New federal statistics show an epidemic of twins among IVF patients, and two babies come with added risk during pregnancy. Reproduction experts are now urging more women in fertility treatment to try it one embryo at a time. View what the experst say:

http://www.usatoday.com/videos/news/nation/2013/12/02/3800989/

At Waterstone Clinic our goal is to create healthy families and we have experienced great success with single embryo transfers, thus significantly reducing the risk of multiple embryo implantation and multiple births.

THE reasons women postpone having babies are complex – and include the availability of safe and effective contraception, preferring to be in a stable relationship with a supportive partner, wanting to build a career and achieve financial independence, or enjoying the freedom that family life may potentially compromise.

It is a universal challenge that the best years for having babies coincides with the best years for establishing a career and the trend towards later maternity appears to be strongest among women with better educational qualifications. While delaying pregnancy and parenting until a couple achieve financial security seems wise, there is no doubt that it also comes with difficulties.

Women need to be aware of how fertility and pregnancy outcomes change with age, and that their decision to postpone pregnancy may in turn have financial implications.

Although women are healthier than ever, biology can still determine destiny. The decline in fertility and increased risk of pregnancy complications with age remain.

Biologically, the optimum period for childbearing is between 20 and 35 years of age. At the age of 30, 75pc of women will conceive naturally within a year. This falls to 66pc by 35 years and 40pc by age 40.

The risk of chromosomal abnormalities, such as Down Syndrome, increases with age, from one in 950 at age 30 to one in 100 at 40 years.

Many couples turn to IVF and other assisted reproduction techniques but these techniques cannot compensate for the effect of age on a woman’s eggs. The live birth rate for women under the age of 35 undergoing IVF is approximately 30pc. This rate falls to between 5pc and 10pc for women over 42 years of age.

In addition to the huge emotional and social stress that infertility and embarking on assisted reproduction carries, these treatments also come at a considerable financial cost.

Currently in Ireland a single cycle of IVF costs approximately €5,000. Couples are usually advised to budget for more than one cycle.

Women should be supported in their decisions of whether or not to have children and when to plan childbearing.

There are many advantages to postponing pregnancy, from greater financial stability to increased satisfaction with parenting.

However, while the unflattering term ‘elderly primagravida’ (a woman who becomes pregnant for the first time after 34) is now defunct, delaying having a family may still come at a cost.

Dr Aoife Mullally, Clinical Fellow in Obstetrics & Gynaecology, Coombe Hospital

 Irish Independent

http://www.independent.ie/opinion/analysis/aoife-mullally-despite-advances-delaying-childbirth-may-still-come-at-a-cost-29743325.html

The first confirmed pregnancy in the State using a technique to screen embryos for genetic conditions such as cystic fibrosis prior to implantation has been announced by a fertility clinic in Cork.

The Waterstone Clinic is one of just two clinics in the Republic licensed by the Irish Medicines Board to offer pre-implantation genetic diagnosis (PGD) which involves embryo biopsy and screening in collaboration with a specialist genetics laboratory in the UK.

Laboratory Manager at Waterstone Clinic Clinic, Dr Tim Dineen said the woman in this case, who is in the early stages of pregnancy, is a carrier of the CF gene while her partner is also affected by the CF gene and the risk of them having a child with CF was one in two without PGD.

The PDG process, which costs €9,800 at the Cork centre, involves generating a number of embryos via IVF treatment with the embryos then biopsied through the removal of one cell from each embryo. These are then sent to the Genetic Centre in the UK for analysis.

Dr Zhang explained that, after the biopsy procedure for this couple, the embryos were frozen by means of ‘Vitrification’ with the female partner returning later to have one embryo, which was diagnosed as being unaffected by the condition, being transferred into the uterus.

“Only embryos diagnosed as being unaffected by the condition are selected for transfer into the womb of the female partner,” said Dr Zhang, adding that the remaining embryos are currently cryo-preserved pending the outcome of the treatment and the decision of the parents.

Head of Research and Development at Waterstone Clinic, Dr Xiao Zhang said the centre were delighted for the couple involved and hailed the result as “an important landmark” for fertility treatment in Ireland.

“Pre-implantation genetic diagnosis and pre-implantation genetic screening (PGS) is a breakthrough for Irish couples as it now enables them to avail of these very specialised treatments at home and avoid the travel costs and stress associated with going abroad,” he said.

Dr Zhang explained that Cystic Fibrosis in the most commonly inherited genetic disease in Ireland with one in 19 Irish adults carrying the altered gene that causes the condition and if both partners carry the gene, there is a one in four chance their baby will have Cystic Fibrosis.

