Category Archives: Human Reproduction

STUDY QUESTION

What is the rate of spontaneous live births after successful IVF treatment in a cost-free environment, and were couples who achieved a spontaneous live birth referred prematurely?

SUMMARY ANSWER

Despite unlimited IVF treatments offered free of charge, the spontaneous live birth rate following successful IVF remained unchanged compared with that cited in previous literature. Couples were not referred prematurely to IVF before fully utilizing other less invasive treatments.

WHAT IS KNOWN ALREADY

A significant number of infertile couples, who achieve their first live birth through assisted reproductive technology (ART), subsequently achieve a second live birth spontaneously. As IVF has become more widely available, it is used in less severe cases of infertility, perhaps explaining a rise in the subsequent spontaneous live birth rate after successful treatments.

STUDY DESIGN, SIZE, DURATION

This retrospective cohort study was performed at a university-based tertiary medical center. The study population included women aged <35 years, with primary infertility, referred for their first IVF treatment to the Sheba Medical Center IVF unit between 2001 and 2002 and followed up for 7 years. The primary outcome was spontaneous live birth rate following successful ART. Relevant data were obtained from the patient files and supplemented by a standardized telephone questionnaire.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Of the 171 couples who met the study inclusion criteria, 6 refused to participate in the questionnaire and 31 couples were lost to follow-up. Of the 134 couples who participated, 109 achieved a first live birth with ART. After achieving their first live birth with ART, seven couples who began using contraception or separated or divorced were excluded.

MAIN RESULTS AND THE ROLE OF CHANCE

Of 102 couples who continued unprotected intercourse after successful ART, 22 subsequently achieved their second live birth spontaneously (21.6%). The women who achieved a second birth spontaneously were not referred earlier to IVF, and actually performed a higher number of ovulation induction cycles before initiating IVF, compared with women who did not conceive spontaneously.

LIMITATIONS, REASONS FOR CAUTION

This is a retrospective cohort study, and findings should be reaffirmed with a larger prospective randomized study comparing retreatment to achieve a second pregnancy with attempting to conceive spontaneously.

WIDER IMPLICATIONS OF THE FINDINGS

Our data suggests that young patients (<35 years), who previously conceived with IVF, without utilizing ICSI and with no known tubal pathology, should consider attempting to conceive spontaneously.

STUDY FUNDING AND COMPETING INTEREST(S)

No funding was obtained for this study and the authors have no competing interests.

Source:
http://humrep.oxfordjournals.org/rss/current.xml

Published on 09 July 2012 Hits: 79

ROME: The number of babies born as a result of assisted reproduction technologies (ART) has reached an estimated total of 5 million, according to information presented at the 28th annual meeting of the European Society of Human Reproduction and Embryology (Eshre), which opened on July 1, in Istanbul, Turkey.

According to the July 2 press release from Eshre the estimate comes from Icmart (International Committee for Monitoring Assisted Reproductive Technologies) and was based on the number of In Vitro Fertilizations (IVF) and Iintracytoplasmic Sperm Injection (ICSI) treatment cycles recorded worldwide up to 2008 with projections added for the following three years.

Dr. David Adamson, of Fertility Physicians of Northern California, USA, and chairman of Icmart, said about 1.5 million ART cycles are now performed globally each year, producing around 350,000 babies.

The news came shortly after the death of Lesley Brown, 64, who lived in Bristol, England, and made history in July 1978 when her daughter Louise was the first child to be born as the result of IVF treatment.

Lesley Brown had two daughters, Louise and Natalie, both born following IVF treatment, the BBC reported June 20.

In reaction to the latest news on IVF babies Anthony Ozimic, communications director for the English Society for the Protection of Unborn Children, said that What is largely overlooked is that many millions more embryonic children have been killed following IVF, a quality-controlled process which is also intrinsically abusive of human beings.

If the countless millions of pounds given to IVF had been given to the much-more successful ethical alternatives, many more children would have been born, he added.

Health risks In a July 3 press release Irelands Iona Institute pointed out that a recent Australian study has revealed serious health risks for those using IVF.

An Australian study, published in the journal Fertility and Sterility, found that women who went through the IVF procedure around their 24th birthday were found to have a 56 percent greater chance of developing breast cancer than those in the same age group who went through treatments without IVF.

Excerpt from:
The hidden costs of reproductive technology

Public release date: 4-Jul-2012 [ | E-mail | Share ]

Contact: Christine Bauquis christine@eshre.eu 32-499-258-046 European Society of Human Reproduction and Embryology

Istanbul, 4 July 2012: There is growing interest in a "freeze-all" embryo policy in IVF. Such an approach, which cryopreserves all embryos generated in a stimulated IVF cycle for later transfer in a non-stimulated natural cycle, would avoid any of the adverse effects which ovarian stimulation might have on endometrial receptivity during the treatment cycle. Ovarian stimulation has been shown to have adverse effects on endometrial receptivity and the risk of ovarian hyperstimulation syndrome (OHSS) is also increased when embryo transfer is performed in the stimulated cycle.

