IVF may raise risk of diabetes, hypertension and cancer

People conceived through in vitro fertilisation treatment should be monitored for the early onset of high blood pressure, diabetes and certain cancers before the age of 50, according to a fertility specialist.

While IVF is generally considered to produce healthy babies, doctors have identified subtle genetic changes that may raise the risk of particular medical conditions in later life.

Since the birth of the first test tube baby, Louise Brown, on 25 July 1978, more than three million babies have been born through fertility treatment around the world. The vast majority are still under the age of 30.

The extent to which IVF babies develop more hypertension, diabetes and cancer will begin to emerge over the next two decades as they enter middle age, doctors said.

"By and large these children are just fine, it's not like they have extra arms or extra heads, but they have a small risk of undesirable outcomes. What's going to happen to them down the line? Bear in mind none is older than 31-years-old," said Carmen Sapienza, professor of pathology at Temple University School of Medicine in Philadelphia.

"They have a much higher frequency of being low birthweight and this results in a higher tendency to be obese, a higher risk of type 2 diabetes and hypertension when you reach 50 years old," Sapienza told the annual meeting of the American Association for the Advancement of Science in San Diego on Monday.

In 2006, the Department of Health warned that Britain was facing a new wave of cancer on the back of increasing obesity in the population.

Obesity plays a role in 4% of cancers, including breast and womb cancer, and has also been linked to the disease in the bowel and kidney. In most cases, hormones released from fat are to blame.

"It makes sense for IVF children to watch out for hypertension, obesity and related diabetes and cancers as they reach their fifties," Sapienza said. "It will be interesting to monitor these children."

IVF: Did India miss a medicine Nobel?

Robert Edwards of Britain won the 2010 Nobel Prize in medicine for the development of in-vitro fertilization, a ground-breaking process that has helped many couples over the last two decades have children. While Edwards was working towards his dream - creating the world’s first in vitro fertilized or test tube baby - a physician in India was working on the same subject but the odds were piled heavily against him.
Bengali doctor Subhash Mukhopadhyay was two months late in announcing the birth of Durga or Kanupriya Agarwal - India’s first test tube baby created by him on October 3, 1978. While Edwards, professor emeritus at University of Cambridge, was lauded for his efforts, Mukhopadhyay was fighting a hostile state government that rubbished his findings. Ridiculed and ostracised, Mukhopadhyay was also not allowed to publicise his work in the international arena.
He was invited by the Kyoto University in 1979 to present his findings during a seminar in Japan but denied a passport by the Indian government. The depressed physician committed suicide in 1981. Here are some facts about the man considered the father of India’s IVF research, who remained unsung during his lifetime but inspired many physicians after his death to bring his life and work to the public domain.

So who was Dr. Subhash Mukhopadhyay?

Born on January 16, 1931 in Bihar, Mukhopadhyay studied medicine at the prestigious National Medical College in Kolkata. He received his doctorate from Calcutta University in reproductive physiology in 1958. He obtained a second doctorate from Edinburgh in reproductive endocrinology. He was noted for his work on ovarian stimulation - he used the protocol successfully on Durga’s mother even before any scientist in the world had resorted to the method. He was also successful in his methodology of cryopreservation of a eight cell embryo.
However, the news of the birth of Durga, the world’s second test tube baby, was met with disdain and skepticism by his peers.
The only evidence of his work was a report he had prepared for the West Bengal government facing an enquiry. He was questioned by a government committee several times and his work was discredited as “bogus”. What went against Dr. Mukhopadhyay then was the fact that no physiological or biochemical technique could distinguish between in vivo and in vitro fertilised babies. He was transferred to the ophthalmology department of Calcutta Medical College in 1981 and prevented from completing his work on IVF.
Mukhopadhyay had no documented evidence and the credit for bringing his work to the public domain is largely given to Dr. T C Anand Kumar who was recognized officially as the first to deliver a test tube baby in 1986. Kumar went through Mukhopadhyay’s notes and credited the doctor posthumously for his pioneering work.Medical scientists opine that had Mukhopadhyay been allowed to publish his work and given adequate government funds and infrastructure to complete his research, he would have been recognized as the pioneer in in vitro fertilization process, hopefully paving the way for a Nobel prize in medicine such as his precursor Edwards.
The Indian Council of Medical Research in 2005 acknowledged Mukhopadhyay as the creator of India’s first test tube baby. Filmmaker Tapan Sinha, who was deeply impressed by Mukhopadhyay’s work, based his award-winning film ‘Ek Doctor Ki Maut’ on him.

Alcohol hinders having a baby through IVF, couples warned

Couples who share a bottle of wine a week reduce their chances of having a baby through IVF by more than a quarter, according to a study by American fertility specialists.

Research into alcohol consumption among couples being treated at a fertility clinic found fewer successful pregnancies when the women drank several glasses of wine a week, or the man had a daily beer.

Doctors at Harvard medical school, in Boston, asked 2,574 couples about their drinking habits shortly before they embarked on a course of IVF treatment.

A little over half of the women (56%) and a third of the men had less than one alcoholic drink a week, while 4% of women and 5% of men consumed at least one drink every day.

Dr Brooke Rossi, who led the study, said men and women who each drank six units of alcohol a week each or more "significantly reduced their likelihood of pregnancy".

At these levels of consumption, women were 18% less likely to have a successful IVF baby, while men reduced their chances of fatherhood by 14%.

