Wednesday, September 7, 2016

Simple 'scratching' technique tested in first-time IVF patients

A new simple procedure which involves gently scratching the lining of the womb in the month before IVF treatment, potentially improving treatment success, is being tested on first-time IVF attempters in a ground-breaking study.

A team of scientists from the University of Sheffield and gynaecologists from Sheffield Teaching Hospitals NHS Foundation Trust are testing the technique – known as endometrial scratching – on women about to have IVF or Intra-cytoplasmic sperm injection (ICSI) for the first time.

The £1 million multi-centre study, funded by the National Institute for Health Research's Health Technology Assessment Programme, is running at Sheffield's Jessop Fertility as well as approximately 12 nationwide assisted conception units.

If shown to improve the success rate of embryo implantation, the trial could lead to endometrial scratching being offered routinely to all women having their first IVF treatment cycle.

Previous trials into the technique have focused on women who have had IVF at least once before – but initial findings from this research are highly promising, with pregnancy rates in women undergoing IVF doubling from 29 per cent to 49 per cent. The number of live births also increased from 23 per cent to 42 per cent.

The technique involves placing a small tube about the size of a drinking straw through the neck of the womb and gently scratching the womb's lining. The 'scratching' releases certain chemicals believed to help the fertilised egg implant in the womb's lining – increasing the chances of a successful pregnancy.

Mr Mostafa Metwally, a Consultant Gynaecologist and Sub-specialist in Reproductive Medicine and Surgery at Sheffield Teaching Hospitals NHS Foundation Trust, said: "The use of endometrial scratch has not yet been fully tried in women who are about to have IVF for the first time.

"If found to be beneficial then it could be used to improve the chance of achieving a pregnancy for a large group of women without the need for repeated IVF attempts, so we are delighted to be leading the way with this research. By the end of the study we hope to be able to tell whether or not endometrial scratch should be offered routinely to women having their first IVF treatment cycle."

The study will involve 1,044 participants and run over the course of two and a half years. Women taking part will be randomised to receive the Endometrial scratch or not prior to commencing their planned IVF/ICSI treatment, and need to be 37 years or younger.


Monday, August 22, 2016

Mini-IVF: The next breakthrough in fertility treatments?

For three years, Saralda Ortiz-Howard and her husband tried to get pregnant until they decided to turn to fertility treatments. They spent more than $30,000 on multiple cycles of both intrauterine insemination  (IUI) and in vitro fertilization (IVF) but neither was successful, not to mention that the physical side effects of the treatments were harsh.

“The amount of medicines that I was taking, my body felt out of whack,” Ortiz-Howard, now 43, said. “I felt that was one of the reasons I wasn’t successful in achieving pregnancy.”

Then the Hicksville, New York woman learned about mini-IVF, an alternative to traditional IVF that has been in use for years but isn’t as widely known or administered. Her physician, Dr. Zahir Merhi, director of research and development in IVF technologies at New Hope Fertility Center in New York City, explained that since mini-IVF uses a smaller amount of medication it would be less taxing on her body.

In June, Ortiz-Howard started mini-IVF treatments and said immediately she noticed her body wasn’t as swollen and she didn’t have the severe night sweats  that she had experienced with IVF.

“With the low dose, I felt regular, I felt normal,” she said. “Everything felt so much better.”

What is mini-IVF?
Mini-IVF or “minimal stimulation IVF,” is also referred to as “mild stimulation IVF” or “gentle stimulation IVF.”

“It’s very similar to IVF but you’re not stimulating the ovaries too much with high doses of medication,” Merhi said.

There isn’t data available on the number of U.S. clinics that offer mini-IVF, in 2014, there were 143 Society for Assistive Reproductive Technology (SART)-member clinics that submitted data about their use of the treatment.

Proponents of mini-IVF say it’s an option for some women who may respond better to lower doses of medication and the quality of the eggs and the embryos might even be better.

“There is this feeling that high doses of shots can be detrimental to the quality of eggs,” Merhi said.

Unlike traditional IVF which requires daily injections, mini-IVF needs fewer injections and uses tablets as well as a nasal spray in place of the “trigger shot” used for traditional IVF. However, the specific protocol varies between patients.

