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Duration of Embryo Cryopreservation Does Not Affect Pregnancy Outcome

A study in the latest online issue of Fertility and Sterility has reported that the length of embryo cryostorage does not adversely affect the post thaw survival rate or pregnancy outcome, suggesting it to be a safe and valuable adjunct to assisted reproduction technology (ART).
Sergio Oehninger, Director of the Division of Reproductive Endocrinology and Infertility, Jones Institute for Reproductive Medicine, Virginia, and coworkers, conducted the retrospective study to investigate the effect of cryostorage duration on embryo survival, implantation competence, and pregnancy outcome. The cryopreserved embryos were isolated from in vitro fertilization (IVF) patients, and recipients of oocyte donation cycles. Researchers analyzed a total of 11,768 cryopreserved embryos which had undergone at least one thaw cycle during 1986 to 2007. Post thaw survival proportion and implantation, miscarriage, clinical pregnancy, and live birth rates were considered as the primary outcomes of the study.
The study findings showed that the extent of cryostorage duration for IVF or oocyte donation cycles did not significantly affect the post thaw survival of embryos (frozen at pronuclear or cleavage stages), implantation competence, or pregnancy outcomes. Logistic regression analysis, however, confirmed that factors, such as stage of oocyte, number of embryos transferred and survival proportion, positively predict pregnancy outcomes.
Earlier, Machtinger, et al. (Gynecological Endocrinology, 2002) conducted a case-control study to evaluate the impact of long-term cryopreservation of embryos on its survival, and implantation rate. The study compared 101 women, implanted with their embryos which were cryopreserved for 2–9 years, and the same number of women (control) implanted with embryos stored for 6 months or less. The implantation rate was found to be 4.5% and 5.5% in the study and control groups, respectively. Based on the similar implantation rate observed in both the groups, the researchers concluded that prolonged cryopreservation, do not have an adverse impact on embryo survival and could thereby be an effective option for embryo storage in ARTs.
Embryo cryopreservation plays a major role in the overall outcome achieved by assisted reproduction programs. The procedure also facilitates an improved cumulative success rate for IVF, preventing ovarian hyperstimulation syndrome (OHSS) and reducing the rate of multiple pregnancies. Although several researches suggest that long time preservation of embryos does not affect its survival rate and pregnancy outcome, the maximum duration up to which the embryo can remain in the frozen state for successful implantation, needs further investigation.
References
1. Riggs R, Mayer J, Dowling-Lacey D, et al. Does storage time influence postthaw survival and pregnancy outcome? An analysis of 11,768 cryopreserved human embryos. Fertil Steril. 2008 Nov 20. [Epub ahead of print]
2. Machtinger R, Dor J, Levron J, et al. The effect of prolonged cryopreservation on embryo survival. Gynecol Endocrinol. 2002 Aug;16(4):293-8.

