A serious blunder at one of Britain's top fertility clinics dramatically increased the risk its patients would suffer a miscarriage or give birth to a child with serious health problems, sparking fresh fears about how IVF centers are run in the wake of a series of scandals.
Unscreened sperm used by staff at the London Women's Clinic (LWC) to create dozens of embryos was later found to have a chromosome abnormality that could have been passed on to any unborn child, The Independent on Sunday has learnt. The British Fertility Society's screening guidelines make it clear that the clinic should never have accepted the donor. At least one couple suffered a miscarriage as a direct result.
The blunder constituted the most severe mistake that a clinic can make, according to the Human Fertilization and Embryology Authority, which regulates the multimillion-pound IVF sector. In future, the watchdog will name and shame clinics for similar incidents under new rules to expose mistakes and near misses.
Fertility experts believe the LWC's error could be the "tip of the iceberg", and that it raises serious concerns about how the industry is regulated. It is the latest in a series of high-profile incidents, including a couple's last viable embryo being implanted into another woman, and eggs fertilized with the wrong sperm, forcing three couples' embryos to be destroyed.
Guy Forster, a solicitor at the law firm Irwin Mitchell who has represented several couples who have suffered mix-ups, said: "It's fair to say the problem is widespread. The HFEA must do more to ensure clinics meet their responsibilities, and clinics must pay more attention to systems they have in place and not just to success rates."
Dr Sammy Lee, a London-based fertility expert, said the HFEA was failing to ensure clinics followed guidelines. "It's a problem of compliance. The HFEA must make clinics adopt pharmaceutical-style quality audits."
The most recent HFEA figures show there were 182 "incidents" at clinics last year, eight of them serious. But lawyers believe the actual figures could be far higher. Several couples are pursuing legal proceedings.
The London Women's Clinic, one of the UK's top three fertility centers, was warned in the HFEA's latest inspection report last January, after inspectors found its staff failed to carry out "a number of witnessing stages", vital to ensure processes such as sperm screening are done correctly.
Yet as recently as June, the clinic was still using embryos created with unscreened sperm, according to one couple who spoke about their ordeal. At least 11 other women are thought to have had treatment using the sperm, including three couples who had frozen embryos in storage. The clinic, in Harley Street, does 1,300 treatment cycles annually and recently recruited more staff to cope with demand.
The prospective mother, who spoke on condition of anonymity, said she suffered a miscarriage as a result of the blunder. The couple paid £15,000 and wasted more than a year trying to become pregnant. "It's left a very bitter taste. We felt that the clinic failed at a very basic level to provide a service we had paid for," she said.
Allan Pacey, secretary of the British Fertility Society, which draws up sperm- screening guidelines, said spotting the abnormality should have been "pretty standard". The couple had to destroy all 22 frozen embryos created with the unscreened sperm. They then faced a bitter compensation battle with the clinic. "It made us so aware that IVF is a business and it all comes down to money," they said. In the end, the clinic paid for them to undergo a further cycle of treatment abroad, and they are now expecting a baby.
Dr Kamal Ahuja, head of the LWC, insisted "all necessary screening" was done on donor sperm. He added that two affected couples had later had healthy babies.
An HFEA spokeswoman said it had audited all the stored samples at the LWC after it was notified about the incident.
Demand for IVF is soaring. Recent figures show the number of treatments rose by 6 per cent in 2007 to nearly 47,000.
Wednesday, December 2, 2009
Tuesday, December 1, 2009
Lying down after artificial insemination improves pregnancy rates, study shows
A study in the Netherlands has shown that lying down following artificial insemination, also known as intrauterine insemination (IUI), increases the chances of pregnancy by 50 per cent.
The findings, published in the British Medical Journal (BMJ) last month, revealed that 27 per cent of women who remained in a supine position following treatment for 15 minutes achieved a live birth, compared with only 17 per cent of those who got up and moved around. In total, 391 couples aged between 18 and 43 took part in the study, which took place across several hospitals in the Netherlands. Each couple received up to three cycles of insemination and were split into two groups - one remained immobilised immediately after treatment and the other, the control group, were asked to walk around.
