"Well..I'm fortunate to have a chemical engineering background, and one of the things I enjoy most is turning beer, wine, Scotch, and margaritas into urine."
Tuesday, September 8, 2009
Wisdom of a Retiree
'I've often been asked, 'What do you old folks do now that you're retired?'
"Well..I'm fortunate to have a chemical engineering background, and one of the things I enjoy most is turning beer, wine, Scotch, and margaritas into urine."
"Well..I'm fortunate to have a chemical engineering background, and one of the things I enjoy most is turning beer, wine, Scotch, and margaritas into urine."
Monday, September 7, 2009
Sunday, September 6, 2009
Lord Winston, Labels Egg Feezing As "Expensive Confidence Trick"
Lord Winston, emeritus Professor of Fertility Studies at Imperial College London and pioneer of IVF, has criticized fertility clinics for over-hyping egg freezing services. In an interview with the Daily Mail newspaper he accuses providers of creating false optimism in the effectiveness of the procedure particularly where signing up patients for purely 'social' reasons. Before use of egg freezing grows further he calls for more research into both the effects of egg freezing on the ability to later conceive and into the long-term health implications for those born
from frozen eggs.
The comments come in response to calls, made at last week's European Society for Human Reproduction and Embryology (ESHRE) annual conference, for greater availability of egg freezing as an option for women who are postponing pregnancy until later in their lives. Lord Winston's comments partially mirror a joint statement made in February by the UK's Royal College of Obstetricians and Gynaecologists and the British Fertility
Society (BFS) which also called for women not to freeze eggs for social reasons.
Lord Winston noted that the production of six to ten eggs for freezing involves both the risk of ovarian hyperstimulation syndrome for the woman and an increased likelihood of chromosome defects in the eggs produced. Producing such a quantity of eggs he sees as dangerous yet also inadequate to ensure a viable embryo is produced. The BFS has stated that the average chance of success for any individual frozen egg is six per cent and only four children have been born from frozen eggs in the UK to date.
Additionally, the lack of data on the long term health effects - the first children conceived with frozen eggs are only now five - is provided as reason enough for adopting a cautious approach towards increasing availability of egg freezing and makes encouraging those without a pressing need (such as impending cancer treatment) all the more dubious. Lord Winston states, in unequivocal terms, 'in my view it is irresponsible [for clinics] to egg freeze until long-term animal research has been done'. The most detailed research to date is due to be published next month.
Describing the procedure as a 'quick fix', Lord Winston sees the best path forward for prolonging the ability to have a child, for social reasons, is to attempt to develop better means of postponing the menopause. Though the procedure can be justified for those with serious medical conditions it is not be encouraged as a means of delaying motherhood. The provision of egg freezing for social reasons, available for between £2,500 and £5,000 at 45 clinics in the UK, is in his view simply an 'undesirable commercial activity' and should not be encouraged.
from frozen eggs.
The comments come in response to calls, made at last week's European Society for Human Reproduction and Embryology (ESHRE) annual conference, for greater availability of egg freezing as an option for women who are postponing pregnancy until later in their lives. Lord Winston's comments partially mirror a joint statement made in February by the UK's Royal College of Obstetricians and Gynaecologists and the British Fertility
Society (BFS) which also called for women not to freeze eggs for social reasons.
Lord Winston noted that the production of six to ten eggs for freezing involves both the risk of ovarian hyperstimulation syndrome for the woman and an increased likelihood of chromosome defects in the eggs produced. Producing such a quantity of eggs he sees as dangerous yet also inadequate to ensure a viable embryo is produced. The BFS has stated that the average chance of success for any individual frozen egg is six per cent and only four children have been born from frozen eggs in the UK to date.
Additionally, the lack of data on the long term health effects - the first children conceived with frozen eggs are only now five - is provided as reason enough for adopting a cautious approach towards increasing availability of egg freezing and makes encouraging those without a pressing need (such as impending cancer treatment) all the more dubious. Lord Winston states, in unequivocal terms, 'in my view it is irresponsible [for clinics] to egg freeze until long-term animal research has been done'. The most detailed research to date is due to be published next month.
