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UK fertility safety for women is 'among the worst in Europe'
Mothers' health may be put at risk in the quest for high
pregnancy rates at British IVF clinics, warn experts
By Adele Waters
Sunday, 6 April 2008
The UK has one of the worst fertility treatment safety
records in Europe, according to new figures published by the
European Society for Human Reproduction and Embryology.
The chances of developing serious complications are up to
four times higher in the UK than in other countries carrying
out similar numbers of fertility treatments. Experts warn
that women's lives are being jeopardised in order to improve
the numbers of successful pregnancies
Britain has the highest levels of ovarian hyperstimulation
syndrome (OHSS), the most serious and potentially fatal
side-effect of IVF treatment, the figures show. At least two
women with OHSS have died in the past three years, and there
are fears of more cases going unrecorded.
Complications from IVF treatment from the use of drugs to
stimulate the production of eggs can range from severe
bloating and vomiting, to kidney failure, and even death in
rare cases. Fertility experts say they fear many serious
cases are not being recorded, because women go straight to
casualty or end up in intensive care, the cause of their
symptoms going unnoticed by the Human Fertilisation and
Embryology Authority (HFEA).
Germany carried out in 2003 almost three times as many IVF
cycles – implantations of fertilised embryos – as the UK,
researchers found, but the UK had nearly three times more
cases of OHSS. In 2004, France carried out nearly twice as
many IVF cycles as Britain, but its OHSS rate was a quarter
of that in UK clinics.
The figures have been compiled on the eve of a major
international fertility conference, which opens in London on
Thursday. It will debate how fertility treatments should be
made safer, which would include the use of less intensive
drug treatments.
Many European doctors believe the figures reflect the UK's
emphasis on results – successful conceptions – over patient
safety. They say the UK achieves average to above average
pregnancy rates, but lags behind Europe when it comes to
safety of women undergoing treatments.
Dr Karl Nygren, chairman of the International Committee on
the Monitoring of Assisted Reproductive Technology, which
monitors IVF treatments worldwide, said: "When it comes to
measuring success of fertility treatments there are two
measures: efficacy and safety.
"In the UK, you are good on efficacy – your success rates
are in the top 10 countries – but your safety record is
low."
Referring to the birth of the first IVF baby Louise Brown in
Britain in 1978, he said: "You should be better – you are
the ones who started it all off! In the UK, procedures are
not being handled as optimally as they should be."
Dr Geeta Nargund, president of the International Society for
Mild Approaches in Assisted Reproduction, said: "These OHSS
figures raise alarm. In the UK, we are moving towards safer
fertility treatment. Natural and mild IVF are aimed at
preventing and reducing serious complications like OHSS.
"We have a duty to safeguard the health and safety of women
undergoing fertility treatment. The HFEA takes into account
the 'welfare of the child', but it should also implement
strict clinical guidelines to ensure the 'welfare of the
woman'. In my view, clinical information regarding risks and
complications for each clinic should be publicly available."
The HFEA said: "Women considering IVF should have a full and
frank discussion with their clinician about the risks
involved and about what other treatment approaches might be
suitable, such as newer techniques like in vitro maturation
(IVM) or soft IVF (using fewer drugs)."
Overall scrutiny was difficult, it said, as there is no
central reporting system. An HFEA commissioned report found
severe OHSS occurs in about 1 per cent of treatment cycles
in the UK.
Link: The
Independent
Concerns over decreasing male fertility rates
Two new studies have identified factors that could be
causing a decline in male fertility. Research published in
the journal Fertility and Sterility on the anti-impotence
drug Viagra concluded that men taking the drug could be
damaging their sperm and lowering their ability to conceive.
Charlotte Maden
10 March 2008
Sperm
Image by Hasan Burjaq ,MT (BGS), TCART, Toronto, Canada
http://www.tcartonline.com/
Scientists argue for freedom to develop sperm and eggs from
stem cells
An international panel of experts has argued that political
'interference' in scientific research should not be based
solely on moral or ethical concerns.
Evelyn Harvey
21 April 2008
IVF WITNESS ELIMINATES RISK OF MIX-UPS
A groundbreaking new device has been launched worldwide that
takes the IVF process to a much higher level of safety.
W.R.Brown MBA
08 February 2008
The Practice Committee of the American Society
for Reproductive Medicine today issued the new
practice committee opinion on the use of
preimplantation genetic testing.
Source: ASRM, IVF.net news
ASRM Urges Caution, Strong
Counseling for Women Seeking Egg Freezing
The Practice Committee of the American Society for
Reproductive Medicine today issued a committee
opinion saying that oocyte cryopreservation, or egg
freezing, remains an experimental procedure that
should not be offered or marketed as a means to
defer reproductive aging.
Source: ASRM, IVF.net news
The Cost Effectiveness of
IVF
Researchers today presented studies on the economics
of Assisted Reproductive Technologies. One study
found that adding an ART benefit did not greatly
increase the cost of health insurance and another
examined the cost/quality-adjusted life year ratio
for ART treatment strategies.
Source: ASRM, IVF.net news
Advising Cancer
Patients to Preserve their Fertility
Determining the need for information on
fertility preservation and the extent to
which that need is being fulfilled is a
subject of international interest at the
63rd Annual Meeting of the American Society
for Reproductive Medicine.
Source: ASRM, IVF.net news
Do Older
Women Need More Embryos?
Several new research studies
presented at the American Society
for Reproductive Medicine meeting
tackled the question of how best to
help older women seeking to have
children.
Source: ASRM, IVF.net news
Warning issued over egg freezing
Egg
freezing should not be offered to women who want to put off
having a family purely for lifestyle reasons, say experts.
