IVF odds of success are decent - study

IVF treatment continues to be a popular choice for making babies.

The treatment, known formally as in vitro fertilisation, is successful in producing a live birth in 41.4 per cent of treatment cycles for women under age 35, according to information released Monday by the Society for Assisted Reproductive Technology.

Data for 2009, the most recent year analysed, showed the rate of live births per cycle with fresh embryos did not change much from 2008, when it was 41.3 per cent for women under 35. However, that's an improvement from 2003, when the rate was 37.5 per cent.

Success rates fall off quickly for older women, however. In 2009, the percentage of cycles with fresh embryos resulting in live births was 31.7 per cent for women aged 35 to 37, 22.3 per cent for women aged 38-40 and 12.6 per cent for those aged 41-42.

The more embryos transferred, the higher the risk of multiple births. Several years ago, the Society for Assisted Reproductive Technology called on doctors and patients to limit embryo transfers to one in healthy, younger women who have a good chance of pregnancy.

But it appears as if SART's goal of reducing the number of embryos transferred isn't enthusiastically embraced. Only 7.2 per cent of women under age 35 opted for a single-embryo transfer in 2009, up from 5.2 per cent in 2008. In 2003, the rate was 0.7 per cent.

Overall, the average number of fresh embryos transferred was 2.0 for all age groups in 2009 compared with 2.6 in 2003.

The rate of live births with twins for women under age 35 was 32.9 per cent, a trend that hasn't changed much since 2003. The rate of triplet births in that age group, however, was 1.6 per cent in 2009 compared with 6.4 per cent in 2003.

The leading, single cause of infertility continues to be the male factor, which accounts for 17 per cent of cases in which people seek IVF treatment. A diminished number of eggs, which occurs most often in women age 35 and older, accounted for 15 per cent of cases, and in 12 per cent of cases the cause of infertility cannot be explained.

The rate of patients who elect to have preimplantation genetic diagnosis, in which a cell from the embryo is screened for evidence of genetic disorders, was 4 per cent in 2009.

The reports on specific clinics' success rates can be found on the SART website at www.sart.org. The society announced plans to enhance its website for consumers later this year to make it easier to find data.

Google Earth Images Actually Make for Great Surrealist Art

Who knew Google was hiding an artistic touch in Google Earth? Clement Valla, an artist, fiddled with Google Earth and found some amazingly surrealist images. Turns out, when you zoom in at just the right angle, bridges droop dramatically, 2D roads look pasted on in a 3D world and the entire world looks like it's melting.

Here's what Valla says about the pictures:

"The images are screenshots from Google Earth with basic color adjustments and cropping. I am collecting these new typologies as a means of conservation - as Google Earth improves its 3D models, its terrain, and its satellite imagery, these strange, surrealist depictions of our built environment and its relation to the natural landscape will disappear in favor of better illusionistic imagery.

Valla wants to preserve these images so that we remember how awkward technology and reality once co-existed. I just love 'em cause they're funny lookin'.

I love how the bridge disappears and then pops back up again.

Bridges really get twisted in Valla's collection.

Gnarly drive.

This would make for a great roller coaster, actually.

IVF parents travel overseas to pick baby's sex

A leading IVF clinic is helping clients choose the sex of their baby by sending them to an overseas clinic it co-owns, avoiding Australian rules which allow the practice only for medical reasons.

Sydney IVF, which has several clinics in NSW as well as in Canberra, Perth and Tasmania, is part-owner of Superior ART, a Thai clinic that will provide IVF for ''family balancing'' - when families with children of one gender are seeking another child of the opposite sex.

It costs $11,000 including flights and accommodation, a spokesman for Sydney IVF said.

Australian fertility clinics are prohibited from offering sex selection for non-medical reasons by national ethical guidelines by which they must abide to be accredited.

But Sydney IVF maintains it is not doing anything wrong, arguing the rules banning the procedure are hurting Australian families.