Describing the procedure as a 'quick fix', Lord Winston sees the best path forward for prolonging the ability to have a child, for social reasons, is to attempt to develop better means of postponing the menopause. Though the procedure can be justified for those with serious medical conditions it is not be encouraged as a means of delaying motherhood. The provision of egg freezing for social reasons, available for between £2,500 and £5,000 at 45 clinics in the UK, is in his view simply an 'undesirable commercial activity' and should not be encouraged.
Saturday, September 5, 2009
Fertility "Fingerprints"
Scientists in Ireland have discovered a group of genes that could potentially be used to predict the success of IVF treatment. The prospect of a clinical test for IVF success was raised at the annual conference of the European Society for Human Reproduction and Embryology (ESHRE), in Amsterdam.
The group, led by Dr Cathy Allen at the Rotunda Hospital, Dublin, examined the genetic profiles from blood samples taken at eight different stages during the period around conception and the early stages of the IVF cycle to analyze what differences in gene expression were seen at certain points before, during and after pregnancy. The blood samples were from five women who achieved clinical pregnancy, three women who had implantation failure and three subfertile women who conceived spontaneously.
The findings showed that activity levels of genes controlling the growth of new blood vessels, inflammation and the supply of energy to cells were different in women undergoing IVF. There was a marked difference in the expression of 200 genes at the beginning of fertility treatment between women who became pregnant and those who did not. The group concluded that this gene 'signature' was highly predictive of whether IVF worked or not, and could be used to develop a clinically useful predictive tool.
Dr Allen thinks that one of the most difficult decisions to make when undergoing IVF treatment is whether to continue with treatment after a failed attempt, as this can be emotionally and physically draining, as well as expensive. A reliable blood test could help patients and doctors with this decision.
She said: 'This work has generated a unique profile for IVF success and failure... As a practicing clinician, I think this might have a use for patients trying to decide whether they should undergo IVF or not. It's going to be a while before we have a clinical test but my gut feeling is it will be useful for identifying the unfavourable profile - those who won't get pregnant'.
Currently, advice from doctors on this decision is based upon factors such as age, lifestyle and hormone levels, but these are not often reliable. A separate team of scientists at Cardiff University has developed a questionnaire, called the FertiSTAT. Based on questions about a woman's menstrual cycle, reproductive health, lifestyle factors, age and length of time for which they have been trying for a baby, the test can be used to judge whether a woman will have fertility problems, and whether changing
their lifestyle could improve their chances of pregnancy.
Professor Luca Gianaroli, the ESHRE chairman, said of Dr Allen's findings: 'this test could save a lot of unnecessary treatment. You have to balance the cost of research and the benefits of research.'
The group, led by Dr Cathy Allen at the Rotunda Hospital, Dublin, examined the genetic profiles from blood samples taken at eight different stages during the period around conception and the early stages of the IVF cycle to analyze what differences in gene expression were seen at certain points before, during and after pregnancy. The blood samples were from five women who achieved clinical pregnancy, three women who had implantation failure and three subfertile women who conceived spontaneously.
The findings showed that activity levels of genes controlling the growth of new blood vessels, inflammation and the supply of energy to cells were different in women undergoing IVF. There was a marked difference in the expression of 200 genes at the beginning of fertility treatment between women who became pregnant and those who did not. The group concluded that this gene 'signature' was highly predictive of whether IVF worked or not, and could be used to develop a clinically useful predictive tool.
Dr Allen thinks that one of the most difficult decisions to make when undergoing IVF treatment is whether to continue with treatment after a failed attempt, as this can be emotionally and physically draining, as well as expensive. A reliable blood test could help patients and doctors with this decision.
She said: 'This work has generated a unique profile for IVF success and failure... As a practicing clinician, I think this might have a use for patients trying to decide whether they should undergo IVF or not. It's going to be a while before we have a clinical test but my gut feeling is it will be useful for identifying the unfavourable profile - those who won't get pregnant'.