Meanwhile Dr Dineen said the PGD technique allows people with a specific inherited conditions such as Fragile X syndrome, Duchenne Muscular Dystrophy, Myotonic Dystrophy, Tay-Sach’s disease and Haemophilia A the option of trying to avoid passing it on to their children.

http://www.irishtimes.com/news/ireland/irish-news/first-pregnancy-in-ireland-using-new-screening-technique-1.1582427

A COUPLE with cystic fibrosis are set to give birth to Ireland’s first genetically screened baby next July.

The couple have been treated at the Waterstone Clinic Clinic, which is one of just two centres licensed by the Irish Medicines Board (IMB) to carry out the controversial procedure.

The parents opted for ‘gene screening’ for the child they desperately wanted over concerns they had an exceptionally high chance of having a baby with cystic fibrosis.

The couple, who want to remain anonymous, sought the assistance of CFC after discovering that while one parent already has cystic fibrosis, the other also carried the defective gene responsible for the condition.

DISORDER

That meant their child had a one in four chance of inheriting cystic fibrosis which, without a heart and lung transplant, is a life-limiting condition.

However, using a technique called Pre-implantation Genetic Diagnosis (PGD), fertility clinics can screen potential embryos for traces of the disorder.

The treatment costs under €10,000 but can guarantee that potentially fatal genetic conditions are not passed on.

Using PGD, fertility clinics implant only healthy embryos and assure worried couples that potentially fatal genetic disorders are not passed on to their children. The Cork clinic has been operating for over a decade but the case is the first confirmed use of PGD for an Irish baby.

The Pro-Life Campaign has called for a detailed ethical debate on the issue of genetic screening.

http://www.independent.ie/irish-news/first-gene-screened-irish-baby-due-in-july-29723997.html

Ralph Riegel  04 November 2013

The first confirmed pregnancy in Ireland using a new technique known as ‘Pre-Implantation Genetic Diagnosis” has just been announced by Waterstone Clinic. http://www.corkfertilitycentre.com/?s=page&id=24#pgd  

Dr. Tim Dineen, Laboratory Manager at Waterstone Clinic, says “We are delighted to confirm the first pregnancy following Pre-Implantation Genetic Diagnosis carried out in an Irish Fertility Clinic”.

Waterstone Clinic carried out its first PGD treatment for a couple at risk of having children affected by Cystic Fibrosis, the most common genetic disease in Ireland. One in 19 Irish adults is a carrier of the altered gene that causes Cystic Fibrosis. If both partners carry the Cystic Fibrosis gene, there is a one in four chance that their baby will have Cystic Fibrosis which is a debilitating, life-limiting condition, sometimes requiring heart/lung transplant. https://www.cfireland.ie/

Dr. Xiao Zhang, Head of Research and Development at Waterstone Clinic, whose expertise in the area was central to the introduction of the procedure, explained that following the biopsy procedure for this couple, the embryos were frozen by means of ‘vitrification’ with the female partner returning later to have one embryo transferred into the uterus.

PGD is the most complex procedure in IVF. This success in Cork has relied upon the introduction of several new techniques. Waterstone Clinic is one of only two Irish IVF units currently carrying out embryo biopsy. The breakthrough would not have been possible without a robust blastocyst culture system nor without a successful embryo vitrification programme. Dr Zhang says “we are not surprised by today’s success; it is the result of a lot of hard work over the past few years validating and perfecting the underlying laboratory processes”. http://www.youtube.com/watch?v=8CGImVRVG8U&feature=youtu.be

This cutting-edge technique allows people with a specific inherited condition the option of trying to avoid passing it on to their children. PGD will be beneficial for individuals whose offspring are at risk of disease caused by single gene defects or chromosomal disorders. Such conditions include Fragile X syndrome, Duchenne Muscular Dystrophy, Myotonic Dystrophy, Tay-Sach’s disease and Haemophilia.

Waterstone Clinic in collaboration with Shady Grove Fertility invite you to a Free Donor Egg Seminar presented by Dr. John Waterstone and Dr. Gilbert Mottla.

Our integrated International Donor Egg Program allows patients to access the exceptional services provided locally by Waterstone Clinic and the vast donor egg database available only at Shady Grove Fertility. Join us for an opportunity to meet with experts from both Waterstone Clinic and Shady Grove Fertility to discuss the benefits of seeking treatment through our unique partnership

 Monday, October 28^th, The Shelbourne Hotel, Stephens Green, Dublin 2, 19:00

Tuesday, October 29th, The River Lee Hotel, Western Road, Cork, 19:00

For further information please contact our dedicated Egg Donation Coordinator, Eilis McCarthy at Waterstone Clinic at 021 4624405 or [email protected]

The Telegraph

By Nick Collins, Science Correspondent

Women who want a family should start thinking about having children in their twenties and begin no later than 35, a group of leading fertility experts has warned.

