Saturday, January 22, 2011

Surrogacy: the brave new world of making babies


As actress Nicole Kidman becomes the latest star to take delivery from a surrogate mother, the social and moral boundaries of reproduction are becoming increasingly blurred. Hollywood stars are good at paying tribute to the production teams who helped them create their latest masterpiece. But last week, when actress Nicole Kidman and her musician husband announced the birth of a baby girl – and thanked the “gestational carrier” in whose womb she grew – they conjured up a Brave New World indeed.
In Aldous Huxley’s chilling dystopia, natural reproduction has been abolished, with children created in bottling factories and decanted, to be brought up in hatcheries and conditioning centres.
Issuing a statement on Monday, hours after shimmering tautly at the Golden Globes, Kidman said no words could adequately convey the gratitude that she and husband Keith Urban felt to those who supported them through the process, and in particular to their gestational carrier.
Yet it was precisely this inelegant euphemism for surrogate mother – perhaps an attempt by baby Faith Margaret’s biological parents to assert their authority – which calls to mind Huxley’s vision of 2540.
The pronouncement came days before singer Sir Elton John, 63, and partner David Furnish, 48, shared the first images of their baby son, born via a surrogacy arrangement on Christmas Day. The celebrity pair said they had “no clue” which of them was the father of Zachary Jackson Levon, both having contributed sperm samples to be mixed with eggs donated anonymously.
Is this just the stuff of Hollywood – or a glitzed-up mirror to a new world of reproduction, where traditional social and moral conventions are quickly changing?
Natalie Gamble is one of this country’s leading fertility lawyers, specialising in surrogacy. A lesbian mother of two children (both born via donor insemination), she won a landmark legal case last year, in which two British parents were allowed to keep a child who had been born via commerical surrogacy.
Since Britain’s first official surrogate birth, in 1985, laws have limited payments to cover only what is described as “reasonable expenses”, such as loss of income. Women cannot make a profit by “renting out” their wombs, nor can infertile couples pay such rates to surrogates, even if they live in countries with different laws.
But, last month, Mr Justice Hedley explained how he had allowed a British couple to keep their child, despite the fact that they made higher payments to a surrogate living in Illinois, in the United States, where there is no ceiling on amounts.
In making the ruling, he went further, saying that the welfare of the child was the paramount consideration,
and future cases would be rejected only in the “clearest case of the abuse of public policy”.
Ms Gamble, a partner at Gamble and Ghevaert, says: “The ruling was pretty important. It doesn’t change British law, but it shifts the focus within it, so that people know that, if they do go abroad and pay more than expenses, the chances are that those deals will be ratified afterwards.”
Support groups for surrogacy believe many women who want children but are unable to carry them will feel they have no alternative.
In October, Surrogacy UK, which brings together potential surrogates with intended parents, was forced to close its waiting lists for those seeking surrogacy, such is demand.
Kim Cotton, Britain’s first surrogate mother, was paid £6,500 when she had a child for an infertile Swedish couple, using her own eggs and the sperm of the father, 26 years ago.
Estimates suggest that, since then, about 750 children have been born in this country of such arrangements, with “expenses” payments averaging about £15,000.
Soon after the birth, Mrs Cotton, who had already had two children with her husband, said: “You can cut off all maternal feeling if you try hard enough.”
She has never met her child, nor the couple who brought her up. Now a grandmother, aged 54, she does not regret her place in British fertility history, but she believes it was both wrong and damaging that a relationship was never forged between the parties involved. A later happier agreement saw her carry twins – unpaid – for a friend with fertility problems.
Yesterday, details emerged of a surrogate mother allowed to keep her baby girl after refusing to hand her over to the prospective parents.
Explaining his ruling, Mr Justice Baker said on Friday that the woman – the biological mother of six-month-old child T – was better able to meet the girl’s needs than were the married couple, who were alleged to have a violent relationship. Surrogacy support groups insist that such disputes remain rare.
Jayne Frankland, 45, from Herefordshire, tells perhaps Britain’s most unusual surrogacy story. She is bringing up a child born via surrogacy, has acted as a surrogate three times – and in between has had four children who were conceived naturally.
She and her husband Mark had been married for more than 10 years and had undergone repeated fertility treatments in their attempts to start a family when they decided to contact a surrogate agency. After four months of insemination with Mark’s sperm, the surrogate, Susan, a mother-of-two, became pregnant with baby Abigail, who is now 14.
