There’s an old bell jar that sits on top of a cupboard at a Cambridgeshire fertility clinic where history was made; it was in a dish inside this jar that the world’s first IVF baby spent the hours after her conception. With the success of in vitro fertilisation (IVF), scientist Robert Edwards and his gynaecologist colleague Patrick Steptoe had changed the future for infertile couples around the world.

Louise Brown, that first IVF baby, is 35 this month and what was then a revolutionary scientific advance has become a routine medical treatment. More than five million IVF babies have been born, and it’s easy to forget quite how controversial the idea of fertilising human eggs in a laboratory was at the time of Louise’s birth. “It was viewed with absolute suspicion,” says Professor Peter Braude, head of the Department of Women’s Heath at King’s College London. “If you talk to people today about human reproductive cloning, the feeling you get that it is playing God is just how it was in 1978 with IVF.”

Steptoe and Edwards started to work together in the 1960s. Scientists had been experimenting with fertilising animal eggs outside the body, but few believed it would ever be possible to create human embryos this way. Steptoe and Edwards thought that they could help couples with fertility problems if they could take eggs directly from the ovaries and return them to the womb once they had been fertilised. Many, even within the scientific community, felt that their research using human eggs and sperm was unethical and immoral. They were refused a grant by the Medical Research Council, but set up base in Oldham, where they had no shortage of infertile women volunteering for the experimental treatment.

Grace MacDonald, whose son Alastair was the world’s second IVF baby, had read an article in the Lancet about the research Steptoe and Edwards were doing, and her overwhelming desire for a child led her to volunteer. “It was all very new so when we started in Oldham we were sworn to secrecy – I think for our own protection,” she explains. “There had been so much controversy. I never looked on going there as being anything to do with courage though, it was just determination.”

MacDonald discovered she was pregnant after her second attempt at IVF, and gave birth to Alastair, the first IVF boy to be born, in January 1979. Across the world, other scientists were attempting to replicate the British achievement, and Australia’s first success came in 1980. A year later, the first IVF baby in the US was born, but the total number of children across the world conceived using the process still only stood at 15.

Steptoe and Edwards had originally hoped to carry on their work within the NHS, but it was clear that there was no appetite for this so they eventually set up their own private clinic at Bourn, just outside Cambridge. Treatment was expensive with each cycle of IVF costing £3,000, at a time when the average annual income was around £6,000. Fertility treatment was restricted to those who could pay, and were willing to undergo this radical new technique.

The media fascination with IVF was intense, and the literature given to patients included advice about publicity; women were warned not to talk to the media, to “beware of telephone enquiries” and to avoid mentioning the names of any other women they’d met at the clinic. Many people, even within the medical profession, knew little about the treatment, as Ro Facer, who went on to have three children using IVF, discovered. She had been trying to conceive for some years when she heard Steptoe interviewed on the radio. “I’d never heard of IVF, I’d never heard of Louise Brown, and when I went to my doctor, she had never heard of IVF either so I had to do the research myself,” she explains. “Eventually I got a referral. We saw Patrick Steptoe and I felt in very safe and caring hands. It didn’t ever feel as if you were being taken advantage of or experimented on.”

With success rates in the early years averaging 12%, most women who went to Steptoe and Edwards did not end up with a baby, but that didn’t deter couples from around the world joining the waiting list. Lucy Daniel Raby had eight cycles of treatment in the 1980s before she finally got pregnant with her daughter Izzy. “It was all new and a bit sci-fi,” she says. “We were the early pioneers, and part of this exciting experimental process. I didn’t have a second thought about it once I knew it was the only way I could get pregnant. We were lucky that it was available.”

Gynaecologist Dr Thomas Mathews moved down from Scotland to learn about IVF from Steptoe and Edwards and he says patients were often very secretive about the fact that they were trying IVF, not telling their friends or families what they were doing. “The term test-tube baby had a stigma attached to it and it wasn’t seen as natural,” he explains. “I was passionate about it, but many people didn’t understand.”

The embryos created during IVF are stored in small dishes rather than test tubes, but the term “test-tube baby” has stuck and, as Mathews suggests, does have negative connotations. There were wild rumours about what went on inside the clinic and the hostility and suspicion took a while to die down, as Vivien Collins discovered when she went to work for Steptoe and Edwards as a receptionist in the 1980s. “It was all very new and there were people who were critical. I had somebody who was disgusted that I worked at what she called a test centre where they made babies.”