Currently, advice from doctors on this decision is based upon factors such as age, lifestyle and hormone levels, but these are not often reliable. A separate team of scientists at Cardiff University has developed a questionnaire, called the FertiSTAT. Based on questions about a woman's menstrual cycle, reproductive health, lifestyle factors, age and length of time for which they have been trying for a baby, the test can be used to judge whether a woman will have fertility problems, and whether changing
their lifestyle could improve their chances of pregnancy.
Professor Luca Gianaroli, the ESHRE chairman, said of Dr Allen's findings: 'this test could save a lot of unnecessary treatment. You have to balance the cost of research and the benefits of research.'
Friday, September 4, 2009
One-stop Genetic Test For Embryos
A one-step gene mapping test for identifying genetic and chromosomal abnormalities in embryos may be available in the UK within a year. The technique, known as karyo-mapping, can screen for almost any inherited disease and is much faster than those currently available as it does not need prior knowledge of the specific gene mutation involved. The method was unveiled at the annual conference of the European Society for
Human Reproduction and Embryology (ESHRE), in Amsterdam, after researchers from the UK and US announced they had successfully screened cells taken from donated embryos that were known to have cystic fibrosis (CF).
Since 1989, couples who are known to be at risk of having a child with a genetic disorder have had the option of screening their embryos using a technique called pre-implantation genetic diagnosis (PGD). PGD involves identifying the exact mutation causing a particular disease in a particular family, then spending many months developing a custom test. The process costs several thousand pounds and can only pick up two per cent of known genetic disorders.
Now, for a similar price, karyomapping can identify any known genetic disorder and is faster because scientists do not need to know the exact DNA mutation they are looking for. Instead they compare the DNA of affected and unaffected family members to work out which DNA section is carried only by those affected by the condition. Embryos can then be screened for this section of DNA to find out if they have inherited the mutation. In practice this involves DNA comparisons at over 300,000 locations genome-wide, but can be achieved rapidly through current microchip technology known as
'microarrays'. Another advantage is that karyomapping can simultaneously check for abnormal numbers of any of the 23 pairs of chromosomes, which can lead to conditions such as Down syndrome or trigger miscarriages.
'The hope is that clinicians will be able to test embryos for specific genetic diseases and know that, with one test, they are transferring chromosomally normal embryos. This will be a step forward from current technology that is mostly limited to choosing one test or the other,' explained karryomapping's inventor, Professor Alan Handyside of the London Bridge Fertility Gynaecology and Genetics Centre in London.
Some have argued the new technique may add to the controversy over 'designer babies' because it widens the range of genetic characteristics for which embryos can be screened and could theoretically be used to screen for non-serious conditions, or non-medical traits such as blue eyes. Professor Handyside believes this is not an issue because the relevant regulations in the UK are very strict and would remain so. 'We're not mad Frankensteins working away in our laboratories to create designer babies. We are only allowed to look for major diseases which cause handicaps,' he retorted.
Elsewhere at ESHRE scientists announced that up to 90 per cent of IVF embryos contain chromosomal abnormalities, even those produced by young, fertile couples. The surprising finding implies that current PGD techniques do nothing to improve pregnancy and live birth rates, and can potentially lead to viable embryos being discarded. This news means that the timely announcement of the new karyomapping method will be warmly welcomed by many.
Human Reproduction and Embryology (ESHRE), in Amsterdam, after researchers from the UK and US announced they had successfully screened cells taken from donated embryos that were known to have cystic fibrosis (CF).
Since 1989, couples who are known to be at risk of having a child with a genetic disorder have had the option of screening their embryos using a technique called pre-implantation genetic diagnosis (PGD). PGD involves identifying the exact mutation causing a particular disease in a particular family, then spending many months developing a custom test. The process costs several thousand pounds and can only pick up two per cent of known genetic disorders.
Now, for a similar price, karyomapping can identify any known genetic disorder and is faster because scientists do not need to know the exact DNA mutation they are looking for. Instead they compare the DNA of affected and unaffected family members to work out which DNA section is carried only by those affected by the condition. Embryos can then be screened for this section of DNA to find out if they have inherited the mutation. In practice this involves DNA comparisons at over 300,000 locations genome-wide, but can be achieved rapidly through current microchip technology known as
'microarrays'. Another advantage is that karyomapping can simultaneously check for abnormal numbers of any of the 23 pairs of chromosomes, which can lead to conditions such as Down syndrome or trigger miscarriages.
