Gastric banding helps big women have babies

Weight-loss surgery can help obese women conceive babies more easily through IVF, according to research showing lap bands can partially restore fertility. Very overweight Australian women have been increasingly taking up the option of bariatric surgery after failing to fall pregnant naturally, and a new study from the US backs the move.
A team from Washington University reviewed the records of five obese women who underwent bariatric surgery followed by IVF.Three of the women got pregnant after just one treatment cycle and delivered healthy full-term infants, while the other two women are still pregnant after requiring three cycles.
Lead researcher Dr Beth Lewkowski told a fertility conference in San Francisco that all five women had been infertile for two to 10 years before the surgery. Dr Anne Clark, a fertility specialist in Sydney, said while no such study had been completed in Australia there had been a steep increase in women seeking weight-loss surgery to improve fertility.
Obese women undergoing fertility treatment generally have less success, require higher doses of medication to help get them to ovulate, and have a higher miscarriage rate.
"We have been able to show that women with a body mass index (BMI) under 35 kilograms can dramatically improve their chances of pregnancy with just seven kilos of weight loss," Dr Clark said.
"But women who are very obese, with a BMI of 40 or more, need to lose even more weight to have the same success, and that can be impossible for some women to do naturally.
"It's in these cases women get surgery, and we definitely notice it helps."
Professor Rob Norman, director of the Research Centre for Reproductive Health at the University of Adelaide, said that gastric banding, in which a rubber band is surgically wrapped around the stomach, was getting the best results.
"It's something we are going to see more and more among very big people, and it's clear there a big benefits for the women and for their babies," Prof Norman said from San Francisco.
About 14,000 Australians are expected to get lap band surgery this year, with guidelines requiring patients to have a BMI over 30 and have failed to lose weight by other means. About 80 per cent of patients were female, but only a very small proportion sought surgery primarily to aid pregnancy, obesity experts say.

IVF does not raise breast cancer risk

A new research has dispelled fears that In Vitro Fertilization (IVF) may elevate women's risk of developing breast cancer.

The nationwide study in the Netherlands found that the fertility treatment has no effect on the disease.

Although no firm link between IVF and breast cancer has been established, some boffins are worried about the potential effects of fertility drugs used to stimulate the ovaries so that eggs can be collected and fertilised, reports Times Online.

These expose the body to high levels of oestrogen, a female hormone to which some breast tumours are sensitive.

The research, which was led by Alexandra van den Belt-Dusebout, of the Netherlands Cancer Institute, should reassure women considering fertility treatment that it does not pose a breast cancer risk.

The study was presented at the American Society for Reproductive Medicine conference in San Francisco last month.

In the study, the Dutch team used a national registry to investigate more than 25,000 women who received IVF or other fertility treatments between 1980 and 1995. Almost 19,000 of the women had had IVF, while the other sub-fertile women had had different treatments or none.

There was no statistically significant difference in breast cancer incidence between either group as a whole and the general population. There was a slight increase in breast cancer risk among the infertility patients who had been followed up for the longest periods - 15 years - but this was accounted for by the size of their families.

The study also compared women who had had different numbers of IVF cycles, and found no relationship between extra cycles and breast cancer risk.

British surrogacy ruling saves baby twins from Ukraine orphanage

A British couple this week won custody over a pair of twins born to a
surrogate mother in the Ukraine. The twin babies were caught in a legal
loophole whereby the expectant British couple were unable to bring the twins
into the UK, as they were not recognised by English law as the parents.
Simultaneously, the Ukrainian biological mother no longer had any
responsible for, or even rights over, the children under Ukrainian law as
this (in contrast to UK legislation) gives binding effect to surrogacy
arrangements. Consequently, had the British couple failed to gain the
'parental order' for custody of the children, the twins would have been
returned to the Ukraine and placed in an orphanage.
The situation arose as a result of the couple being unable to find a
surrogate mother in the UK, where it is illegal to pay a woman more than her
expenses in a surrogacy arrangement, were advised to look abroad to a more
permissive jurisdiction, and subsequently employed the services of a
commercial surrogacy organisation in the Ukraine for a fee of around
£23,000. However, as the surrogate mother was married, the UK father, who
supplied the sperm, is not considered to be the father under UK law
(specifically s.28 of the Human Fertilisation and Embryology Act 1990) and
thus was unable to bring the children to the UK after birth. Though the Home
Office gave special leave for the children to enter the country pending the
High Court ruling, had the application for custody failed. The peculiar
legal effect of the disparity between the two legal systems is that the
children had, until the date of the court order, no legal parents and no
nationality.
The case highlights the ongoing problems surrounding the legal status of
surrogacy in the UK. Mr Justice Hedley, in his judgement on the case, stated
that 'surrogacy remains an ethically controversial area' and that
international surrogacy arrangements raise potentially difficult problems of
a kind not experienced with domestic agreements. However at present it is
impossible to enforce a surrogacy arrangement in the UK and the couple's
solicitor, Natalie Gamble, stated that the UK surrogacy law requires urgent
updating to reflect the realities of modern fertility practices and that
currently it provides inadequate protection to vulnerable children. This
view was reflected in the court's judgment, which noted the case
'highlighted the wisdom' of a review to surrogacy law (as proposed during
the debates on the Human Fertilisation and Embryology Act 2008, earlier this
year) and expressing a hope that the problems experienced by the couple 'may
alert others to the difficulties inherent in this journey'.