Lead author Dr Inge Custers, from the Academic Medical Center in Amsterdam, said that the pregnancy rate for the immobilised group was 'significantly higher'. He explained that 'immediate mobilisation might cause leakage [of the sperm]', which may take longer to reach the fallopian tubes if the woman is moving around. 'As immobilisation is easily done and carries very little cost, we suggest incorporating immobilisation as a standard procedure in intrauterine insemination treatment', said Custers, adding that clinics in the Netherlands were already adopting the method. However, there is concern that extending the period each bed is used in clinics could mean that clinics treat fewer patients. Custers said that improving the success rate of IUI will be more economical for patients. 'Although immobilisation takes more time and occupies more space in busy rooms, the intervention will be economic in the long run, as pregnant patients will not return in subsequent cycles,' he said.
In an editorial piece which accompanied Custer's publication in the BMJ, Professor William Ledger, from the Academic Unit of Reproductive and Developmental Medicine at the University of Sheffield, said that there remain many unexplained factors that need to be explored, such as the optimal length of time a woman should remain immobile following treatment to achieve pregnancy. He also noted that it was not clear what proportion of women in the study were given drugs to stimulate their ovaries to produce eggs and expressed some doubt over the benefits of remaining immobile. 'Such postcoital positioning was advocated in the United States many years ago but did not seem to improve conception rates after sex,' he said. He also warned that the overall pregnancy rate achieved in the study is somewhat lower than can be expected in Britain.
Ledger said that clinics should perform their own studies in the 'real world' to test Custers' findings. If further studies confirm the findings of the Netherlands team then he agreed that some couples will be spared the cost of IVF (in-vitro fertilisation). Artificial insemination is cheaper than IVF and requires minimal drug treatment. It is often used prior to IVF and success rates vary from 5-70 per cent, according to Ledger.
The findings, published in the British Medical Journal (BMJ) last month, revealed that 27 per cent of women who remained in a supine position following treatment for 15 minutes achieved a live birth, compared with only 17 per cent of those who got up and moved around. In total, 391 couples aged between 18 and 43 took part in the study, which took place across several hospitals in the Netherlands. Each couple received up to three cycles of insemination and were split into two groups - one remained immobilised immediately after treatment and the other, the control group, were asked to walk around.
Lead author Dr Inge Custers, from the Academic Medical Center in Amsterdam, said that the pregnancy rate for the immobilised group was 'significantly higher'. He explained that 'immediate mobilisation might cause leakage [of the sperm]', which may take longer to reach the fallopian tubes if the woman is moving around. 'As immobilisation is easily done and carries very little cost, we suggest incorporating immobilisation as a standard procedure in intrauterine insemination treatment', said Custers, adding that clinics in the Netherlands were already adopting the method. However, there is concern that extending the period each bed is used in clinics could mean that clinics treat fewer patients. Custers said that improving the success rate of IUI will be more economical for patients. 'Although immobilisation takes more time and occupies more space in busy rooms, the intervention will be economic in the long run, as pregnant patients will not return in subsequent cycles,' he said.
In an editorial piece which accompanied Custer's publication in the BMJ, Professor William Ledger, from the Academic Unit of Reproductive and Developmental Medicine at the University of Sheffield, said that there remain many unexplained factors that need to be explored, such as the optimal length of time a woman should remain immobile following treatment to achieve pregnancy. He also noted that it was not clear what proportion of women in the study were given drugs to stimulate their ovaries to produce eggs and expressed some doubt over the benefits of remaining immobile. 'Such postcoital positioning was advocated in the United States many years ago but did not seem to improve conception rates after sex,' he said. He also warned that the overall pregnancy rate achieved in the study is somewhat lower than can be expected in Britain.
Ledger said that clinics should perform their own studies in the 'real world' to test Custers' findings. If further studies confirm the findings of the Netherlands team then he agreed that some couples will be spared the cost of IVF (in-vitro fertilisation). Artificial insemination is cheaper than IVF and requires minimal drug treatment. It is often used prior to IVF and success rates vary from 5-70 per cent, according to Ledger.