The Obama Inaugural Ball

Surrogacy Law Must Be Reviewed in the UK

Pressure for a review of surrogacy law is mounting in legal, media and
political quarters following the case of Re X & Y (Foreign Surrogacy) 2008.
The case - the first to test thelaw for British couples going abroad for surrogacy
- has highlighted the complexity and confusion surrounding surrogacy law in the UK.
The case hit the headlines after twins, biologically the children of a
British father and an anonymous egg donor and carried by a Ukrainian
surrogate mother, were left parentless and stateless by a conflict between
English and Ukrainian law. The British commissioning parents were not
treated as the twins' parents under English law, despite the British
father's biological paternity. The twins could have faced a childhood in a
Ukrainian orphanage if the High Court had not made a groundbreaking decision
to authorise the payment of £23,000 made to the surrogate mother.
The issues in the case go to the very core of society's attitude to
fertility treatment and highlight the problems with the current constraints
on surrogacy in the UK, particularly in the wake of increasing
permissiveness of commercial surrogacy in foreign jurisdictions. The
landmark legal judgment has ramifications for all those involved in
fertility practice, including patients, their legal advisers, clinicians and
the HFEA.
The case follows hard on the heels of recent parliamentary debates on
the Human Fertilisation and Embryology Act 2008. The government indicated in
those debates that it was minded to review the law and regulation of
surrogacy, but it fell short of tackling the issue head-on. This was a lost
opportunity to overhaul the inherent problems and inconsistencies with
English surrogacy law.
The case of Re X and Y highlights quite how significant this omission
was. The risk of many more couples ending up in a similar nightmare is
worrying. More British couples are travelling abroad for treatment, for
reasons including the acute shortage of egg donors in the UK and
restrictions on commercially-arranged surrogacy which make it difficult to
find a suitable surrogate mother in the UK. Mr Justice Hedley acknowledged
this trend, saying 'more and more couples are likely to be tempted to follow
the applicants' path to commercial surrogacy in those places where it is
lawful'.
The problem is that many foreign systems of law take a very different
approach to surrogacy, so that children are born following arrangements
which would not be permitted in the UK. In Re X & Y, the British couple had
paid the surrogate mother 27,000 Euros (£23,000), far more than the
'reasonable expenses' permitted under UK law. The High Court's decision to
authorise the payments was a watershed, but the court made it clear that the
UK maintains a public policy against commercial surrogacy and that every
case will be decided on its own facts. Other British couples who conceive
through foreign surrogacy can therefore expect to face a similar legal
battle to the parents in Re X and Y.
Of equal concern, Mr Justice Hedley acknowledged that the British couple
in Re X and Y had made diligent enquiries about parenting options and made
what they felt was an informed decision about entering into a surrogacy
arrangement in the Ukraine. He commented that none of the legal difficulties
the couple experienced were 'foreshadowed in any of the extensive enquiries
they had made before leaving this country, whether on Home Office websites
or the information given by the bodies who advised them in the United
Kingdom or the information given to them in and through the Ukrainian
Hospital'. There is currently a dire lack of good quality information about
the legal treatment of international surrogacy arrangements, Mr Justice
Hedley commenting that 'the quality of information currently available is
variable and may, in what it omits, actually be misleading'.
Fertility practitioners and regulatory bodies beware. Following Re X
and Y, relevant professionals (and regulatory bodies) in the UK will be
expected to provide patients with much better information about the legal
complications of foreign surrogacy. Re X and Y highlights quite how
dangerous it can be for patients (and perhaps their doctors) to focus
exclusively on the goal of conceiving and to give too little thought to the
legal consequences that may follow after their long-awaited child is born.
Surrogacy remains a sensitive and difficult subject and there needs to
be greater awareness of the complex legal issues. Those working with
fertility patients can also play their part for a better future by
increasing pressure for a review of surrogacy law in the UK.

- By Louisa Ghevaert, Associate Solicitor at Lester Aldridge LLP. Louisa
works with Natalie Gamble and represented the parents, together with
Natalie, in the Re X and Y case. For further information see
www.lesteraldridge.com/services/private/fertility/index.asp

