IVF? It's a crazier gamble than a Las Vegas casino (and I should know - I'm a test-tube baby pioneer)

The stakes couldn't be higher... your health, your wealth, your relationships. Yet your chances of hitting the jackpot could hardly be slimmer

Above the door of every IVF clinic should hang a sign that reads: 'Welcome to Las Vegas.' When you step inside and start playing the fertility game, your chances of losing thousands of pounds far outweigh your chances of hitting the jackpot.

But like hopeless gamblers, unable to shake the idea that they might win with the next throw of the dice, an ever-increasing number of British couples are putting their emotions, their financial stability, their relationships and their own health on the line - all for the chance of a baby.

After more than 20 years in the industry (and I use that word quite deliberately), I have yet to find the words to persuade a couple to give up that dream. I can hit them hard with the bleakest facts I have to offer: that even in the most capable hands, roughly two out of three IVF cycles fails.

I often look them in the eyes and say: 'The only guarantee I can give you is that your treatment is more likely to fail than succeed.' Or: 'Keep your money. You'd be better off spending it on a holiday to help you come to terms with the inevitable.'

But after the tears (and on one memorable occasion, after a patient thumped my desk in frustration and yelled: 'We didn't come here to hear this, we came here for a baby!'), they come back more determined than ever to go ahead.

For wherever there is sliver of hope, there will be men and women queuing for IVF treatment.

It is inevitable that specialists like me come in for criticism when we are seen to treat and take money from people whose chances of conceiving are slim to none.

Making a living from desperate people who want to achieve a pregnancy at any cost can look something like exploitation, and any clinician worth his salt will worry that it is. We take their last pennies and allow them to take unquantifiable risks with their health, all for the agony of yet another failed cycle.

Forcibly removing those rose-tinted spectacles and making them question the blind faith that led them to my office is the only way I have found to ease my conscience. It releases me to do my very best for them, without the worry that i have given them false hope.

And, in my mind at least, it allows me to stay on the right side of the line that we all walk in fertility treatment between help and abuse.

Unlike other areas of medicine, it is a potent combination of money and emotion that fuels IVF and other fertility treatments. But while every treatment - successful or unsuccessful - fills our coffers, it is the emotions involved that drive us to try again and again, if at first we don't succeed.

'We take their last pennies and expose them to risk'

When patients look at me helplessly, it becomes impossible to abandon them. There are times when I think I should refuse to treat couples for whom the treatment just isn't working, but I can't ignore their desperation.

After all, doctors are human, too, and their desire to become parents grabs at our hearts and reels us in. It means that when the time comes to decide whether or not to go for it again, I don't want to say, 'Let's give up,' any more than they do.

But the fact of the matter is that if I turn a couple away, they will often go across the street for treatment. And when the clinic across the street can't help, they will go abroad, making them even more vulnerable to abuse. Abuse in which they, of course, are complicit.

When I know that a couple are prepared to invest everything - not just financially - into achieving this almost impossible dream, how could I not feel that I was failing them if I did not try everything in my power to help?

Add to this the fact that, generally speaking, IVF clinicians are a high-achieving and highly competitive breed who do not easily accept when a cause is lost, and you begin to see the complexity or the moral maze that we navigate with every patient.
Britain's oldest mother Elizabeth Adeney, 66, went to the Ukraine for IVF as the UK refuses to treat women over 50!

Some 15 years ago, as a young fertility specialist, I wrote that we were in the grip of a fertility cult, in which advances in our knowledge and capabilities had made having a baby seem not only possible, but vital. That is truer today than it ever was.

I have heard of three recent cases in which pregnant women with cancer decided to forgo all treatment until after they'd had a baby.

They knew that in delaying crucial treatment they might be condemning themselves to death, but believed so strongly that having a baby was their sole purpose, there was no stopping them. If they died, they died happy, knowing that they had achieved motherhood, despite leaving their children motherless.

Cases like that of Maria Bousada, who died from cancer this summer at the age of 69 leaving two-year-old IVF twins, are the thin end of the wedge in terms of this ever increasing worship of assisted pregnancy, no matter what the cost to the mother or the resulting children.

In effect, the development of IVF has turned people like me into high priests and priestesses, and our clinics into temples filled with the blindly and fervently faithful, unwavering in their conviction that we can make miracles happen.

For those of us who have been working in fertility since the early days, it is a very strange place to find ourselves. Although we knew that it was possible to help with conception in certain cases, there was no way of knowing that it would become so mainstream.

We could never have imagined that, one day, almost all of us would know someone who has tried it, or that we would walk into the local newsagent and see celebrities boasting about their 'miracle babies' on the front covers of magazines.

I've lost count of the number of times that someone I know, from school or university, has walked into my office. I like to let them realize for themselves that we have met before. I don't think it helps their nerves when I pipe up with: 'Hey, weren't you in my biology class?'


So how has IVF become mainstream? Well, it's certainly not because it has become affordable. It still costs up to £4,000 per cycle, at an average of £2,500 per time, and I have known two patients in my career who have invested in a dozen cycles.

Remarkably, one of those patients had a baby boy after her 12th and final try - and stories like that are the ones you remember when you are on the verge of giving up the quest.