The National Health and Medical Research Council's health ethics committee developed the guidelines. Its chairwoman, Sandra Hacker, said Australians generally believed parents should not be allowed to choose their child's gender to "balance" out their family.

"The right to life should not be determined by gender," she said. "There is a view that you should be happy with whatever gender you bring into the world, as long as they are well and happy".

However, it would breach people's rights to ban them from travelling overseas to have the procedure. If they did, she could understand Sydney IVF wanting to ensure they used a reputable provider. "But that doesn't make it any more ethical, it just makes it safer," she said.

The chief executive of Sydney IVF, Kylie de Boer, said that when the company had stopped offering sex selection in early 2005 families were left "devastated".

"These were people who loved children," she said. "They had a lot of children already and they wanted to have more."

She said the clinic still received about 15 phone calls a week from parents seeking the procedure, despite openly explaining on its website it was banned and the only option was to travel overseas.

Dr de Boer said when Sydney IVF had done the procedure clients were often mothers wanting a daughter.

"The desire for a mother-daughter relationship was very strong," she said.

She believed the decision was a highly personal one which should be made between doctors and patients.

"I think the guidelines are due for review and I think the guidelines are wrong,'' she said.

The medical director at Sydney IVF, Mark Bowman, said the sense of ''loss and grief'' felt by couples who could not conceive a child of the gender they desired was as strong as that felt by infertile couples.

The president of the Fertility Society of Australia, Peter Illingworth, did not have a problem with Sydney IVF providing sex selection overseas, so long as it complied with the rules of the country it operated in.

Public debate on whether the national guidelines were right and enforceable was needed.

"What is important is the community view about these matters, not necessarily the views of IVF specialists," he said.

The National Health and Medical Research Council said the guidelines would be reconsidered after a legislative review into the use of human embryos. That review, chaired by the former Federal Court judge Peter Heerey, is open for submissions.

Michiana woman creates Invitro App for Apple

Facebook, Twitter and Angry Birds are all popular apps. There are apps for almost anything these days, including an app to help you get pregnant.

Yup, there's an app for that and it was designed for Apple by a mom from Michiana.

The sound of a lullaby is music all people wanting to be parents hope to hear. And it's the ring tone alert you will hear when using Apple's Invitro App called "IVF-Baby in the Making."

Granger mom and designer Kim Konopa was motivated to design an invitro app because she knew the pain of trying to become pregnant, saying, "It was actually a personal experience with invitro fertilization and I just thought the need was there."

So Konopa, who works in sales decided to put her organization skills to work. She did her homework and found a software developer to work with her and her 22-year-old son, JR, who is one of her partners.

She explains how it works.

"The main component is the calendar and, because you're taking so many medications and making so many appointments, we've pre-loaded those into the iPhone app so it's very simple to use. So, let's say you have a doctor's visit. You can put the location in. Let's say you're going to add a medication, you do the same thing. You choose from a pre-populated list of all the medications they could give you."

And because women often feel so alone going through invitro, Konopa has that covered too.

"We built in a blog so that people can kind of get together and share their experiences. We also built in a resources section, things like how to inject, which I was naïve about too at the time."

And since invitro isn't cheap and not always covered by insurance, the application is also practical.

"It has a budget tracker, which allows you to easily enter your invoices so when you enter them it keeps track of the remaining budget and then it just keeps a running balance."

You can also personalize your app.

"It has a photo and journal section so when they hand you your embryo picture, or when you have an ultrasound --a lot of people are excited-- and want to share that. So you can journal about it and share it on facebook or email if you want too."

And in the three months Apple has offered the Invitro App, Konopa says the response has been steady in the U.S., U.K., Australia and Japan.

Konopa says becoming a mother is the best thing that happened to her and she's hoping her app may give other women the same experience.

"I love it. It allows me somewhere to put my energy that's extremely positive and hopefully it helps other become successful in their journey to become pregnant."