Monday, November 30, 2009
Moving surrogacy law forward in the UK?
Of all the prospective parents conceiving through assisted reproduction, those in surrogacy arrangements often face the most difficult legal issues. The surrogate and usually also her husband will be treated as the child's legal parents at birth, leaving the commissioning parents with no legal connection with their child whatsoever, even where both are the biological parents.
There is a special remedy available called a parental order. This is an order made by the family courts which reassigns parenthood after surrogacy, extinguishing the responsibility of the surrogate parents and transferring it to the commissioning couple. The process takes place post-birth: the application must be made within the first six months of the child's life (though the surrogate's consent is ineffective until after the first six weeks) and typically takes many months to be processed by the courts. At present, only married couples can apply, but as from 6 April 2010, unmarried and same sex couples will also be eligible.
The Department of Health (DH) is currently consulting on new draft regulations which prescribe the detail of this court process, and which will replace existing regulations that have been in place since 1994. The consultation closes on 23 November.
What is in the draft regulations?
Like the existing regulations, the proposed revised regulations apply provisions of adoption law to the parental order application process, setting out court procedure and giving a surrogate child broadly the same legal status as an adopted child. Adoption law has itself been overhauled substantially in recent years, and this is reflected in the wording of the new regulations. However, as part of the general updating, there are some important revisions being made to the existing parental order system which need to be looked at carefully.
For example, a court considering whether to grant an adoption order now has to first consider the 'welfare checklist', a prescriptive list of considerations which includes ascertaining the child's wishes and feelings and considering his or her relationship with the birth family. The new parental order regulations incorporate this checklist into the parental order process. However, it does not seem appropriate for the court to have to address all these issues in surrogacy cases, given that the child will inevitably be less than six months old, and will be already living with the applicants (at least one of whom is his or her biological parent).
Importing the new adoption law without amendment fails to adequately take account of the special nature of surrogacy arrangements, and there may be a risk that this could make the process of applying for a parental order even more onerous than before. While a parental order is similar to an adoption order (in the sense that it transfers legal parenthood from one person to another), surrogacy is very different from adoption. Because a surrogate child (or at least those to which parental orders can apply) is biologically connected to at least one of the commissioning parents and is almost invariably in their care from birth, the dynamic of the family is perhaps closer to donor conception than to adoption. Adapting adoption law is therefore a difficult task, and one which we think could be handled more carefully by the regulations.
The parental order system
Even though a more fundamental review may not be within the power of these regulations, it seems impossible to look at any legislation relating to parental orders without making the point that the whole system is problematic. Parental orders were introduced as a late amendment to the Human Fertilisation and Embryology Act 1990 in response to a specific surrogacy case. At the time, surrogacy was viewed as very rare and something which occurred largely on the fringes of the law and ethical acceptability. The 1990 rules on legal parenthood clearly prioritised donor conception (making the carrying mother the legal mother, and her husband the legal father), and parental orders were designed as a limited remedy - a 'sticking plaster' - in respect of the awkward application of legal parenthood rules in surrogacy situations.
As all those working in this field know, things have changed radically since then. Surrogacy as a form of fertility treatment has blossomed, both in the UK and abroad, and no longer affects just a small number of altruistic inter-family arrangements. Indeed, the Human Fertilisation and Embryology Act 2008 itself has endorsed this, by legalising non-profit making surrogacy agencies like Surrogacy UK and COTS and extending the categories of couples eligible to apply for parental orders. We are also seeing growing numbers of fertility patients travelling abroad for surrogacy, which brings even more complex legal challenges.
The current system, which came about by historical accident rather than a concerted policy decision, fails to meet this increased demand, and is inadequate from almost every perspective. The surrogate and her husband (who, in the vast majority of cases do wish to surrender the child) remain legally and financially responsible for the child for up to a year after the birth, and may have no legal redress against intended parents who refuse to assume responsibility. The intended parents often have no status in respect of their child for many months, including no right to make decisions or to consent to immunisations, no right to transmit inheritance or citizenship rights automatically and the intending mother has no rights to maternity leave (though this is the subject of another current campaign), leaving children very vulnerable during the early months of their lives.