The
American Society for Reproductive Medicine (ASRM) warned the
procedure was still experimental, and the chances of success
poor.
It said
it would be wrong to give women a false sense of hope.
Instead they should be offered counseling. However, a UK
expert said egg freezing was a valid option for some women.
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It is wrong to
deprive women of this option, which many of them say
is empowering
Dr Gillian Lockwood
Midland Fertility Services |
An
increasing number of women are choosing to freeze their eggs
for social reasons in the hope they will be able to have a
child when they are older.
Critics
argue they are delaying motherhood for the wrong motives,
such as climbing the career ladder or until they have more
money.
Dr Marc
Fritz, of the ASRM, said it would be wrong for women who
have frozen their eggs to think they had ensured their
future fertility.
He said:
"Existing medical evidence simply does not justify that
conclusion."
The ASRM
estimates that the overall live birth rate from frozen eggs
is as low as 2% per egg.
It warned
the figures may be even lower for women over 35 - the age at
which fertility begins to decline rapidly.
Dr Fritz
said a 25-year-old woman freezing her eggs now would have
more chance of achieving a pregnancy through IVF using her
fresh eggs when she was 35.
Successes
At the
end of 2006, 185 women in the UK had eggs on ice. Many are
cancer patients whose fertility is affected by treatment.
Four
babies have been born from egg freezing in the UK - all
following treatment at Midland Fertility Services.
Dr
Gillian Lockwood, medical director, argued success rates
using frozen eggs were comparable with those using frozen
embryos.
She
dissuades older women from freezing their eggs due to low
success rates.
But she
added: "As long as women know it's not an insurance policy
or a guarantee, then it remains an option they may wish to
pursue."
"Many of
those women have been with commitment-phobic men or have not
found Mr Right, or they are part of a couple that needs two
salaries to get a mortgage.
"These
are social issues but it is wrong to deprive women of this
option, which many of them say is empowering."
Caution key
Dr Simon
Fishel, of the CARE Fertility Group in Nottingham, agreed it
was important to explain to women that egg freezing was
experimental, and carried no guarantee of success.
"Although
significant research has been undertaken, and babies are
being born from these new techniques, caution and
counselling are imperative at this stage, and for several
years to come."
Josephine
Quintavalle, of the campaign group Comment on Reproductive
Ethics, said the ASRM had issued "sound advice".
She said:
"The best solution to lifestyle problems is to change one's
lifestyle.
"Have
babies naturally at the time nature intended and give IVF a
miss altogether."
Story
from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/7048361.stm
Published: 2007/10/17 08:07:18 GMT
© BBC MMVII
Effects of Infection on Sperm
Sexually
transmitted diseases affect male fertility on the level of
physiological function as well as on a molecular genetic
level. At the 63rd Annual Meeting of the American Society
for Reproductive Medicine, researchers presented new studies
on the impact STIs have on sperm’s DNA and on the use of
assisted reproductive techniques to help HIV-discordant
couples in which the male partner is positive achieve a safe
pregnancy.
An
international group from Spain, Mexico, and the United
States found that infection with Chlamydia trachomatis and
Mycoplasma sp. might contribute to reduced fertility in
infected men by increasing DNA fragmentation. Antibiotic
treatment to cure the infection resulted in decreased DNA
fragmentation and the achievement of pregnancy for a large
majority of the treated couples. Sperm DNA fragmentation in
the male partners of 143 infertile couples was compared with
that in a control group of 50 fertile males. The infertile
men’s sperm exhibited a level of DNA fragmentation 3.2 times
higher than that of the controls. Sperm concentration,
motility and morphology also were impaired in the infected
men. The effect of antibiotic treatment on sperm DNA
fragmentation was assessed in 95 patients. After
approximately four months of treatment, the patients’ sperm
DNA integrity improved an average of 35.7%. During the
course of treatment, 12.5% of couples achieved pregnancy,
while after treatment was concluded, 85.7% of couples
achieved pregnancy.
Researchers in Monterrey, Mexico investigated the effect of
HIV infection on the DNA maturation process and the
integrity of sperm cells. They found that the HIV-positive
patients’ sperm chromatin did not exhibit any increased
incidence of alteration in
comparison to the healthy controls’. There was also no
correlation between the patients’ viral load and sperm
chromatin alteration or the semen parameters of
concentration, motility or morphology.
Dr. Anne
Kiessling and her colleagues have shown that HIV infection
need not be a barrier to fatherhood. Over six years, from
2000 to 2006, the group evaluated semen specimens from 262
HIV-positive men. Semen specimens that tested positive for
the presence of the HIV virus were discarded; specimens with
undetectable viral loads were washed, frozen, and shipped to
the patients’ infertility centers for use in assisted
reproduction procedures After freezing two sperm specimens
with an undetectable viral load, 151 couples went on to have
IVF or artificial insemination. By the end of 2006, 69
pregnancies had been initiated, with 62 babies born. All of
the mothers and babies tested negative for the HIV antibody.
Steven J.
Ory, MD, President of the American Society for Reproductive
Medicine, commented, “Assisted reproduction for patients
living with HIV has been shown to be safe when the correct
protocols are followed; it is very encouraging to see also
that HIV does not cause damage to sperm’s DNA.”
O-12,
Fernandez et al, Frequency of sperm cells with fragmented
DNA in males infected with Chlamydia trachomatis and
Mycoplasma sp., determined with the sperm chromatin
dispersion, test.
O-49,
Ayala et al, Evaluation of sperm chromatin integrity and
seminal quality in HIV positive patients.
O-109,
Kiessling et al, Assisted reproduction with sperm from
HIV-infected men.
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