IVF was far more demanding for patients than it is today. Women were required to spend two to three weeks as inpatients, staying in Portakabins in the grounds of their clinic. They had to collect all their urine during treatment as this was the only way doctors could monitor their hormone levels. If they weren’t at the clinic, this meant carrying large plastic containers around with them at all times, and inpatients had to give samples every three hours, even during the night, as Daniel Raby recalls. “We were in beds in ranks, six of us in each of the Portakabins. They’d come round and wake us up in the middle of the night and we’d all troop off and we had to wee in a bottle so they could monitor our hormones. It did help us all to bond with one another.”

When these checks showed the hormone surge that indicated ovulation, the eggs had to be collected exactly 26 hours later. This meant that the medical team would often have to get up in the middle of the night to carry out operations to harvest women’s eggs. It was felt that gravity might increase the chances of embryos implanting, so women were required to crouch forward with their bottoms in the air for an hour or two after embryos had been transferred. Despite all this, former patient Ro Facer says that it was a very supportive environment, which made the emotional strain of infertility and treatment more bearable. “The collaborative, team atmosphere helped with the stress and pressure,” she explains. “We felt that we were all in it together, the staff and the patients.”

Today, IVF is a far more streamlined process. Women are treated as day patients, and there are no three-hourly urine collections, no hours of crouching after egg collection. Although moral and ethical questions still surround new advances, for the most part it has become an everyday treatment. Freezing allows spare embryos to be stored for future use and the advent of intra-cytoplasmic sperm injection (ICSI), where sperm are injected directly into the egg, has meant that male fertility problems can be treated too. Donor eggs, sperm and embryos can all be used to help couples with more complex fertility problems, and the multiple birth rate, which has been the biggest health risk from IVF, is coming down.

The advances continue. This week it was reported that the first IVF baby to be screened using a procedure that can read every letter of the human genome had been born in the US. The birth of Connor Levy in Philadephia in May suggests next-generation sequencing (NGS), which was developed to read whole genomes quickly and cheaply, is poised to transform the selection of embryos in IVF clinics.

In another significant development, it was reported this week that the cost of IVF could be cut dramatically from thousands of pounds to around £170 in what could mark the start of a “new era” in IVF. Fertility doctors from Belgium told a London conference that 12 children had already been born through the technique, which replaces expensive medical equipment with “kitchen cupboard” ingredients, like bicarbonate of soda and citric acid, with a success rate similar to conventional IVF.

In the 35 years since Louise Brown’s birth, IVF has become a global money-making business producing very healthy profits, and there are hundreds of centres offering treatment around the world. Labour peer Lord Winston, who was head of the IVF unit at Hammersmith, has been highly critical of the charges patients face in many clinics. “The biggest change has been the increasingly commercial market which has driven IVF,” he says. “I think that the inequalities in treatment are scandalous, and I do feel very angry that the NHS has used IVF as a moneyspinner.”

Susan Seenan is deputy chief executive of Infertility Network UK, a charity that supports patients and campaigns for changes to the postcode lottery for NHS treatment. “Infertility is a devastating medical condition, and the emotional impact is exacerbated when people cannot access treatment,” she says. “Thirty-five years after IVF started in the UK, we have a situation where your chances of having NHS-funded fertility treatment depend entirely on where you live, leaving many people unable to get the help that they need.”

Despite that, the most recent figures show an annual IVF birth rate of more than 17,000 babies in the UK, and average success rates have risen to around 25%. Professor Braude worries that women may put too much faith in fertility treatment, believing that it can override the biological clock. “There is a huge expectation, and people think that if they stave off motherhood for whatever reason then IVF will be their salvation, but that’s not true. If one is realistic, it isn’t that successful.”

So where will we be in another 35 years? Yacoub Khalaf, director of the IVF unit at Guy’s and St Thomas’s, suggests that ongoing stem cell research is the area to watch. “IVF has evolved significantly, but I think it is almost near the limits of biology now unless we find a way of creating eggs,” he explains. “We do see patients who are struggling at 40 to 45, and the only thing which would change the face of treatment would be if we could make gametes from stem cells; if we could make sperm from men’s skin cells, or eggs from women’s hair cells.”

