Saturday, February 7, 2009
Friday, February 6, 2009
Thursday, February 5, 2009
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
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
Wednesday, February 4, 2009
Doctors Confirm First Successful Essure Tubal Ligation Reversal
Lakeshore Surgical Center made medical history less than one year ago by being the first facility to perform an Essure Tubal Occlusion Reversal. The Essure procedure is a new type of Tubal Ligation, for women who want a permanent type of birth control or sterilization. The Essure procedure has only been performed for a little over 5 years and is reported to be permanent and NOT reversible by the manufacturing company. On November 5, 2007 Dr. William A.C. Greene Jr. and Dr. Wendell Turner at Lakeshore Surgical Center, were the first surgeons in the country to perform an Essure Reversal.
The Essure procedure differs from other Tubal Ligation due to the fact that a coil-like device is inserted into the fallopian tube where it meets the uterus. Scar tissue then grows around the inserted coil over the next 3 months to form a natural barrier that prevents sperm from reaching the egg. To reverse this procedure the doctors at Lakeshore Surgical Center developed specific instruments to allow for the Essure coil-like device to be removed with the utmost of care, and not damage the fallopian tube. Then a custom needle, designed by Dr. William Greene is used to sew the tube back into the wall of the uterus without cutting the uterus open.
The success of the procedure was confirmed October 8, 2008, by a patient who came to Lakeshore Surgical Center in March, 2008, to be one of the first women in the country to have the Essure Reversal performed by expert tubal ligation reversal surgeons, Dr. William Greene Jr. and Dr. Wendell Turner. The first Essure Reversal pregnancy has been confirmed by the patient's physician, by ultrasound and the fetal sac was seen in the uterus.
This medical procedure is a huge stepping stone in the medical field of Reproductive Surgery and Infertility. Tubal Ligation Reversals have been performed for years, but the Essure procedure, which is stated to be non-reversible, has not been successfully reversed before now. Women who want to have more children, due to divorce, loss of a child or have just changed their mind, Tubal Reversal is an option. This advance in Reproductive Surgery will allow women to be able to conceive naturally, after having the Essure procedure. In-Vitro Fertilization and other infertility treatments are no longer the only option for women who have made this choice and changed their mind.
To date Lakeshore Surgical Center has performed 4 Essure Reversals, including the case above who is now pregnant. Of these three other patients, one has yet to become pregnant, another did have a confirmed pregnancy but miscarried and the third patient has not yet become pregnant but has been seen by another physician, who confirmed through a Hysterosalpingogram (HSG) that her tubes were open.
Lakeshore Surgical Center is the leading specialized Tubal Ligation Reversal center. Located in Gainesville, GA, surgeons Dr. William A.C. Greene, Jr. and Dr. Wendell Turner have combined 50 years of outpatient gynecologic surgery experience and have performed thousands of Tubal Ligation Reversals. For 10 years, this cutting edge facility, along with the skills and expertise of its doctors and staff have provided women with the opportunity to become "pregnant again".
Tuesday, February 3, 2009
New Sperm Shaker Set To Improve IVF Success Rates
Scientists have developed a ground-breaking method for testing the quality of a sperm before it is used in IVF and increase the chances of conception.
Researchers at the University of Edinburgh, funded by the EPSRC (Engineering and Physical Sciences Research Council), have created a way of chemically 'fingerprinting' individual sperm to give an indication of quality. Scientists can then consider whether the sperm is healthy enough to be used to fertilise an egg as part of an IVF treatment.
The sperm are captured in two highly focussed beams of laser light. Trapped in what are essentially 'optical tweezers', an individual sperm's DNA properties are identified by the pattern of the vibrations they emit in a process known as Raman spectroscopy. This is the first time this process has been used to evaluate DNA damage in sperm.
Dr Alistair Elfick, lead scientist on the project, said: "In natural conception the fittest and healthiest sperm are positively selected by the arduous journey they make to the egg. What our technology does is to replace natural selection with a DNA based 'quality score'. But this is not about designer babies. We can only tell if the sperm is strong and healthy not if it will produce a baby with blue eyes."
In the past quality tests of sperm have mostly been carried out on the basis of shape and activity. While these do give some indication of health of the sperm they do not give its DNA status.
There are established tests for sperm DNA quality but they work by cutting the cells in half and tagging them with fluorescent dye a process that kills the sperm and renders it useless. This new process does not destroy the sperm, so if it is found to have good DNA quality, it can still be used in IVF treatment.
Conception rates in both IVF treatment and intercourse are at around one in four. By selecting the best quality sperm it is hoped this new process could both increase a couple's chances of conception and give the child the best potential start in life.
The research is currently in a pre-clinical phase, and if successful could be available to patients in the next five to ten years.
Researchers at the University of Edinburgh, funded by the EPSRC (Engineering and Physical Sciences Research Council), have created a way of chemically 'fingerprinting' individual sperm to give an indication of quality. Scientists can then consider whether the sperm is healthy enough to be used to fertilise an egg as part of an IVF treatment.
The sperm are captured in two highly focussed beams of laser light. Trapped in what are essentially 'optical tweezers', an individual sperm's DNA properties are identified by the pattern of the vibrations they emit in a process known as Raman spectroscopy. This is the first time this process has been used to evaluate DNA damage in sperm.
Dr Alistair Elfick, lead scientist on the project, said: "In natural conception the fittest and healthiest sperm are positively selected by the arduous journey they make to the egg. What our technology does is to replace natural selection with a DNA based 'quality score'. But this is not about designer babies. We can only tell if the sperm is strong and healthy not if it will produce a baby with blue eyes."
In the past quality tests of sperm have mostly been carried out on the basis of shape and activity. While these do give some indication of health of the sperm they do not give its DNA status.
There are established tests for sperm DNA quality but they work by cutting the cells in half and tagging them with fluorescent dye a process that kills the sperm and renders it useless. This new process does not destroy the sperm, so if it is found to have good DNA quality, it can still be used in IVF treatment.
Conception rates in both IVF treatment and intercourse are at around one in four. By selecting the best quality sperm it is hoped this new process could both increase a couple's chances of conception and give the child the best potential start in life.
The research is currently in a pre-clinical phase, and if successful could be available to patients in the next five to ten years.
Monday, February 2, 2009
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."
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."
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