Delaware Fertility Centre Overcomes Miscarriages and IVF failures

Major advances utilizing embryo genetic testing with in vitro fertilization (IVF) technology have led to many new and expectant families, as reported by Reproductive Associates of Delaware (RAD) in their recent presentation at the October national meeting of the American Society for Reproductive Medicine in Denver, CO.

"This is a milestone of progress," noted Ronald F. Feinberg MD, PhD, the Center's IVF Medical Director. "We have merged our latest IVF techniques with successfully testing all 24 chromosomes within an embryo before it is placed back in the mother's uterus."

RAD's study demonstrated that almost 50% of 167 well developed and normal-appearing blastocyst embryos contained major chromosome defects, all of which were incompatible with normal pregnancy. The technology was applied to 26 patients who had previously suffered with miscarriage, unexplained infertility, and/or prior IVF failure. Preimplantation Genetic Screening (PGS) with blastocyst trophectoderm biopsy was the technique utilized.

Following PGS, 71% of patients who were found to have at least one normal embryo achieved a successful pregnancy to date, despite previously negative outcomes and poor prognosis. One RAD patient that had never been pregnant had very few normal embryos via PGS. However, she successfully delivered healthy twins earlier this year after having two normal embryos biopsied via PGS and later placed in her uterus. All of the other PGS pregnancies at RAD have been singletons, following placement of just one normal embryo.

"We likely have a new and important reason for offering IVF and PGS to patients with infertility, prior IVF failure, and miscarriage", said Marc Portmann, Director of Lab Technology and Innovation at the RAD Center, who was also the lead author of the study. "This advance in IVF is of great significance because it will improve success rates, foster increased confidence in single embryo transfer, and will lower costs and risks of IVF." Many authorities within the field believe PGS could be applied to all patients undergoing IVF, but the larger benefits need to be fully evaluated.

Though many consider IVF and PGS to be expensive treatments, RAD's physicians believe this should be weighed against other factors, such as the health, emotional, and societal costs associated with infertility and miscarriage. High risks and costs of multiple gestations caused by other suboptimal treatments, including the transfer of multiple embryos during typical IVF procecures, must also be considered.

Approximately 15-20% of reproductive age women and men attempting pregnancy have infertility, a miscarriage history, or have experienced both.

source:sfgate.com

New Method Could Make IVF More Effective

Researchers using a microscope and time-lapse photography believe they have developed a method for predicting which test-tube embryos are the most likely to develop properly, and are licensing development of a commercial test.
Their findings, published in the journal Nature Biotechnology, also provide some new insights into the development of days-old embryos, such as how babies inherit some genes from the mother and some from the father.
They said the new test could help fertility clinics pick the best embryo to implant in the womb.
This would save mothers from having several treatments and help improve on the current method of implanting multiple embryos to try to get one pregnancy and risk multiple births in the process.
"Our results shed light on human embryo development," wrote Renee Reijo Pera of Stanford University in California and colleagues. "Our methods and algorithms may provide an approach for early diagnosis of embryo potential in assisted reproduction."
So called test-tube babies are conceived by uniting egg and sperm in a lab dish and transferring the embryo into a woman's uterus to develop. Most do not develop properly and labs have been looking for ways to improve their success rate.
Although it is not recommended, some IVF clinics will implant more than one embryo into the mother's womb -- leading to the birth of triplets, quadruplets and even more. Such babies almost always are born too early and face lifelong health problems.
All pregnancies are tenuous, even those achieved the old fashioned way. The March of Dimes, a charity founded to battle birth defects, estimates that as many as 50 percent of all pregnancies end in miscarriage -- most often before a woman knows she is pregnant.
For the new test the researchers watched embryos divide and develop from the time sperm met egg in a lab dish. As the embryos split and grew, they also tested gene expression -- looking at which genes activated, and when.
To their surprise, they found that almost from the very beginning some of the handful of cells had different sets of active genes.
An embryo's fate -- whether it would develop normally or not -- seemed determined in many cases from the moment of conception and relied heavily on the mother's egg cell, they found.
Embryos most likely to form a ball of cells called a blastocyst developed at a certain, measurable rate, they found.
Auxogyn, Inc., a privately held medical technology company, said in a statement it had acquired an exclusive license from Stanford University to develop products related to the findings.
"Blastocyst formation is a critical time point in human embryo development and provides more objective criteria for selecting which embryo(s) to transfer," Lissa Goldenstein, president and CEO of Auxogyn, said in a statement.
"For years, researchers have searched for ways to predict the embryos most likely to reach the blastocyst stage in order to enable earlier transfer and ultimately improve live birth rates for in vitro fertilization procedures."
The company estimates that there are 500 clinics in the United States providing in vitro fertilization or IVF services, with combined annual revenues of nearly $2 billion.

