH) shows 607 women who had operations with private doctors have been forced to turn to the NHS to have them removed after their clinic refused to help.

Of those 384 of these having already had the surgery.

More than 7,000 have approached the NHS in total and more than 5,000 have had appointments with doctors and scans to establish if the implants have ruptured.

The cost to the NHS of the appointments and scans that have already taken place is more than £850,000 and this will rise by a further £901,000 once the 607 women have all had their surgery.

The cost could rise further as the women already in the pipeline work their way through and if more women come forward.

There has been a furore over who should pay for the removal or replacement of implants.

In January, the Government announced that anxious women given PIP breast implants on the NHS would be able to have them removed for free, with private firms expected to offer the same deal.

But it emerged that some private clinics no longer existed and others refused to remove the implants.

The Department announced that any woman refused help by a private company would be able to visit their GP and access NHS care, but the NHS will only remove the implants, not replace them.

From: http://www.telegraph.co.uk/NHS-bill-for-PIP-breast-implant-scandal-is-almost-2m-so-far

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

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