Since less medication is used, mini-IVF can be more affordable than IVF. A traditional IVF cycle can cost anywhere between $12,000 and $15,000 while a mini-IVF cycle might be as low as $4,500, on average.

Mini-IVF has drawbacks
Critics say that mini-IVF is not the magic bullet proponents claim it is. For starters, IVF is the most successful fertility treatment because the medications are meant to yield a large amount of eggs, said Dr. Peter Ahlering, medical director of the Missouri Center for Reproductive Medicine in St. Louis.

Studies show that after female age, the greatest predictor of pregnancy and live birth from IVF is the number of embryos produced.

“In general in IVF, quality and quantity run in parallel,” said Dr. Norbert Gleicher, founder and medical director of the Center for Human Reproduction in New York City.

Mini-IVF, on the other hand, can take more cycles on average to result in a pregnancy and a baby.

“The problem with the process is that if you get fewer eggs, then the probability of success is lower,” Ahlering said.

For women under age 35, 23.1 percent of mini-IVF cycles resulted in a single live birth, compared to 6.2 percent for women between ages 38 and 40, according to SART statistics. With traditional IVF, women under 35 had a 31.9 percent success rate, compared to 18.3 percent for women in the older demographic.

A study conducted by New Hope Fertility Center and published in the American Journal of Obstetrics and Gynecology found the live birth rate for mini-IVF was 49 percent versus 63 percent for conventional IVF.

Experts say the idea that mini-IVF results in better-quality eggs and embryos while high-dose stimulation can result in poorer quality eggs and embryos is a myth.

“If that were true, everybody would be doing [mini-IVF] all the time for all patients,” Ahlering said.

Another thing women should know is that similar to traditional IVF, there is always the chance that they will not respond to the medication, or get quality eggs or embryos, Merhi said.  

Although mini-IVF is often cited as a means to prevent ovarian hyperstimulation syndrome, a condition that can cause bloating, pain, weight gain or more serious symptoms, Ahlering said that there are traditional IVF medication protocols that can prevent this from happening.

“You can still achieve the high clinical pregnancy rates and get a good number of follicles but don’t expose the patient to extra risk of hyperstimulation,” she said.

Mini-IVF may be an option for some women, such as those who have diminished ovarian reserve, because regardless of the amount of medication they take, the same number of eggs will likely be retrieved, Ahlering said.

“I’m always going to recommend [the method] which gives the patient the optimal probability of pregnancy,” he said.

Although mini-IVF cycles are cheaper, if multiple cycles are required, it may not be cost saving in the long run.

“The whole thing is completely bogus [and] it’s a disservice to patients. It’s amazing that people are still using it,” Gleicher said.

For Ortiz-Howard, however, mini-IVF may turn out to be her best option for having a healthy baby. Unlike previous IVF cycles that yielded five or six viable, quality embryos, this time around doctors implanted four and froze seven. Now four weeks pregnant, she and her doctors are hopeful about the future.

“So far everything is great,” she said. 

Monday, June 13, 2016

World's First Delivery After Successful Womb Transplant: Mother tells of her 'Total Happiness' After Son's Birth

  • Malin Stenberg was only 15 when told she had been born without a womb
  • Her friend donated one as part of programme at Gothenburg University
  • She has now spoken about the magic of being a mother to her son Vincent 

Malin Stenberg was only 15 when she was told she had been born without a womb and so would never carry a child of her own.

But now she has spoken of the magic of motherhood after becoming the world’s first woman to have a baby with a womb transplant.

Miss Stenberg, 38, said she wanted to tell her story to give hope to others in the same situation.

‘If you wish for a family and you are unable to have one naturally, for whatever reason, it is so sad,’ she said

‘Total happiness comes from having a family and it doesn’t matter if it is through a womb transplant, or adoption or something else. It is magical.’

Three years ago, Miss Stenberg was given a womb by a family friend, as part of a pioneering transplant programme at Gothenburg University, in Sweden, and 20 months ago, she made history by giving birth to a son, Vincent.

