Who’s the IVF daddy? Anyone you care to name

SINGLE women undergoing fertility treatment will be able to name almost any other adult as their child’s second parent on the birth certificate, under laws coming into force next month.

A man being named as the “father” or even a woman as the second parent will not need to be biologically related to the baby and will not even need to be the mother’s boyfriend or girlfriend.

Guidance issued last week by the Human Fertilisation and Embryology Authority (HFEA) states that, as long as a second parent agrees to take on legal rights and responsibilities, they can be named on the birth certificate and consent forms in IVF clinics. The only exclusions are close blood relations.

The arrangements come into force from April 6 and critics claim they are a further erosion of family values. Advocates say they will provide more support for one-parent families. The rules state: “The woman receiving treatment with donor sperm (or embryos created with donor sperm) can consent to any man or woman being the father or second parent.”

Critics say the laws allow single women to choose random individuals and will lead to genetically incorrect information on the birth certificate.

They say legal parents will be nominated in the way godparents have traditionally been chosen, often based on transient friendships. They fear that, if the second parent has no biological link to the child and is not the boyfriend or girlfriend of the mother, the arrangement will be fragile.

Opponents also argue the legal changes further dismantle the traditional family.

David Jones, professor of bioethics at St Mary’s University College in southwest London, said: “These fathers or second parents sound more like godparents. I wonder how wise it is to encourage people to do this because the ‘father’ or second parent will have legal rights and responsibilities.”

He added: “This sounds like social engineering on the hoof. This is now arbitrary.” Baroness Ruth Deech, a former chair of the HFEA, said: “What I object to is the falsification of the birth certificate. It is supposed to be a true record of the genetic origins of birth.

“This is putting the rights and wishes of the parents way above those of the child. It is absurd that anyone can be named as the father or the second parent.”

The HFEA points out that, for the first time, when donated sperm is used, an unmarried woman will be asked who she consents to being named as the child’s “father” or second parent. The chosen parent will also need to give specific consent.

Clinics will be obliged to offer counselling before the agreements are signed. It would be unlikely for the donor to be
named on the birth certificate because the sample is normally obtained from a sperm bank.

The health department says the new laws, set out in the Human Fertilisation and Embryology Act 2008, clarify the legal identity of parents who are not married or in civil partnerships.

For women who are married or in a civil partnership and who use donor sperm, the husband or lesbian girlfriend will automatically be named unless they make a written objection.

The laws also remove the need for clinics to consider a child’s “need for a father” when offering fertility treatment, a move to prevent discrimination against lesbian couples.

Supporters of the changes deny random individuals will be named as parents because they will need to give formal consent to legal obligations, including potentially being pursued for financial contributions to the upbringing of the child.

Evan Harris, a Liberal Democrat MP, said: “This is a big step and is unlikely to be taken by someone who does not take their responsibilities seriously.”

by Sarah-Kate Templeton

Men urged to make sperm will

Increasing numbers of women are asking hospitals to harvest the sperm of their dead or dying partner for IVF.

Experts have called for young men to make special wills recording their consent (or otherwise) for the use of their sperm if they die unexpectedly.

Michael Buist, director of intensive care at Dandenong Hospital, said requests for sperm harvesting were becoming more frequent.

"When I was first confronted with it, I thought 'this is right out of left field, I have got no idea (what to do)'," Associate Professor Buist said. "It's certainly something we have seen a bit more of recently. For people who practise in (intensive care or hospital emergency departments) it's a request that takes most people by surprise."

He is co-author of a paper in the latest Medical Journal of Australia examining the issue.

The paper found a glaring paradox in Victorian law. In many circumstances sperm may be legally harvested; for instance, by consent of the coroner in case of death, or through consent of next of kin if a patient is unconscious.

But harvested sperm cannot lawfully be used in IVF in Victoria without the explicit written consent of the man. The partner must take it to another state in which implied consent is enough.

Co-author Sarah Middleton, a lecturer at the Monash University Law Faculty, said the safest option was to insist on written consent.

Dr Middleton said sperm donation was different from organ donation. In organ donation, doctors could rely on the word of a family member about the deceased's wishes.