Three years later, to her amazement, Mrs Frankland discovered she was pregnant. Her fertility had spontaneously recovered and she was now producing eggs. Four children – Sam, 11, Charlie, 10, Elisabeth, seven, and Scarlet, three – followed.
Because of their experiences, the couple had become members of support group Surrogacy UK. Soon after Elisabeth was born, they got to know a couple who were desperate to have a child. It was their eldest child Abigail, then seven, who asked Mrs Frankland if she could have a child for somebody else “now that your tummy is mended”.
Mrs Frankland has now done that twice, giving birth to Isaac, now six, and Hector, five, for two more couples. She is currently three months pregnant for another couple. In the 14 years since Abigail was born, she belives that the stigma attached to surrogacy has almost evaporated.
“When we had Abigail, I was afraid of what people would think. I wondered how they would treat us – would they accept her? Would we be outcasts or be seen as buying a baby? Compared with how it used to be, people really don’t bat an eyelid any more.”
She acts as surrogate, she says, because of her empathy for those struggling to have a family. She believes that no one would enter lightly into surrogacy, or choose it for convenience, or to maintain a figure: “I don’t think anyone who wanted children would choose this as an option over anything else.”
But it is the ethics for the surrogate mothers and the risks of exploitation that most concern fertility experts.
Dr Gillian Lockwood, a fertility doctor and vice-chairman of the Royal College of Obstretricians and Gynaecologists’ ethics committee, believes the current British laws restricting payments are hard to justify.
In response to a national shortage of eggs and sperm donated for fertility treatment, the Human Fertilisation and Embryology Authority (HFEA) is currently consulting on proposals to raise the amount donors can be paid.
But the rules on surrogacy remain mired in controversy, and, so far, watchdogs and Parliament have shown little appetite to relax the current restrictions, which say payments should not overtake expenses.
Dr Lockwood says: “If you can pay for egg and sperm donors, it starts to look ridiculous that a woman can agree to carry a child for nine months and all they can get is a bit of money to buy a few maternity frocks. It would have made good sense to include this in the HFEA review rather than doing law on a case-by-case basis, which introduces a lot of uncertainty.”
The difficulty, as the fertility doctor acknowledges, is that, if the rates are too high, “temptations can become irrestistable for those living on the margins”.
Looking abroad, the global economy in surrogacy makes it almost impossible for “fair rates” to be set.
Since 2002, when India legalised the practice, it has become a world centre for surrogacy tourism, expected to generate £1.5 billion for the country annually by next year.
Dr Lockwood says: “If you have a woman in India with two children who she is struggling to bathe and feed, and one surrogacy arrangement means she can send them to school and build a house, is that exploitation? Renting a womb out might seem a much better option than a year of breaking rocks.”
Dr Allan Pacey, a fertility lecturer at the University of Sheffield, says the ethical issues are different but just as complex on home turf. “I worry particularly about the cases involving family members, who might feel under intense pressure to act as a surrogate. Areas like that are a great concern,” he says.
While media commentators have been in turn vitriolic and squeamish about the latest cases, with Sir Elton John accused of treating babies as the latest “must-have” accessory in an extravagant lifestyle, some religious figures express a deeper unease.
The Rt Rev Michael Nazir-Ali, the former Bishop of Rochester recently told The Sunday Telegraph of his concerns that the introduction of a “third party” into parenthood would affect the child psychologically. He also highlighted the age of Sir Elton, who turns 64 in March. “It is very important for a child’s parents to be of an age that provides the child with a fair chance of being brought up by them without unnecessary disrupution,” he said.
Naturally, where ethical commentators see an issue that is divisive and explosive, popular entertainment sees a ratings opportunity.
Barely recovered from the furore over its controverisal cot death/baby swap storyline, BBC soap opera EastEnders is reportedly planning to dramatise a surrogacy plot, involving gay characters Christian Clarke and Syed Masood.
It wouldn’t be the first time that the dramatic potential of reproductive technology had been detected. In 1946, Aldous Huxley reconsidered the futuristic satire – or prophecy – he had penned 15 years earlier.
“Technically and ideologically, we are still a long way from bottled babies,” he concluded – 32 years before the birth of Louise Brown, the world’s first test-tube baby.
And what of the rest of his brave new world? He looked again at the picture he had painted for 2540, with its widespread promiscuity and babies being decanted, hatched and then conditioned to live in a state that was almost free of emotion.
His verdict: “Today it seems quite possible that the horror may be upon us within a single century.”
By Laura Donnelly, The Telegraph