If that all sounds rather “brave new world”, it is worth remembering that’s just what many people thought about IVF itself 35 years ago. Whatever the future holds, it is clear that Steptoe and Edwards, who are now both dead, have left an extraordinary legacy. Mike Macnamee worked with them in the early days and is now chief executive at Bourn Hall. “They inspired incredible loyalty, but what came through most from both of them was that they understood the pain of infertility,” he explains. “We forget that until Louise was born there was no hope for many couples.”

Louise Brown may have grown up in the media spotlight, but is keen to stress that today she leads an ordinary life. She is married and has a son, Cameron, who was conceived naturally. She says she tries not to think too much about being the first IVF baby, which is to her “just a normal thing because I have never known anything else”. However, she is clearly proud of what Steptoe and Edwards achieved. “They helped thousands of people, people they hadn’t even ever met, to have babies,” she says. “Without them, these children wouldn’t have been born.”

Louise’s own birth was the landmark that changed the face of reproductive medicine, but it was the tenacity of Steptoe and Edwards, and the courage of their early patients, that so many parents today have to thank for their families.

Irish Examiner

By Catherine Shanahan

BY the time we hit 30, most women have been bitten by the baby bug.

For those who have met Mr Right, there is opportunity to try for that child. For those who have not, motherhood may look like a long shot. Certainly, in the past, singledom equalled a life consigned to childlessness.

But the world has moved on. Giant strides in the fertility industry, particularly in the last decade, make having a baby far more attainable, regardless of marriage or relationship status.

With her biological clock ticking loudly and no suitable partner on the horizon, Spanish actress and model Monica Cruz, pictured right, sister to Penelope, took matters into her own hands to “fulfil the dream of a lifetime”. In May, the 36-year-old delivered a healthy baby girl conceived through anonymous donor sperm.

She decided to go public on her decision to prevent endless speculation about the father of the child. “… my thanks to all those anonymous men that help to give many women like me, the dream of their lives,” she said to El Pais in January.

The industry has come a long way from the first known case of a child by donor insemination in 1884 when an American professor chloroformed the wife of a sterile quaker, then let his medical students vote who among them was “best looking”. The winner provided the donor sperm and the merchant’s wife gave birth to a son.

While the science behind fertility treatment has improved hugely since then, women have still been dependent on men to provide that much longed-for child — until now. Suddenly, medical advances have opened up a whole new vista. Fertility clinics in Ireland (with the exception of the HARI unit at the Rotunda Hospital which does not offer donor sperm) are reporting a steady increase in the number of single women opting to go it alone.

At the Galway Fertility Clinic (GFC), laboratory manager Jenny Cloherty says since 2009, four babies have been born to women using donor sperm, in addition to two ongoing pregnancies. They have treated 27 single women, 10 of whom only started treatment in the last few months.

The Waterstone Clinic (CFC), which has offered donor sperm since 2009, says demand for this treatment is “small and steady”. It has treated 28 women using donor sperm, nine of whom have either had a baby or have an advanced successful pregnancy.

At the Kilkenny Clinic, which established a donor sperm service in 1999, medical director Dr Martine Millet-Johnston says they are seeing about 20 single women a year and the numbers are increasing among older women.

In Dublin’s Sims Clinic, patient co-ordination manager Dr Lyuda Shkrobot says of the women without a male partner that they treated in 2011, about two-thirds were “same sex couples”, the remainder — single women.

Annabel*, an American business woman living near Dublin, is one such woman.

“Around the age of 40, after several long-term relationships, and having built a career, I decided to look into it. I had thought about it in the past, but at around 40, it seemed more important,” she says.

She heard an interview on the radio with Dr David Walsh of the Sims Clinic and was impressed. A few months later, she decided to go ahead with treatment.

Sims, like most of the Irish clinics, sources sperm mainly from Denmark, home to Cryos International, the world’s biggest sperm bank.

While previously its clients were predominantly couples affected by infertility, 40% of demand is now coming from single women.

