CHECK OUT THIS INTERESTING BLOG BY LOLLIPOP GOLDSTEIN; ABOUT INFERTILITY AND PREGNANCY LOSS, AN EXPLORATION OF ADOPTION AND DONOR GAMETES, A BITCH SESSION ABOUT DAILY LIFE AND BOOKS...ETC. AT:
http://www.stirrup-queens.blogspot.com
Tuesday, July 29, 2008
Sunday, July 27, 2008
The birth that started a revolution
Thirty years ago Louise Brown, the first test tube baby, was born, and the world of fertility changed forever.
Her mother, Lesley, 33, had blocked fallopian tubes, so Dr Patrick Steptoe and Bob Webster took an egg from one of her ovaries, under anaesthetic, and fertilised it with sperm from her husband, John, in a laboratory, before placing it in her uterus. Nine months later, on July 25, 1978, Louise was delivered by Caesarean section at Oldham and District General Hospital.
Since that day, a series of in-vitro fertilisation (IVF) breakthroughs has enabled tens of thousands of couples to have the children they longed for. Other leaps have included treatments for male infertility, the use of donor eggs, surrogates and the genetic screening of embryos.
In Britain alone, 111,633 children have been born through fertility treatment; worldwide, the figure is estimated to be 3.5 million. The latest figures from the Human Fertilisation and Embryology Authority (HFEA), the regulatory body set up in 1991, show that 32,626 couples in Britain had IVF in 2005, leading to a total — including twins and triplets — of 11,262 children. About 25 per cent of IVF treatments are funded by the NHS; the rest are paid for privately, costing up to £8,000 (Dh58,525) a cycle.
Exceptions: But while IVF has answered the prayers of many couples, it is not a cure-all. The average success rate nationally for women under 35 is 29.6 per cent, while those aged between 40-42 have just a 10 per cent chance of conceiving using their own eggs. (There are exceptions: at the Assisted Reproduction and Gynaecology Centre in London, for example, the take-home baby rate is 59.9 per cent for women under 35). And fertility treatments are also transforming the family, raising ethical questions about concepts such as “saviour siblings”, babies genetically matched and created to provide tissue — often umbilical cord stem cells — to treat disease in an older child.
Similarly, treatment for post-menopausal women, same-sex couples and the spectres of sex selection for social reasons (illegal in the UK) and “designer babies”, where embryos are chosen or discarded for reasons other than health and viability, have also led to disquiet. Meanwhile, Louise, has a child of her own. Cameron, aged 18 months, was conceived naturally — an everyday miracle perhaps, but no less a miracle for that.
The first IVF triplets were born in 1984. In recent years, the HFEA has raised concern over the relatively high incidence of multiple births conceived through IVF; the risk of death before birth or within the first week after birth is more than four times greater for twins, and almost seven times greater for triplets, than for single births. Currently, around one in four IVF pregnancies results in twins or triplets, and the HFEA is now calling for more single embryo transfers to reduce this figure to 10 per cent —although clinicians are reluctant to do so, as replacing just one embryo reduces the chance of pregnancy. Mindy Vernon, 44, and her banker husband James, 43, live in Sevenoaks, Kent. They have triplets William, Thomas and Katherine, aged seven. “James and I got married when I was 32 and we tried for a year and a half to have a baby, without any success. Medical tests revealed no major issues and when the doctors diagnosed unexplained infertility, we decided to go for IVF. We had three rounds of treatment at Shirley Oaks hospital, at a cost of £2,000 a cycle, which failed. By the fourth cycle we were really losing heart, so we had three embryos replaced instead of the two we'd done previously. “Around the time of the IVF transfer I had terrible backache, so I had acupuncture treatments for the pain. When I mentioned that I was having fertility treatment, the practitioner said she could treat that, too, by inserting the needles at other sites on my body. Multiple pregnancy risk “I know there's conflicting opinion about whether acupuncture increases the success of IVF.
It may just have been coincidence, of course, but in my case it really did seem to work. “When we were told we were expecting triplets, we were overjoyed that I was pregnant at all and we didn't immediately take in the significance of what it meant to be carrying three babies at once.