Freezing all embryos for later transfer might therefore improve implantation and pregnancy rates and increase the safety of IVF. Presently, the highest success rates in reproductive medicine are seen in the recipients of donor eggs. These are women who have not had ovarian stimulation - their endometrial tissue has not been exposed to high hormone levels, and they are not at risk of OHSS.

However, while the theory of a freeze-all policy seems attractive - and the technique has been commonly employed as a safety measure when OHSS is a threat - no robust systematic studies have indicated whether the cryopreservation of all viable embryos with later frozen embryo transfer (FET) is associated with better outcomes than fresh embryo transfers.

Now, the first meta-analysis on this subject indicates that the chance of a clinical pregnancy is around 30% higher when all embryos are frozen for later transfer than with fresh embryo transfer. The results were presented today at the annual meeting of ESHRE (European Society of Human Reproduction and Embryology) by Professor Miguel Angel Checa from the Hospital Universitari del Mar in Barcelona, Spain.

The study was a systematic review of the entire literature, which provided a pool of 64 relevant studies - with three randomised trials - performed before December 2011. The current review was based on information from 633 IVF/ICSI cycles in which 316 were randomised to fresh embryo transfer and 317 to FET. Results showed - based on a relative risk calculation - that the probability of a clinical pregnancy is significantly higher from freeze-all cycles than in fresh embryo transfers (a relative risk of 1.31, which was statistically significant). The miscarriage rates did not show significantly differences between the two groups.

"The pooled data demonstrates that embryo cryopreservation and subsequent FET may improve the outcome of assisted reproduction treatment," said Professor Checa. The study recorded an ongoing pregnancy rate of 38% in fresh transfer cycles, and 50% in the FET cycles.

Professor Checa also explained why FET in a later non-stimulated cycle might improve IVF results. He noted that the multiple eggs generated by ovarian stimulation will increase release of the hormone estradiol from the ovary, which affects the receptivity of endometrial tissue. In addition, some recent studies have shown that ovarian stimulation causes changes to the endometrial DNA pattern, which are not evident in the normal receptive endometrium.

Professor Checa added that the results of his study were "preliminary", but statistically robust. However, with other groups known to be performing similar studies, he urged patience until their results were known. "We are quite confident with our results," he said. "But in our view we should wait until the end of the year for results from other studies to confirm our data and recommend a change in IVF policy."

More:
Freezing all embryos in IVF with transfer in a later non-stimulated cycle may improve outcome

Public release date: 4-Jul-2012 [ | E-mail | Share ]

Contact: Christine Bauquis christine@eshre.eu 32-499-258-046 European Society of Human Reproduction and Embryology

Istanbul, 4 July 2012: A policy of single embryo transfer (SET) reduces the risk of perinatal mortality in infants born as a result of IVF and ICSI. The conclusion emerged from an analysis of more than 50,000 births recorded in the Australian and New Zealand Assisted Reproduction Technology Database between 2004 and 2008, where the introduction of an SET policy has been associated with a reduction in overall perinatal mortality for IVF and ICSI babies.

Results of the analysis were presented here today at the annual meeting of ESHRE (European Society of Human Reproduction and Embryology) by Professor Elizabeth Sullivan from the Perinatal & Reproductive Epidemiology Research Unit of the University of New South Wales in Sydney, Australia. Professor Sullivan said that from a public health perspective "there is justification for advocating SET as first line management in assisted reproduction with the aim of minimising preventable perinatal deaths".

The study she described included 50,258 births which were of more than 20 weeks gestation and/or 400 grams birthweight following IVF and ICSI pregnancies. Total perinatal deaths were defined as the number of fetal deaths (stillbirths) plus the number of neonatal deaths (deaths that occur before 28 days after birth).

Analysis showed an overall perinatal mortality rate of 16.2 per 1000 births, representing 813 perinatal deaths during the study period (630 stillbirths and 183 neonatal deaths).

However, births following the transfer of two embryos had a significantly higher perinatal mortality rate than births following SET (19.1 per 1000 births and 13.2 per 1000 births). The risk of perinatal mortality for all births following two embryo transfer was 53% higher than those following SET. This difference was especially apparent in births following the transfer of fresh (and not frozen) embryos; births following the transfer of two fresh embryos had 74% higher risk of perinatal mortality than births following fresh SET.

Twins accounted for half the total neonatal deaths and one-third the perinatal deaths. Twins also had significantly higher perinatal mortality rate than singletons (27.8 per 1000 births and 12.4 per 1000 births). However, twins born from SET (ie, monozygotic) had a higher risk of perinatal mortality than those born from two embryo transfers.

Professor Sullivan noted that the voluntary adoption of an IVF policy of single embryo transfer in Australia and New Zealand has been associated with a reduction in overall perinatal mortality for all babies conceived by assisted reproduction methods, which was justification in itself for recommending SET as a first line fertility treatment for non-donor cycles in women aged under 35 years.

Moreover, said Professor Sullivan, there are wider public health benefits from an SET policy. She explained: "The number of embryos transferred per procedure is the major determinant of multiple pregnancy and multiple delivery, which contribute to an elevated risk of preterm birth and low birth weight, and its sequelae. These are risks in addition to those already faced by women being treated for infertility.