But in sperm donation, the person giving evidence of consent was likely to be the woman wanting access to the sperm, she said. "She may have a conflict of interest. It's about the man's reproductive rights, and I think they should survive your death."

She said the idea of taking something from a corpse to create new life was a difficult issue. "It would be good if people were encouraged to record their wishes — (but) people in this reproductive age group aren't usually going to make their intentions clear in writing."

Others have challenged the role of consent in posthumous reproduction.

In the Journal of Law and Medicine last year, Sarah Jones, of the University of Otago, wrote in a paper consent should be considered along with a fuller picture including the values of the sperm donor, the future prospects of the child and the needs and motivations of the mother.

"The interests of deceased and permanently unconscious patients are notoriously difficult to ascertain," the paper said.

Another MJA paper reported that women were freezing their eggs as a form of insurance against their decline in fertility.

The report by the Queensland Fertility Group found success rates with thawed eggs were now close to fresh IVF.

The authors said egg freezing was still an expensive and not always reliable option.


* Nick Miller

Bacteria in semen influences sperm quality

Investigators studied bacterial contamination in sperm samples of 1256 men at an infertility clinic. The presence of bacteria in semen samples is closely associated with sperm quality, their research shows.

The contamination of sperm samples by some bacteria species is also closely associated with infertility, report Elena Moretti, from the University of Siena, Italy, and colleagues.

Over an 8-year period, 1,256 male individuals were referred to an infertility clinic for semen analysis. The median duration of infertility was 3.75 years of unprotected intercourse without conception.

Spermiogram, semen culture, and sperm transmission electron microscopy (TEM) were performed, along with a culture test to identify common bacteria that colonize the male reproductive tract.

Overall, 33% of men had bacteria in their semen samples.

Within each bacteria species identified, fertile men had semen quality similar to that of uninfected controls. On the other hand, sperm quality was significantly decreased among infertile men.

"Bacteria in semen samples may influence the sperm quality, mainly by the induction of apoptosis and necrosis, which may in part be responsible for the observed reduction of sperm motility," suggest the researchers.

Source: Journal of Assisted Reproduction and Genetics 2008; Advance online publication

Grandad donates sperm for 'grandchild'

A 72-year-old British man is to donate his sperm to his daughter-in-law, allowing her to become a mother and produce a "grandchild", fertility authorities said.

The unnamed man is donating his sperm because his son and daughter-in-law's attempts at IVF treatment failed due to the poor quality of the husband's sperm, according to London's Evening Standard newspaper.

"It's not uncommon for someone in the family to donate, although normally the age limit for sperm donors is 45," said a spokesperson for Britain's Human Fertilisation and Embryology Authority, which has advised the clinic overseeing the 72-year-old's donation.

"What's uncommon in this case is the donor's age."

The donated sperm is being handled by the London Women's Clinic, where the couple are having treatment.

Dr Peter Bowen-Simkins, a director of the clinic, told the Evening Standard the couple and the grandparents-to-be had undergone counselling to prepare them for the arrival of a child produced in such an unusual way.

"I've certainly never come across a case like this before," Bowen-Simkins told the paper.

"In this case, keeping the genetic identity of the child similar to their own was a huge factor. The husband does not have a brother which is why he chose his own father to assist."

Experts said they had no ethical problems with the man donating his sperm, but did have medical concerns about the health of the child.

"What worries me are the genetic risks to the child because of the quality of the donor's sperm, given his age," said Dr Alan Pacey, a senior lecturer in andrology (male fertility) at Sheffield University.

Pacey said the man's age could reduce the chances of the donation working, increase the chances of the woman having a miscarriage and also increase the likelihood that the child produced inherits a genetic condition, such as autism, Down's Syndrome or dwarfism.

The dangers of being an older dad

Women with older partners may be at higher risk of suffering miscarriages irrespective of their own age, according to a study that has linked the increased chance of a failed pregnancy with men over the age of 40.