Quite simply, the first reason for the increase is that infertility is rising. I have said in the past that it may be caused by environmental factors, such as the prevalence of chemicals in what we eat or drink, but there is still a lot of research to be done in that area.

Fertility treatments have also become part of our on-demand culture. Like it or not, making a baby the natural way takes time and effort, and won't necessarily happen within the window of time that we have set aside in our busy schedules.

I am constantly advising patients, 'Don't give up the night job', because, as obvious as it may sound, having sex is crucial.

However, because it is so hard to establish absolutely whether a couple have a fertility problem that will never result in a natural conception, many are losing patience and seeking private treatment when it's possible they don't need it at all.

Our celebrity culture is partly responsible for the boom, too. While only two or three per cent of the general population have fertility treatment, I estimate the figure is closer to 10 per cent in the celebrity population, and they are not shy of telling us all about it.

I don't know why celebrities require so much more treatment that 'ordinary people', but I do know that cocaine abuse, low body weight, drinking, smoking and being too busy to have sex, or not trying to get pregnant until you're pushing 40, will drastically reduce your chances of conceiving naturally.

And as with any celebrity trend, I believe there is now a certain cache attached to IVF. It's as if unnatural conception is cool.

But whatever the reason, we have reached a point where more patients are putting more faith than ever into what we do.

The advances of science seem to promise couples an everlasting hope. The goalposts move constantly, giving both patients and clinicians alike the belief that anything is possible, and that no problem - not even the fact that a woman is in her 60s - is insurmountable.

Before the development of ICSI (Intracytoplasmic Sperm Injection), where sperm is injected into the egg outside the womb, there was nothing we could do for male infertility. But suddenly there was a solution for that, too, and it brought with it a whole new wave of people who were desperate for our help.

It remains a highly experimental area, however, and comes with risks that are impossible to quantify.

Every new patient I see asks me whether IVF drugs increase the risk of certain cancers, and all I can say is that they might do. It is an area of science in its infancy, and we simply don't have the long-term figures to know what, if any, risks our patients take when they start the journey.

But some research that I have conducted suggests that women begin to produce certain antibodies when they hit their third or fourth cycle of treatment, which indicates that the drugs we use may have some longterm effects in higher doses.

One problem is that fertility treatment remains largely privately funded and because - regardless of the risks - patients will do whatever it takes, treatments develop very quickly. When emotions are running high and we have piles of readies under our noses, who has time for lengthy clinical trials?

It's not reckless, but it is experimental - and that is something that all patients accept.

The baby that was born after his mother's 12th IVF cycle would not be here today had I not taken a spur-ofthe-moment decision to try something new. She lay sobbing on the operating table, knowing that this was her last embryo and her last chance.

But as I looked at the embryo, the outer skin appeared a little thicker and yellower than is normal. So I asked her: 'Do you mind if I try something that has never been done before?' There was no time for clinical trials: she needed my help at that moment.

'Anything, anything!' she said, which can hardly count as formal consent. So I perforated the embryo all over with my needle, until it looked like a microscopic teabag.

It was controversial - but it was, I believe, her only chance. Not only did it give her the baby boy she so desperately wanted, but the technique, now known as assisted hatching, has helped many other women since.

Moments like that highlight the extraordinary possibilities. But as the expectations of our patients rise inexorably, it becomes more and more important to acknowledge our frailties and limits.

By Prof. Sammy Lee, UK

Nature given a helping hand to make endangered frogs spawn

WITH fewer than 200 adult southern corroboree frogs left in the wild, scientists have initiated an IVF program to try to bring the tiny black and gold amphibians back from the brink of extinction.

The technique, carried out on the thumbnail-sized frogs in Sydney and Melbourne, involves injecting the males and females with a synthetic hormone under the skin.

Eggs are then collected by gently squeezing the females, and sperm are obtained by placing a catheter into a male's cloaca, or rear opening.

This was one of the trickier aspects of the method, said Phil Byrne, a biologist carrying out the IVF for the NSW Department of Environment and Climate Change.

"They're tiny little frogs," said Dr Byrne, of Monash University. "It's better if you have small hands."

To mimic natural processes during the frogs' "nuptial embrace" the sperm are then squirted with force onto the eggs in the laboratory.

Dr Byrne and his colleague, Aimee Silla, of the University of Western Australia, had initial success in a pilot study of IVF on corroboree frogs in Melbourne earlier in the year.

About a dozen IVF embryos were obtained. "We got fertilisation, which was exciting. But the embryos failed during the early stages of development," Dr Byrne said.

For the past fortnight they have carried out IVF with a further 38 corroboree frogs bred in captivity at Taronga Zoo, but no embryos had formed, Dr Byrne said yesterday.

A Department of Environment scientist, David Hunter, said the development of frog IVF was part of a multi-pronged strategy to try to save the southern corroboree species, which is found only in Kosciuszko National Park.

"Scientists believe its sudden and dramatic decline is due largely to the effects of a fungus known as the amphibian chytrid, which has devastated frogs worldwide," Dr Hunter said.

Installation of 25 large plastic breeding ponds at five sites in the park began last month. Eggs collected in the wild will be placed in the ponds to grow in fungus-free water until the corroboree frogs are big enough to hop out.