Freezing eggs holds promise

Human oocyte-freezing techniques are improving so rapidly that this procedure may soon be incorporated into routine in vitro fertilization cycles, experts predicted recently at the WARM meeting in Mexico last month. Currently, most oocyte freezing is done for cancer patients and other women who face potentially sterilizing chemotherapy treatments. And it is beginning to be offered for fertility preservation in young, healthy women worried about their biological clock.

But extending its application to the general in vitro fertilization (IVF) population could increase the flexibility of IVF; oocytes could be frozen rather than discarded in cycles that have to be canceled because of ovarian hyperstimulation syndrome or the absence of a sperm sample. Oocyte cryopreservation could also overcome some legal and ethical dilemmas posed by embryo freezing.

Until now, oocyte freezing has not been a satisfactory alternative to embryo freezing, because oocytes are more fragile than embryos and thus less likely to survive after being thawed. But recent technological improvements have made oocyte freezing a much more viable option, though there is still much debate over the merits of various freezing and thawing methods and of cryoprotective and culture solutions.

"Oocyte freezing will become a standard part of IVF within 5 years worldwide," predicted Giovanni Battista La Sala, M.D., whose clinic at Santa Maria Nuova Hospital in Reggio Emilia, Italy, is the first in the world to use the procedure in all standard IVF cycles. Under the protocol, patients have three of their oocytes fertilized, and the resulting embryos are transferred to the uterus. The remaining oocytes that have been retrieved are frozen and stored for future use, he told this newspaper.

Italy has always been at the forefront of oocyte-freezing research, and its efforts in this field have intensified in the last year after the introduction of new Italian legislation that bans embryo freezing and restricts standard IVF to the creation of no more than three embryos.

The Italian efforts to make oocyte freezing a viable alternative to embryo freezing may end up setting new standards even in less restricted countries, such as the United States, suggested Thomas L. Toth, M.D., director of the in vitro fertilization unit at Massachusetts General Hospital, Boston.

"This alternative approach may be more ideal for providing IVF therapies to our patients. I think the Italians have done very well, and the rest of the world should be watching carefully," he said in an interview.

Dr. La Sala's experience of incorporating oocyte freezing into his standard IVF protocol has produced only 8 ongoing pregnancies out of 324 thaw attempts in the last 14 months. However, worldwide data on oocyte freezing are more encouraging, suggested Eleonora Porcu, M.D., director of the fertility and IVF center at the University of Bologna and a pioneer in the field.

Although the world's first frozen oocyte birth was announced in 1986, followed by two more--one from her own patient and another in 1987 in the United States--there were no more such births in the ensuing decade. Since then, only about 150 babies have been produced using frozen oocytes because of specific technical difficulties, some of which can now be overcome.

"I am convinced that the previously poor results leading the majority of researchers to conclude that oocyte freezing was unreliable, inefficient, and unsafe were due to the fact that they were generally restricted to using excess oocytes," which were few, of inadequate quality, and often old, Dr. Porcu said.

In a study attempting to overcome these limitations, her team froze all oocytes of IVF patients with tubal infertility who were under age 38. They then performed oocyte thawing, fertilization, and embryo transfer in the subsequent cycle.

After more than 500 transfers, the team reported a pregnancy rate per embryo transfer of 17% and a pregnancy rate per patient of almost 24% (sometimes over more than one thaw cycle). There was a high spontaneous-abortion rate (25%), however, which has been noted by other oocyte-freezing experts.

The most extensive U.S. experience with oocyte freezing is from the IVF program at Community Hospital North in Indianapolis, where there have been 13 births reported from frozen oocytes since 1999. This brings the pregnancy rate per embryo transfer to 34% said Donald Cline, M.D., medical director of the clinic.

When comparing frozen-oocyte with frozen-embryo pregnancies, his group noted similar success rates--between 34% and 36% per transfer. "We were pleasantly surprised. It will take more numbers to determine if these data are accurate. But if they are, and we have the same pregnancy rates with frozen oocytes as we do with frozen embryos, this will be the way a number of our patients will want to go," he said.

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