Hoping her Baby in the Making app will give more moms-and-dads-to-be their own bundle of joy, with a little help from technology.

Konopa consulted with her own reproductive endocrinologist while working on the invitro app.

Granulocyte-colony stimulating factor (G-CSF) significantly improves inadequate endometrium

During in vitro fertilization (IVF) cycles, treatment with a medication called granulocyte-colony stimulating factor (G-CSF) significantly improves inadequate endometrium (lining of the uterus), according to a report published electronically on February 15 in Fertility and Sterility - the official journal of the American Society for Reproductive Medicine (ASRM). The reported case series also suggests that G-CSF treatment may, in general, improve IVF pregnancy chances.

G-CSF is a cytokine (protein molecules that facilitate communication between cells) that has already been FDA approved for other clinical indications.

Researchers from New York City-based Center for Human Reproduction (CHR) and a second NY fertility center reported on four women with highly inadequate endometrium, unresponsive to conventional treatments and facing IVF cycle cancellation. In all four cases, endometrial perfusion of G-CSF expanded the endometrium to a minimal thickness of 7mm within approximately 48 hours, allowing for embryo transfer. Surprisingly, all four patients also conceived.

In approximately 1% of all IVF cycles, the endometrium stays too thin for embryos to successfully implant, even with treatment. In such IVF cycles, patients and physicians face two poor options: they either accept lower pregnancy chances and transfer embryos despite inadequate endometrium, or they can cancel the embryo transfer and freeze all embryos in hope of better future cycles. Unfortunately, women with inadequate endometrium often show inadequate endometrium again in future cycles. This situation was demonstrated by two patients in this reported case series with histories of repeat IVF failures due to thin endometrium.

"Conventional treatments for inadequate endometrium have had spotty success at best. Without G-CSF perfusion, these patients, likely, would not have reached embryo transfer," explains David Barad, MD, Director of Clinical ART at CHR and one of the senior authors of the report. "That all of them also conceived was a big surprise, and is, of course, quite remarkable."

"The efficacy of G-CSF in improving endometrium, and possibly pregnancy rates in general, still needs to be confirmed in randomized controlled trials," adds Norbert Gleicher, MD, lead author of the report and Medical Director of CHR. "Indeed, we already started two such trials to test both hypotheses; but until first results become available later in 2011, we caution against over-interpreting results of this small pilot study."

Pilanesberg, South Africa - A Short Story

Bribeless In Bihar

Bureaucrats in India’s most corrupt state are facing the heat from their own chief minister

by K.P. Narayana Kumar

Raghuvansh Kunwar could not believe it. For the motor vehicle inspector based in the Aurangabad district of Bihar, the news item in the Hindi daily was more chilling than the December morning. The government was going to throw him out of his
house and start a school there. The announcement was made by Bihar’s human resources development minister, P.K. Sahi,
at a public meeting.

“I was shocked to read the news item,’’ says Kunwar in a tone that barely conceals fear. “I have lived in this house for 20 years
with my wife, children and three brothers and suddenly I was being told to hand over my house.”

The vehicle inspector did not realise then that he was the first prey caught in a new anti-corruption drop-trap devised by
the state government and hailed as a model for other states to follow. Kunwar had been booked under a new law allowing
for summary confiscation of property of government officials found to be having more assets than their income justified.

The state vigilance department, the government’s internal watchdog, had found in 2008 that Kunwar owned property
worth Rs. 54 lakh but was unable to explain how he could afford it. The department has lined up 18 more such cases to
confiscate property valued at Rs. 21 crore before the special courts created under the new legislation, the Special Courts
Act 2009. It is reviewing another 87 cases for possible confiscation of assets.