Only later did we learn how much riskier it was for both me and the babies; we were informed that they might not all survive and were given a choice of terminating one of them. But after talking through the pros and cons, we knew we wanted to keep all three. “I have always felt it is important to keep fit, but I was told not to exercise and to eat as much as I could, so I stuffed myself and put on five stone.
I wasn't anxious during the pregnancy, because I had faith in my body and faith in the medical staff who were looking after me. I had a really easy pregnancy, too; I wasn't badly affected by morning sickness. “I gave up work at 22 weeks, and at 26 weeks my consultant advised me to go to hospital and stay there, so I could have complete rest and be monitored twice daily in case any problems arose. I knew I was having two boys and a girl, which the hospital had named A, B and C, and I spent my time listening to classical music and visualising them as individual little people.
“My mother was cooking for me at home every day and bringing food into the hospital, so I sat around getting fatter and feeling very special and quite serene. The babies were finally born by C-section at 34 weeks — a team of 21 doctors and nurses was involved in the delivery.
None of them had any medical problems at birth, or subsequently. “They were allowed home after three weeks, by which time they had put on weight — and then the work really started: I breast-fed them as best I could for two months, but I didn't have much milk so they also got through 24 bottles a day. “James and I were lucky to have lots of support from my mother, in particular, who stayed with us for a whole year, and in the first few months James's mum crossed half the country every weekend to help out. “My mother and I did the weekday shifts and James and his mother took over at weekends so we could rest. Those early days, months and years were utterly exhausting and looking back, I can't believe we managed, but somehow we did. Having triplets is a joy, but it's also emotionally and financially draining.
Not convinced “I feel ambivalent about the guidelines that only two or even just one embryo should be replaced. There's no doubt that replacing three embryos maximises a woman's chances of getting pregnant, but it's not without its medical risks and bringing up three babies is not for the fainthearted. Still, we were fantastically lucky with our three; we love them dearly and wouldn't swap them for the world.”
The first commercial surrogacy took place in Britain in 1985 when Kim Cotton, a mother of two, was paid £6,500 to carry a child conceived using her egg and the infertile woman's husband's sperm. It is now illegal for a surrogate to charge fees, but reasonable expenses may be paid to cover clothing, travel, food, time off work, etc, amounting to anything from £7,000 to £15,000.
Two types of surrogacy: There are two types of surrogacy. Straight surrogacy uses the egg of the surrogate and the sperm of the intended father and is usually carried out via artificial insemination at home. Host (or gestational) surrogacy requires IVF, as embryos are created using eggs and sperm from the intended mother and father and transferred into the surrogate mother. Fiona O'Driscoll, 38, who works for the charity Save the Children, is married to Andrew, 39, a business consultant. A surrogate mother is carrying their baby, due in October. “I have a condition called Mayer Rokitansky Kuster Hauser Syndrome (MRKH), which means I was born without a womb — although I do have ovaries — so I knew that if I wanted a family I would need to use a surrogate mother or adopt. We looked at adoption, but it's almost impossible to get a baby, and we really wanted to create one that is genetically ours. “We got in touch with the non-profit organisation Surrogacy UK in order to make contact with a surrogate and find out more about the process. The ethos is one of friendship before surrogacy and, at the social events, we got to know another couple, Kate and Dennis, really well over a period of months. They already have two children and offered to help us. “To be honest, my first instinct was: ‘Why on earth would someone offer to carry another woman's baby?' It was hard to believe anyone would do something so momentous purely out of the goodness of their own heart. But Kate is such a selfless person and she's certainly not in it for the money; all we do is make sure she's not out of pocket by covering expenses like multivitamins and maternity wear, taxis and childcare. “We were treated at the London Fertility Clinic in Harley Street; I took drugs to stimulate my egg production. These were fertilised by Andrew's sperm, and the resulting seven embryos were frozen. Two survived the thawing process and were transferred into Kate, who had taken drugs to prepare her body. Two nail-biting weeks later, Kate, Andrew and I were all together in a coffee shop in central London when the call came through that she was pregnant and we all burst into tears. “Kate is now 28 weeks pregnant. Andrew and I — and Dennis — will all be at the birth; it's very exciting. We're so proud of what they are doing. You read horror stories about surrogacy costing a fortune or the surrogate trying to keep the baby, but the truth is, it's about a good friend giving you the most extraordinary gift imaginable.”