Continue reading here:
Single embryo transfer reduces the risk of perinatal mortality in IVF

Public release date: 3-Jul-2012 [ | E-mail | Share ]

Contact: Christine Bauquis christine@eshre.eu 32-499-258-046 European Society of Human Reproduction and Embryology

Istanbul, 3 July 2012: Cigarette smoke reduces the production of a Fallopian tube gene known as "BAD", which helps explain the link between smoking and ectopic pregnancy. The finding, from scientists led by Drs Andrew Horne and Colin Duncan at the Medical Research Council (MRC) Centre for Reproductive Health in Edinburgh, UK, was described today at the annual meting of ESHRE (European Society of Human Reproduction and Embryology) in Istanbul.

Ectopic pregnancy - when the embryo implants outside the uterus and in the Fallopian tube - occurs in up to 2% of all pregnancies and is the most common cause of maternal death in early pregnancy. There is currently no way to prevent an ectopic pregnancy, and the condition must be treated by abdominal surgery or, when the ectopic is small and stable, by injection of a drug called methotrexate.

In presenting background information to the study, Dr Horne explained that ectopic pregnancy is the result of a combination of factors affecting the transport of the developing embryo from the Fallopian tube to the uterus and changes in the tubal environment which allow early implantation to occur. Smoking is known to be a major risk factor, but how smoking changes the environment of the Fallopian tube for an ectopic pregnancy to occur has so far remained largely unknown.

For the purpose of this study, Dr Horne's group first exposed cells from the Fallopian tube to a breakdown product of nicotine called cotinine. They then showed that cotinine had a negative effect on genes known to be associated with cell death (or apoptosis), and in particular with a gene called BAD. In a further study the researchers showed that BAD expression was reduced in the Fallopian tube of women who were smokers.

Dr Horne explained that changes in the production of BAD and related genes are seen in the uterus as it prepares for normal implantation of the embryo and early pregnancy. A reduction in the expression of BAD is normally seen in the cells of the uterus just before the embryo implants.

The results of this study, said Dr Horne, suggest that the reduced production of the BAD gene in the Fallopian tube leads to an environment like that of the uterus, which encourages and allows ectopic pregnancy to occur. "So our research," he added, "may in future help scientists find ways to prevent ectopic pregnancy, diagnosis it better, and treat it earlier."

He went on: "The research is exciting because it provides new scientific evidence to help understand why women who smoke are more likely to have ectopic pregnancies. It appears that smoking reduces the production of genes such as BAD which are involved in the control of cell death and promote an environment in the Fallopian tube which is attractive to the developing embryo.

"The information gained from this study can also be applied to other conditions caused by smoking, and could help us prevent or treat them better in the long term."

Continued here:
Why smoking is 'BAD' for the Fallopian tube -- and increases the risk of ectopic pregnancy

July 3, 2012

redOrbit Staff & Wire Reports Your Universe Online

According to research presented this week at the 28th annual meeting of European Society of Human Reproduction and Embryology (ESHRE) meeting, the number of babies born as a result of assisted reproduction technologies (ART) has reached an estimated 5 million since the worlds first, Louise Brown, was born in July 1978.

The calculations are based on the number of IVF and ICSI treatment cycles recorded worldwide up to 2008 and estimates added for the next three years. The collective total of births was put at 4.6 million in 2011, and in 2012 has now reached an estimated 5 million.

Dr David Adamson, from Fertility Physicians of Northern California, USA, and Chairman of International Committee for Monitoring Assisted Reproductive Technologies (ICMART), commented: It means that this technology has been highly successful in treating infertile patients. Millions of families with children have been created, thereby reducing the burden of infertility.

The technology has improved greatly over the years to increase pregnancy rates. The babies are as healthy as those from other infertile patients who conceive spontaneously. The technology is available globally in many different cultures. The major barriers to access are economic, and societal in some situations. With these accomplishments as a technology, and with recognition of Professor Robert Edwards as a Nobel Laureate, IVF is firmly established now in the mainstream of medicine.

Other ICMART information shows that around 1.5 million ART cycles are now performed worldwide each year, producing approximately 350,000 babies. The two most active countries of the world are the USA and Japan, but the most active region by far is Europe.

European data to be presented at the ESHRE congress are from 2009 and show that demand for treatment continues to grow, from 532,260 in 2008 to 537,287 in 2009.

The average availability of ART in Europe is close to 1000 cycles/million inhabitants, but this figure varies greatly between countries and is largely dependent on local state funding policies. For example, availability in Europe is greater than in the USA but less than in Australia.

Dr Anna Pia Ferraretti, chairman of ESHREs IVF Monitoring Consortium, said that the global need for ART is estimated to be at least 1500 cycles/million population per year, a figure only seen in Denmark (2726 cycles/million), Belgium (2562 cycles), Czech Republic (1851 cycles), Slovenia (1840 cycles), Sweden (1800 cycles), Finland (1701 cycles) and Norway (1780 cycles). Countries with much lower availability included Austria (747 cycles/million), Germany (830 cycles), Italy (863 cycles) and UK (879 cycles).

See the original post here:
5 Million IVF And ICSI Babies Worldwide