Jacqueline Gold: I'm just so lucky to be pregnant at 48

Jacqueline Gold likes to joke that she has lived her whole life "backwards". At 48, at the peak of an enormously successful career – she is CEO of Gold Group International (which owns Ann Summers) and one of the most powerful women in British retailing – she is about to fulfil a dream that she put on hold as a young woman. Finally, at an age when most women are approaching menopause, Jacqueline is settling into her first pregnancy.
"I left home when I was 18, got married when I was 20 and started the business when I was 21 – all things that people tend to do later in life. I did the partying that most people do in their 20s in my 30s after my marriage broke down and of course here I am at 48 – five months pregnant and engaged to be married," she says, placing a small, manicured hand on the bump that already dominates her 5ft 2in frame.
Delicately pretty and softly spoken, it is difficult to believe that this woman is responsible for turning the male-dominated business started by her father David into a female-friendly preserve with a £115 million annual gross turnover. She attributes her business success to a combination of hard work, determination and creativity; qualities, she admits with a rueful smile, that she has also had to draw on in her quest to start a family.
Because, like a great many other ambitious women of her generation, Jacqueline always felt that she would have children "when the time felt right". But when it finally did – seven years ago when she met her banker fiancé Dan Cunningham, 31 – she was in her forties and infertility had become a major issue.
"I feel that evolution hasn't kept up with women," she says. "We live longer, we are healthier, we have careers and we are just not ready to have babies at the age of 20. I think it's such a shame that our bodies haven't evolved with us so that we can be fertile longer"
Jacqueline and Dan embarked on their first round of IVF in 2002 at a private clinic near the home they share in Kent. It was not a happy experience and when it failed they went to Britain's leading private IVF unit at the Lister Hospital in London where they had two more unsuccessful attempts. "The strain that IVF puts on your relationship is just incredible," she says. "It is a hard process and the disappointment when it fails is so overwhelming that a lot of couples have problems, and in 2006 it affected Dan and I so badly that we parted for a while."
When they got back together they decided to try IVF once more but this time they would go to America where the process is more advanced. "We had all the appointments over the phone here in the UK and all the medical checks and blood tests were done here and the results faxed over to the clinic in San Francisco. It wasn't until the end of three months that we finally flew out to the States late last August for the IVF."
They flew home shortly after the procedure unaware of whether or not they had been successful. Ten days later Jacqueline went for the blood test that would – when the results had been faxed through to America – reveal if she was pregnant.
"I remember driving to the hospital to have that test and being so nervous and so tense that I couldn't see properly, it was as if my sight had been impaired. I had the test at 8.30 in the morning but because of the time delay I had to wait until the evening for the result to come through. Dan and I sat by my computer in my office in absolute agony and it was just incredible when that email came through and it said 'Congratulations you are pregnant'."
Jacqueline admits that for the first few weeks of her pregnancy her elation was tempered by the fear that she might miscarry. But at 12 weeks – at the point at which she was beginning to feel safe – doctors discovered a problem.
"I am carrying twins but sadly one of them will not make it," she says. "When we found out it was devastating because even at that early stage you are very attached. I know people will say 'Yes but you have still got one healthy baby' but it doesn't work like that. It took me a while to come to terms with it. I took a few days off work and then I pulled myself together and thought 'OK, now I have got to concentrate on the healthy baby, that is my priority'."
The rare complication in Jacqueline's pregnancy means that she has to be very closely monitored, and scanned every two weeks.
"When we found out we were given the choice to have a selective termination immediately but because that would put the other baby at risk we decided to leave things as they were. At the moment they are planning on leaving me until I am 32 weeks, and then doing a selective reduction. But I may have to go to full term, which could be quite an emotional and traumatic experience."
It is a measure of Jacqueline's courage that she is prepared to talk openly about the problems she faces in her first pregnancy. She hopes that her story will inspire other women who may have had a negative IVF experience to pursue their dream. The fact that her own successful IVF outcome has brought with it new anxieties doesn't, she insists, make it any less exciting. She is absolutely determined to enjoy the experience of pregnancy.
"It's really strange but I just have this very good feeling. I know I face lots of challenges along the way but I am very positive. At first when I used to talk about the baby to Dan he would stop me and say 'let's not get ahead of ourselves'. We got to the point where I said [to Dan] 'I think if things go wrong we will be really devastated but I don't want to get to the end of my pregnancy and think all I did was worry when I should have been relishing every moment of being pregnant'."
Jacqueline is still nervous about thinking too far in the future – she and Dan decided not to know the sex of their healthy baby because they think the surprise will add excitement and ease the pain of what could be a difficult birth –- but she longs to be a mother. She will continue as CEO of the company but with the right help – and an office at home – she wants to be "totally" involved in raising her child.
She will have reached the age of 60 by the time her child is 12, but says that she is not concerned by the fact that she will be a pensioner while her child is an adolescent – or about society's unease about older mothers. "I think I will be a good mother," she says. "I don't want that to sound big-headed or arrogant. Some people might be concerned about my age but I believe I have much more to give a child now than I would have done when I was 20. The biggest part of me wants to give my child love, warmth and the security of a happy childhood. I will just be so lucky to have the chance to do that.