The system is not an effective guardian of public policy against commercial surrogacy, since the check on payments comes at the end the process (by which time any payments have already been made) and the only sanction available to the court is a refusal to grant an order, which is almost impossible to enforce since this would prejudice the welfare of a newborn child. And, most importantly of all, these problems mean that surrogate children lack even basic protection. The problems are highlighted most starkly in foreign surrogacy cases. For example, in the landmark case of Re X and Y (foreign surrogacy) [2008], the law left surrogate twins born abroad to a British couple stateless and parentless. Such children risk being abandoned to foreign state care in the absence of complex and expensive legal intervention - surely this is an outcome which the law has an obligation to avoid at all costs.
We need a better and more planned approach to surrogacy. Of course, there are difficult and sensitive issues to be handled in creating new law. Surrogacy arrangements are among the most ethically and humanly complex in assisted reproduction, with three or even four adults involved throughout the process of conception, pregnancy and birth, and possibly third party gamete donors as well. The respective interests, protection and independence from exploitation of all these adults and, most importantly, the resulting child, need to be adequately balanced and protected by the law.
It is disappointing that such issues were not properly addressed during the government's overhaul of assisted reproduction law last year. Although the Minister indicated that surrogacy was a sensitive issue which would be looked at separately, no firm commitment for this review, or a date, has yet been set - and it seems, given the current 'status' of surrogacy - odd to continue treating it separately. In order to ensure that our law can cope with the demands of modern surrogacy practice, and to ensure that vulnerable children are protected, we urge the government to take a fresh look, not only at the regulations, but at the law itself.
By Natalie Gamble and Louisa Ghevaert
Partners with specialist fertility law firm Gamble and Ghevaert LLP (www.gambleandghevaert.com)
There is a special remedy available called a parental order. This is an order made by the family courts which reassigns parenthood after surrogacy, extinguishing the responsibility of the surrogate parents and transferring it to the commissioning couple. The process takes place post-birth: the application must be made within the first six months of the child's life (though the surrogate's consent is ineffective until after the first six weeks) and typically takes many months to be processed by the courts. At present, only married couples can apply, but as from 6 April 2010, unmarried and same sex couples will also be eligible.
The Department of Health (DH) is currently consulting on new draft regulations which prescribe the detail of this court process, and which will replace existing regulations that have been in place since 1994. The consultation closes on 23 November.
What is in the draft regulations?
Like the existing regulations, the proposed revised regulations apply provisions of adoption law to the parental order application process, setting out court procedure and giving a surrogate child broadly the same legal status as an adopted child. Adoption law has itself been overhauled substantially in recent years, and this is reflected in the wording of the new regulations. However, as part of the general updating, there are some important revisions being made to the existing parental order system which need to be looked at carefully.
For example, a court considering whether to grant an adoption order now has to first consider the 'welfare checklist', a prescriptive list of considerations which includes ascertaining the child's wishes and feelings and considering his or her relationship with the birth family. The new parental order regulations incorporate this checklist into the parental order process. However, it does not seem appropriate for the court to have to address all these issues in surrogacy cases, given that the child will inevitably be less than six months old, and will be already living with the applicants (at least one of whom is his or her biological parent).
Importing the new adoption law without amendment fails to adequately take account of the special nature of surrogacy arrangements, and there may be a risk that this could make the process of applying for a parental order even more onerous than before. While a parental order is similar to an adoption order (in the sense that it transfers legal parenthood from one person to another), surrogacy is very different from adoption. Because a surrogate child (or at least those to which parental orders can apply) is biologically connected to at least one of the commissioning parents and is almost invariably in their care from birth, the dynamic of the family is perhaps closer to donor conception than to adoption. Adapting adoption law is therefore a difficult task, and one which we think could be handled more carefully by the regulations.