Best Human Embryos Selected For IVF Using Mathematical Model

From the images taken with the microscope, the scientists were able to measure and classify the zygotes and embryos, as well as the blastomeres (undifferentiated animal cells produced by the division of the zygote), their degree of fragmentation and the thickness of the ‘zona pellucida', a membrane that surrounds them. (Credit: Morales et al / SINC)

A team of researchers from the University of the Basque Country (UPV-EHU) have developed a mathematical classification which makes it possible to select human embryos for use in assisted reproduction treatments. Scientists have used the morphology of embryos to select the best candidates for implantation in the woman's uterus.

"Up to now experts working in in vitro fertilisation have selected the best embryos subjectively, based on their training and experience", so SINC was informed by Dinora A. Morales, from the Intelligent Systems Group at the UPV-EHU. However, in two studies carried out by researchers from this team the use of mathematical classifiers to help embryologists with that task was looked at.

In the first work, published in the journal Computer Methods and Programs in Biomedicine, the scientists presented an "intelligent system" of support for infertility treatments. For this they used information from 63 cases from the infertility programme at Clínica del Pilar in San Sebastian (Guipúzcoa), and analysed the evolution of trios of embryos (Spanish law allows for the transfer of up to three embryos to a woman's uterus).

To prepare the study, the researchers focused on the case history of infertile couples (age, type of infertility, quality of sperm, etc), as well as the morphological characteristics of the zygote (the resulting cell from the fusion of two gametes) and the embryos.

From the images taken with the microscope, the scientists were able to measure and classify the zygotes and embryos, as well as the blastomeres (undifferentiated animal cells produced by the division of the zygote), their degree of fragmentation and the thickness of the ‘zona pellucida', a membrane that surrounds them.

All this information was processed with Bayesian classifiers, so-called due to the application of Bayes rules, which make it possible to calculate the probability of implanting an embryo in a woman's uterus if transferred there. "What's more, these types of mathematical classifiers provide experts with evidence on what embryo characteristics enable the identification of the most ideal embryos, through the selection of variables", explained Morales.

The results of this study indicate that the size and degree of fragmentation of the blastomeres, thickness of the zona pellucida and the fact that they might have various nuclei are some of the aspects embryologists should concentrate on.

The Basque research group also carried out a second study, published in the journal Computers in Biology and Medicine to check the effectiveness of different Bayesian classifiers as a tool for choosing the best embryo.

The researchers analysed 249 photographs of embryos from the database at the Genesis Centre in Rome (Italy) and discovered that the "wrapper-TAN" classifier had a success rate of over 90%.

The team's next lines of work will concentrate on perfecting these techniques for selecting the best embryo in infertility treatments and in predicting multiple pregnancies, due to the risk they pose to women. The scientists will try to collaborate with other hospitals in this task.

Clown Car

Malignant Conditions In Children Born After Assisted Reproductive Technology

A recent article article reviews the risks of childhood malignancies and imprinting disorders in children born as a result of assisted reproductive technology (ART) (Bibliography at the end of this post). Since the birth of Louise Brown, there have been 3 million babies born by IVF. Factors which have been implicated in potentially increasing the risk of malignancies in these offspring include:

1. gonadotropins for superovulation,
2. intracytoplasmic sperm injection,
3. blastocyst culture,
4. assisted hatching,
5. and preimplantation genetic diagnosis.

For example, whereas, a significant risk of neuroblastoma, retinoblastomas, acute lymphatic leukemia and non-Hodgkin lymphoma has been reported after ART, others have failed to replicate these findings.

Epigentic alterations leading to DNA modifications and imprinting disorders have also been implicated as a result of assisted reproductive techniques. Two genetic imprinting disorders that are known to cause birth defects and childhood malignancies, Beckwith-Wiedmann syndrome and Angelman syndrome. Each of these have been associated with ART.

The current paper provides a literature review that was unable to identify the precise risks of imprinting disorders and childhood cancers in children conceived with ART.

Although, most studies have not shown an increase in the incidence of childhood cancers after ART, patients should be advised about the known and unknown associated risks.

Neelanjana M, Sabaratnam A
Obstet Gynecol Surv. 2008 Oct;63(10):669-76

IVF treatments often work for women under 35

Women under 35 who undergo six cycles of in vitro fertilization have up to an 86 percent chance of giving birth, a new study found.

But for women over 40, the odds are less than 50 percent -- in some cases, significantly less.

"IVF is a mainstay of the treatment of infertility, and it can overcome most causes of infertility for those under 40," said study senior author Dr. Alan S. Penzias, surgical director of Boston IVF, and an associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School.

But, he added, "Fertility is a function of age. It starts to decline at age 27, and the most pronounced decline is above age 40."

"Unfortunately, there's no test that shows when fertility starts to decline," said Dr. Jamie Grifo, program director for the New York University Langone Medical Center's fertility clinic, who added that this study could serve as a reminder to women to "be really thoughtful about the decisions you make about the reproductive process. Don't expect to be able to get pregnant at any time. You don't have to be pessimistic, but the older the patient, the lower the chance of success, unless a couple is willing to consider donor eggs."