Names have been changed
SOURCE: Daily Telegraph
Friday, July 25, 2008
HOW DO COUPLES COPE WHEN IVF FAILS?
Broke, babyless and in need of help. John Naish examines the taboo question of how couples cope when it all goes wrong:
Across Britain next Friday, thousands of couples will brace themselves for a welter of “miracle-baby” stories as the world marks the 30th birthday of Louise Brown, the first test-tube child. In the shadow of assisted conception's many successes are the 75 per cent of women patients for whom the gruelling medical process never works. The vast majority are neither monitored nor offered counselling but, it seems, are expected to slink away, marked “failed.”
Caroline Gallup is among the 25,000 women each year whose fertility treatment proves fruitless, often after spending all their available funds and putting their relationships under perilous strain. Rather than quietly grieving, Gallup is campaigning for the NHS and high-earning private clinics to give support after assisted conception has failed and to fund studies into what happens to these people's lives.
Very little research has been done, but in 2000 a small study of 76 women by the Royal Maternity Hospital in Belfast found that five years after their unsuccessful treatment they suffered “significant psychological dysfunction”, particularly stress and depression. The research, published in the journal Human Fertility, concluded: “There is a strong need to prepare women better for treatment failure and to ensure that counselling is available when further treatment is no longer appropriate.” This echoes the findings of a Hull University study three years earlier. Both recommendations have fallen on deaf ears.
The government watchdog, the Human Fertilisation and Embryology Authority, says that it sees issues about follow-up monitoring and counselling as outside its remit, because it regulates only the process of infertility treatment itself.
Hence Gallup's campaigning. “I see the routine provision of post-treatment counselling as a moral duty,” says the 44-year-old Londoner. “When you are treated, you have to believe that a baby will grow. When it doesn't, the crash is awful, but you're buoyed as long as you can go through another cycle. I think it's only morally right for clinics to carry on with ‘after-sales service' when that hope has disappeared.”
COUPLES HAVE THE UTMOST OPTIMISM
“The clinics do tell you at their open days that there is a 76 per cent failure rate across the board, but couples aren't in a position to take that in,” says Gallup. “The only way you can enter into something so grim is with the utmost optimism.” Indeed, a study in The Obstetrician & Gynaecologist journal found that although clear information on success rates is given to couples, “the majority believe that they will be the minority who achieve pregnancy”.
Gallup and her husband decided to stop trying after they had paid £8,000 for private treatment. “It was partly down to money - we'd run out - and partly the fact that it was wrecking our relationship. My husband said he didn't want to go through it any more. It was turning me into a total obsessive,” she says, adding: “Blame can play a really big part in relationships after treatment failure. It's one of the big reasons why counselling is needed.”
Four years after the treatment ended, she says: “My husband and I are still dealing with it. I have had to reinvent myself. I didn't know what my identity was after we had finished. That's a huge psychological thing.” Now she has taken a less demanding job in her career in events management to spend time lobbying interest groups and politicians. She is also trying to develop a career as a writer, having published a book on her fertility treatment experiences, 'Making Babies the Hard Way.'
Emerging from fertility treatment babyless, broke and in need of professional support to get back on the rails is a common experience, according to the British Infertility Counselling Association. “A lot of people come out of the process highly stressed and they think they can go for free counselling, but there is no such thing,” says a spokeswoman. “Funding is a big problem for most people. They may well not be able to pay for private counselling because they have spent all their money on treatment.”
One of the few organisations to provide social support is More To Life, which helps involuntarily childless people to develop networks and swap advice. Membership costs £20 annually and has grown rapidly in the two years since it was established, says Susan Seenan, one of the organisers. “Social life can be difficult for infertile couples, especially women,” she says. “Wherever you go - barbecues, parties, christenings - everyone has children.
“It's difficult to talk about infertility and childlessness. It's seen as a stigma. But with more people leaving it until later in life to try for children, there is bound to be more infertility, more treatment, and more disappointed couples.”