Womb transplants have been attempted before but all had failed, until Vincent was born. As she watched the youngster play with a toy golf set in their home near Gothenburg, Miss Stenberg described her devastation at being told as a teenager that she suffered from MRKH Syndrome, a rare genetic condition which meant she was born without a womb.

‘I wasn’t ready to hear it, I couldn’t take it in,’ she said. ‘I thought that this means that I’ll never be able to carry a child of my own – but that is what women are made for. It felt so unfair. I loved kids and babies and I wanted to know what I had done to deserve this. I felt so alone.’

Eventually, she resigned herself to a life without children and threw herself into her career as a broker in the aviation industry.

Everything changed after she met her fiancé Claes Nilsson when she was 30. She told him about her condition early in their relationship and he vowed to find a way for them to have a family.

The couple looked into adoption and surrogacy before joining the womb transplant project at Gothenburg University.

Malin Stenberg
has spoken of the magic of motherhood after becoming the world’s first woman to have a baby with a womb transplant

Most of the nine women who took part in the scheme were given wombs donated by their own mothers. But Miss Stenberg’s donor was 61-year-old family friend Ewa Rosen.

After the womb was successfully transplanted, Miss Stenberg had IVF treatment – and became pregnant on her first attempt. She and Claes, 40, then ‘walked on eggshells’, until their son was born two months premature.

The couple chose the name Vincent, which is derived from the Latin for ‘to conquer’, to mark the extraordinary lengths they undertook to have him.

Miss Stenberg said: ‘When I held him for the first time, it was just amazing. I felt immediately that he was my baby. It just felt so natural. We truly are a family now.’

Mrs Rosen, whose womb made everything possible, is his godmother and sees him regularly.

Since Vincent was born, four more babies – three boys and a girl – have followed and several other countries have launched their own programmes.

Surgeon Richard Smith, head of charity Womb Transplant UK, is gearing up to start a series of similar operations here.

An estimated 15,000 British women were born without a womb or have had it removed because of cancer or other illness.

Vincent will not be joined by a little brother or sister because his mother has had her new womb removed over fears a second pregnancy would be more dangerous.
By Fiona Macrae Science Editor For The Daily Mail

Friday, February 12, 2016

New IVF Device Will Allow 'Natural Fertilization'

The AneVivo device
IVF patients in the UK are to be offered a ground breaking treatment that allows fertilization to take place inside the body, rather than in a lab.
The new device will enable fertilization in the womb.
Conventional in vitro fertilization (IVF) treatment involves removing eggs from the ovaries, fertilizing them with sperm in a laboratory, selecting embryos and returning them to the womb to continue the treatment process.
 Previous studies have suggested that babies born as a result of IVF treatment have a lower birth weight. While not a problem in itself, low birth weight has been linked to long-term health, which researchers are keen to improve.
 Prof. Nick Macklon, of the Princess Anne Hospital in Southampton, UK, believes long-term health in babies born through IVF could be improved by spending a shorter time in the laboratory. He was involved with the development of the new device, which is called AneVivo.
 The technique involves putting egg and sperm cells inside a tiny capsule, which is then placed painlessly into the womb for 24 hours. During this time, embryos begin to develop.
 Doctors then remove the device, which is around 1 cm long and 1 mm wide. After 2-4 days, they select the embryos that are healthy enough to be implanted back into the lining of the womb, in the hope of achieving a pregnancy.
 Fertilization in the natural environment
Prof. Macklon believes that the device signals "a real breakthrough in IVF treatment," as it enables women to care for an embryo in its earliest stages of development for the first time.
 Psychologically, it brings parents-to-be closer to the fertilization process and early embryo development. It could provide health benefits for the baby, as fertilization will occur in the natural environment of the womb with access to nutrients and signals from the mother. It will also reduce exposure to the synthetic culture fluids used in the laboratory.
 Prof Macklon, who is also chair in obstetrics and gynaecology at the University of Southampton, says:
 "This is a very significant moment in the advancement of fertility treatment in the UK, and we are all extremely excited to be able to offer patients the option of a more natural fertilization process."
 Martin Velasco of Anecova, the company that manufactures the device, says that it will allow free passage of fluids, nutrients, endometrial cells and other cellular and non-cellular components to enable interaction between the embryos and the maternal environment.
The AneVivo device was approved by the Human Fertilization and Embryology Authority (HFEA) in September 2015.