The new study, published in the Jan. 15 issue of the New England Journal of Medicine, looked at IVF success in a different way. Traditionally, IVF success is reported as the number of pregnancies per cycle of IVF treatment, but that doesn't let couples know the exact odds of having a pregnancy that ends up with a healthy baby. And that information is exactly what people want to know, Penzias said.

"Couples really want to figure out how likely it is that they'll have a baby if they undergo IVF," he said.

To give people a better idea of the live-birth rates, Penzias and his colleagues followed more than 6,000 women undergoing IVF at a large center. Almost 15,000 cycles of IVF were completed. A cycle is the implantation of one or more eggs. Penzias said for this study, an average of 2.3 eggs were transferred for the first cycle and 2.8 for the sixth.

The overall live-birth rate after six cycles of IVF was between 51 percent and 72 percent. For women under 35, the rate was 65 percent to 86 percent. The rates differed, because not all women returned for all six cycles, the researchers said.

So, the researchers developed a best-case and worst-case scenario to account for these women. The highest number assumes that the women who stopped IVF treatments would have had a baby, and the lower number assumes that none of them would have. The actual number likely lies somewhere in between those two scenarios.

Penzias said that means that women under 35 who go through IVF have roughly the same chance of having a baby as someone who's a similar age in the general population.

The live-birth rate decreased as the age of the women increased, and women over 40 had only between a 23 percent to 42 percent chance of having a baby.

Overall, about 70 percent of the women had one baby, and less than 30 percent had twins. Fewer than 2 percent had triplets, according to the study.

"It's not a surprise to know that if you do more than one IVF cycle, you have a better chance of having a baby, but this study gives an indication of what one can expect if one is going to do IVF and try it multiple times," said Grifo, who added that the bottom line is, "that for any one woman, each cycle is either 100 percent or zero percent."

Study fails to find link between fertility treatment and breast cancer

Fertility treatment does not increase a woman's risk of developing breast cancer, according to a study of more than 25,000 women with fertility problems in the Netherlands.

The study will help to reassure patients concerned that the powerful doses of hormones that are part of fertility treatment might put them at risk of developing cancer in the future.

At the beginning of an IVF treatment cycle, women are given a course of hormone drugs to stimulate their ovaries to produce more eggs than usual so that clinicians can produce several fertilised embryos in vitro.

The treatment causes large spikes in oestrogen levels in the body. In theory this could promote the development of breast cancer, which is sensitive to the hormone.

The Dutch study, carried out by Dr Alexandra van den Belt-Dousebout at the Netherlands Cancer Institute in Amsterdam, examined patient records from all 12 IVF clinics in the country between 1980 and 1995.

Her team compared 18,970 women who had had at least one cycle of IVF treatment and 7,536 other women with fertility problems who had not received fertility treatment. They matched these patients to records in the National Cancer Registry to establish whether they had gone on to develop breast cancer.

Of the 378 women who developed breast cancer, 266 were in the IVF group and 112 were in the non-IVF group. After adjusting for known risk factors such as age, the number of children the women already had, the age they began menstruating, family history of breast cancer and body mass index, the team found no statistical difference between the two groups, suggesting that IVF treatment does not increase a woman's chances of developing breast cancer.

Van den Belt-Dousebout presented her results at the American Society for Reproductive Medicine in San Francisco.

"From 10 years after treatment breast cancer risk was moderately increased in the IVF group but also in the non-IVF group, compared to the general population," van den Belt-Dousebout and her colleagues wrote in their presentation, "This may be explained by a lower number of children compared to the general population."

Having children is known to reduce the risk of breast cancer in women.

IVF drugs 'increase risk of cancer of womb"

Egg inducing drugs have been in use for more 30 years and have been taken by millions of women as part of IVF treatment to help them have children. Now a study of more than 15,000 women - 30 years after they gave birth - has suggested they are at least three times more likely to develop cancer of the womb. While the risk still remains low, the scientists who carried out the survey, believe it is worth further investigation and that those who undergo the treatment should be carefully monitored.
It is estimated that one in six couples have difficulty conceiving and around 34,000 women a year undergo fertility treatment in Britain. Ovulation-inducing drugs are prescribed to women who have trouble conceiving, are undergoing IVF, or who want to donate or sell their eggs.
Dr Ronit Calderon-Margalit at Hadassah-Hebrew University in Jerusalem and colleagues have studied the effects of these drugs by comparing cancer incidence in a group of 15,000 Israeli women 30 years after they gave birth. Of the 567 women who reported having been given ovulation-inducing fertility drugs, five developed uterine cancer – which is about three times the incidence in members of the group who had not been given these drugs. For the 362 women who took clomiphene, which tricks the body into making extra eggs by blocking oestrogen receptors, the risk was over four times that of women who did not take the drugs. Calderon-Margalit accepts that the numbers are small, but says they carry extra weight because they make "biological sense" as tamoxifen, a breast cancer treatment which, like clomiphene, reduces sensitivity to oestrogen, was known to increase the risk of womb cancer.
But Richard Kennedy, a consultant at the Centre for Reproductive Medicine at the University Hospital Coventry and a spokesman for the British Fertility Society, sought to reassure patients.
"There have been a high number of studies that have failed to find a conclusive link," he said.
"It is important to remain vigilant about these things but the broad message must be reassurance."
Jodie Moffat, health information officer at Cancer Research UK, said it is difficult to draw any firm conclusions from the results.
"This study didn't include a detailed history of fertility drug use, and the number of women who developed uterine cancer was very small," she said.
A spokesman for Sanofi-Aventis, which markets clomiphene, says: "This concern had already been by experts and so far no conclusion has been established."
An earlier study relating fertility drugs and a link to ovarian cancer found there was no link.

