Triplet ‘waiting in freezer’ born 11 years after sisters

One of three triplets conceived on the same day through IVF was born last month in Britain — 11 years after her twin sisters who say she was waiting "in the freezer" to be born.The girls, daughters of Lisa and Adrian Shepherd, all come from the same round of fertility treatment and it is believed there is no other known case where such an age gap exists.

The British couple began treatment in 1998 after Ms Shepherd was diagnosed with medical conditions that made her chances of her becoming pregnant naturally slim. During the treatment at the Midland Fertility Clinic near Birmingham, doctors successfully fertilised 14 eggs with Mr Shepherd’s sperm. Two embryos were implanted with the remaining 12 placed into freezer storage.

Soon afterwards scans showed Ms Shepherd was expecting twins. The girls, Megan and Bethany, arrived six weeks early and weighed less than 8lbs between them but made a great recovery.

When the girls were nine, the couple started to consider another baby. "We had been so busy raising the twins that it wasn’t until then that we stopped to think about having another one," Ms Shepherd said.

"We asked the girls what they thought about having another addition to the family and they really wanted it."

So last year, they returned to the clinic for another cycle of IVF, using the embryos stored 10 years previously. "We didn’t know if it would work… It was one last chance, and if it was meant to be, then it would happen."

And so it was meant to be with Ryleigh was born last month, weighing 7lb 10oz.

"The girls are thrilled to have a sister — and they know that she was conceived at the same time that they were, but has been in the freezer," Ms Shepherd said.

"She’s a really happy baby and has got a really good appetite — it’s as though she’s making up for lost time."

Egg-sharing and Cryopreservation: for who's benefit?

Nataly Atalla's uncritical advertorial 'freeze and share: an evolution of egg sharing' in BioNews 476 (week 15/9/2008 - 21/9/2008) did not address a number of important points.
I would have expected some comment on the success rate of the vitrification technique in their hands. She cites 100,000 procedures in 12 countries and 95 per cent survival and 96 per cent fertilisation rates being reported, but makes no mention of live delivery rates and in particular no reference to the results at her own unit, the London Bridge Fertility Gynaecology and Genetics Centre (the Bridge Centre). Results presented at the recent European Society of Human Reproduction and Embryology (ESHRE) meeting in Barcelona were very encouraging. Chang et al in Atlanta, Georgia, US, vitrified and warmed 155 mature donated oocytes, 135 survived and 117 fertilised with ICSI. They transferred 52 blastocysts into 20 recipients and detected 29 fetal hearts in 17 recipients (1).
However, great care needs to be taken when comparing results elsewhere with those in the UK. In the US, success rates per fresh cycle of egg donation treatment are commonly quoted as being over 60 per cent, whereas the Bridge Centre's most recent published results (HFEA 2007 clinical pregnancy data) was 27 per cent (9/34). This discrepancy is probably due to
the age of the donors - 23 year-old eggs can always be expected to do better than 33 year-old eggs. The vitrification technique may prove to be better than slow freezing but cryopreservation followed by IVF and embryo transfer cannot be expected to give better results than those achieved with fresh embryos. Further, slow freezing results vary from clinic to clinic and the same is likely to be the case with vitrification. Vitrification is more demanding in the laboratory than freezing because precisely controlled exposure to the vitrification solution before cooling and the subsequent rate of warming are critical for survival (2). In the 'freeze and share' scheme, vulnerable women as they approach their mid-30s are being encouraged to put their faith in a storage technique with as yet unproven efficacy in the hands of a clinic offering to exchange storage for eggs to donate to other women. These women may then delay childbearing, become infertile, not conceive with their own stored eggs and know that a woman or women conceived with the fresh eggs they donated some years previously.
How many eggs should the donor store to give herself a 'reasonable' chance of success should she find she needs to use them? Motta et al in Sao Paulo, Brazil and Michigan, US, using excess eggs vitrified and stored and subsequently, if the woman did not conceive following fresh embryo transfer, warmed and ICSI'd, achieved a clinical pregnancy rate of 38 per cent (3).
Although the eggs they used were provided by women with a fertility problem this result is much more like what we could expect in the UK. They estimated that 17 cryopreserved oocytes were required to establish a single clinical pregnancy. At the Bridge Centre suitable donors will undergo three treatment cycles in a year. If they are to store that number of eggs they will need, in order to give half to the recipient, to produce 34 mature eggs, say a total of 40 eggs from about 50 - 60 follicles. It can be seen that this will require a degree of overstimulation with the risks that that would incur.
What proportion of women storing their eggs will need them later? Atalla's commentary makes it clear that only women who are likely to respond to relatively low doses of fertility drugs will qualify to be donors. These women are less likely than those not suitable to donate to have difficulty conceiving in their late thirties and early forties. It appears therefore that the women who are least likely to need the eggs are storing their eggs - perhaps the idea is that they will donate these eggs to the women who were not suitable to donate and store their eggs? A win / win situation for the clinic?