Friday, January 21, 2011

Fertility expert: IVF discount in return for eggs is exploitation


One of Britain's leading fertility experts today accused clinics of exploiting women by offering them cut-price IVF in return for their eggs.

Professor Robert Winston said that schemes where patients are encouraged to share their eggs with infertile women were wrong.

Lord Winston said: "Egg-sharing is a very bad idea and an easy way of exploiting women wanting treatment. It's a pretty devastating scenario to give eggs to someone else and that other person gets pregnant and you don't. Then 20 years later you're contacted by that child. It's shocking."

Lord Winston said he supported a change in the law to allow payments for egg donation. At present, egg donors can be compensated up to £250 but proposals published by the Human Fertilisation and Embryology Authority this week suggest they could in future be paid several thousand pounds.

The HFEA consultation also covers sperm donors, egg-sharing and the ethics of clinics offering "inducements" in return for eggs.

Peter Bowen-Simpkins, medical director of the London Women's Clinic which runs an egg-sharing scheme, said his clinic opposed payments to egg donors as they might not appreciate the health risks of fertility medication. "It's asking young people, especially students with debts, to donate and could permanently harm them," he said. "With egg-sharing, women are already undergoing IVF and know the risks."

Elaine O'Hara, 30, of Hampshire, and civil partner Suzanne, 29, started fertility treatment at the LWC last autumn. The couple, who are in the Army, are taking part in the egg-sharing scheme in return for part of their treatment costs. Ms O'Hara, an accountant, said: "I decided to donate eggs because we couldn't conceive and have a family without a (sperm) donor.

"More people would come forward if donors are paid - of course money would be an incentive. But I don't know if that guarantees the quality of eggs. It was made clear that if another women conceives with my eggs then we might get a 16-year-old contacting us. That would be exciting though."

The Government is also under pressure over the ban on paying women who act as surrogate mothers. Actress Nicole Kidman, 43, and her husband Keith Urban have revealed that they have become parents to a girl born with a surrogate mother last month. The couple are the biological parents of Faith Margaret, They already have a two-year-old daughter, Sunday Rose.

Thursday, January 20, 2011

First Genetic Test for Predicting IVF Success





A researcher at Albert Einstein College of Medicine of Yeshiva University has helped to develop the first genetic blood test for predicting the chances that in vitro fertilization (IVF) will lead to a successful pregnancy. The test, reported in the online medical journal PLoS ONE, is based on the finding that different subtypes of the FMR1 gene (also known as the fragile X mental retardation gene) in potential mothers are associated with significantly different chances of conceiving with IVF.
"This is the first evidence that a specific gene appears to be directly associated with IVF outcomes," said David Barad, M.D., associate clinical professor of epidemiology & population health and of obstetrics & gynecology and women's health at Einstein and one of the study's senior authors. Dr. Barad is also director of assisted reproduction at the Center for Human Reproduction (CHR) in New York City.
"Our research also suggests the FMR1 gene, some forms of which are known to predict premature ovarian failure, could be used to predict at what age a woman's fertility is going to start decreasing," he added.
The study also supports the belief that autoimmunity (immunity to one's own cells or tissues) plays a role in infertility -- a controversial topic among reproductive medicine specialists.
The study involved 339 female infertility patients who underwent a total of 455 IVF cycles at CHR. The researchers investigated the relationship between three different FMR1 genotypes and pregnancy outcomes and autoimmunity levels. Women with the "normal" FMR1 genotype had a 38.6 percent pregnancy rate; those with the "heterozygous-normal/high" genotype had a 31.7 percent pregnancy rate; and women found to have the "heterozygous-normal/low" genotype had a 22.2 percent pregnancy rate.
The genotype associated with the lowest pregnancy rate (heterozygous-normal/low) was also associated with increased measures of autoimmunity. Women with this genotype also had a higher incidence of polycystic ovary syndrome (a common cause of infertility), which is thought to have an autoimmune component. "Previous studies have suggested that autoimmunity plays a role in infertility," said Dr. Barad. "Now, for the first time, we have a potential genetic mechanism that underlies several different threats to infertility."
The cost of the blood test for the FMR1 should be relatively low -- comparable to screening tests for Tay-Sachs and other genetic diseases. While the FMR1 gene test is not yet clinically available, "It's likely that the findings will lead to clinical applications in the future," said Dr. Barad.
"Any test that is proven to have predictive value for a woman's fertility would give her a heads up in terms of planning a family," he added. "For instance, if a woman planning to go to law school or medical school learns she has a certain amount of risk of losing her ovarian function before she is 35, she may choose to bank her eggs or try having children at an earlier age, rather than delay."