'The hope is that clinicians will be able to test embryos for specific genetic diseases and know that, with one test, they are transferring chromosomally normal embryos. This will be a step forward from current technology that is mostly limited to choosing one test or the other,' explained karryomapping's inventor, Professor Alan Handyside of the London Bridge Fertility Gynaecology and Genetics Centre in London.
Some have argued the new technique may add to the controversy over 'designer babies' because it widens the range of genetic characteristics for which embryos can be screened and could theoretically be used to screen for non-serious conditions, or non-medical traits such as blue eyes. Professor Handyside believes this is not an issue because the relevant regulations in the UK are very strict and would remain so. 'We're not mad Frankensteins working away in our laboratories to create designer babies. We are only allowed to look for major diseases which cause handicaps,' he retorted.
Elsewhere at ESHRE scientists announced that up to 90 per cent of IVF embryos contain chromosomal abnormalities, even those produced by young, fertile couples. The surprising finding implies that current PGD techniques do nothing to improve pregnancy and live birth rates, and can potentially lead to viable embryos being discarded. This news means that the timely announcement of the new karyomapping method will be warmly welcomed by many.
Thursday, September 3, 2009
More Ovarian Transplants
Two studies reported at the annual conference of the European Society for Human Reproduction and Embryology (ESHRE) in Amsterdam show advances in ovarian transplant techniques. The advances could make the procedure available to women seeking to avoid fertility problems as they age.
Ovarian transplants have been primarily used as a way to preserve fertility in women undergoing treatments that damage the reproductive system, such as chemotherapy. The ovaries can be removed and frozen before such treatment begins, and then re-implanted after treatment has finished. Previously, it has only been used for women with serious disease; due to the uncertainties involved. Now, advances in the technique mean transplants are more successful, and it may be possible that the procedure can become more widely available.
In the first study Dr Sherman Silber reported that freezing ovarian tissue using vitrification gave the same success rate as using fresh tissue. Freezing ovarian tissue using the vitrification method avoids ice formation, and egg viability was almost identical to that seen in fresh tissue. Dr Silber and colleagues tested the different methods in 15 women undergoing cancer treatment. He explained that 'we found that 91.9 per cent of the fresh oocytes were viable compared with 88.9 per cent of those vitrified.
However, slow freezing resulted in a 56 per cent loss of viability. Transplantation resulted in patients regaining a normal ovarian cycle in about five months, and ovarian function lasted for four years in some of the patients. There were no differences in pregnancy rates or ovulatory menstrual cycling between the fresh and frozen grafts. In the second related study, researchers in France led by Dr Pascal
Piver reported on a technique that may improve success of ovary transplant.The technique is a two-step process, where a very small section is implanted first, and the ovary implanted three days later. This encourages blood flow and hormone supply to be quickly restored to the implanted ovary. This helps the implanted ovary to become functional - something that doctors have previously struggled to do. The procedure is also less invasive than the previous one-step method. Dr Piver reported on the first success of the technique in his clinic, saying: 'On June 22, a baby girl was born to a
mother who had been menopausal for two years as a result of treatment for sickle cell anemia. After transplanting her own ovarian tissue she started ovulating in four months and became pregnant naturally six months after transplantation. Both mother and baby are doing well.'
Experts said the possibility of healthy women being offered ovary transplants may spark controversy. 'This is not an experimental procedure for cancer patients anymore', said Dr Silber, director of the St. Louis Infertility Center in Missouri, US, adding: 'The question is whether more women should be able to have this option.'
'We are in the middle of an infertility epidemic,' he told AP news. 'With these new techniques, we could dramatically expand our reproductive lifespan', he added.
Ovarian transplants have been primarily used as a way to preserve fertility in women undergoing treatments that damage the reproductive system, such as chemotherapy. The ovaries can be removed and frozen before such treatment begins, and then re-implanted after treatment has finished. Previously, it has only been used for women with serious disease; due to the uncertainties involved. Now, advances in the technique mean transplants are more successful, and it may be possible that the procedure can become more widely available.
