Could endless IVF cycles be a thing of the past?

A pioneering new chromosome counting technique could put paid to endless IVF cycles.

Microarray CGH (comparative genomic hybridisation) is used to check for any significant abnormalities present in the chromosomes of the embryo before implantation in IVF treatment.

A small number of cells are removed from the growing embryo five days after fertilisation and the DNA in them is scanned for any clear problems.

The results are available within 24 hours, which allows the maximum information to be obtained from the embryo before it is used.

Armed with this knowledge, doctors can then ensure that only embryos with the correct number of chromosomes are transferred in IVF, thereby improving the chances of a successful pregnancy and reducing the likelihood of miscarriage or Down’s syndrome.

Read more on this story here


New hope for women at risk of miscarriage

Great to read this latest piece of news in today’s Irish Times:

WOMEN AT risk of miscarriage are becoming pregnant following treatment with an inexpensive intravenous infusion, a major fertility conference in Dublin has heard.

A new study carried out by Care Fertility in the UK has shown that use of the special infusion resulted in 50 per cent positive pregnancy tests in a group of women with recurrent embryo implantation failure following IVF.

Dr George Ndukwe, medical director of Care Fertility, told the Fertility 2011 conference in Dublin that 20-25 per cent of women trying to have a baby could have faulty immune systems.

“Every day in my clinic, I see women who have endured numerous IVF cycles, all with the same negative outcome,” said Dr Ndukwe. “I also regularly see couples who have suffered the misery of repeated miscarriage.

“We are devoting our attention to finding answers when nature goes wrong. This infusion is inexpensive, well tolerated and easy to administer.”

The average age of the 50 women in the study was 37 and the mean number of failed cycles was six. A matched cohort of 46 women who had no therapy had a clinical pregnancy rate of just 8.7 per cent compared with 50 per cent.

“Previous studies had treated the condition with Humira, a drug used in the management of rheumatoid arthritis. Humira is expensive [a prescription costs up to £2,000], it has risks and is unsuccessful in about 20 per cent of patients, ” Dr Ndukwe said.

He found that intravenous Intralipid was more effective, and cheaper at £200. Intralipid is a fat emulsion containing egg extract and soya oil, used for patients requiring intravenous feeding

Fertility method raises pregnancy rates

From today’s Irish Times comes a report about a new assisted reproductive technique which analyses embryonic chromosomes is significantly increasing pregnancy rates in couples struggling with infertility, particularly older mothers.

The Fish technique, developed at the Institut Marquès in Barcelona, is now being applied to Preimplantational Genetic Diagnosis (PGD) to analyse all embryo chromosomes in a single cell and to identify which embryos derived from invitro fertilisation are healthy enough for transfer to the uterus of the woman.

Click to read more

How can you judge me?

If I’m learning one thing through this journey, I am learning how judgemental and self-righteous people can be about our decisions to undergo fertility treatment.

I have just returned from a trip to the US and while checking e-mails and reading some online newspapers in the airport while waiting for our homebound flight, I came across some of the most upsetting comments online I have heard to date. All the way home across the Atlantic, the words burned in my brain and the level of vitriol tore at my heart.

The article I read concerned American E! News host, Giuliana Rancic and her decision to undergo IVF treatment. The 36-year-old television presenter speaks about the realities of the arduous process, undergoing up to 63 injections a month as part of the fertility treatment, and a miscarriage that she suffered.

Now I wouldn’t be the biggest fan of her or her reality TV show Guiliana and Bill, but as always my sympathies lie with anyone going through this heartache. What shocked and dismayed me were the comments online afterwards – almost to a man/woman the comments all said how she deserved this pain as it was self-inflicted and representative of  a self-centered desire to ‘spread her genes’  and that she needs to face up to the fact that her genes weren’t just meant to replicate. This judgement of course they also apply to anyone undergoing the same process.

While I absolutely respect the right to everyone to hold their own opinion, I am dismayed by the level of self-righteous judgment and the nastiness of some of the comments. I wonder how many of these commentators are childless? And was their desire to have children not self-centered too? Isn’t that the nature of having children –  an innate biological desire to replicate their own genes?

I wonder how many of these commentators have gone month after painful month wishing, hoping and praying for a positive pregnancy test? How many have experienced a miscarriage? How many know what it feels like to long to hold yours and your partner’s child in your arms? To marvel as you gaze on that little bit of you, and that little bit of me in their face, their gestures, their look? To nurture that baby, watch and guide it as it grows? And how many of these people can honestly say hand on heart, that if they were faced with childlessness, they wouldn’t make the same very same decisions in the end?

So please people, some compassion here. We all walk a hard life at times, with or without children – there is pain along the way. Let’s not judge each other, for unless we’ve walked in each other’s shoes, we have no idea what we would have done in similar circumstances.

A new direction for fertility in Ireland

I am so excited about today’s post for several reasons. Firstly, I haven’t blogged in quite some time and I wanted to wait until I had something positive to write about before I did again. Secondly, I am excited to introduce you to two professionals who I sincerely believe will make a difference to fertility in Ireland.