Wednesday, January 19, 2011

Vitrolife receives patent protection for Swemed Sense needle in European markets




Swemed Sense™ is a unique needle that is used for the collection of oocytes in connection with IVF. The approved patent means that Vitrolife has both design protection and product patent protection for Swemed Sense™ in strategically important European markets. A patent has also been applied for in other prioritized markets.

A recently presented study shows that Swemed Sense™ gives less pain and bleeding during the collection of oocytes, compared with a conventional needle.

Swemed Sense™ has a unique design, as advantages from both thin and thick needles are combined in one and the same needle. Swemed Sense™ is designed with a thinner front part and tip so as to minimize tissue damage, bleeding and pain. The rear part of the needle has a larger diameter, which means that the needle is stable and at the same time maintains flow and speed.

The market for needles used in the collection of oocytes for IVF is estimated to amount to approximately 40 million Euros globally.

Tuesday, January 18, 2011

Couple's baby joy after spending £54k on IVF treatment


When she lost her son Jack to meningitis, just weeks before his second birthday, ­Jennifer Heneghan’s world fell apart.
She was a single mum and ­everything she did revolved around her little boy. But as she battled to cope with her grief at just 23, ­doctors dealt her another ­devastating blow – she would never be a mum again.
But despite being told she was infertile, Jennifer refused to give up on her dream of having another child.
And now, after years of trying and £54,000 spent on IVF treatment she has finally given birth to her longed-for baby.
Jennifer, 33, says: “I didn’t want to replace Jack. Nothing ever could. I simply wanted to be a mum again. To lose a child is unbearable; to then be told you can never have any more shatters you.
“I just couldn’t give up and thank goodness we didn’t. Now when people ask I say I have two sons.”
Jack was born when she was 21. Though she split with his dad shortly after the birth and life hadn’t turned out as she’d planned it, as a single mum at 21, Jennifer couldn’t have been happier.
“Jack was my world. I loved being a mummy and the two of us were joined at the hip,” she recalls.
But just a few weeks before his second ­birthday, Jack went off his food and became clingy and lethargic.
A worried Jennifer took him to the GP who prescribed ­antibiotics for a ­suspected infection.
But as the days passed Jack got worse and one night, with his temperature soaring, he seemed difficult to rouse.
Jennifer rushed him to ­Wexham Park Hospital in Slough, Berkshire, but was advised to take him home and continue with the medication.
Only hours later Jack’s eyes became glazed and he started gasping for breath.
Jennifer’s mum called an ambulance and he was rushed back to the hospital. “A crash team were waiting and whisked him straight off,” ­Jennifer remembers. “We were taken to the relatives’ room and that’s when I heard the ‘M’ word.”
She was told Jack had ­suffered a heart attack caused by ­meningitis. He was on life support.
“When the doctor told me to call Jack’s family, in my heart I knew he was never coming home. A piece of me died right then,” she says.
Just three hours later Jack’s fight was over. “I screamed in shock and broke down,” recalls Jennifer. “I don’t even remember the next few weeks. I should have been planning his second birthday, not his funeral.”
In time Jennifer moved on and fell in love with best friend Marie’s brother Kevin, a National Grid engineer.
“It helped that Kevin had known Jack,” says Jennifer. “I don’t think I could have been with someone who didn’t know him because he was such a big part of my life.”
The couple discussed kids and both agreed they wanted to try. “I didn’t want to replace Jack but I knew life would always be empty without ­children for me,” she says. “I ­wanted to be a mum and I knew Kevin would be an excellent dad.” The couple decided to get married the following ­summer but started trying for a baby straight away.
But the wedding came and went with no news so they decided to ask doctors for some advice.
And after being referred to hospital for tests, ­Jennifer’s dreams were about to be destroyed.