Wednesday, December 30, 2015

By 6th IVF attempt, 65% of couples achieve pregnancy

A UK study recommends that couples undertaking IVF (In Vitro Fertilization) should have up to six attempts, rather than the 3 or 4 embryo transfers that is currently standard practice. By that stage, 65% of women, with an average age of 35, have been able to have a baby.

This recent study, which was published in The Journal of the American Medical Association, could give fresh hope to couples who have tried to have a child for several years via IVF. In practice, IVF is often stopped after three or four unsuccessful embryo transfers.

An IVF cycle includes treatment with hormones to stimulate the ovaries, egg retrieval and the transfer of embryos arising from that hormonal stimulation.

Professor Debbie Lawlor of the University of Bristol and Professor Scott Nelson of the University of Glasgow suggest that the number of IVF cycles per patient should be extended beyond the usual three or four. Their research shows that 65% of women have a baby by the sixth attempt, taking an average of two years.

The researchers calculated the live birth rate for each cycle, as well as the cumulative probability of achieving a live birth across multiple IVF cycles up to 9.

The study followed 156,947 patients (with an average age of 35, and a median four year duration of infertility) and 257,398 IVF ovarian stimulation cycles.

The researchers found that in all women, the live birth rate for the first cycle was 29.5%, and 32% for those under 40. The rate remained above 20% up to and including the fourth cycle for women under 40. The cumulative live birth rate across all cycles continued to increase until the ninth cycle. By the sixth cycle, 65.3% of the women had a live birth, taking an average of 2 years.

Because of these encouraging results, the study's authors advise parents-to-be to consider IVF as a process with multiple cycles, rather than a single shot.

A test to predict the success rate of IVF is currently being developed by a team at France's Montpellier University Hospital in partnership with researchers at the French institute Inserm. They are studying an IVF outcome biomarker: the cell-free DNA present in a woman's blood. With a simple blood test, it will be possible to know the best moment for fertilization, thereby increasing the chances of success. This test could be used in the hospital from January 2016.

source: yahoonews

Tuesday, February 3, 2015

UK Steps Forward on Babies Made From 3 People's DNA

scientist working during ivf process
House of Commons was in favour; Bill next moves to House of Lords

British lawmakers in the House of Commons voted today to allow scientists to create babies from the DNA of three people—a move that could prevent some children from inheriting potentially fatal diseases from their mothers. The vote in the House of Commons was 382-128 in favor. The bill must next be approved by the House of Lords before becoming law. If so, it would make Britain the first country in the world to allow embryos to be genetically modified. The controversial techniques involve altering a human egg or embryo before transferring it into the mother. British law currently forbids any such modification and critics say approving the techniques could lead to the creation of "designer babies."

Defects in the mitochondria can result in diseases including muscular dystrophy; heart, kidney, and liver failure; and severe muscle weakness. The techniques would likely only be used in about a dozen British women every year who have faulty mitochondria, the energy-producing structures outside a cell's nucleus. To fix that, scientists remove the nucleus DNA from the egg of a prospective mother and insert it into a donor egg from which the nucleus DNA has been removed. This can be done either before or after fertilization. The resulting embryo would end up with the nucleus DNA from its parents but the mitochondrial DNA from the donor. Scientists say the DNA from the donor egg amounts to less than 1% of the resulting embryo's genes. Last year, the US FDA held a meeting to discuss the techniques and scientists warned it could take decades to determine if they are safe.

Tuesday, March 4, 2014

IVF After Womb Transplant

A Swedish doctor says four women who received transplanted wombs have had embryos transferred into them in an attempt to get pregnant.

He would not say on Monday whether any of the women had succeeded. In all, nine women in Sweden have received new wombs since 2012, but two had to have them removed because of complications.

The women received wombs donated by their mothers or other close relatives in an experimental procedure designed to test whether it's possible to transfer a uterus so a woman can give birth to her own biological child. The women had in vitro fertilization before the transplants, using their own eggs to make embryos.