The parental order system
Even though a more fundamental review may not be within the power of these regulations, it seems impossible to look at any legislation relating to parental orders without making the point that the whole system is problematic. Parental orders were introduced as a late amendment to the Human Fertilisation and Embryology Act 1990 in response to a specific surrogacy case. At the time, surrogacy was viewed as very rare and something which occurred largely on the fringes of the law and ethical acceptability. The 1990 rules on legal parenthood clearly prioritised donor conception (making the carrying mother the legal mother, and her husband the legal father), and parental orders were designed as a limited remedy - a 'sticking plaster' - in respect of the awkward application of legal parenthood rules in surrogacy situations.
As all those working in this field know, things have changed radically since then. Surrogacy as a form of fertility treatment has blossomed, both in the UK and abroad, and no longer affects just a small number of altruistic inter-family arrangements. Indeed, the Human Fertilisation and Embryology Act 2008 itself has endorsed this, by legalising non-profit making surrogacy agencies like Surrogacy UK and COTS and extending the categories of couples eligible to apply for parental orders. We are also seeing growing numbers of fertility patients travelling abroad for surrogacy, which brings even more complex legal challenges.
The current system, which came about by historical accident rather than a concerted policy decision, fails to meet this increased demand, and is inadequate from almost every perspective. The surrogate and her husband (who, in the vast majority of cases do wish to surrender the child) remain legally and financially responsible for the child for up to a year after the birth, and may have no legal redress against intended parents who refuse to assume responsibility. The intended parents often have no status in respect of their child for many months, including no right to make decisions or to consent to immunisations, no right to transmit inheritance or citizenship rights automatically and the intending mother has no rights to maternity leave (though this is the subject of another current campaign), leaving children very vulnerable during the early months of their lives.
The system is not an effective guardian of public policy against commercial surrogacy, since the check on payments comes at the end the process (by which time any payments have already been made) and the only sanction available to the court is a refusal to grant an order, which is almost impossible to enforce since this would prejudice the welfare of a newborn child. And, most importantly of all, these problems mean that surrogate children lack even basic protection. The problems are highlighted most starkly in foreign surrogacy cases. For example, in the landmark case of Re X and Y (foreign surrogacy) [2008], the law left surrogate twins born abroad to a British couple stateless and parentless. Such children risk being abandoned to foreign state care in the absence of complex and expensive legal intervention - surely this is an outcome which the law has an obligation to avoid at all costs.
We need a better and more planned approach to surrogacy. Of course, there are difficult and sensitive issues to be handled in creating new law. Surrogacy arrangements are among the most ethically and humanly complex in assisted reproduction, with three or even four adults involved throughout the process of conception, pregnancy and birth, and possibly third party gamete donors as well. The respective interests, protection and independence from exploitation of all these adults and, most importantly, the resulting child, need to be adequately balanced and protected by the law.
It is disappointing that such issues were not properly addressed during the government's overhaul of assisted reproduction law last year. Although the Minister indicated that surrogacy was a sensitive issue which would be looked at separately, no firm commitment for this review, or a date, has yet been set - and it seems, given the current 'status' of surrogacy - odd to continue treating it separately. In order to ensure that our law can cope with the demands of modern surrogacy practice, and to ensure that vulnerable children are protected, we urge the government to take a fresh look, not only at the regulations, but at the law itself.
By Natalie Gamble and Louisa Ghevaert
Partners with specialist fertility law firm Gamble and Ghevaert LLP (www.gambleandghevaert.com)
Sunday, November 29, 2009
Saturday, November 28, 2009
Mental Humor
Yesterday, I was walking along the fence to the hospital's mental wing
and I could hear a chorus of patients in the courtyard shouting, "13....13....13....."
I couldn't see through the fence, but I saw a small peephole in the
planks, so I looked through to see what was happening.
Some idiot squirted me in the eye with water!
Then they all started shouting, "14....14....14......"
After a brief recovery, I almost laughed up my lunch.
and I could hear a chorus of patients in the courtyard shouting, "13....13....13....."
I couldn't see through the fence, but I saw a small peephole in the
planks, so I looked through to see what was happening.
Some idiot squirted me in the eye with water!
Then they all started shouting, "14....14....14......"
After a brief recovery, I almost laughed up my lunch.
Friday, November 27, 2009
Thursday, November 26, 2009
Singh is King!