“The consultant ­explained that I had ­developed a condition that had fused my tubes ­together,” ­explains Jennifer. “I asked what they could do and he just shook his head and said nothing. I was ­infertile.” Jennifer was only 25.
“It took a few minutes for it to sink in. I was stunned. I’d got ­pregnant so easily with Jack it seemed impossible.Apparently now I had more chance of winning the lottery than having a baby.”
For Jennifer the pain of losing Jack came flooding back. He’d been her only chance at motherhood and she’d lost him. The couple asked to have her tubes flushed to remove the blockages but it failed.
“It looked like there really was no hope. But then Kevin suggested we cancel a holiday we were ­planning and put the money ­towards IVF instead,” she says.
But four painful attempts and £25,000 later, Jen, who manages a care home for adults with learning difficulties, was still not pregnant.
“It was like being on a rollercoaster,” she ­recalls. “One minute up, the next minute ­heartbroken at another failed attempt.”
And then to top it all off Jennifer developed Bell’s Palsy – a weakness of the facial muscles – which made her look like she’d had a stroke.
“The doctor said it could be stress-induced because of the worry of the IVF,” she says. “He advised me to start looking after myself and he was right. After four cycles in as many years everything had taken a back seat to IVF and we needed a break.”
For the next three years Jennifer and Kevin, now 35, ­focused on their ­relationship – enjoying holidays and time ­together without the pressure of treatment cycles. But the yearning for a baby got stronger.
So in 2008 the couplecontacted London’s ­Assisted Reproduction and Gynaecology ­Centre and signed up for another course.
Just three weeks later, Jennifer found out she was ­pregnant with twins.
But their joy was short-lived after ­Jennifer miscarried at six weeks.
“I told Kevin I wasn’t sure I could go through it all again,” she says. By this time Jennifer was 33 and the couple had already forked out a huge £40,000.
Over the eight years they had been trying to conceive, the couple spent all their money on IVF giving up holidays and even missing out on home improvements. They had taken out one loan of £4,000 early in the process.
But they agreed to have one last shot using the two frozen eggs they had left. And when they realised it would cost another £14,000 to have the eggs thawed and implanted they turned to Jen’s parents for the money.
It was their first frozen cycle and they were apprehensive, ­especially when one egg didn’t survive. But the other did and two weeks later, Jennifer was pregnant again.
For Jennifer, the whole ­pregnancy was fraught with worry. She was terrified the worst would happen again, especially when a blood clot developed in her womb.
But week after week, her regular scans showed their baby clinging on. At 14 weeks they found out it was a boy. Then at 34 weeks ­Jennifer went into early labour and had baby Tiernan. At just 5lb 10oz he was taken to baby care, but the next day she got to hold him. At 18 days he was allowed home.
And now he’s seven months old. “After what we went through it doesn’t matter what he cost because we feel like we have won the ­lottery,” Jennifer beams. “We never gave up on our dream and finally it came true. I can never thank Mum and Dad enough because the money they gave us bought us Tiernan.”
Jennifer thinks Tiernan is the image of his big brother Jack.
“People always used to tell me how Jack was cheeky but adorable at the same time – and Tiernan is the same,” she says. “The older he gets the more he looks like Jack with the same mousey hair and blue eyes.”
And while Jennifer ­admits being a mum in her 30s is much more tiring, she’s ­loving every minute.
“I don’t take anything for granted and I’m afraid to say he has me wrapped around his little finger.
“He’s the miracle I’ve waited years for and he’s here in my arms at last. When I’m cuddling him I look at his little face and know it was worth every minute of the pain and ­anguish of IVF.”
Needless to say the family had their best Christmas ever last month.
“There’s only one word to describe the presents piled under our tree – shameless!” she laughs.
“I never thought I’d be ­opening presents with a child again on Christmas Day. How could I not go over the top with him?
“It used to be a sombre day because it’s all about children and just reminded us what we couldn’t have. Now Tiernan is the best gift of all.”

