As the technology of freezing eggs improves, more options open up for women

If you're not a woman of child-bearing age, you may never have heard of egg freezing.
But this form of in vitro fertilization has gained traction as its success rate has improved.

Pix left:A cryoloop, a critical tool in advancing pregnancy results from frozen eggs, is smaller than the point of a pen, right. Film is placed on the loop, which holds eggs for freezing

It was in 1978 when the first "test tube" baby was born in England. There, doctors fertilized an egg with sperm in a petri dish, then implanted the resulting embryo into the womb. Since then, hundreds of thousands of women have conceived using this method. In 2006, more than 54,000 IVF babies were born in the United States.

IVF using frozen eggs is newer. In the past decade, as many as 500 babies worldwide have been born from embroys that originated from a thawed-out egg. The first report of such a baby was in 1986. In 2007, the United States recorded its first baby born using both frozen egg and frozen sperm.
Egg freezing appeals to several groups of people, including young cancer patients facing life-saving but fertility-damaging treatments and women who want to extend the window of opportunity to have children because they don't yet have a life partner in the picture.

Couples undergoing fertility treatments also may be drawn to egg freezing. Perhaps they don't like the idea of having to destroy unused embryos or keeping them in limbo. Or -- erring on the side of caution -- they opt for the procedure to avoid the potential issue of custody: Unlike embryos created with a partner's sperm, frozen eggs, which belong to the woman, don't pose problems. (Who "owns" the embryos has landed more than a few soon-to-be-ex couples in court.)

Because oocyte cryopreservation (the medical term for egg freezing) is still considered experimental by the American Society of Reproductive Medicine, many U.S. fertility clinics only offer the service to cancer patients.
But that may soon change.

In 2006, an experimental program at Toledo Hospital's Fertility Center of Northwest Ohio welcomed the arrival of its first baby born from a once-frozen egg.
"It was our fertility doctor's idea [to join the study]," said Stacey LaPointe of suburban Toledo, who was 31 when her eggs were retrieved and frozen. "I think we were a little leery, a little hesitant at first."
But after doctors explained the process to LaPointe and her husband, Ryan, the couple decided to go forward.
"We had tried other things unsuccessfully," she said. "It was one of those crapshoots. The odds were so low, we thought, 'Well, it's worth a try.' "
Doctors froze seven of LaPointe's eggs. The five that survived the thawing process were fertilized. Two embryos were implanted, and the other three were frozen.
On Aug. 21, 2006, Claire LaPointe was born.
"We were thrilled," LaPointe said.
On April 1, 2008, she gave birth to her second child, Katie -- conceived the old-fashioned way.

Cleveland Clinic's Beachwood Fertility Center has frozen the eggs of a dozen cancer patients over the past two years. Roughly half of the Clinic's cancer patients do some type of "fertility sparing" procedure, such as embryo or sperm freezing.

As part of a trial to demonstrate that the procedure can work, the Clinic's Partnership For Families program recently picked up most of the expenses -- egg donation, freezing, thawing and fertilization -- for two healthy women in their early 40s who used frozen eggs from a woman in her early 20s. The two women have progressed beyond their first trimesters.

Prior to these two pregnancies, talking to cancer patients about freezing their eggs wasn't a comfortable conversation. No one knew if the success at other clinics could be replicated at the Clinic, said Dr. James Goldfarb, director of the in vitro program at the Clinic's fertility center.
Now, he said, "It's so much nicer to say, 'We can freeze your eggs and have a reasonable chance of this working.' "

The Clinic will consider on a case-by-case basis whether it will offer egg freezing as an elective procedure to healthy women.
University Hospitals Case Medical Center hopes to develop an egg-freezing program in the next six months, said Dr. William Hurd, director of the division of reproductive endocrinology at UH's MacDonald Women's Hospital. And like the Clinic's program, the hope is to expand it to healthy women.

Increasing chances of success
The closer you are to 40, the less likely you are to be a good candidate to freeze your eggs. The cutoff age at Extend Fertility Inc. in Massachusetts is 40, while the Florida Institute for Reproductive Medicine in Jacksonville won't accept women over age 38. CHA Fertility Clinic in Los Angeles has a cutoff of 35, with few exceptions.

Beyond age, women need to be as healthy as possible.
So what's the optimal age to freeze one's eggs? About the same that a woman should thinking about having kids.
"Before 30 is ideal," said Hurd. "In her 20s is a good time to have the first child."

At the Florida Institute for Reproductive Medicine, 53 babies have resulted from frozen eggs in the past nine years. One of those babies is now 3, the child of a cancer patient whose frozen eggs were thawed, fertilized and then carried by a surrogate.

At last count, the University of Bologna in Italy has reported a 25 percent success rate using frozen eggs -- roughly one baby for every four pregnancy attempts -- resulting in around 150 babies.

A clinical study operated by Extend Fertility Inc. -- which works with five partner centers in Boston; Austin, Texas; New York; Beverly Hills, Calif.; and Seattle -- has resulted in 13 babies born from women who used frozen donor eggs, said spokeswoman Marla Libraty.
"The data is early, but it is encouraging," she said.
CHA Fertility Clinic in Los Angeles -- which touts itself as the country's first commercial egg bank -- has had 27 babies born. Five women are currently pregnant.

At the Florida Institute, between 40 percent and 50 percent of women who have had about 10 eggs frozen and then thawed have taken home a baby, said program director Dr. Kevin Winslow.