You never heard about him,but he is the KING!!
Fauja Singh in an Adidas poster !!!
Fauja in Adidas 'Nothing Is Impossible' advertising campaign.He replaced David Beckham as Adidas’s new poster boy. On the Adidas billboards, spread across London, he was sitting cross-legged; as if cooling his heals after a day’s work out, peeping over Londoners, tired and overworked, telling them the secrets of his unfailing energy.
Fauja Singh, Britain’s most popular Sikh is 98 now, the oldest runner in London Marathon.He is threatening to break his own world record of 5.40 hours in the 90 plus age bracket that he set previously. While running Marathon races in London, New York and Toronto, he raised thousands of pounds for various charities promoting Sikh culture around the world. He has also raised money for B.L.I.S.S., a charity dedicated to the care for premature babies. He describes it as the ‘oldest running for the youngest.Fauja’s jogging skills were developed on an Indian farm in Punjab, and then at the magical age of 81, when he moved to the UK, his love for the sport became more “serious”.
Fauja Singh (born April 1, 1911) is a Sikh marathon runner in his nineties from India who is a world-record holder in his age bracket. His current personal best time for the London marathon is 6 hours 2 minutes, and his marathon record, for age 90-plus, is 5 hours 40 minutes.Fauja Singh shot to fame, when aged 89, he completed the gruelling 26.2 mile distance in 6 hours and 54 minutes. This knocked 58 minutes off the previous world best for anyone in the 90 plus age bracket. The career of this extraordinary Marathon runner is closely supervised by his personal trainer Harminder Singh. He says ‘he can still run for a few more years. And perhaps he might be the oldest man to run a Marathon.
Fauja Singh came to London in 1992 to live with his son after his wife’s death in his village in Jalandhar. He says ‘Sitting at home was really killing. Most elderly people in Britain eat a rich diet, don’t move about and only travel in cars, and that makes them sick’. He wasn’t prepared to go the same way. So he took up jogging initially to beat the boredom of sitting at home.
‘I never thought of running a Marathon then. But slowly it grew.’ What surprises many is that he supports is eight stone and six feet tall body frame with a very simple vegetarian diet. ‘I am very careful about different foods. My diet is simple phulka, dal, green vegetables, yoghurt and milk. I do not touch parathas, pakoras, rice or any other fried food. I take lots of water and tea with ginger’.And that smile is eternally fixed beneath his silver haired beard. Perhaps that’s the reason behind his strikingly inspiring and positive attitude. ‘I go to bed early taking the name of my Rabba [God] as I don’t want all those negative thoughts crossing my mind.’ Doesn’t he find it difficult to cover 26 miles at this age? ‘The first 20 miles are not difficult. As for last six miles, I run while talking to God.’
Adidas signed him up for its ‘Nothing Is Impossible’ advertising campaign. He won’t reveal how much money the deal involves, but says that a large part of his earnings goes to charity.
Fauja Singh has stated,”I won’t stop running until I die.. The next target, God willing, is to be the oldest marathon runner ever.
Fauja Singh hopes to return in 2009 to break the record for the oldest marathon runner - presently held by a 98-year-old Greek athlete.
His profile as found on Face Book:
Born: 1st April 1911 in India
Former Occupation: Farmer
Running Career: Rediscovered at age of 81
Diet: Ginger Curry
Marathons: London (5), Toronto (1), New York (1)
Marathon Debut: London, 2000 aged 89
London Marathon Personal Best: 6h 2m
London Flora Marathon 2000 6 Hours 54 m
London Flora Marathon 2001 6 Hours 54 m
London Flora Marathon 2002 6 Hours 45 m
Bupa Great North Run (Half Marathon) 2002 2h 39m
London Flora Marathon 2003 6h 2m
Toronto Waterfront Marathon 2003 5h 40m
New York City Marathon 2003 7h 35m
London Flora Marathon 2004 6h 7m
Glasgow City Half Marathon 2004 2h 33m
Capital Radio Help a London Child 10,000m 2004 68m
Toronto Waterfront Half Marathon 2004 2h 29m 59s
Subscribe to:
Posts (Atom)