Most women’s fertility begins to decline sharply in their mid-thirties but a growing number are waiting until a later stage in order to focus on a career or save money, experts from Newcastle University said.

The percentage of mothers giving birth aged between 35 and 59 rose from 6 per cent in 1986 to 17 per cent in 2008, while the median age for giving birth increased from 27.2 years to 29.3 over the same period.

Women should not assume that advances in fertility treatments will allow them to delay having children until after their biological “clock strikes 12”, said Prof Mary Herbert, a specialist in reproductive biology.

Speaking before a public discussion on fertility at the British Science Festival in Newcastle, she said: “What we can say for sure is that reproductive technologies do not do much to buy time.

“Perhaps the most important message to give is that the best cure of all is to have your babies before this clock strikes 12.

“I would be getting worried about my daughter if she hadn’t had a child by 35.”

Research shows that better-educated women are more likely to delay having a child, with climbing the career ladder and the cost of childcare two of the leading factors affecting their decision. But as women age, their chances of conceiving decline and the risk of stillbirths and conditions such as low birth weight, preterm birth and Down’s syndrome increase steadily.

The decline in fertility is generally slow in the twenties and early thirties, but increases much faster thereafter, with most women stopping childbearing in their early forties.

Judith Rankin, a professor of maternal and perinatal epidemiology at Newcastle, said women who wanted families ought to at least begin thinking about having children in their twenties.

“I think it’s better to think about it [in your twenties], and have that thought process informed by all possibilities,” she said. “From a public health perspective, when we look at the whole population, [the] message has to be that if you’re 35 or over, your likelihood of pregnancy is greatly reduced.”

Although IVF techniques can now allow women to have children later in life, their chances of success using their own eggs, rather than those of a donor, falls at the same rate as their fertility.

Natika Halil, of the Family Planning Association, said: “Conversations about planning a family are important, as is accurate information about contraceptive choice.

“Women are mindful of their fertility and any discussion should be done without scaremongering. Fertility doesn’t disappear after 35 and doesn’t stop overnight.”

http://www.telegraph.co.uk/health/women_shealth/10300708/Dont-leave-babies-until-your-thirties-women-are-told.html

Australian doctors have achieved a world first by helping a woman become pregnant from ovarian tissue grafted into her abdomen.

The woman asked for the tissue to be frozen seven years ago, when her second ovary was removed because of cancer.

Now she is 25 weeks’ pregnant with twin girls, thanks to work carried out by fertility preservation scientists at Melbourne IVF and The Royal Women’s Hospital.

“It’s two girls. We’re pretty excited. A bit freaked out,” says the mum-to-be, identified only as Vali.

In a voice recording released to the media by Melbourne IVF, Vali says she is lucky her doctor offered her an opportunity to freeze tissue.

She did not fully understand the implications at the time but hoped it would one day allow her to have a baby.

“It’s almost science fiction … it’s phenomenal,” says proud dad-to-be Dean.

Doctors around the world have previously achieved 29 births by grafting preserved ovarian tissue back into the pelvis.

This is the first sustained pregnancy through a graft outside the pelvis.

The team, led by Associate Professor Kate Stern, reported the result on Monday at the annual scientific meeting of the Fertility Society of Australia in Sydney.

Prof Stern explained the process. Seven months after a graft of thawed ovarian tissue was implanted into the abdominal wall and after a cycle of gentle IVF hormone stimulation, two follicles were found in the graft site.

Two eggs were retrieved from the follicles and transferred to the uterus.

“Ultrasound tests have shown that the twin pregnancy is proceeding normally,” Prof Stern said.

“This pregnancy provides unequivocal evidence that normal ovarian function and pregnancy can occur at a non-ovarian site.”

http://www.sbs.com.au/news/article/2013/09/03/world-first-pregnancy-aussie-woman

Irish Examiner

By Eoin English and Catherine Shanahan

Leading fertility experts have clashed over the merits of social egg-freezing, with one doctor warning women against wasting their money on trying to have a baby in this way.

 John Waterstone, the vice-president of the Irish Fertility Society and medical director of the Waterstone Clinic, branded as “unethical” the promotion of the cryopreservation technique by certain clinics that have yet to prove it works in their labs.

“It remains the case that no clinic in Ireland and very few in the UK have frozen eggs, thawed them, and produced a baby after fertilising them,” said Dr Waterstone.

“It is the case that more than one Irish fertility clinic is now offering social egg freezing to the general public, never having proven that the technique works in their hands. To me, this situation appears unacceptable and unethical.

