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.

SOURCE: medicalxpress.com

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. 

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

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.