"In theory, eggs may be stored indefinitely. It is the freezing and thawing process that damages the eggs, not the duration that they are frozen," said Scott Brown, spokesman for California Cryobank.
Dr. Glenn Schattman, a specialist in reproductive surgery at Cornell University's Weill Medical College in New York, says many clinics don't know what their success rates will be because they haven't thawed any of the eggs that they've frozen.

"Most programs don't have their own data," he said.
Most of the women who come through the doors of CHA Fertility Clinic in Los Angeles end up not going through with the procedure, said clinic director Dr. Vicken Sepilian.
"The big misconception is that it's a sure thing and it can be done at any age, that fertility doctors can undo the clock," he said.
Prospective patients should do their research and homework before committing to freezing their eggs, Sepilian said.
Some of the most important questions to ask a clinic: How adept are you at freezing and thawing? What is your pregnancy success rate? How many babies have been born through the specific technology at your clinic?
"It's not this magical treatment that's going to work 100 percent of the time," he said. "It's a backup plan."

SOURCE: CLEVELAND.COM

A cheap, painless alternative to IVF?

Breakthrough in fertility treatment as first British babies are born using new technique

A landmark in the development of fertility treatment was announced by doctors yesterday with the birth of the first babies to be conceived using a revolutionary technique that offers a safer, cheaper alternative to IVF.

The twin boy and girl, who were born on 18 October at the Radcliffe Infirmary in Oxford, were conceived using In Vitro Maturation (IVM), a method that dispenses with the use of costly fertility drugs, saving up to £1,500 on the normal price of treatment.

The technique is also safer for the one in three women among those seeking fertility treatment who have polycystic ovaries, a condition that puts them at high risk of dangerous side effects from fertility drugs.
Specialists said the development could make in vitro techniques available to more infertile couples by cutting the cost of treatment. Infertility is estimated to affect one in six couples in the UK but IVF costs around £5,000 a cycle and treatment is restricted on the NHS.

Tim Child, a consultant gynaecologist at the Oxford Fertility Clinic and senior fellow in reproductive medicine at Oxford University, who led the work, said: "I think it is a safer, cheaper alternative to IVF for all women. However, for many women the success rates are currently much lower. Research in the future will address this."

The Oxford Fertility Clinic is the only one in the UK licensed to use the technique: 20 cycles of treatment have been carried out and four other women are currently pregnant, giving a pregnancy rate of 25 per cent. This is expected to improve with further experience. In addition, without the need for drugs, repeating the procedure would be less taxing on the woman. For standard IVF, the Oxford clinic's pregnancy rate is 45 per cent.

The parents of the babies, who have asked to remain anonymous, were delighted, Mr Child said. At birth the boy, born first, weighed 6lb 11oz and the girl weighed 5lb 14oz. "The parents are ecstatic. They have got absolutely stunning twins. They went home on Tuesday to start their new life together. It is wonderful."

In standard IVF, the woman takes fertility drugs for five weeks to stimulate production of her eggs, which are then collected direct from her ovaries under the guidance of ultrasound, before being fertilised in the laboratory. The drugs cost between £600 and £1,500, with charges often higher in London.

The procedure is time consuming and uncomfortable and for the third of women with polycystic ovaries there is a one in 10 risk of severe ovarian hyperstimulation syndrome, a dangerous side-effect that in rare cases can prove fatal.

IVM avoids the use of drugs and instead involves collecting eggs from the ovaries while they are still immature. The eggs are then grown in the laboratory for 24 to 48 hours before being fertilised and replaced in the womb.

Mr Child said: "The main advantage is improved safety for women. Women with polycystic ovaries have a one in 10 chance of severe ovarian hyperstimulation syndrome. IVM completely takes away that risk. IVF is also expensive. With IVM the cost is reduced, meaning it could become a more accessible form of fertility treatment."

The technique was pioneered by the University of McGill in Montreal, Canada, where Mr Child spent two years researching and developing it before joining the University of Oxford in 2004. It has also been used in Seoul, South Korea, and Scandinavia. To date about 400 babies have been born worldwide using IVM compared with around two million by IVF.

At present the Oxford Fertility Clinic is only offering the treatment to women with polycystic ovaries, but in the long term Mr Child said he hoped to offer the procedure to all women. "When we see patients we say these are the options and it is up to them to decide. We are not offering it to women with normal ovaries at present because we don't get enough eggs from them. It depends on the number of resting follicles and with normal ovaries you don't get so many.

"On average we get four eggs from a woman with normal ovaries compared with 16 from one with polycystic ovaries. The procedure involves a process of attrition – two-thirds mature and two-thirds of those fertilise – so you need a decent number to start with."

Research on developing the culture medium in which the eggs are matured in the laboratory could reduce the attrition rate so that fewer eggs are needed. The technique could then become suitable for women with normal ovaries, Mr Child said.

A second drawback of the procedure was that eggs grown in culture had a harder outer shell than those matured in the ovary and were more difficult for sperm to penetrate. The eggs had to be fertilised by ICSI – injecting a single sperm directly into the egg. "We hope to develop the culture medium so the egg doesn't mind being grown in the laboratory and we can use ordinary insemination [mixing eggs and sperm so fertilisation occurs naturally]. But in most IVF clinics, 50 per cent of patients are treated with ICSI anyway," he said.

A spokesman for the Human Fertilisation and Embryology Authority said IVF was expensive for most couples and a minority got treatment on the NHS. But it was too soon to tell whether IVM would replace IVF.

"Anything that reduces the cost of IVF, provided it is safe, means treatment could be available to more people. But this is an emerging technology – it is very early days. The most important thing is that patients get proper information so that they can make a decision on what is best for themselves."

Source: independent.co.uk