Test-tube babies profitable business for the state

In many countries in Europe, too few children are being born for the population to replace itself. In the future this can entail major problems when it comes to financing health care and pensions, for example. In Greece, Italy, and Spain roughly 1.3 children are born per woman, and in Sweden the figure is 1.88. At the same time, in Sweden, for instance, some 10 percent of all couples are unable to have children for various reasons, even though they wish to.

"Subsidized in vitro fertilization is not a total solution for aging populations, but it is part of a strategy. And it's important to have plan to make Sweden and other countries better able to deal with the future," says Anders Svensson, today a medical student, who is the lead author of the article and who was prompted by a suggestion from the American think tank Rand to look at state-subsidized IVF treatment.

The author of the article points out that there are great regional differences in Sweden today when it comes to how easy it is to get access to county-subsidized in vitro fertilization. Certain county councils will not pay if the couple already has children; some pay for two attempts only, and others for three attempts.

"Actually roughly half of all test-tube fertilizations are paid for out of pocket, which means that only those who can afford it can undergo IVF treatment."

In the longer term the state benefits from subsidizing the costs of test-tube children for couples that are involuntarily childless.

"This is a group that could potentially help boost population growth. Our calculations show that in a long-term perspective in vitro fertilization doesn't cost the state anything at all since the state actually sees a return on its investment in the form of the tax monies the individual will pay during his or her lifetime."

Anders Svensson uses a scenario where every test-tube baby is an average person in terms of longevity and income, for example. The study is based on a net present value calculation, which factors in inflation and other parameters. If the state invests in a test-tube baby today, that investment today is worth SEK 254,000, calculated only on what the individual will pay in income tax and value-added tax – other taxes have not been counted, which means that the state's profit per individual is likely underestimated.

"The effect on the Swedish population curve is comparable to raising state child allowances by 25 percent, but at a lower cost."

In other countries, IVF children are probably even more profitable, since Sweden has a relatively costly welfare system. In a similar calculation based on British conditions, two co-authors of the article in SJPH, Federico Callo, Rand, and Mark Connolly, Global Market Access Solutions, have found that every IVF child yields a profit of GBP 160,069.

"The difference can largely be explained by the fact that schooling, elderly care, and health care are relatively higher costs for the Swedish state than for the UK state. In other words, the Swedish welfare system is more expensive, which reduces the profits," says Anders Svensson.

One third of all inhabitants in Europe will be older than 65 years old in 2050, compared with every sixth person today.

"If we want to maintain our various welfare systems as they look today, we need to reverse the downward population trend, since in the future fewer and fewer working people will be supporting more and more old people."

Increased subsidization would moreover reduce some of the personal suffering that comes from wanting to have children, but not being able to.

"Test-tube fertilization differs from all other medical treatment. It creates life instead of extending life. This is unique," says Anders Svensson.

Source: Swedish Research Council

Karyomapping to screen "all genetic disorders" in IVF babies

British researchers have developed a revolutionary test that will let prospective parents screen embryos for almost any known genetic disease.

The £1500 (Rs 125,000) test, which should be available as early as next year, will allow couples at risk of passing on gene defects to conceive healthy children using IVF treatment, The Times reports.

Unlike current tests it takes just weeks from start to finish and is suitable for couples at risk of almost any condition.

At present only 2 per cent of the known genetic conditions can be identified by current tests.

The new test involves creating embryos by IVF and removing a single cell from each when they are two days old.

The cells are then tested using a technique known as karyomapping before a healthy embryo is implanted, The Times reports.

Developed at the Bridge Centre in London, the test can check for mutations that cause serious disorders such as cystic fibrosis, muscular dystrophy and Huntington's disease.

It can also screen for multiple genetic variations, so that scientists could screen for combinations that together confer higher risks of diabetes, heart disease or cancer.

Such applications would first have to be approved by the regulator.

The test will also reveal an embryo's future susceptibility to a host of medical conditions.

For example, parents could be told about their embryo's future risk of developing Alzheimer's disease, heart disease or breast cancer.

Professor Alan Handyside, who has pioneered the technique, will apply to the Human Fertilisation and Embryology Authority for a licence to use it.

"We are still validating it, but it is going to be a revolution if it works out," Handyside told The Times.

"It makes genetic screening very much more straightforward."

Technically, it would be possible to use the test to select an embryo with a particular eye colour or to screen for multiple genes known to affect height or weight.

But Alan Thornhill, the scientific director of the Bridge Centre, told The Times: "When you start looking for more than two or three traits, you've just got no chance of getting a match. You'd need thousands of embryos, and we don't have a practical way of making thousands of embryos."