"We have already begun transferring embryos into four of the women and plan to make attempts with the others when they are ready," said Dr. Mats Brannstrom, a professor of obstetrics and gynecology at the University of Goteburg, who is leading the research.

Brannstrom predicted that three or four of the seven women might successfully give birth.

"One or two more will perhaps get pregnant and miscarry, and one or two won't be able to get pregnant," he said.

There have been two previous attempts to transplant a womb — in Turkey and Saudi Arabia — but both failed to produce babies. Doctors in Britain and Hungary also are planning similar operations, but using wombs from women who had just died.

Brannstrom said any woman in the study who does get pregnant will be on a low dose of drugs to keep from rejecting the transplanted womb and will be monitored as a high-risk pregnancy.

The transplants are intended to benefit women unable to have children because they lost a uterus to cancer or were born without one.

Some doctors said women who got pregnant with a new uterus would have to be watched carefully for how the womb progresses throughout pregnancy.

"There are questions about how the physiological changes in the uterus will affect the mother and whether the transplanted uterus will be conducive to a growing baby," said Dr. Charles Kingsland, a spokesman for Britain's Royal College of Obstetricians and Gynaecologists and a gynecologist at Liverpool Women's Hospital.

In a study published last week, Brannstrom and colleagues described the procedures used to transplant the nine wombs and said there were "mild rejection episodes" in four patients.

He said the transplanted wombs would be removed after a maximum of two pregnancies.

Other experts called it a promising step but said it would be crucial that babies get enough nutrients from the mother's blood supply.

"We really don't know if the blood flow to the uterus will increase and adapt in the same way," as in a regular pregnancy, said Dr. Yacoub Khalaf, director of the Assisted Conception unit at Guy's and St. Thomas' hospital in London.

"It is a good sign they have done the (embryo) transfers," Khalaf said. "But a live birth will be the best validation that this works."


Sunday, February 2, 2014

'Most exciting breakthrough in IVF treatment in 30 years' could triple number of births

Thousands of infertile couples could benefit from a new IVF procedure that can dramatically improve the

Scientists believe they can double or even triple the proportion of healthy babies born as a result fertility treatment with a relatively simple technique that takes a series of time-lapse photographs of the developing IVF embryos.

On average only about 24 per cent of IVF embryos implanted into women in the UK lead to live births but the researchers believe this could be increased to 78 per cent using the new technique for selecting the best embryos.

“I believe it is the most exciting breakthrough we've had in probably 30 years,” said Professor Simon Fishel, managing director of the CARE Fertility Group, where the technique was developed.

“Every IVF practice in the world is unintentionally and unwittingly putting back into the womb unviable embryos that don't make babies,” Professor Fishel said.

“We hope to see a paradigm shift in terms of IVF. It's a game changer for everybody to have such an uplift in live birth rates. This is the beginning of something revelatory,” he said

Each year, licensed clinics in Britain carry out about 60,000 IVF treatments but most of them end in failure, causing immense emotional upset to couples, many of whom have paid between £5,000 and £10,000 for each treatment cycle.

The new procedure, which costs £750, identifies the best embryos to be implanted into the womb based on the time it has taken to develop between two key stages in the early life-cycle of the embryo.

Thousands of time-lapse pictures are taken during the first few days of an IVF embryo's life and these are used to identify the time between the first appearance of the fluid-filled cavity, called the blastula, and the final moment before the embryo “hatches” from its protective shell.

Scientists have discovered that when this period lasts longer than about six hours, the IVF embryo is likely to be carrying an abnormal number of chromosomes, called aneuploidy, which will lead to a failure of the pregnancy.

A preliminary study, published in the journal Reproductive Medicine Online and based on a retrospective analysis of 88 IVF embryos of 69 couples, found that the time-lapse technique could have improved the success rate of life births in this particular group of patients from 39 per cent to 61 per cent.

Even better success rates can be expected once the procedure is refined and applied to the wider population of infertile couples seeking IVF treatment, Professor Fishel said.

“Our work has shown that we can easily classify embryos into low or high risk of being chromosomally abnormal. This is important because in itself this is the largest single cause of IVF failure and miscarriage,” he said.