Kunwar’s case was the first headline-grabber from the Nitish Kumar regime that returned to power with a resounding
mandate that many say was an endorsement of the chief minister’s reputation as a leader with a cause. In its first innings, the administration locked up 54,000 people in a bid to break the criminal-politician nexus that had plunged Bihar into such an anarchic mess — a place that everybody knew where it was but nobody wanted to go, even those who had fled from their ‘native place’ for greener pastures. The third axis in the unholy nexus was the government official for whom the general public is the golden goose.

Blunt Axe No Good

It was not that Nitish Kumar avoided them in his first term. His attempt was to hit all three simultaneously, though the
babudom — cocooned in rules and procedures — turned out to be the most resilient. Kumar set up a Special Vigilance Unit (
SVU) in 2006 to go after the big fish in the government. It was a crack team of former Central Bureau of Investigation (CBI)
officials with a separate headquarters on the rather quirkily named Serpentine Road. The unit soon made headlines as it caught several senior government officials such as a police chief Narayan Mishra and state drug controller Y.K. Jaiswal, with enough wealth to finance the annual budgets of entire villages. State vigilance squads trapped about 400 government officials in the next four years. However, much of it came to nothing as only two of them have been convicted so far. News reports suggest that even the elite SVU managed to file only five First Information Reports (FIRs) in four years.


Meanwhile, Nitish Kumar was regularly besieged by villagers with tales of corruption on his frequent countryside tours. In
Bihar, big ticket deals are few. The corruption that is endemic is petty. For the general public, it is difficult to get government
certificates and entitlement documents without paying touts. Unlike big deals where money is often received and stashed in
numbered accounts in safe havens or as stocks and bonds, in Bihar the nature of corruption is localised. Ill-gotten money
hardly leaves the country and is invested mostly in real estate or gold. That means empowered officers can easily help track it
down. A vigilance officer pointed out the case of a milk-vendor in Patna. The man is said to own a dozen cars, wealth that he
acquired by laundering money for government officers and politicians. “Most government departments have their own
paan-wallahs, ice-cream vendors and traders who act as collectors for the babus,” says the officer who did not wish to be
identified.

Bureaucrats who own black money typically invest it in real estate projects outside Bihar; Bangalore and Noida are particular favourites. But junior level officers such as block development officers, panchayat members and clerks keep their cash in bank accounts and lockers apart from building houses in their village. Having cash stashed in the mattresses also helped if they got caught. They could use the same money to pay off investigators and the game could go on.

It was clear to Nitish Kumar that merely catching a culprit was not enough. A major handicap was that under the Prevention of
Corruption Act, vigilance officials had to get clearance to prosecute an errant bureaucrat from his own department. That took time. He realised that the only way to deter corruption was to take away the wealth itself — ASAP. Kumar put his then attorney general P.K. Sahi on the job. (Sahi would go on to become Nitish Kumar’s minister in the second term).After consulting experts and studying the provisions of the Prevention of Corruption Act, Sahi prepared a draft bill by the end of 2008 and it was passed by the Bihar Assembly in February 2009. It then languished in the union home and law ministries for a year. The delay often prompted Bihar politicians to snigger that the Centre did not want Nitish Kumar to have one more feather in his cap. “The Centre kept asking for one clarification after the other. The delay meant that we could not swing into action before the state elections and the CM himself had to repeatedly follow-up with the Centre,’’ says Sahi. The Bihar Special Courts Act, 2009, was eventually signed into law by the President in March 2010.




Slash And Burn

The Bihar law is not a pioneering one. That credit goes to Orissa, which passed a similar law in 2008 and also set up two special courts. However, it was challenged in court and until recently its validity was uncertain. In Bihar, the Act comes into play when investigating agencies are convinced that an official owns assets in excess of his known sources of income. Now, even as it pursues a corruption case against an official, the state separately seeks to take control of the assets owned by the person. Bihar
has set up six special courts that exclusively deal with this. The vigilance department files a declaration with a special
court that the target has amassed unexplained wealth. The special courts then conduct speedy trials and decide within six months whether the property should be confiscated or not. The property would be returned with interest (at 5 percent
annually) if the person is acquitted.