Until now it was widely assumed that miscarriage rates largely increased with female age only, but a study into women undergoing artificial insemination with their partner's sperm has found that it can also be linked with older men. Scientists also found that pregnancy rates fell as the male partner gets older. This may reflect a decline in sperm quality in men over 40 that affects both the chances of conception and the increased risk of a miscarriage, they said. It is the first time scientists have discovered such a strong paternal effect on rates of pregnancy and miscarriage, and they suggest that, in future, fertility clinics should look more closely at the age of men as well as the age of women when advising on treatment.

Stephanie Belloc, of the Eylau Centre for Assisted Reproduction in Paris, said: "Until now … the message was to get pregnant before the age of 35 or 38 because afterwards it would be difficult. But now the gynaecologists must also focus on paternal age and give this information to the couple.

'Fertility clinics should look more closely at the age of men' "We suggest that there is a link between paternal age and DNA decay in the spermatozoa because we previously demonstrated that age is associated with increased sperm DNA fragmentation. So maybe there is a link between paternal age and DNA decay that are implied in the miscarriages.

"I think it's important to consider not only the woman, but both members of the couple in natural conception, but also in assisted reproductive technology [such as artificial insemination and IVF]."

The scientists analysed data gathered at a fertility clinic that performs artificial inseminations directly into a woman's uterus, a technique which improves the conception rate.

They followed up 21,239 cases of these intrauterine inseminations to see whether the age of the man or the woman had any significant effect on the chances of conception and miscarriage.

As expected, they found maternal age was a strong factor in pregnancy rates, with just 8.9 percent of women over the age of 35 getting pregnant, compared with 14.5 percent in younger women.

'We also found that the age of the father was important in pregnancy rates' "But we also found that the age of the father was important in pregnancy rates - men over 35 had a negative effect," said Belloc.

"And, perhaps more surprisingly, miscarriage rates increased where the father was over 35."

The study - the results of which were to be released at the European Society for Human Reproduction and Embryology in Barcelona - found the miscarriage rate among women with partners aged between 35 and 39 was 18.1 percent, but 33 percent for the partners of men aged between 40 and 44.

Couples undergoing assisted reproductive technology where the man is older than 35 or 40 should consider using the technique of intracytoplasmic sperm injection (ICSI), for directly injecting single sperm into an egg, because then the best sperm could be chosen for fertilisation, Belloc said.

"It's the conclusion of my study that ICSI should be the [technology] of choice when paternal age is increasing because we can choose the best spermatozoa.

"We can choose spermatozoa without DNA fragmentation, and DNA fragmentation is increasing with paternal age. So it is a way to be free of paternal age."

Older dads

TV presenter Des O'Connor's wife, the Australian singer-songwriter Jodie Brooke Wilson (35), gave birth to their son Adam in September 2004. O'Connor, then 72, claimed: "It felt like the right time."

US presidential hopeful John McCain was 48 when he and his wife Cindy had their first child together, the now-award-winning blogger Meghan McCain. They have since had two more.

There were a few sleepless nights at the Playboy mansion in the early 1990s when a sexagenarian Hugh Heffner fathered sons Marston and Cooper by his fiancee Kimberley Conrad.

When Leo Blair was born in 2000, 47-year-old Tony became the first serving prime minister to have a baby in more than 150 years.

Actor David Jason became a dad for the first time aged 61 when his daughter, Sophie Mae, was born.

A 56-year-old Michael Douglas welcomed Dylan Michel into the world in 2000, then married the mother, Catherine Zeta-Jones, soon afterwards. The couple had a daughter three years later.