“The beauty of this technology is that the information is provided by a non-invasive process. So far we have seen a 56 per cent uplift compared to conventional technology, giving our patients the equivalent to a 78 per cent live-birth rate,” he added.

Normally, IVF embryos in an incubator are checked manually each day by embryologists but the time-lapse cameras are able to do this automatically by taking pictures every 10 minutes without interfering with embryo development, said Alison Campbell, embryology director at Care Fertility in Nottingham, who developed the computer algorithm controlling the analysis.

“With time-lapse we have the ability to view more than 5,000 images over the same time period to observe and measure more closely each stage of division and growth. As a result of continuous monitoring we have demonstrated that delays at defined points indicate abnormal development,” Ms Campbell said.

Martin Johnson, a fertility expert and editor of the journal where the work is published, said further “prospective” studies comparing the technique to existing methods of embryo selection are still needed before the procedure is recommended as standard treatment. “There are caveats with this research….and for these reasons we have to be cautious,” he said.

Sue Avery, director of Birmingham Women's Fertility Centre, said: “Unfortunately the study does not compare this exciting new approach with standard practise in embryology in which embryologists already look for the best embryos to place in the womb. Until the new technique is compared to current practise we cannot know whether different embryos are being chosen.”

Egg timing: Key stages

The developing embryo (image one, above) goes through two key stages when the fluid-filled cavity or “blastula” first forms (image two) and when the blastula is fully formed before the embryo “hatches” (image three).

The time between the two is used to judge whether the embryo is viable, with no defects in chromosome numbers. If the period is longer than six hours, the embryo is at high risk of abnormal chromosomes, which will inevitably lead to complications. Time-lapse photographs can indicate which embryos have a shorter time-period between these two points, and so which embryos are best for implantation into the womb.

Friday, April 5, 2013

New IVF breakthrough

Researchers have discovered that a chemical can trigger the maturation of small eggs to healthy, mature eggs in IVF treatment in the future.

Researchers at the University of Gothenburg have discovered that a chemical can trigger the maturation of small eggs to healthy, mature eggs, a process that could give more women the chance of successful IVF treatment in the future. The results have been published in the revered journal PloS ONE.

Women and girls treated for cancer with radiotherapy and chemotherapy are often unable to have children as their eggs die as a result of the treatment.

Although it is now possible to freeze eggs and even embryos, this is not an option for girls who have yet to reach puberty. A better way of preserving their fertility is to freeze slices of ovarian tissue that contain small immature eggs, and subsequently mature these eggs so that they can be used in IVF treatment. Unfortunately there is, at present, no way of maturing small eggs in an artificial environment outside the body.

How the study was done

A research group led by professor Kui Liu at the University of Gothenburg has recently discovered that a chemical which inhibits the PTEN molecule can trigger the maturation of small eggs to form healthy, mature eggs.

Carrying out a study on mice, the researchers managed to produce five live young mice from eggs matured using this PTEN inhibitor to help the growth and maturation process.

The results have been published in PloS ONE and build on previous results published in Science, where the group showed that PTEN is a molecule that inhibits an egg's development.

"This discovery demonstrates that there is a realistic chance of being able to use PTEN inhibitors to

activate small eggs in a test tube," says Kui Liu, professor at the University of Gothenburg's Department of Chemistry and Molecular Biology.

Methods used during study

Professor Kui Liu has led the study and is optimistic about the new method. "This technique is extremely valuable for those women who have only small eggs in their ovaries and cannot be helped by IVF as things stand," says Kui Liu.

Kui Liu's group demonstrated in the study that a short treatment with the PTEN inhibitor can trigger the growth of small eggs, and that this treatment makes it possible to produce plenty of mature eggs.

The results also show that healthy, live young can be born from treated eggs used in IVF. Not only were the young mice born fertile, they also showed no signs or symptoms of chronic disease at the age of 15 months, which equates to 70 human years.

Kui Liu is a professor of molecular biology and his group specialises in the study of molecular mechanisms that affect the development of female reproductive cells. His aim is to be able to use this method to help women.

"We hope to see this method being used clinically within five to ten years," says Kui Liu.

(EurekAlert, September 2012)

Source: health
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