Restrictions are in place to limit the number of children produced by any one donor. Dr Tim Dineen, lab manager at the Waterstone Clinic, says limits are imposed by the clinic, the Government and the sperm bank. “These limits are aimed at minimising the small possibility of consanguinity, ie a man and a woman, both children of the same sperm donor, but unaware of that fact, marrying,” he says.

CFC’s policy is that a particular donor can only be used by one recipient female. All pregnancies achieved are also reported to the donor bank as it has a maximum limit to the number of families that each donor can produce.

In addition to informing the donor bank, Dr Millet-Johnston says there’s a centralised database in Ireland where each clinic registers usage of a given sperm donor. She says the clinics abide by the “three-family rule” — donations from one donor cannot be used by more than three Irish families.

The client fills in a donor characteristic form and the embryologist tries to match it to available sperm donors.

Dr Dineen explains that the characteristics always specified are physical: hair colour, eye colour, height, weight, ethnicity and skin colour.

Annabel sought a donor with physical characteristics similar to her father. She estimates it took about two months for the sperm to arrive. Initially, she opted for ICSI (Intracytoplasmic Sperm Injection), where a single sperm is picked up with a fine glass needle and injected directly into the egg.

After three failed rounds of ICSI, she decided to try IVF, a process where the woman’s egg is fertilised outside the body and then replaced in the uterus.

At Sims, prices for sperm vary according to type of treatment. An IVF cycle using donor sperm at Sims is priced at €4,500. At CFC, the cost is €3,750 for IVF. Neither price includes the cost of sperm.

The cost of donor sperm depends on what is specified by the woman, Dr Dineen says.

“She may choose to import a larger amount in case she needs a number of treatment cycles and to cover the possibility of trying for a second baby with the same donor. The cost also depends whether the donor is anonymous (versus open to identification) and the characteristics profile (basic versus extended). At CFC we recommend allocating approximately €1,500 to €2,000 for importation of sufficient donor sperm straws to allow for a sibling,” says Dr Dineen.

Unfortunately for Annabel, three rounds of IVF failed. By now, she had spent about €16,000 on trying to get pregnant. After a trip to Italy, she decided to take stock. Treatment had put her body under stress. The cost was draining her financially.

It was at this stage that her doctor suggested dual donation (sperm and egg), a treatment she had initially ruled out because she felt there would be no biological link with the child. But she was encouraged by the live birth rates — donors are young women and generally produce more and better quality eggs. By now, Annabel was approaching 44 and was afraid that by using her own eggs, she would give birth to a child with special needs.

Because egg donation treatment is not available in Ireland, Annabel travelled to the Ukraine. The egg donor treatment cost €5,000, excluding travel costs and fertility medication from Sims, which between them added approximately another €2,000 to her bill, she says.

The doctor implanted two eggs — one subsequently miscarried — and Annabel says she “knew immediately” that she was pregnant.

Annabel, now 46, is the proud mum of an eight-month-old baby girl, born last November by emergency C-section, weighing 9lbs 7oz. She recalls how she burst into tears when she first heard the baby’s heartbeat at her seven-week scan.

Family, including Annabel’s mother, flew from America for the birth. “My parents were delighted, really supportive. I was really surprised. I thought their generation would think it was bizarre,” she says.

Annabel says she’s not concerned about telling her daughter about her genesis. “I think she has a really unique story, she’s one of a kind. People talk about adoption being special, but this is a whole new level. I created this,” she says.

Annabel’s donors were anonymous, something she is happy about — she didn’t want anyone “laying claim” to her child in the future, she says.

Angela O’Mahony, fertility counsellor and psychotherapist at the CFC, feels it’s important for single women who opt for donor sperm to consider the issues and challenges involved for mother and child now and into the future.

“Most women have made their decision to proceed with treatment prior to our session. They generally come from a mid socio-economic bracket, with their own homes and secure employment. The common theme tends to be the need to fulfil a deep desire to have a child.”

Counselling offers an opportunity to explore feelings around the challenges of single parenting and identifying where the woman will obtain practical, emotional and psychological supports.

“While single parenting is a common feature of our world today, donation brings the unique challenge around telling a child about his/her birth origins,” O’Mahony says.

For instance, it raises issues around the identity of father. The woman can choose a ‘known anonymous donor’ which means the child can opt to make contact through the sperm bank at the age of 18.