IVF teenagers more aggressive, UK research shows

Teenagers born through IVF may be more prone to aggression and conduct problems at school than other youngsters - and "softer" parenting could be to blame.

British researchers have found that while children conceived through assisted reproductive technology are “extremely well adjusted”, there was a weak trend towards behavioural problems at the age of 18.

But Australia's first test tube baby, Candice Reed, now 28, has challenged the findings, which suggest these children are slightly more likely to be suspended or expelled from school, or show signs of aggression.

The University of Cambridge study, presented at a fertility conference in Brisbane last month, compared 26 IVF children with 38 kids who were adopted and 63 who were conceived naturally.

“We found very few differences between the groups and found that the IVF adolescents were on the whole functioning extremely well and very positive about their IVF conception,” said researcher Lucy Blake from the Centre for Family Research.

“But we did have a small difference in conduct problems which is worthy of further study.”

The research, which included interviews with both parents and the child, found IVF mothers had higher levels of warmth and so-called disciplinary indulgence towards their children.

“This finding that IVF mothers were slightly more easygoing could perhaps be related to how the adolescents behaved,” Ms Blake said.

But Ms Reed, who attended the conference, said she thought any such trend would be “extremely unlikely”.

“Of course every child is different, and I can't speak for us all, but I can't imagine there's any trend towards aggression or other problems,” Ms Reed said.

And as for differences in parenting style, this too is doubtful, she says.

“I'm in a perfect position to address this as my brother was conceived naturally and there were the same usually disciplinary rules for both of us in the family house, so there was no leniency in my experience,” she said.

More than 80,000 IVF babies have been born in Australia since Candice was delivered in Melbourne on June 23, 1980.

Indian Mom World's Oldest , Now!

Girl babies likely for big IVF mums

Heavier women are more likely to have baby girls after IVF treatment, and boys are more common among lighter mums, new Australian research suggests. But Western Australian specialists behind the small study say while the data is "fascinating'' they don't advise prospective parents to change eating habits in the hope of changing their child's gender. "It's very interesting indeed to see such a clear gender trend, and we understand it might be quite alluring to couples who desperately want a girl or a boy, but we still need to look at it on a larger scale,'' said study leader Dr James Stanger, an embryologist at Pivet Medical Centre in Perth.

Dr Stanger analysed the clinic's database over the past five years to look at trends in body mass index (BMI) and baby's sex among the 800 children born. "I found that women who were very thin, with a BMI under 20, were more likely to have boys, with about six boys to every four girls,'' Dr Stanger said. "And women who were overweight, with a BMI over 30, were more likely to have girls by the same rate.'' The findings, presented at a fertility conference in Brisbane last month, showed no gender bias among women in the middle weight range.

Dr Stanger said it was possible that the additional weight had an impact on how embryos implant or the rate at which they grow in the womb. "We know that male embryos grow faster than female embryos by about half a day so it may be that male embryos are growing faster or female embryos are being slowed down and held back in the lower carbohydrate environment usually seen in thinner women,'' he said. "Or it could be something to do with the implantation, or the inactivation of the X chromosomes, but this all requires more investigation.''

He said that if the findings prove true in bigger studies then they may have implications for both IVF and natural conception.
Professor Michael Chapman, a spokesman for the Fertility Society of Australia, said gender biases had been linked to certain diets and environments, but most proved false in bigger studies. "It's certainly an interesting observation, and there might be something in it, but I certainly wouldn't be recommending that women rush out and go on a crash diet because they'd prefer a boy,'' Prof Chapman said.

Adolescents conceived with IVF psychosocially similar to those born naturally

Adolescents conceived through IVF show similar psychosocial development to adolescents conceived naturally and have comparable relationships with their parents, researchers report.

Hilde Colpin and G. Bossaert from the University of Leuven in Belgium previously compared psychosocial development at age 2 years in children born naturally and those born using IVF.

Most previous studies of this kind have found no statistically significant differences between children conceived through IVF and those conceived naturally, but these focused on young children, mostly less than 5 years of age.

For the current report, Colpin and Bossaert studied 24 of the families involved in the original research, each of which had a child conceived through IVF now aged 15 or 16 years.

The investigators assessed psychosocial development in these families and in 21 control families with children born through natural means.

The results of this assessment show that parents who used IVF to conceive and their children are not significantly different to families who did not use IVF in terms of parenting style, parenting-related stress, and behavioural problems in the child.

Behavioral problems also occurred at a similar frequency in children who knew they were conceived using IVF and those who did not, the team reports.

"As far as we know, this is the first psychosocial study following up IVF families into children's mid-adolescence and the first to investigate adjustment level by disclosure status in this age group," conclude the investigators.

IVF wife sues over delays that made her use donor eggs

A pregnant woman is suing her health trust after she was forced to conceive using a donated egg because of delays in treating her.

Greta Mason, 42, claims a barrage of unnecessary fertility tests followed by a six-year wait for treatment meant her eggs were too old to be used and she could only conceive using a donor.

She is upset that she will now give birth to a baby to which she is not genetically related, and claims earlier tests showed it was her husband who had the fertility problem.