References
(1) C.C. Chang et al, 'Clinical evaluation of blastocyst transfer in oocyte cryopreservation cycles' (P-369 Poster. Abstracts of the 24th Annual Meeting of the ESHRE. Barcelona, Spain, 7-9 July, 2008).
(2) M. Wood, 'Vitrified embryos and oocytes: the way forward' (O-092 Oral. Abstracts of the 24th Annual Meeting of the ESHRE. Barcelona, Spain, 7-9 July, 2008).
(3) E. Motta et al, 'Prospective randomised study of human oocyte cryopreservation by slow-rate freezing or vitrification' (P-374 Poster. Abstracts of the 24th Annual Meeting of the ESHRE. Barcelona, Spain, 7-9 July, 2008).

- John Parsons, Lead Consultant for King's Assisted Conception Unit

First 'fast-freeze' IVF baby born

A couple have become the first in the UK to have a baby using a pioneering IVF technique which fast-freezes embryos, doctors in Cardiff say. Evie, who was conceived through "vitrification", was born to Ian and Rebecca Bloomer on 23 July. The method uses liquid nitrogen to freeze embryos quickly, reducing the risk of damage when they are thawed.
The couple, of Cwmbran, had tried for a baby for seven years and say their success should offer hope to others.
The couple had been trying for a baby since they married in 2001 but tests revealed Mrs Bloomer, 28, had endometriosis, a condition which was making it difficult for her to conceive.
They attended the IVF clinic at the University Hospital of Wales, in Cardiff, and after a failed attempt, the hospital offered the Bloomers a new way of freezing their unused embryos.
The technique - vitrification - gives embryos a better chance of surviving until couples are ready to try IVF again because the fast-freeze method prevents the formation of crystals that can damage embryos when they are thawed.
It's overwhelming. I'm still staring at her now thinking 'wow, she's ours - it's actually happened for us'
Mrs Bloomer became pregnant almost immediately using one of the fast-frozen embryos and gave birth to Evie at the Royal Gwent Hospital, in Newport, on 23 July.
"We were willing to try anything really, we'd both always wanted children. It's overwhelming. I'm still staring at her now thinking 'wow, she's ours - it's actually happened for us'," said Mrs Bloomer.
"I hope that if anybody going through treatment sees us and sees Evie it gives them one last little bit of hope to go for it.
"It's been a real emotional rollercoaster. There's been ups and downs, but you get through it and to have Evie now, you forget what you went through. It makes it all worthwhile."
The Cardiff hospital was the first in the UK to begin offering embryo vitrification, in August 2007.
Lyndon Miles, head of embryology and andrology for IVF Wales, said 17 out of the 39 women offered the treatment so far had fallen pregnant and four of those were expecting twins.
He said the process would also be helpful to women diagnosed with cancer who wanted to freeze a number of eggs in case chemotherapy left them infertile.
"Though this is a new technique for the UK, early results and publications in Japan and the USA have been extremely encouraging," Mr Miles said.
Lyndon Miles said he was delighted to have helped the Bloomers. "The first published study on babies born from vitrification shows no adverse effects of the technique and there are no implications to Evie's health as a result of the vitrification process.
"I'm delighted we have been able to help Ian and Rebecca."
Vitrification involves rapidly cooling and storing embryos at very low temperatures for future use.
"An IVF cycle produces a number of embryos. Those that aren't immediately transferred back to the patient and that are of good enough quality are cooled slowly to the temperature of liquid nitrogen (-196C) and stored until needed.
"Conventional, slow freezing creates ice crystals which can damage the embryo as it is thawed," Mr Miles said.
"Vitrification differs from traditional cooling and storing techniques in that it allows instantaneous 'glass-like' solidification of eggs and embryos without the formation of ice crystals.
"Since no ice crystals form, a much greater percentage of embryos survive thawing following vitrification."
He said with conventional freezing methods, post-thaw survival rates varied from 50% to 80% whereas with vitrification they had achieved 98%.
"In addition, since the introduction of the technique, our pregnancy rate has more than doubled compared to conventional freezing methods," Mr Miles added.