In the first study Dr Sherman Silber reported that freezing ovarian tissue using vitrification gave the same success rate as using fresh tissue. Freezing ovarian tissue using the vitrification method avoids ice formation, and egg viability was almost identical to that seen in fresh tissue. Dr Silber and colleagues tested the different methods in 15 women undergoing cancer treatment. He explained that 'we found that 91.9 per cent of the fresh oocytes were viable compared with 88.9 per cent of those vitrified.
However, slow freezing resulted in a 56 per cent loss of viability. Transplantation resulted in patients regaining a normal ovarian cycle in about five months, and ovarian function lasted for four years in some of the patients. There were no differences in pregnancy rates or ovulatory menstrual cycling between the fresh and frozen grafts. In the second related study, researchers in France led by Dr Pascal
Piver reported on a technique that may improve success of ovary transplant.The technique is a two-step process, where a very small section is implanted first, and the ovary implanted three days later. This encourages blood flow and hormone supply to be quickly restored to the implanted ovary. This helps the implanted ovary to become functional - something that doctors have previously struggled to do. The procedure is also less invasive than the previous one-step method. Dr Piver reported on the first success of the technique in his clinic, saying: 'On June 22, a baby girl was born to a
mother who had been menopausal for two years as a result of treatment for sickle cell anemia. After transplanting her own ovarian tissue she started ovulating in four months and became pregnant naturally six months after transplantation. Both mother and baby are doing well.'
Experts said the possibility of healthy women being offered ovary transplants may spark controversy. 'This is not an experimental procedure for cancer patients anymore', said Dr Silber, director of the St. Louis Infertility Center in Missouri, US, adding: 'The question is whether more women should be able to have this option.'
'We are in the middle of an infertility epidemic,' he told AP news. 'With these new techniques, we could dramatically expand our reproductive lifespan', he added.
Wednesday, September 2, 2009
Similar Outcomes In Babies Born Following ICSI Or IVF
Analysis of the longest running ICSI programme in the United States has found reassuring evidence that babies born from frozen embryos fertilised via ICSI (intracytoplasmic sperm injection) do just as well as those born from frozen embryos fertilised via standard IVF treatment.
The researchers also compared babies born as a result of cycles in which the women had additional hormone medication with babies born as a result of unmedicated, natural cycles, and, although they found a slightly higher rate of malformations in babies born from medicated cycles, the difference was small - 2.2% versus 0.4%.
Ms Queenie Neri, a research associate at Cornell University (New York, USA) and a member of the team headed by Professor Gianpiero Palermo who pioneered ICSI in 1992, told the 25th annual meeting of the European Society of Human Reproduction and Embryology in Amsterdam that she and her colleagues had looked at all births from frozen embryos, conceived via ICSI or IVF, between 1993 and 2007.
Ms Neri identified 720 IVF and 1231 ICSI frozen embryo transfers. The survival rate of the frozen embryos was 74% after IVF and 77.2% after ICSI. The clinical pregnancy rate was 42.8% after IVF and 39.4% after ICSI. These resulted in 84.1% IVF and 89.7% ICSI deliveries. There were 27.8% multiple IVF pregnancies and 21.1% multiple ICSI pregnancies. Outcomes at the time of birth for Apgar scores, gestational ages, birth weights and congenital malformations were similar for both IVF and ICSI singleton babies.
When she grouped the babies according to whether they came from medicated or unmedicated cycles, she found that the clinical pregnancy rate was 42.1% and 39.4% respectively; delivery rates were 86.7% (with 28.7% multiple births) and 87.5% (19.2% multiple births) respectively. Gestational ages and birth weights were similar between the two groups, but the malformation rate was 2.2% from the medicated cycles and 0.4% from the natural cycles.
Ms Neri said: "Freezing embryos as part of fertility treatment has become a fundamental part of assisted reproduction technology. We found no differences in the ability of embryo generated by IVF or ICSI to implant, even after undergoing the stress of cryopreservation. We were unable to confirm a significant benefit of the unmedicated cycle on the neonatal outcome of the cryopreserved embryos; the difference in malformation rates was small.