“Ideally I would like to see the availability of non-identifying information on the donor, so that mum can share it with the child as he/she grows. It is understood that the more information a child has about his/her beginnings, the more it supports the child’s sense of self.”

O’Mahony points out that there is considerable research done on the importance of a father or father figure in a child’s development.

“A dad plays a significantly different role to mum, often helping a child to individuate and separate from mum at the appropriate developmental stage. Many women identify a close male friend, granddad or brother as having offered to provide a positive male role in the child’s life.”

O’Mahony says it is her experience that the majority of women she sees “continue to hold the possibility for a relationship at some point in the future”.

Annabel is a case in point. “I haven’t given up on the idea of getting married and finding a husband,” she says. “Having a baby may even increase my chances. Your network expands.” she says.

*Name has been changed

serif;””>In view of the unproven benefit of any timelapse system with regard to success rates we are astonished that in some units patients are being asked to pay an additional charge for the ‘privilege’ of their embryos being cultured in an incubator which incorporates the technology.

“

Irish Examiner By Eoin English

A leading Irish fertility clinic is to begin screening embryos for cystic fibrosis (CF) to help couples facing difficult family planning choices.

The Waterstone Clinic has been licensed by the Irish Medicines Board to carry out embryo biopsy as part of its new pre-implantation genetic diagnosis (PGD) treatment.

It will be used to identify embryos with Ireland’s most common genetic disease and select ones which are “safe” to transfer as part of the various forms of IVF.

The centre, which carries out roughly 700 cycles of IVF treatment every year, has about six couples under-going IVF poised to avail of the treatment.

It follows the introduction of a new CF alert system in Jul 2011, which sees all newborn babies screened to see if they have CF or are CF carriers.

The centre’s medical director, Dr John Waterstone, said many couples who have learned since then that their baby is a CF carrier now want to know whether one or both of them is a carrier before having another child.

And couples who know they are both carriers — who face a one-in-four chance of having a baby with CF — are forced into making difficult reproductive choices which most never have to face, he said.

“PGD allows science to provide information which can inform these decisions. Some couples are so fearful of the risk of CF that they choose not to have another child. Others avoid the risk by using donor semen — the donor having been screened to ensure he is not a CF carrier.

“PGD is another strategy which ‘at risk’ couples can use in order to have a baby which is genetically their own while reducing the risk of CF to practically zero.

“The process is complex and it is very possible that after all the work, screened embryos may fail to implant so that no pregnancy is produced.

“However, PGD is an option which many at risk Irish couples have chosen over the past decade; now at least some couples who choose PGD will not have the additional burden of having to travel to the UK for treatment.”

The introduction of the service at the Cork centre has been led by Dr Xiao Zhang, head of research and development, in conjunction with laboratory man-ager Dr Tim Dineen.

Scientists there will test embryos three days after fertilisation, removing one cell from each — an embryo biopsy. The remaining cells can still develop normally.
The removed cells will be sent to either Reprogenetics in Oxford or Guy’s and St Thomas’ Hospital in London for genetic diagnosis to identify “safe” embryos which can be selected for transfer during IVF, in the hope that the couples will become pregnant.

All couples will be required to discuss their situation with a genetic counsellor before proceeding with PGD treatment, which can cost up to €10,000 for the first cycle. The technology is applicable to the detection of other genetic risk factors in embryos.

The CFC was established in Jun 2002 by Dr Waterstone, with one nurse, two scientists and a receptionist. Today, the unit on College Rd has a team of over 30.

They achieved the first successful pregnancy in Ireland following embryo vitrification, a new freezing technique, last year, and achieved the first live birth following the technique on Christmas Day.

http://www.irishexaminer.com/ireland/cwmheysnaugb/rss2/

Time-lapse imaging which takes thousands of pictures of developing embryos can boost the success rate of IVF, according to British research.

The method, reported in Reproductive BioMedicine Online, can be used to select embryos at low risk of defects.

Scientists at the CARE fertility group say such informed selection can improve birth rates by 56%.

Other experts say the result is exciting, but the study of 69 couples is too small to be definitive.

The research followed the couples at the CARE fertility clinic in Manchester last year, when 88 embryos were imaged and implanted.