It is not only infertile women who face bereavement and loss of purpose. David Downage regularly attends More To Life social events. He and his wife went through treatment in the NHS and privately, but ultimately decided that their hopes were beyond slim. “It was a traumatic decision, but the danger is that you go on trying too long and damage your relationship,” he says. “So we decided to move on.”
The Downages joined More To Life to extend their social network beyond old friends with their new families. “We had to find it by searching the web,” he says. “It's strange that clinics can't point you to organisations like this after the treatment has failed,” says David, 47, a property developer. “For a man, discovering that you're going to be childless raises questions about what you are doing with your life. Once you can pay the bills, what is there after that? My wife and I came to view it as an opportunity to do other things. She is keen to get involved in charity work with children. We plan to retire early and, hopefully, be able to put some of our money into building children's schools. Certainly we will be able to do that as a legacy.”
Finding renewed purpose is one of the best survival strategies, says Jacky Boivin, a researcher at Cardiff University's School of Psychology. She has followed more than 100 women undertaking IVF over seven years, and is running a five-year study of 818 couples in Denmark.
“There is not much research into what happens to people in the long term after unsuccessful treatment, but our data indicates that about 40 per cent of couples are highly distressed at having to stop. After they have made the decision, around 5 to 10 per cent remain stuck in that state. People who come to the end of the IVF treatment and feel they could have had more are often seized with resentment.
“You have to reinvent a life that is not about having a family,” she stresses. “You have to look for the positive while acknowledging the negative. People have to regain a sense of control over their lives, after having it taken over by regimens that tell them exactly when they should be having sex. And they need to look at the experience as an opportunity to renew life interests. Sadly, the lack of post-treatment counselling means people don't have support in this.”
AND NOW THE GOOD NEWS
There is one surprise. Boivin says: “Oddly, the divorce rate is much lower among couples whose fertility treatment failed than for the general population: 10 per cent versus 50 per cent. We don't know why. There is life after infertility treatment. Not always an easy one, but most people will go on to find contentment, though the experience will always carry a sting.”
SOURCE: THE TIMES ONLINE
Across Britain next Friday, thousands of couples will brace themselves for a welter of “miracle-baby” stories as the world marks the 30th birthday of Louise Brown, the first test-tube child. In the shadow of assisted conception's many successes are the 75 per cent of women patients for whom the gruelling medical process never works. The vast majority are neither monitored nor offered counselling but, it seems, are expected to slink away, marked “failed.”
Caroline Gallup is among the 25,000 women each year whose fertility treatment proves fruitless, often after spending all their available funds and putting their relationships under perilous strain. Rather than quietly grieving, Gallup is campaigning for the NHS and high-earning private clinics to give support after assisted conception has failed and to fund studies into what happens to these people's lives.
Very little research has been done, but in 2000 a small study of 76 women by the Royal Maternity Hospital in Belfast found that five years after their unsuccessful treatment they suffered “significant psychological dysfunction”, particularly stress and depression. The research, published in the journal Human Fertility, concluded: “There is a strong need to prepare women better for treatment failure and to ensure that counselling is available when further treatment is no longer appropriate.” This echoes the findings of a Hull University study three years earlier. Both recommendations have fallen on deaf ears.
The government watchdog, the Human Fertilisation and Embryology Authority, says that it sees issues about follow-up monitoring and counselling as outside its remit, because it regulates only the process of infertility treatment itself.
Hence Gallup's campaigning. “I see the routine provision of post-treatment counselling as a moral duty,” says the 44-year-old Londoner. “When you are treated, you have to believe that a baby will grow. When it doesn't, the crash is awful, but you're buoyed as long as you can go through another cycle. I think it's only morally right for clinics to carry on with ‘after-sales service' when that hope has disappeared.”
COUPLES HAVE THE UTMOST OPTIMISM
“The clinics do tell you at their open days that there is a 76 per cent failure rate across the board, but couples aren't in a position to take that in,” says Gallup. “The only way you can enter into something so grim is with the utmost optimism.” Indeed, a study in The Obstetrician & Gynaecologist journal found that although clear information on success rates is given to couples, “the majority believe that they will be the minority who achieve pregnancy”.