Sperm DNA Damage Linked To Increased Risk of Pregnancy Loss after IVF and ICSI

Earlier studies have indicated that spermatozoa of infertile men possess considerably more sperm DNA damage than that of fertile men, which could adversely affect both natural reproduction and assisted reproduction technology (ART) outcomes. Since the use of ART to treat infertility has increased substantially from its introduction in the US, in 1981, there is a huge concern regarding the safety of using DNA-damaged spermatozoa. Now, a recent study published online in the journal, Human Reproduction, demonstrates that sperm DNA damage is associated with a significantly enhanced risk of pregnancy loss following in vitro fertilization (IVF) and intra cytoplasmic sperm injection (ICSI).
Armand Zini from the St Mary’s Hospital Center, Canada and coworkers conducted a systematic review and meta-analysis of studies involving sperm DNA damage and pregnancy loss after IVF and/or ICSI treatment to determine the relationship between the two. The researchers analyzed 11 studies, which included 808 IVF and 741 ICSI cycles of treatment, resulting in 640 pregnancies (345 with IVF and 295 with ICSI) and 122 pregnancy losses. From the estimates of pregnancy loss, two by two tables were constructed and odds ratios (ORs) were calculated to examine the association. It was found that the combined odds ratio was 2.48, suggesting that damage to spermatozoa DNA raises the risk of pregnancy loss in IVF and ICSI cycles. The data indicates that sperm DNA damage has to be evaluated prior to ARTs to achieve better outcomes and also forms a basis for further investigations to validate the findings.
Recently, Bhattacharya SM (International Urology and Nephrology, 2008) conducted a study to examine the link between different sperm parameters and repeated unexplained early pregnancy loss. Semen samples obtained from male partners of 74 couples with a history of repeated pregnancy loss were assessed according to WHO criteria and the DNA integrity in each case was evaluated using Acridine Orange staining test. A comparison of the results was also drawn by studying semen samples obtained from 65 husbands of proven fertility. It was noted that there were a lack of statistically significant differences between the two groups in the following criteria: age of husbands, total count per ejaculate, sperm concentration, and rapid progressive motility of sperms. However, DNA integrity value, percentage of motile sperm and total motile sperms per ejaculate, were different in the two groups. Based on the findings, it was concluded that repeated embryonic or early fetal loss is associated with sperm DNA-integrity damage, implying that sperm DNA damage may be a key paternal factor for predicting pregnancy outcomes.
To determine the relationship between sperm DNA fragmentation in IVF/ICSI patients, ART outcome, and sperm parameters, Borini and colleagues (Human Reproduction, 2006) conducted a study on 132 men undergoing ART. The scientists found that the embryo post-implantation development in ICSI procedures is affected by sperm DNA fragmentation; with a high fragmentation rate compromising embryo viability, and thereby leading to pregnancy loss.
Sperm DNA damage is attributed to various intra-or extratesticular factors such as chemotherapy, radiation therapy, genital tract inflammation, testicular hyperthermia, varicoceles, cigarette smoking and environmental toxins. Although previous studies have found no consistent relation between sperm DNA damage and fertilization rates during IVF or ICSI, the recent research provides evidence that sperm DNA damage may be associated with an increased risk of significant spontaneous abortion. Substantiating the current research with further larger trials may help in the development of stringent processes for selecting sperms and embryos during ART to alleviate the adverse effects related to sperm DNA damage.
References
1. Zini A, Boman JM, Belzile E, Ciampi A. Sperm DNA damage is associated with an increased risk of pregnancy loss after IVF and ICSI: systematic review and meta-analysis. Hum Reprod. 2008 Dec;23(12):2663-8. Epub 2008 Aug 29.
2. Bhattacharya SM. Association of various sperm parameters with unexplained repeated early pregnancy loss–which is most important? Int Urol Nephrol. 2008;40(2):391-5.
3. Borini A, Tarozzi N, Bizzaro D, et al. Sperm DNA fragmentation: paternal effect on early post-implantation embryo development in ART. Hum Reprod. 2006 Nov;21(11):2876-81. Epub 2006 Jun 22.

Freezing improves DNA integrity

Gamete cryopreservation could help improve the fertility of men whose spermatozoa show a high level of prefreeze DNA fragmentation, study findings indicate.

Laura Thomson (Fertility First, Hurstville, Australia) and co-authors note potential cryoinjury of sperm from subfertile men is an issue of primary concern “considering that subfertile men form a very large proportion of the men requiring semen cryopreservation.”

The findings were observed during a study comparing different cryoprotectants used to store spermatozoa for fertility treatment. The study involved 320 men who presented for fertility investigations and provided semen samples.