The effects were particularly strong for women who drank white wine and men who preferred drinking beer, Rossi told the American Society of Reproductive Medicine annual meeting in Atlanta, Georgia last month.

"In general, women are told they should stop drinking when they are trying to achieve pregnancy," Rossi said. The men and women who took part in the study had average ages of 37 and 34 respectively. They were all from the Boston area and completed questionnaires about their drinking habits between 1994 and 2003.

Tony Rutherford, chairman of the British Fertility Society, said guidelines from the society and the National Institute for Health and Clinical Excellence (Nice) advise women to stop drinking completely throughout their pregnancy. "The link between alcohol and conception is an area where the evidence is not clear-cut. It may well be that couples who are already subfertile are more affected by alcohol that those who are perfectly fertile," he said

"If you are going to have IVF, my recommendation would be that it makes sense to avoid alcohol all together, from three months beforehand."

A previous study, published in the British Medical Journal by Tina Jensen at the National University hospital in Copenhagen, Denmark, found that women were less likely to conceive if they drank moderately.

But other studies have found that alcohol had little effect on the time it took women to conceive.

Rutherford added: "This is further evidence to suggest that alcohol does have an impact and that those women who try for a baby should think about their lifestyle choices.

"Eggs and sperm take at least three months to develop so women have got to stop smoking, reduce alcohol consumption or, if you are overweight, correct that weight, that far ahead if you want to maximise your chances of conception."

Lesbian couple win fight for IVF on the NHS

A Lesbian couple have won the right to IVF on the NHS after a legal tussle, ahead of laws that will put same-sex patients on an equal footing with heterosexuals.

The couple, who remain anonymous, had to go through a legal fight to push the NHS to fund IVF because, at the moment, individual trusts decide whether they wish to pay for treatment for lesbians.

The couple were initially refused IVF by their primary care trust because they were of the same sex. One of the women had polycystic ovarian syndrome, which disrupts ovulation, and is one of the most common causes of infertility.

From October, clinics will no longer be able to block lesbians by referring to a child’s “need for a father”. Instead, same-sex couples will need to demonstrate only that they can offer “supportive parenting”.

If NHS trusts continue to deny lesbians fertility treatment after this date they face possible legal action.

Ruth Hunt, head of policy at Stonewall, the lesbian, gay and bisexual charity, said: “The changes in the law should mean that no infertile lesbian is refused NHS fertility treatment on the grounds of her sexual orientation.

“We have just published a guide on how to get pregnant for lesbians in response to lots of queries. This is a hot topic for us at the moment.”

While same-sex couples have won new rights, many heterosexual couples continue to be denied IVF on the NHS. Only 27% of trusts offer heterosexual couples three cycles of treatment as recommended by the National Institute for Health and Clinical Excellence, the NHS guidance body.

If lesbians are fertile they can usually conceive by intrauterine insemination (IUI), the medical name for donor insemination. This is less complicated than IVF, which involves fertilising eggs in a test tube. IUI is also cheaper,at about £700 per attempt compared with £3,000 per cycle of IVF.

The lesbian couple enlisted David Herbert, a partner at the law firm Lester Aldridge, when they were denied IVF on the grounds that they were of the same sex. The trust reversed its decision in June.

Herbert said: “Discrimination on the grounds of sexual orientation is contrary to the Human Rights Act and the Equality Act. There is an element of conflict in the Human Fertilisation and Embryology Act 1990 which requires clinics to consider a child’s ‘need for a father’.

“This was used historically to justify denying treatment to same-sex couples. The ‘need for a father’ element is just about to be removed on the grounds that it is discriminatory. The assessment will be for ‘supportive parenting’, which will come into force in October.”

The government’s equality watchdog, the Equality and Human Rights Commission, took an interest and offered its support to the couple.

This is the second known case in which lesbians have been given fertility treatment after a legal fight. In February a Scottish couple forced Greater Glasgow and Clyde NHS health board to offer them treatment.

The Louise Brown Birthday

A quarter-century on, and the clamour surrounding "test tube baby" Louise Brown has barely died down. It is hard to imagine how it must feel for your whole public image to have been shaped by the manner of your conception. The pioneering achievements of Steptoe and Edwards have pursued Louise relentlessly, the press interest hardly slackening for a moment.
On the 25th anniversary, Louise is doing her bit for the fertility "community", guest starring at a grand party at Bourn Hall clinic for hundreds of babies who followed in her footsteps. She remains proud to have been the first of well over a million worldwide.

However, the number of interviewers she is prepared to put up with is dropping. These days Louise is working as a postal worker in the Bristol area, an occupation lending itself to puns about "deliveries" - just as her previous job as a nursery nurse proved useful to writers and reporters. She had, at last reports, a fiance and a place of her own. Previous interviews have revealed a liking for swimming, the pub and even darts, and indeed, coupled with a general zest for life.

Every child is told he or she is special, and Louise was four before her parents told her exactly why that was true in her case.
She was shown the famous video taken in the operating theatre at Oldham General Hospital in 1978 as she took her first breaths. Her fame led to a barrage of questions from schoolmates, each of whom needed to be told that she was not actually born in the laboratory.

To her, there were a few extra "uncles" who remained precious both to her and her parents. Patrick Steptoe and Robert Edwards kept a close interest in her progress, and the Browns still visit Professor Edwards at his home near Cambridge.

Louise Brown, however, has ended up as the perfect advert for IVF in the face of critics and sceptics - a picture of health and level-headed normality.