Gallup and her husband decided to stop trying after they had paid £8,000 for private treatment. “It was partly down to money - we'd run out - and partly the fact that it was wrecking our relationship. My husband said he didn't want to go through it any more. It was turning me into a total obsessive,” she says, adding: “Blame can play a really big part in relationships after treatment failure. It's one of the big reasons why counselling is needed.”
Four years after the treatment ended, she says: “My husband and I are still dealing with it. I have had to reinvent myself. I didn't know what my identity was after we had finished. That's a huge psychological thing.” Now she has taken a less demanding job in her career in events management to spend time lobbying interest groups and politicians. She is also trying to develop a career as a writer, having published a book on her fertility treatment experiences, 'Making Babies the Hard Way.'
Emerging from fertility treatment babyless, broke and in need of professional support to get back on the rails is a common experience, according to the British Infertility Counselling Association. “A lot of people come out of the process highly stressed and they think they can go for free counselling, but there is no such thing,” says a spokeswoman. “Funding is a big problem for most people. They may well not be able to pay for private counselling because they have spent all their money on treatment.”
One of the few organisations to provide social support is More To Life, which helps involuntarily childless people to develop networks and swap advice. Membership costs £20 annually and has grown rapidly in the two years since it was established, says Susan Seenan, one of the organisers. “Social life can be difficult for infertile couples, especially women,” she says. “Wherever you go - barbecues, parties, christenings - everyone has children.
“It's difficult to talk about infertility and childlessness. It's seen as a stigma. But with more people leaving it until later in life to try for children, there is bound to be more infertility, more treatment, and more disappointed couples.”
It is not only infertile women who face bereavement and loss of purpose. David Downage regularly attends More To Life social events. He and his wife went through treatment in the NHS and privately, but ultimately decided that their hopes were beyond slim. “It was a traumatic decision, but the danger is that you go on trying too long and damage your relationship,” he says. “So we decided to move on.”
The Downages joined More To Life to extend their social network beyond old friends with their new families. “We had to find it by searching the web,” he says. “It's strange that clinics can't point you to organisations like this after the treatment has failed,” says David, 47, a property developer. “For a man, discovering that you're going to be childless raises questions about what you are doing with your life. Once you can pay the bills, what is there after that? My wife and I came to view it as an opportunity to do other things. She is keen to get involved in charity work with children. We plan to retire early and, hopefully, be able to put some of our money into building children's schools. Certainly we will be able to do that as a legacy.”
Finding renewed purpose is one of the best survival strategies, says Jacky Boivin, a researcher at Cardiff University's School of Psychology. She has followed more than 100 women undertaking IVF over seven years, and is running a five-year study of 818 couples in Denmark.
“There is not much research into what happens to people in the long term after unsuccessful treatment, but our data indicates that about 40 per cent of couples are highly distressed at having to stop. After they have made the decision, around 5 to 10 per cent remain stuck in that state. People who come to the end of the IVF treatment and feel they could have had more are often seized with resentment.
“You have to reinvent a life that is not about having a family,” she stresses. “You have to look for the positive while acknowledging the negative. People have to regain a sense of control over their lives, after having it taken over by regimens that tell them exactly when they should be having sex. And they need to look at the experience as an opportunity to renew life interests. Sadly, the lack of post-treatment counselling means people don't have support in this.”
AND NOW THE GOOD NEWS
There is one surprise. Boivin says: “Oddly, the divorce rate is much lower among couples whose fertility treatment failed than for the general population: 10 per cent versus 50 per cent. We don't know why. There is life after infertility treatment. Not always an easy one, but most people will go on to find contentment, though the experience will always carry a sting.”
SOURCE: THE TIMES ONLINE
Wednesday, July 9, 2008
Science thinks big for better IVF
A new IVF technique involves selecting sperm with a shape and size that indicate good genetic quality. The best are injected into eggs to fertilise them. Results show improved pregnancy rates
Infertile men can more than double their chances of fatherhood with a new IVF technique, according to the most comprehensive study of the procedure yet conducted.