The embryos were put into an incubator and imaged every 10-20 minutes.

Embryo screening

Continual embryo monitoring through time-lapse imaging is aimed at selecting those with the lowest risk of aneuploidy – where the cells have chromosome abnormalities. Aneuploidy is the single biggest cause of IVF failure.

But this form of embryo screening is a predictive rather than diagnostic tool.

Couples at high risk of passing on a chromosomal abnormality may prefer to have Pre-implantation Genetic Screening. This invasive test removes cells from the early embryo for analysis. It costs around £2,500 on top of the £3,000 charged for conventional IVF.

The researchers classified the embryos as low, medium or high risk of chromosome abnormalities based on their development at certain key points.

Eleven babies were born from the low risk group (61% success rate) compared to five from the medium risk group (19% success rate) and none from those deemed high risk.

“In the 35 years I have been in this field this is probably the most exciting and significant development that can be of value to all patients seeking IVF,” said Prof Simon Fishel, managing director of CARE Fertility Group.

“This technology can tell us which embryo is the most viable and has the highest potential to deliver a live birth – it will have huge potential. This is almost like having the embryo in the womb with a camera on them.”

In standard IVF, embryos are removed from the incubator once a day to be checked under the microscope. This means they briefly leave their temperature-controlled environment and single daily snapshots of their development are possible.

Dr Sue Avery, British Fertility Society: “We haven’t really got clear clinical evidence yet”

Using the time-lapse method embryos don’t leave the incubator until they are implanted allowing 5,000 images to be taken.

“Removing embryos from the incubator potentially exposes them to damage, so it must be a good thing to be able to look at the pattern of development over time.

“These results are very interesting but this is is a very small study and any interpretation of the findings must be made with caution as we are dealing with the hopes and expectations of patients,” said Dr Virginia Bolton from the assisted conception unit at Guy’s and St Thomas’ NHS Foundation Trust.

Sheena Lewis, professor of reproductive medicine at Queen’s University, Belfast, said: “This may well be the technique we have been waiting for to improve embryo selection and thus success in fertility treatment.

“However, this is a small study with just 46 embryos being followed through to birth. Much more research will be needed before this becomes a routine clinical tool.”

Around a dozen private and NHS clinics are using time-lapse embryo imaging. It costs around £750 in addition to about £3,000 for IVF.

http://www.bbc.co.uk/news/health-22559247

 

Sperm DNA damage is more common in infertile men and may contribute to poor reproductive performance. However, current methods for assessing sperm DNA integrity do not reliably predict treatment outcomes and cannot be recommended routinely for clinical use.

Read more; http://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Committee_Opinions/The_clinical_utility(1).pdf

Sperm donation: May be second choice but it’s not second best

Attitudes to egg and sperm donation have moved on a lot, with people much more open about the process

A British couple who became parents to two children by sperm donation close to 30 years ago say Irish couples are very receptive to the idea.

Walter Merricks and his wife, Olivia Montuschi, discovered they couldn’t have children together because of male infertility. Arising out of donor insemination, the couple had William (29) and Susanna (26), each with different donor sperm.

Shortly after the birth of their children, the London-based couple founded the Donor Conception Network to assist couples in similar situations to themselves.

Montuschi encourages families to feel “proud” rather than “ashamed” about having their children via sperm or egg donation. “Because infertility is something that nobody chooses. Nobody has any control over it. It is something that happens to you.”

The couple flew over to Ireland some weeks ago for a talk organised by the Waterstone Clinic. They expected to meet about 30 people who either have had children by sperm/egg donation or were looking into having a family using this method. Montuschi says she was surprised by the 130 people who attended the meeting and pleased with the ease at which they discussed fertility.

Courage

“Maybe it was the collective courage gathered from finding themselves in a room full of people who shared their situation, but these parents [and some would-be parents] were happy to talk to each other. They were hungry for information and most of all to know that they were not alone.”

Montuschi says it typically takes a couple a gestation period of thinking and grieving for the child they are unable to conceive together before they make the decision to use a donor.

“The time you take is important. We decided we wanted to be parents together and we felt we had good things to offer. I know Walter in particular felt he might not be able to pass his genes on but he could pass on his values in life.”