Post-thaw sperm DNA integrity was unaffected by the type of cryoprotectant used during freezing, but showed a significant, negative correlation with the prefreeze level of DNA fragmentation. Among men with prefreeze sperm DNA fragmentation levels within the normal range, 89 percent showed an increase in fragmentation post-thaw. Conversely, 64 percent of those with very high levels of prefreeze fragmentation showed a decrease in fragmentation post-thaw.

The authors suggest that the result “gives rise to a possible novel method of reducing fragmentation in sperm used for assisted reproductive technology treatment cycles, in some cases without the need for invasive and expensive testicular sperm retrievals.”

Cell phone risk to sperm supported

An in vitro comparison study has strengthened concerns that electromagnetic radiation from cell phones impairs male fertility.

Ashok Agarwal (Cleveland Clinic, Ohio, USA) and colleagues set out to validate the implications of recent epidemiologic studies, which reported reductions in sperm motility, morphology, and viability associated with cell phone exposure.

They studied neat semen samples from 23 normal healthy donors and nine infertility patients. They divided the samples into two aliquots and exposed one of each sample to radiation from cell phones in talk mode, leaving the second aliquot unexposed to serve as controls.

Analysis revealed significantly lower sperm motility and sperm viability in aliquots of exposed compared with unexposed sperm (49 vs 52 percent and 52 vs 59 percent, respectively).

Levels of reactive oxygen species were also significantly higher in samples of exposed compared with unexposed sperm (0.11 vs 0.06 x106 cpm/20 million sperm), Agarwal et al report.

Total antioxidant capacity and levels of DNA damage did not differ significantly between the two groups.

“We speculate that keeping the cell phone in a trouser pocket in talk mode may negatively affect spermatozoa and impair male fertility,” the researchers conclude.

Source: Fertility and Sterility 2008; Advance online publication

Heated seats may be frying your sperm

Scientists from the University of Giessen in Germany, reporting in the New Scientist, have warned that heated car seats could damage sperm production.The optimal temperature for healthy sperm production is between 35 and 36 degrees centigrade , which is 1 to 2 degrees centigrade lower than core body temperature. However, having tested the effects of heated car seats on 30 healthy men, scientists found that the average scrotal temperature was 37.3 degrees centigrade . This was enough of an increase to damage sperm production, according to Andreas Jung, leader of the study.

The study involved 30 healthy volunteers, who sat on heated car seats for 90 minutes while fitted with temperature sensors. An hour into the trial, the average scrotal temperature of the men sitting on the heated car seats was 37.3 degrees centigrade, with one man reaching a high of 39.7 degrees centigrade . In contrast, the average scrotal temperature of volunteers sitting on non-heated car seats was 36.7 degrees centigrade . If the scrotum is subject to higher than optimal temperatures, effects
also attributed to laptop use and keeping a mobile phone in a trouser pocket, the body's ability to keep the testes cool is compromised and sperm are able to swim less far. This has a negative impact on men's fertility, with studies also suggesting that the partners of men who drive for over three hours a day take longer to conceive. Tight-fitting underpants have also been found to reduce sperm counts, as compared to men wearing loose-fitting underpants, a Dutch study has found.

IVF/ICSI cause of Congenital Birth Defects?

The use of in vitro fertilization (IVF) or another assisted fertility technique called intracytoplasmic sperm injection (ICSI) to conceive appears to increase the odds of Y-chromosome defects or "microdeletions" in male offspring, Chinese researchers report. Such deletions could result in defective sperm production and possibly also hypospadias -- a common birth defect of the penis that occurs when the urinary outlet develops on the underside of the penis rather than at the tip.

Although this study was small, it "at least sounds an alarm about the genetic safety of assisted reproductive technology," the investigators conclude. Prior research has tied assisted reproductive technologies with low birth weight, preterm delivery, cerebral palsy, and major birth defects, leading some researchers to hypothesize that these therapies may induce gene mutations.

In the new study, Dr. He-Feng Huang, from Zhejiang University, and colleagues sought to answer this question by testing for genetic mutations in 19 male infants conceived through IVF, 18 conceived through ICSI, and 60 conceived naturally. The fathers of the infants were also tested. In an effort to isolate the impact of the fertility treatment, the researchers only studied infants whose parents had a normal genetic background.