The results of a major trial of the approach, which builds upon the technique of injecting sperm directly into an egg, suggest dramatic benefits for the one in 12 couples affected by male factor infertility. A far more powerful microscope is used to identify the sperm most likely to succeed.
The results, from a team in Italy, are encouraging for men with an especially poor fertility prognosis and who have tried and failed to have children by IVF at least twice in the past. Their prospect of becoming fathers using the therapy was double that with standard methods, the study found.
The method, which was first developed in 2004 by a team led by Benjamin Bartoov, of BarIlan University in Israel, is called intra-cytoplasmic morphologically-selected sperm injection (IMSI). It involves examining sperm under a high-magnification microscope, about five times more powerful than standard laboratory equipment, to select those with a shape and size that indicates good genetic quality. The best-looking sperm are then injected into eggs.
British scientists hailed the results as the strongest demonstration yet of the new therapy’s benefits. “I don’t think a lot of people in the UK have woken up to this yet, but they are going to have to,” said Allan Pacey, Lecturer in Andrology at the University of Sheffield. “This is strong evidence from a well-designed study. If it can be repeated in two or three studies, people would seriously have to think about changing their approach.”
The treatment builds on the success of intra-cytoplasmic sperm injection (ICSI), a therapy for male infertility that has enabled thousands to become fathers since it was developed in the early Nineties. ICSI involves fertilising an egg in a laboratory by injecting it with a single sperm. As the sperm does not have to swim up to the egg and penetrate it, the method can help men whose sperm would otherwise be too weak. Even when men produce no sperm, doctors can sometimes recover them surgically from the testes.
ICSI is now used in about 40 per cent of the 41,000 IVF cycles performed annually in the UK, and accounts for about 4,500 children born each year. This suggests that upwards of 10,000 men a year could be appropriate patients for the new technique.
The Italian team, led by Monica Antinori, of the Raprui clinic in Rome, has conducted the largest randomised controlled trial to compare outcomes for IMSI and ICSI. It involved 446 couples in which the man was infertile and the woman was not known to have any problems.
The results, which are published in the journal Reproductive Biomedicine Online, show that the IMSI method can deliver considerable improvements in pregnancy rate. The overall pregnancy rate for the IMSI group was 39.2 per cent, compared with 26.5 per cent for the ICSI patients.
Among men with the worst prognosis, who had had at least two failed attempts at ICSI before, the improvement was better still. The pregnancy rate for IMSI was 29.8 per cent, compared with 12.9 per cent for standard ICSI. The miscarriage rate also fell considerably.
Dr Antinori said the findings demonstrate that the technique has potential, particularly for men with a history of IVF failure. “By treating this kind of patient with this technique, we offer them an opportunity to solve their fertility problems. As you can see from the results, the group that has had two or more IVF failures can get more than twice the opportunity to have a pregnancy with this new technique.”
She cautioned, however, that IMSI is about twice as expensive as ICSI, which typically costs between £3,000 and £5,000 per cycle in Britain. It also requires special training for embryologists, and the purchase of expensive high-magnification microscopes.
IMSI is not yet offered in the UK, though it is performed by clinics in Italy, Israel, Switzerland and Spain.
Dr Pacey said: “People have been seduced into thinking that, as long as you’ve got a sperm that’s half decent, it’s got as good a chance as any. But it looks like we can do better than that.”
Source: The Times July 7 2008
Tuesday, July 8, 2008
COFFEE CUTS CHANCE OF HAVING BABY
Drinking too much coffee or tea can cut the chances of a woman getting pregnant by a quarter if she already has fertility problems. The effect is the same as drinking excessive alcohol, according to researchers in the Netherlands. They looked at 8,669 women who had undergone IVF treatment and found the likelihood of pregnancy was significantly reduced for those who smoked, drank too much coffee and alcohol, and were overweight. Fertility expert Prof Bill Ledger, of the University of Sheffield, said: ‘A lot of women can have 20 cups of coffee a day and get pregnant while falling off a log, but if you’re already sub fertile it could push you over the edge.’
Source: Metro newspaper Tue, July 8, 2008
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