Monday, January 17, 2011

Clowning helps IVF patients become pregnant: study






Dr. Shevach Friedler an infertility doctor with the Infertility and IVF unit at Assaf Harofeh Medical Center, in Zrifin, Israel, led a study of the effects of a bedside encounter with a professional medical clown on the pregnancy rate of women undergoing in-vitro fertilization (IVF).
Dr. Friedler and colleagues tracked 219 women undergoing IVF treatment at the medical center and, over a period of a year, treated half of them to a medical clown's 15-minute routine of jokes, magic tricks and other clowning immediately after their embryos were implanted. The clown’s routine was created especially for the study by Friedler and a colleague.
The results showed 36.4 percent of women exposed to clowning immediately after embryo transfer became pregnant, while only 20.2 percent of the controls became pregnant. Dr. Friedler said the reason was probably because the clowning reduced the stress of what for many was many years of grueling IVF treatments, but this is not certain. It is also unclear what role, if any, stress may play in the success of IVF treatments.
Dr. Friedler, who is also trained in movement and mime, originally thought of the research after reading about laughter as an anti-stress mechanism. He realized that IVF patients are often extremely stressed, and wondered if relieving that stress through clowning at a crucial moment in the treatment could help.
Dr. Friedler and colleagues conclude that medical clowning may be a beneficial adjunct to IVF treatments and it deserves further investigation. Medical clowning is already used to good effect in hospitals in Europe, Australia, North America and Israel, particularly in children’s hospitals.
Dr. Friedler also pointed out that clowning is “one of the least hazardous interventions in our field.” Other methods of reducing stress could also be investigated. The findings are reported in the journal Fertility and Sterility.
More information: The effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer (IVF-ET), Shevach Friedler, M.D et al., Fertility and Sterility, published online 06 January 2011, doi:10.1016/j.fertnstert.2010.12.016

Sunday, January 16, 2011

This is no light bill




Antilla is not just a landmark, a month after Mukesh Ambani moved in, it also generated the city’s biggest power bill for a residence: Rs 70 lakh(152,000 USD approx)

The asymmetrical stack of floors is lit-up like a jewellery box, illuminating the indigo sky, its opulence casting everything around it into a paler shade of their selves. Mukesh Ambani’s Godzilla-sized home, Antilla, has just notched up another headline. In the one month since he moved in with wife Nita and their three children, the tycoon has generated a power bill of Rs 70,69,488, the city’s highest residential electricity bill.

According to the bill for the month of September, made available to TOI, Antilla consumed 6,37,240 units of power. To put it in perspective an average Mumbai household equipped with all electronic amenities consumes 300 units per month. Ambani was in fact, as per BEST norm, given a discount of Rs 48,354 for prompt payment. The 70 lakh quoted earlier is minus this amount. Experts say the RIL boss’s tariff is roughly equivalent to the monthly power bill of 7,000 homes in Mumbai. The 27-storey Antilla, named after a mythical island, with its three helipads, 50-seater theatre, nine elevators, swimming pool and residential quarters takes up 37,000 square meters of space which is larger than the Palace of Versailles and according to the Guardian newspaper of the UK, its estimated value is pegged at Rs 4,567 crore.

“Extensive air-conditioning and elevated parking are big energy consumers,” says a BEST official not wishing to be quoted. Further, he adds, the building is lit up through the night, showcasing the bling. Though, a report in the Forbes magazine says that a four-storey hanging garden was especially built as an energy-saving device, to keep the interiors cool in summers.

Perhaps it is taking effect, for in October their power bill marginally came down to Rs 61,28461, for consumption of 5,96,800 power units. The family is among BEST’s high-tension consumer, a category created for bulk users. Save for a small part of the building which is designated as office space where commercial rates are applicable, the lower residential rates apply to the rest of the building. But even here it’s fortunate that Antilla is located where it is. Altamount Road falls under the BEST radar which has the lowest tariff among all power suppliers. Had brother Anil’s Reliance Energy been their power suppliers, Mukesh’s bill, as half of Mumbai can vouch, would have been further inflated.