“The public need to be made aware that whatever the wisdom of social egg freezing, pragmatically, any woman who spends money on egg-freezing in Ireland today is likely to be throwing that money away.”

Clinics that offer social egg-freezing are targeting women who choose to delay motherhood.

Dublin-based Sims IVF Clinic, which is expanding to Cork, began offering social egg-freezing this year. Medical director David Walsh said that, as long as women were given accurate information and appropriate counselling when considering freezing eggs, he did not have a problem with it.

“As long as women know there is a very low probability of getting pregnant or having a baby, I don’t think it’s a problem,” said Dr Walsh. “Women might feel they do not want to pay €4,000-€5,000 for a one-in-10 chance of a baby, but at least it gives them an option for the future.

“The counter-argument to what John [Waterstone] is saying is that some chance is better than none,” Dr Walsh said, adding that the reality is, because egg-freezing is relatively new here, statistically significant information about live birth rates would not be available for years.

At the Clane Fertility Clinic, licensed since February for social egg-freezing, clinical consultant Osman Shamoun said the technique “is a very acceptable form of treatment”.

“It’s being practised worldwide and there are over 1,000 documented pregnancies worldwide from this treatment,” said Dr Shamoun.

Egg-freezing involves a three-month consultation and counselling process, which includes the medical stimulation of egg production. Experts harvest eggs before subjecting them to a deep-freezing process for storage at temperatures as low as -196C for as many as five years. The process can cost from €3,800 to €5,000 per cycle.

Dr Waterstone, a consultant gynaecologist in Cork University Maternity Hospital and Bon Secours, challenged clinics offering the technique to freeze, thaw, and fertilise eggs and produce a successful pregnancy afterwards before offering the treatment to the public.

“Just imagine a woman freezing her eggs, having put her faith in the fertility clinic concerned, confidently deferring trying for a family until her 40s, and then failing to have a baby with the ‘young eggs’ which were frozen? This scenario is not only possible but highly likely,” said Dr Waterstone.

http://www.irishexaminer.com/ireland/fertility-experts-at-odds-over-egg-freezing-241799.html

Irish Examiner  

By Catherine Shanahan

Whether an expensive male fertility test has any bearing on improving outcomes for couples with difficulties conceiving is being examined as part of a project at Waterstone Clinic (CFC).

 The sperm DNA fragmentation test, which examines the level of damaged DNA found inside the sperm head, costs, on average, €400, and is offered by many fertility clinics.

However, whether these tests have any real value should become clearer when scientists involved in the DNA Fragmentation Trial at CFC determine if excessive sperm DNA fragmentation really precludes conception naturally.

Dr John Waterstone, medical director of CFC, said he was “alarmed by the lack of evidence” in relation to the usefulness of sperm DNA fragmentation tests and for “the recommendations generated by the results”.

Dr Waterstone said the reproducibility of some of the tests being used seems poor.

“We have had male patients who have had two tests, one of which has shown a high DFI and the other a low DFI (DNA fragmentation index).

“If results are not reproducible (the same in separate tests) how can recommendations be made?” Dr Waterstone said.

Even if results were reproducible, Dr Waterstone said there was “insufficient evidence that DFI levels should determine the urgency of fertility treatment or the form of treatment recommended”.

“The worry is that patients who would have conceived naturally, if only they had been given sufficient time, may be subjected to expensive sperm DNA tests and then pushed into expensive unnecessary treatment. The value of sperm DFI tests needs to be studied in order to protect patients,” said Dr Waterstone.

CFC in collaboration with Cork University Maternity Hospital began their research project 18 months ago. In order to complete it, they need more couples to take part.

Research scientist Dr Julie O’Callaghan said only couples with unexplained fertility issues were eligible for the trial which involves carrying out (free of charge) two different tests of DNA fragmentation when eligible couples first attend the centre. Eligible couples can have basic Semen Analysis (a test which measures the volume of sperm produced on ejaculation, as well as the sperm count (number of millions of sperms per ml of semen) and motility (percentage of sperm in the sample that are moving) and the morphology (percentage with normal shape), together with two sperm DNA fragmentation tests all carried out free of charge; they can then, if they wish, avail of up to three IUI treatment cycles carried out at a greatly reduced cost.

Medical director of the Merrion Clinic in Dublin, Dr Mary Wingfield, said she “delighted” the research was being done. “There are lots of tests out there that are not proven, infertile couples are desperate, they are a very, very vulnerable group, I think a lot of us feel anything we do has to be justified.

Data collected during the trial will be coded and anonymity maintained. Anyone interested in taking part can email [email protected] or phone 021 4865764

http://www.irishexaminer.com/ireland/real-effect-of-male-fertility-test-to-be-examined-237847.html