Mrs Mason, from Worthing, West Sussex, claims that when she was finally given a clean bill of health, she and her husband Chris were kept on an NHS waiting list for four years before they even got an appointment for IVF.

Then when they had treatment after a further two years, doctors discovered that Mrs Mason's eggs were too old to be used and she could only conceive using an egg donor.

Mrs Mason, who expects her baby next week, said: 'Whilst I am sure I will love this baby when it arrives, I am absolutely devastated that it is not genetically mine.

'I had always dreamed of having my own flesh and blood child who will inherit my genes so it was an absolutely shattering blow.

'But the hospital failed to monitor my hormone levels and did not notice that my ovaries were getting too old to undergo fertility treatment.

'I always wanted a baby with my husband but the truth is that this baby is genetically another woman's, and at times during my pregnancy, because the baby is not related to me, I have simply felt like an incubator.

'It is so upsetting to think had we not had to wait four years just to get an appointment, we could have had our own genetic child by now.

'Chris and I know we are having a baby boy and are very much looking forward to having him but I also feel terribly sad because I will never look at my son and think, "He's just like me".'

Mrs Mason and her husband, a 43-year-old bus driver, married in 1993 and started trying for a baby in 1995, when Mrs Mason was 29.

After two years without success, they began fertility investigations.

It was soon discovered that Mr Mason had a problem, but doctors insisted that Mrs Mason should also have a range of tests, even though she had become pregnant in an earlier relationship, and miscarried.

'Unsurprisingly, all the tests came back showing my uterus was healthy and my eggs were normal,' she said.

At last, the couple were put on an NHS waiting list for IVF treatment. But after six years, when the treatment started, Mrs Mason was given the shattering news that her ovaries were too old.

'We have since discovered that whilst I was on the waiting list my hormone levels should have been checked twice a year to ensure I was not nearing the menopause,' she said.

'If this had been done, the doctors would have had an early warning that my eggs were getting too old to be used for IVF and they could have brought us in for treatment earlier.'

Having been told their only hope was an egg donor, the couple found there were virtually none in the UK and were forced to seek private IVF treatment in Spain, where donors are guaranteed anonymity and are more plentiful.

Mrs Mason said: 'Because fairhaired donors are rarer in Spain, guaranteeing a baby with blue eyes like me would have meant a wait of another year in Spain, so we opted for the next available donor.

'This means our baby might well have brown eyes and will not have any of my fairer characteristics. But I couldn't deny Chris his chance of having a baby.

'Whilst we were thrilled to be having a baby at last, I couldn't help feeling how unfair it was that although I did not have any fertility problems, I was the one who ended up without a genetically related baby. It has put a huge strain on our marriage.'

The couple have been forced to remortgage their house to pay for their Spanish treatment, which cost £15,000.

A spokesman for Oliver Swain and Co solicitors confirmed that they have taken instructions from Mr and Mrs Mason to sue Worthing and Southlands PCT.

Microfluidic Chip Could Someday Lead to a More Targeted Embryo Selection Process

New technology could eventually make infertility treatments more effective and less expensive. Though it has so far only been tested with mouse embryos, the hope is that it could improve the process of selecting the most viable embryos for in vitro fertilization. Research on the new technology, informally called "lab on a chip," has been published in Analytical Chemistry.

In vitro fertilization, known as IVF, involves combining eggs and sperm outside the body in a laboratory. Once an embryo or embryos form, they are then placed in the uterus. IVF is a complex and expensive procedure. The average cost of IVF is more than $12,000.

Currently, fertility doctors evaluate the quality of an embryo being considered for IVF through microscopic examination of the embryo's physical characteristics, such as cell shape. This process is time-consuming and not reliable enough, according to researchers.

Almost 130,000 women undergo IVF procedures each year in the U.S. -- yet the success rate is only about 30%. To boost a woman's chances of conceiving, doctors may put more than one embryo into the uterus. This can lead to multiple births and makes the pregnancy riskier for both mother and child.

The scientists -- from the Massachusetts Institute of Technology and Fertility Laboratories of Colorado -- worked with a device called a microfluidic chip, which they hope will someday lead to a more targeted embryo selection process. The chip, about the size of a quarter, is designed to evaluate the health of embryos being considered for transplant by measuring how the embryo alters key nutrients in the tissue culture medium surrounding embryos, according to the study.

Researchers collected fluids surrounding 10 mouse embryos and analyzed the fluids using the computer-controlled chip. Within minutes, the device could accurately measure the metabolism of the embryos from the surrounding fluids. Long-term, the chip could improve the quality of embryos selected for human IVF, and it could also reduce the cost associated with the procedure, according to the study's authors.

The World's First Test-Tube Boy Finally Speaks!

The world's first test tube baby boy has launched a campaign for a "long overdue" award for the scientist who pioneered the IVF process that gave him life.

Alastair MacDonald, 29, said it is astonishing that Professor Robert Edwards has received dozens of accolades from all over the globe but he has had little recognition in his own country.

Mr Edwards, who studied at Edinburgh and Glasgow Universities, pioneered in-vitro fertilisation with Dr Patrick Steptoe, who died of cancer in 1988 aged 75, one week before he was due to receive his knighthood from the Queen at Buckingham Palace.