Aisling Killoran of Accomplish Change Clinic is a certified Hypnotherapist and Psychotherapist specialising in helping mums and dads conceive.  She follows the unique HypnoFertility™ programme which is a multi-faceted hypnotherapy programme used to help and support and facilitate natural conception and the medical process for women undergoing IVF, IUI, ICSI, and other medical procedures. This is a powerful, precise programme that supports the entire fertility process and is tailored for each individual for optimal health and wellbeing.

While Aisling can’t promise you will get pregnant, I can personally testify that what she can do is help you to achieve the best state of mind/body connection conducive to pregnancy.  I wouldn’t hesitate to recommend Aisling to anyone who is looking for a holistic approach to fertility.

And speaking of holistic approaches, Aisling has written a post this week on her blog about ReproMed Consultancy Services, a Fertility Clinic in Sandyford, Dublin that is worth blogging about. This service is run by Mr Declan Keane, Consultant Embryologist, with 18 years clinical experience and who is licensed/accredited by the Irish Medicines Board, UK Health Professions Council and European Society of Human Reproduction and Embryology as a Senior Clinical Scientist.

Aisling met with Declan, earlier this week and on her blog she writes that she found him to be “a genuine sincere man full of integrity and passion in helping couples to conceive.” I confess to knowing a little about the man myself, as three years ago, he helped me produce a patient information booklet on breast cancer and fertility and he was wonderfully helpful then. Anyway, I got my own chance to speak with Declan yesterday and I share Aisling’s views. I too am impressed with his patient-centred approach and believe he is going to make a real difference to couples looking to conceive in Ireland.

If you are interested in learning more, check out Aisling’s blog, which incidentally is updated regularly with some great posts on trying to conceive.

Egg screening boosts IVF success

researchDoctors at an annual US fertility meeting heard for the second year running of the merits of a test that screens embryos for genetic faults. So far more than 20 babies have been born using the technique. The UK researchers say they are now able to back the method with “great confidence”. They hope it will eventually be available to all. Currently, it is offered in a few private UK clinics. Doctors believe the £2,000 test, called comparative genomic hybridisation or CGH, will be particularly useful to older women, whose embryos have a greater risk of carrying genetic errors that cause conditions like Down’s syndrome. 

 The screening checks chromosomes in the developing embryo when it is a few days old, meaning only those embryos with the best chance of success are used in fertility treatment. Dr Dagan Wells from Oxford University, who led the study, described the latest results on 115 women – six times as many as last year – as “astonishing”. The results are particularly impressive as many of the women were on their “last chance” at IVF – they were typically aged 39 with two failed IVF cycles behind them.

In total, 66% of the women fell pregnant after screening – more than double the number (28%) who typically fall pregnant without it. Dr Wells told the American Society of Reproductive Medicine’s annual conference: “We were taken aback by the impact it had on the success rates. “I think it’s at the point now that we can say with great confidence that we are seeing a positive effect of this.” Around 37,00 women undergo IVF every year in the UK and less than one in four of these procedures is successful.

Allan Pacey of the British Fertility Society said: “Embryology is really crying out for something like this. “We really haven’t moved on from the science of just looking down the microscope and seeing if an embryo looks good on the basis of some rather loose criteria.”

Susan Seenan, from Infertility Network UK, said: “We welcome all new research which may ultimately improve the success rates of IVF for patients. “Although this is still in very early stages, it could be of great benefit to older women whose chances of success with IVF treatment is lower and it is also welcome given the move towards single embryo transfer in the UK and the lack of NHS funding which often, unfairly, means that patients are being denied access to the three cycles which the NICE guidance recommended in 2004. “Improvements in success rates are always important but even more so where patients are receiving only one, or in some cases, no NHS cycles, and we look forward to seeing if further research confirms these results.”

Source: BBC

Infertility: the last great taboo

I was reading the Irish Times today and in the health supplement this headline stood out: “Infertility:the last great taboo”.

Leaving aside the fact that a lot of things are supposedly the last great taboo, there is certainly a lot of truth to the taboo aspect. We just don’t talk about it  freely in society. Because it is such an emotive subject, many couples find it difficult to discuss what one writer has called ‘the baby-shaped hole in their lives’.

Without a doubt it is the last great taboo, says Prof Robert Harrison. “No one speaks of it. Maybe a woman will talk to a close friend if she’s worried. But it is such a private issue. It’s one even close friends won’t ask about. It goes right to the heart, I suppose, of who we are as adults and why we get together.”

To be infertile gives rise to feelings of failure, of sexual dysfunction. Author Martina Devlin, who has written of her own experiences of infertility and unsuccessful attempts at treatment, said on the issue last week: “It leaves you with a big R’ stamped on you, for rejection.”

Speaking at the publication of two reports by the Women’s Health Council (WHC) on issues surrounding infertility, Devlin spoke of the mourning couples did “behind a wall of silence”.

“There is so much grief and exclusion and disenfranchisement.”

Since she wrote about her infertility some years ago she is still regularly approached “mainly by women”, she said. “They look happy and glossy and as if they have everything they want in life, and they just want to talk to someone about the baby-shaped hole in their lives.”