"The original premise of the study was to identify a difference in neonatal outcome while in the presence or absence of infertility medication, with the assumption that the unmedicated cycles would generate better offspring outcomes. Interestingly, we did not see any clear difference in neonatal outcomes between the medicated and unmedicated groups. From our study, the combination of exposure to cryopreservation and medications or both did not significantly impair offspring outcome."
The malformations ranged from heart defects to defects caused by hereditary factors and sporadic genetic mutations or interactions. However, Ms Neri said: "They were within the spectrum of malformations observed in newborns in the general population."
As there was no statistical difference between the medicated and unmedicated cycles, Ms Neri said that it was not possible to say that medicated cycles were associated with higher rates of malformations, or, if they were, what mechanism might be responsible.
"Our study reported none of the specific abnormalities linked to male factor infertility, medications or other environmental triggers such as extended in vitro culture, which have been reported by other studies," she said.
"When you think about it, the reproductive medical field has created a new sub-population. These children are now reaching puberty and their fertility status still remains to be assessed. Therefore, the continuous monitoring of children generated through artificial conception is of paramount importance," she concluded.
The researchers also compared babies born as a result of cycles in which the women had additional hormone medication with babies born as a result of unmedicated, natural cycles, and, although they found a slightly higher rate of malformations in babies born from medicated cycles, the difference was small - 2.2% versus 0.4%.
Ms Queenie Neri, a research associate at Cornell University (New York, USA) and a member of the team headed by Professor Gianpiero Palermo who pioneered ICSI in 1992, told the 25th annual meeting of the European Society of Human Reproduction and Embryology in Amsterdam that she and her colleagues had looked at all births from frozen embryos, conceived via ICSI or IVF, between 1993 and 2007.
Ms Neri identified 720 IVF and 1231 ICSI frozen embryo transfers. The survival rate of the frozen embryos was 74% after IVF and 77.2% after ICSI. The clinical pregnancy rate was 42.8% after IVF and 39.4% after ICSI. These resulted in 84.1% IVF and 89.7% ICSI deliveries. There were 27.8% multiple IVF pregnancies and 21.1% multiple ICSI pregnancies. Outcomes at the time of birth for Apgar scores, gestational ages, birth weights and congenital malformations were similar for both IVF and ICSI singleton babies.
When she grouped the babies according to whether they came from medicated or unmedicated cycles, she found that the clinical pregnancy rate was 42.1% and 39.4% respectively; delivery rates were 86.7% (with 28.7% multiple births) and 87.5% (19.2% multiple births) respectively. Gestational ages and birth weights were similar between the two groups, but the malformation rate was 2.2% from the medicated cycles and 0.4% from the natural cycles.
Ms Neri said: "Freezing embryos as part of fertility treatment has become a fundamental part of assisted reproduction technology. We found no differences in the ability of embryo generated by IVF or ICSI to implant, even after undergoing the stress of cryopreservation. We were unable to confirm a significant benefit of the unmedicated cycle on the neonatal outcome of the cryopreserved embryos; the difference in malformation rates was small.
"The original premise of the study was to identify a difference in neonatal outcome while in the presence or absence of infertility medication, with the assumption that the unmedicated cycles would generate better offspring outcomes. Interestingly, we did not see any clear difference in neonatal outcomes between the medicated and unmedicated groups. From our study, the combination of exposure to cryopreservation and medications or both did not significantly impair offspring outcome."
The malformations ranged from heart defects to defects caused by hereditary factors and sporadic genetic mutations or interactions. However, Ms Neri said: "They were within the spectrum of malformations observed in newborns in the general population."
As there was no statistical difference between the medicated and unmedicated cycles, Ms Neri said that it was not possible to say that medicated cycles were associated with higher rates of malformations, or, if they were, what mechanism might be responsible.
"Our study reported none of the specific abnormalities linked to male factor infertility, medications or other environmental triggers such as extended in vitro culture, which have been reported by other studies," she said.
"When you think about it, the reproductive medical field has created a new sub-population. These children are now reaching puberty and their fertility status still remains to be assessed. Therefore, the continuous monitoring of children generated through artificial conception is of paramount importance," she concluded.
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