The Prevention of Corruption Act does not provide for attachment of property and instead has a provision enabling a judge to also impose a fine depending on the value of the ill-gotten property. Former CBI director Joginder Singh says the nation should follow Bihar. “If the property of the accused is confiscated in advance, it will make a huge difference. This will help serve as
a deterrent to officers and also ensure that the accused are not able to influence investigations using money,” says Singh, who has investigated several high-profile cases of corruption, including the fodder-scam in which Lalu Prasad Yadav was prosecuted. A.K. Chauhan, principal secretary, vigilance, says that he has not come across any instance of politicians or high-level officials trying to influence a case. “They know that we report to the CM. So there has not been any attempt so far,” says
Chauhan, who has earlier worked as secretary for co-ordination in the state cabinet and is considered to be someone who
enjoys the chief minister’s trust.

“MLAs have also been warned that they should not call up officers directly and try to influence these cases. The Chief
Minister has made it clear within his own party as well that he will not tolerate anyone trying to influence the officers,”
says Rajya Sabha member Ali Anwar, who is considered to be a close confidant of Nitish Kumar. The results are yet to
show, but the tremors are already being felt.Of course, the law has been challenged in court. Narayan Mishra, the police chief booked by the SVU and facing confiscation of property, has moved the High Court arguing that the law is unconstitutional. “It is a draconian rule with no regard for constitutional rights,” says Mishra. Lawyer Abhinav Shrivastava, who represents six officials
who have challenged the validity of the Act, says the main problem with the legislation is that there is no laid down
procedure to decide which cases under the Prevention of Corruption Act would be transferred to the special courts for attachment. “This would make the entire process subjective and arbitrary,” says the lawyer.A state bureaucrat, who spoke on condition of anonymity, said that there was palpable fear among officials after the government lined up cases for confiscation of property. “The officers are in fear of a crackdown and that is good for the health of the system,” he says.


Hindi daily Prabhat Khabar reported that over Rs. 100 crore had been withdrawn from banks in the capital, Patna, in the fortnight following the confiscation of Kunwar’s property. A top bank official confirmed that there has been an increase in
withdrawals from bank branches across the city but was unsure whether panic-driven officials were behind the trend.The state capital, which had acquired a reputation as a crime-hub during Lalu Prasad’s regime, also gained a reputation for scams and middlemen as Bihar led the list of corrupt states in almost every survey carried out between 2000 and 2005.


Renewed Growth


Nitish Kumar’s two terms, when he first re-established law and order and then began weeding out corruption, have brought
new hope to Biharis in the state and those living outside. For long, Patna seemed to be relatively untouched by India’s economic transformation. There are no glitzy malls or international brands that embellish the other cities. There are no hip eating joints or clubs. There is no evidence of any sort of nightlife or even entertainment for families.But the city is changing, slowly. Women move about fearlessly in areas where they would not have dared to venture out just a few years ago. People come out for
shopping and socialising. There is a clear buzz of a consumer economy blooming.The story of change is particularly evident in the new apartment buildings springing up across the city. Real estate developer Narendra Kumar says that property rates in
Patna are comparable to rates in Noida as there is a huge demand and there is shortage of land.“The boom is not entirely fuelled by black money and there is a genuine increase in demand,” says Kumar, who has built and sold over a dozen apartment complexes in the city in the past three years. He says most of the money coming into construction is from people of Bihari origin who live outside the state but are now beginning to hope for a prosperous Bihar. Academician Shaibal Gupta, considered an expert on governance in Bihar, says tough times are ahead for bureaucrats. Next the state is planning to enact a Right to
Services law to ensure efficient government service. Officials will be punished for failure to provide time-bound service.
“There is a lot of pressure on the bureaucracy now like never before,” says Gupta.

This article appeared in Forbes India Magazine of 11 February, 2011