It was a testament to how hidden and unspoken an issue infertility was that people were willing to talk to a stranger about such a personal issue, she said.

“Society in general fails to comprehend what it’s like to be childless. People feel it’s tactless to say anything to people they suspect may be struggling with infertility. People stay silent.”

It’s not surprising then that a couple, worried they can’t get pregnant, feel utterly ill-equipped to know where to start, what treatment to seek, how long it will take, the financial and emotional toll it will exact and, indeed whether they even should seek treatment at all.

Infertility affects one in six Irish couples. It was defined by the World Health Organisation in 2001 as “failure to conceive after at least one year of unprotected intercourse”.

Studies indicate 80 per cent of couples having regular intercourse will conceive within a year and 70 per cent will have a baby.

Factors such as age and health will play a role and older couples should probably not wait as long as a year before seeking help.

Harrison, obstetrician, gynaecologist and founder of the Human Assisted Reproduction unit Ireland (Hari) at the Rotunda Hospital, Dublin, has written a book The Smart Guide to Infertility , to help couples.

Now retired from Hari, he says there is a particular pressure in a Catholic, family-oriented culture such as Ireland’s, to have children.

“There is pressure here and in Arab cultures. Children are seen as the natural next step after a couple have got together and stayed together for a number of years.”

The only published survey of couples affected by infertility in this country, a 2005 study of 129 such couples by the National Infertility Support and Information Group (NSIG), found 87 per cent of them felt under pressure to have children.

It also found 63 per cent felt unable to discuss their infertility with family and 58 per cent were unable to discuss it with any friend, pointing to the isolation many couples feel.

Such findings underline, says Harrison, how important both counselling and accurate information are for any couple considering fertility treatment, given the lack of any in general circulation.

“Any couple’s first port of call should be their GP and they should let the GP know in advance what the consultation is about. These consultations take time.”

In the Hari unit, he says, there is great emphasis on counselling at the beginning and throughout the whole process. The fact that couples feel under social pressure to have children is an important issue, he says.

“The counsellor will work out whether the couple is ready or suitable for treatment, and indeed for children.

“Infertility is a couple’s problem. My book stresses that. It is so important. It is not a woman’s issue or a man’s issue, and both in the couple must be dedicated to wanting to have a child.”

He says the journey of treatment can be so long and stressful that couples can only hope to get through it if they are well prepared for – and prepared to – go through it.

Though many will associate fertility treatment with in vitro fertilisation (IVF), the book is an encyclopedic testament to the fact there is much more to it.

Harrison says IVF is likely to be the last course embarked on. There will be investigations of both the man and woman and the answer may lie in simply taking medications to stimulate ovulation in the woman, or sperm production in the man. Tubes may simply need to be unblocked.

“However, answers are not always clear cut and responses to therapy may be unpredictable and disappointing. No guarantees may be given,” he says.

A fact many couples seeking help must face is that infertility is not always “fixable”.

“It is a sad fact that even with today’s advances one in 20 will be consigned to a meaningless non-diagnosis of unexplained infertility.”

Just one in three couples who embark on IVF will be successful, he points out, and the odds decrease as the woman in particular gets older.

An area often forgotten is how difficult it can be for some couples to decide not to continue with treatment.

“You go in with such high hopes and if after three cycles of IVF and still there’s no baby, some couples might want to try another clinic or another treatment. It must be so difficult. I almost feel it’s like cancer treatment at that point.

“You have to weigh up the costs in terms of money, time and psychological toll, as against the quality of life issue.

“There is a quality of life to be had out there without children. I know that is easy for me to say who has children, but to find you are continually banging your head off a brick wall, without success, it must be soul-destroying.

“I think help is so important for couples in that position. It can become a millstone around your neck and people can isolate themselves, avoiding friends who have children.

“If treatment is unsuccessful you have to learn to accept and live with it. Losing the hope of a baby is like losing a loved one.

“The pain never fully goes away, but you take it on as part of who you are.”

Successful couples also need counselling. Pregnancies as a result of fertility treatment tend to be much more stressful he says, as the couple are more nervous about such issues as miscarriage and other problems.

Asked about the absence of legislation regulating the 10 fertility clinics in the State, he says it is “appalling” that the 40 recommendations made in 2005 by the Commission on Assisted Reproduction have not been acted upon.

Ireland is one of three EU states with no regulation of infertility services. The others are Poland and Romania. The only guidance available to clinicians are the Medical Council’s ethical guidelines, published in 2004.

He understands the Department of Health is drawing up guidelines but not legislation. The obstacle holding things up, he believes, is an awaited Supreme Court judgment on the fate of frozen embryos. “I think they really need to grasp the nettle and make a decision.”

Devlin, in her remarks during the week, spoke of her frustration at delays in legislation.

“It’s too important to leave it to individual clinics to self-regulate. There is a lot of talk about the protection of embryos. Well, the adult human beings need protection too.

“Infertile people already feel second-rate, feel substandard. Don’t let society institutionalise this. Don’t let’s continue to look the other way, in silence.”

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