Merricks, who was formerly the chief financial ombudsman for the UK, says it is vital that couples come to their decision feeling well prepared about what they are going to do. “This may be a second choice but not second best. Okay, this is not maybe where we would have started but it is where we are going. We can now feel that we have made that decision and there is a route down which we are going to go together.”

Openness

For couples who have a donor-conceived child, one of the issues they face is telling the youngster the facts surrounding their entry into the world. Montuschi stresses that even parents who are absolutely convinced of the importance of openness have difficulty with finding the words to talk to their young ones about their conception.

“It is hard. I can remember having conversations with the kids when they were in the bath. Kneeling beside the bath and playing with the ducks and talking about the nice man who gave some sperm to help me. Telling early is the easiest way to go. It is the clearest message we can give.”

Merricks emphasises that you can successfully tell donor-conceived children about their origins at any age. However, once children are past six or seven, it becomes an increasingly complicated affair.

Different ballgame

“You have to sit children down and say there is something we need to tell you. That is a whole different ballgame from this gradual information . If you asked our children when were they first told, they say ‘we really can’t remember.’ If you tell kids at six or seven, they will remember. It will be a moment in their lives that they remember.”

Merricks adds that it has been hugely rewarding to help people who start out feeling isolated by their infertility. “The meetings we have held . . . seeing some of the people who come to those meetings feeling nervous and wondering what they were going to find. And finding us all normal.

“Seeing people coming back to another meeting a year later just looking so proud and coming back the following year with a baby. The same people who felt they couldn’t possibly do it.”

Meanwhile, Susan Waterstone, of the Waterstone Clinic, says attitudes to egg or sperm donation have moved on in recent years in Ireland with staff noticing that prospective parents are more confident having read up on the internet about the process. “People are more open minded about egg donation and sperm donation and are more knowledgeable. It has been a very rewarding 10 years since we first opened seeing people coming in to visit us with babies who they never thought they would end up having.”

http://www.irishtimes.com/news/health/sperm-donation-may-be-second-choice-but-it-s-not-second-best-1.1315224

Irish couples at risk of having a child with Cystic Fibrosis (CF), Ireland’s most common genetic disease, will no longer have to travel abroad to avail of Pre-implantation Genetic Diagnosis (PGD) treatment.

Waterstone Clinic has been licensed by The Irish Medicines Board (IMB) to carry out embryo biopsy.

All new born Irish babies have been screened for Cystic Fibrosis (disease and carrier status) since July 2011. As a consequence, an increasing number of Irish couples are becoming aware that they are at risk of having a baby with CF – because both of them are carriers.

Such couples may pursue Pre-implantation Genetic Diagnosis in order to avoid the 25% risk that their next baby will be affected. Couples opting for PGD try to achieve a pregnancy through IVF rather than naturally. The embryos generated are ‘biopsied’ and the cells removed are tested genetically in order to identify those free of CF and safe to transfer.

http://www.thejournal.ie/clinic-genetic-disorder-667931-Nov2012/

Eilish O’Regan Health Correspondent – 09 November 2012 – Irish Independent

COUPLES who want to find out if they are going to have a baby with an inherited disorder can now avail of controversial tests in Irish clinics for the first time.

Embryos produced through IVF can now be tested to show if they are free of specific disorders, such as cystic fibrosis.

It means the couple can choose not to have an embryo which proves positive for the disorder implanted in the mother’s womb.

Couples previously had to go abroad for the tests, but licences have been granted to the Beacon CARE Fertility Clinic in Dublin and the Waterstone Clinic Clinic.

A spokesman for the Waterstone Clinic Clinic said a couple would need around €10,000 to cover the fertility treatment and the embryo test. Later cycles would be around €1,500 less.

A spokeswoman for the Beacon facility said the pre-implantation genetic diagnosis test costs €5,490 for analysis of a single gene disorder in addition to €4,900 for the fertility treatment.

The Beacon service is also offering another test which screens the egg and embryo for chromosomal abnormalities, a major cause of miscarriage and IVF failure.

Cystic Fibrosis Association chief executive Philip Watt said that it recognised Irish couples were already going abroad for the screening and it had no objection to it.