Huang and colleagues found Y-chromosome microdeletions in one infant conceived with IVF (5.3 percent) and in three conceived with ICSI (16.7 percent). By contrast, no Y-chromosome deletions were seen in the control group.

One of the four infants with microdeletions had hypospadias, the report indicates.

This is not the first study to link ICSI with hypospadias, the investigators note, but the mechanism has been unclear. The current findings suggest that the association may be mediated through Y-chromosome microdeletions.

ICSI is the main method used to overcome male infertility. With ICSI, a single sperm is injected directly into a single egg. If successful fertilization occurs, the embryo is then placed into the female to undergo development as usual.

Larger studies "should be conducted to confirm our preliminary results," the researchers conclude.

Mad Cow Fears Keep Euro Sperm Out of the USA

Health officials in the US have placed a ban on imports of sperm from European men to protect Americans from the human form of mad cow disease. Stores of European sperm are now running out, causing problems for women wishing to use them.
Before the ban, the use of sperm from Nordic donors in particular had grown in popularity. Companies such as California Cryobank in Los Angeles and Cryos International in New York City imported sperm from Denmark for which there was a huge demand, largely due to the donors' blue eyes, blond hair, and their tendency to be tall and well educated.
Since the ban, put in place in May 2005 by the Food and Drug Administration (FDA), sperm banks are no longer allowed to import sperm from Europe for fear it might spread the fatal and incurable human form of mad cow disease, Creutzfeldt-Jaokb disease (CJD). The ban was one of a number of restrictions the US government put in place after the spread of mad cow
disease in Europe in the late 1990s. Other measures included banning people who lived in the UK for more than three months between 1980 and 1996 from giving blood. The disease, in rare cases, is spread from cow to human by eating meat from infected animals, and has also been known to spread from using contaminated surgical equipment and transplanted tissue, such as corneas. There are, however, no known cases of infection from sperm and scientists say that, although it is theoretically possible, the risk is insignificant.
Soon, the last few vials of European sperm imported before the embargo will be gone. Many women, who used this sperm before and now wish to have another baby using the same donor, are having to pay thousands of pounds to travel to Europe for insemination. Other women are travelling to Canada or Mexico, or even haggling with other women who have leftover vials. In response to the uproar, Nordic Cryobank has filed a petition asking the FDA to lift the restrictions.

Soy foods 'reduce sperm numbers'

A group of US researchers have found a potential link between high
levels of soya in the diet and low sperm concentration. The findings were
reported in the journal Human Reproduction.
Dr Jorge Chavarro led the study at the Department of Nutrition at
Harvard School of Public Health, Boston, which looked at 99 men who had
visited a fertility treatment clinic for fertility evaluation between 2000
and 2006. They were asked how often and how much soy-based food they had
eaten in three months, including tofu or soy sausages, bacon and mince, soy
milk, cheese and yoghurt.
The men were divided into four groups according to their intake of soy
foods and, after adjusting for other factors such as age, BMI, alcohol and
caffeine intake and smoking, Chavarro found that men in the highest intake
category had on average 41 million sperm per millilitre less than men who
did not consume soy products. The 'normal' sperm concentration is between 80
and 120 million sperm per millilitre.
The study 'suggests that soy foods could have some deleterious effect on
the reproductive system and especially on sperm production', said Chavarro.
The correlation was also exacerbated in men who were overweight or obese.
The findings do not explain why soy foods have this effect on sperm
concentration, but Chavarro speculates that it could be because of the
levels of 'isoflavones'; plant-derived compounds with oestrogenic effects,
something that may affect sperm production by interfering with hormonal
signals. Obese men have higher levels of natural oestrogen in their body,
further supporting the theory of a hormonal role.
In other parts of the world such as Asia, however, the normal intake of
soya is much higher than in the study, and there is no evidence of higher
levels of infertility in these areas. Chavarro said that this study is not
sufficient to draw firm conclusions and further larger studies would be
needed to determine whether soy intake has implications in infertility.