SOURCE: REUTERS

IVF treatment: 66-year-old childless woman gives birth to triplets •As world’s oldest mum says she is dying from IVF complications

A 66-year-old Indian woman has become the oldest person in the world to give birth to triplets after IVF treatment at a controversial centre.
Childless Bhateri Devi gave birth to two boys and a girl –– who are now being treated in intensive care after being born dangerously underweight.

Mrs Devi received IVF treatment at the National Fertility Centre in Haryana –- where the world’s oldest mum, Rajo Devi Lohan, was also treated.
However, the doctors said the triplets, weighing 2 pounds 6 ounces, 2 lbs 4 ounces and 1pound 7 ounces, were being monitored in the intensive care unit of the centre.
Mrs Lohan, 72, who gave birth 18 months ago aged 70, has revealed she is dying –– and hit out at the centre for not explaining the risks to women about having babies later in life.
However, officials at the centre proudly boasted of their latest achievement.
Dr Anurag Bishnoi, who supervised Mrs Devi’s treatment, said: “According to the birth certificate issued by a government hospital in Rohtak district, Bhateri Devi was born on May 21, 1944 in Madina village of Rohtak.
“This birth is authentic and therefore she has become the oldest mother in the world to give birth to triplets so far.
“Bhateri Devi was coming to us for the last months for the treatment. She has become a mother for the first time and conceived only in our third attempt through IVF technique.
“For the first two attempts, only two embryos were transferred in each cycle.
“But in third attempt three embryos were transferred in her uterus, resulting in the birth of three children by caesarean.’
Mrs Devi’s husband of 44 years, Deva Singh, 64, said he was ecstatic at becoming a father for the first time.
“Bhateri has fulfilled my dream of having a child and gave my family an heir.” he said.
‘She was my first wife and after she failed to conceive a child, I married twice but again I did not have any child from my other wives also.
“I am very happy and I will provide all the best facilities to my children in the coming years.”

In November 2008, 70-year-old Mrs Lohan made headlines after she gave birth to a girl through IVF technique at the same centre.
She and her husband, Balla, 73, are uneducated farmers who said they did not understand the risk of having a baby at such an old age

Is IVF Good Value For Money?

Children conceived by Medically Assisted Reproduction (MAR) have fiscal implications for government both in terms of future government spending and tax revenue. Based on public funding to conceive a MAR child - after factoring in education, future health and pension costs, and future tax contributions of this child - the discounted net tax revenue (the difference between future government spending and tax revenue) of a child born in 2005 is roughly 127,000 euros in today's value.

Considering an average treatment cost of approximately 15,000 euros to conceive an IVF-child, this represents an 8-fold return on investment (ROI) for governments [1]. While the costs of MAR treatment represent a substantial proportion of a patient's annual disposable income, MAR typically represents less than 0.25% of total national healthcare expenditure. By comparison, obesity accounts for 10% and 2-4% of total health care spending in the US and Europe respectively.

MAR treatments elicit significant medical, reproductive and economic influence in developed countries with 3.5 million children estimated to have been born worldwide since 1978. These children make up a substantial proportion of national births with up to 4.1% in Denmark and 3.3% in Belgium. In the US, Europe, and Oceania over 600,000 treatment cycles resulted in 120,000 children being born in 2005. The European Society of Human Reproduction and Embryology (ESHRE) Task Force on 'Reproduction and Society' reviewed the economics of MAR to evaluate the benefits of funding of MAR for society and to inform policy makers on effective, safe and equitable financing of MAR. Dr. Mark Connolly and colleagues who published this review paper in the journal Human Reproduction Update based their findings on key epidemiological and economic studies. Affordability of IVF is one of the main drivers of treatment utilisation, choice of treatment, and embryo transfer practices which ultimately influence the multiple birth rate and infant outcomes.

Although the poorer clinical outcomes are well known, the indirect costs and hence the economic burden associated with MAR multiple birth children - which may extend well beyond the perinatal period - are less appreciated. Lack of affordable treatment may force patients and clinicians to opt for cheaper fertility treatments such as stimulated intrauterine insemination and ovulation stimulation which have less controllable means of minimising multiple births. If treatment is appropriately funded, there is less of a financial incentive to achieve pregnancy in a limited number of cycles. Additionally, restricted treatment and limited financial access coerces some patients to seek cross border reproductive treatment in countries where cheaper or less restrictive treatments are offered. The ESHRE Task Force on 'Cross Border Reproductive Care' showed in a recent survey that, of those patients that sought cross border reproductive care, only 13% received partial reimbursement and 4% total reimbursement in their own country. Different standards of care and less responsible embryo transfer practices are amongst the risks patients' face when going abroad