Sandra Brett, medical director of the Beacon facility, said the test allows for genetic testing of the embryo prior to implantation and before pregnancy occurs.

A second test called Array CGH screens the egg and embryo for chromosomal abnormalities and this has been proven to improve the birth rate in women who have undergone IVF.

The Array CGH costs €2,950 for analysis of up to eight samples in addition to the fertility treatment cost.

Dr John Waterstone, medical director of the Waterstone Clinic said they will initially offer the testing for cystic fibrosis.

Norm

He said that even though one in 19 of the Irish population is a cystic fibrosis carrier, the highest rate in the world, it has not been the norm for couples to be screened.

“Some couples will be aware of the risk because of a family history of cystic fibrosis; most couples only find out when they have a child with the disease.”

The centre has carried out rigorous pilot studies and the Irish Medicines Board is satisfied it will carry out the embryo biopsy to a high standard.

All couples will need to discuss their situation with an independent genetic counsellor before deciding to go ahead with the treatment.

Dr Waterstone admitted the process was complex and expensive while there was also the risk that the embryos may fail to implant in the mother’s womb.

http://www.independent.ie/irish-news/clinics-to-begin-tests-for-genetic-disorders-in-embryos-28894223.html

A technique that flash-freezes embryos has resulted in 13 pregnancies here this year

The first Irish babies conceived from embryos flash-frozen at IVF clinics will be born at the start of next year, after their parents were treated with an improved fertility method.

The technique, which involves freezing embryos in liquid nitrogen at -196C within seconds, may eventually allow single Irish women to store their eggs until they reach their early thirties. At present, Irish women who want to preserve their eggs have to go abroad.

Using embryos thawed from flash-frozen embryos, a process known as vitrification, 13 women in Ireland are now pregnant. The couples were treated at three Irish clinics licensed for the procedure by the Irish Medicines Board earlier this year. They are the Waterstone Clinic; the Hari unit at Dublin’s Rotunda hospital; and the Merrion Fertility Centre at the National Maternity Hospital on Holles Street.

As many as 98% of vitrified embryos survive thawing, compared with 75% of those frozen using the slower method traditionally used by Irish clinics. This makes it easier to transfer them to the womb intact. The process was first successfully used in Japan in 2001, and the first baby in the UK conceived with this technique was born in 2008.

While it has been possible to freeze sperm for decades, eggs and embryos contain more fluid. With the older method of freezing there was a greater chance that ice crystals would form and reduce the likelihood of an embryo or egg surviving the thawing process. To improve conception rates, some Irish clinics had been implanting patients with two or three embryos. This can lead to pregnancies with twins or triplets, which carry greater medical risks.

Fifty-three couples had embryos flash-frozen at the Waterstone Clinic this year, according to Dr John Waterstone, its medical director. Two women subsequently became pregnant. “The numbers are small, but it’s a 100% survival rate so far from embryos vitrified and thawed, compared with 75% before”, he said.

Fertility problems affect about one in six couples, prompting up to 3,000 to turn to IVF every year. The freezing of embryos, an integral part of most fertility treatments, has prompted ethical debates over when life begins and whether unused embryos should be discarded.

Irish clinics now allow unused frozen embryos to “thaw and perish”, according to Waterstone, after the Supreme Court ruled in 2009 that they did not qualify for the constitutional protection of the unborn. The court case involved Mary Roche, a Dublin woman, who wanted three frozen embryos fathered by her estranged husband to be implanted in her womb, against his wishes.

“Some pro-lifers still get hot and bothered and equate a three-day-old embryo with human life”, Waterstone said. “But the law says that they are not protected unless they are implanted”.

The Hari Clinic has had five successful pregnancies since introducing embryo vitrification in February. Edgar Mocanu, its consultant in charge, said it is the only clinic licensed in Ireland to freeze eggs, but offers the service only to women who are about to undergo cancer treatment, which can erode fertility.

As Irish women choose to have children later in life (the average age in 2010 was 31.7 compared with 28 in 1990), demand for egg freezing has increased. “Women’s fertility does diminish after the age of 37,” said Waterstone, who has declined requests from women wanting their eggs frozen.

“Some women have babies at 45, but they are the exception. Women know when they get older, their eggs can deteriorate and they are less like to become pregnant.”