Mr MacDonald, from Glasgow, has written to the Prime Minister to have the man known to him as an "uncle" properly recognised.

He has the support of experts in the field from all over the world including doctors at Cambridge University, the British Fertility Society, the Society for Reproduction and Fertility, the American Society for Reproductive Medicine, Royal College of Obstetricians and Gynaecologist and the European Society for Human Reproduction and Embryology.

Although Leeds-born Mr Edwards was made a CBE 20 years ago, his peers say his achievements far outweigh that award and he "more than deserves" greater recognition, possibly a knighthood.

Professor Martin Johnson, of Cambridge University Anatomy School, described Mr Edwards as the "father of his subject".

"Prof Robert Edwards is the single most important and influential figure internationally in human reproductive biology.

"It is an indisputable fact that he has contributed more to the treatment of human infertility than any other individual and, in so doing, has made the early stages of our own development accessible to study. This achievement clearly places him in a league on his own. He is truly and uniquely the father of his subject'."

His comments were echoed in other clinics and research centres. They included Dr Key Elder, of the Bourn Clinic in Cambridgeshire, which was founded by Mr Edwards and the late Dr Steptoe, and is still going strong. It sees around 850 or 900 women a year, with an average age of 37, and around one in three cycles results in a successful birth.

Dr David Adamson, president of the ASRM, said: "I strongly support Prof Edwards and hope he will receive a knighthood, which is so justified and overdue."

Both Mr MacDonald, now a systems engineering officer with the Royal Fleet Auxiliary, and his mother, Grace, now 62, who separated from his father when he was four, believe Mr Edwards should be recognised for what they said were his "unequalled" achievements.

He wrote to Gordon Brown: "Prof Edwards has been honoured around the world . . . it is a travesty that he has not been honoured by his own country.

"I was born as the second ever IVF baby in 1979 and I have grown up very close to Prof Edwards. I simply would not be alive if it wasn't for Prof Edwards. It saddens me greatly that at his age of 83, he has never been honoured when he has given so much and has never requested anything in return.

"I hope that Prof Edwards can still be alive to see his rightful honour given to him, unlike Patrick Steptoe the co-pioneer with Robert Edwards, who died before he received his knighthood.

"I hope this government does not make that same mistake. I hope you can use your influence to give a truly great man the rightful status he deserves."

IVF test could spot 'dud' embryos

A Big goal in IVF research is a test that reliably sorts dud embryos from those likely to develop into babies. Now differences in gene expression that seem to predict which embryos will go to term are bringing this a step closer.

Doctors usually decide which embryos to transfer to the uterus based purely on their appearance. Yet as only about 30 per cent of them fully develop, women often undergo multiple treatments or have several embryos implanted at once, which carries risks to both the mother and her embryos.

To try to improve the selection process, Gayle Jones at Monash University in Melbourne, Australia, and colleagues removed cells from the early embryos of 48 women undergoing IVF in Greece, 25 of whom went on to have babies. By comparing the babies' DNA and the genetic material in the early embryonic cells, the researchers identified 7317 sets of genetic instructions expressed by the viable embryos but not by those that failed to go to term (Human Reproduction, DOI: 10.1093/humanrep/den123).

They now hope to whittle down the list to about 10 genes that strongly predict which embryos will become babies. A test could be ready for use by doctors in two years, they say.

Husband discovered he was a father of two after estranged wife forged his signature in IVF deception

A UK man has two children he did not know existed, born after his estranged wife conceived using the IVF embryos they had created together, the Sunday Times has reported. The couple were treated for infertility at Bourn Hall clinic, near Cambridge, and the resulting embryos - created using the man's sperm - were frozen. Following the couple's separation, the woman forged her husband's signature on consent forms so that she could have the embryos thawed and returned to her womb, becoming pregnant on two separate occasions.
UK law states that consent from both parties is needed for the continued storage of frozen embryos, or for their use. However, although clinics must have written permission from the father to use an embryo created using his sperm, there is no requirement for him to attend in person. Muiris Lyons, a partner in the law firm Irwin Mitchell, commented that 'This is the first case of its kind that I have been aware of and it underlines the importance of IVF clinics ensuring they obtain proper consent'.
The husband only became aware of the children's existence when one became seriously ill, and a relative contacted him to break the news. He has since sought legal advice about suing the clinic, according to the Sunday Times. Dr Kamal Ahuja, director of the London Women's Clinic, said that they almost had a similar case two years ago - they were about to implant embryos into a woman when they discovered she had lied to them about her husband's consent. 'We were almost hoodwinked and I would imagine this is not rare', he said.
The current situation is in stark contrast to that of Natallie Evans, the UK woman who last year lost her European court appeal to use stored frozen embryos against the wishes of her former partner. Ms Evans underwent IVF with Howard Johnston in 2001, before Ms Evans had treatment for ovarian cancer that left her infertile. Mr Johnston later withdrew his consent for the six embryos to be used when the couple split up. In April 2007, the Grand Chamber of the European Court ruled unanimously that there had been no breach of the right to life (Article 2) of the European Convention on Human Rights. On the right to respect for private and family life (Article 8) and the prohibition of discrimination (Article 14), the judges ruled 13 to four against Ms Evans.