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.”

 

THE FIRST CONFIRMED clinical pregnancy in Ireland using a new technique known as ‘Blastocyst Vitrification’ has just been announced by Waterstone Clinic. The clinic, which has been providing assisted conception services for over a decade, this week confirmed an on-going twin pregnancy of eight week’s gestation.

Waterstone Clinic’s Medical Director, Dr John Waterstone commented: “We are delighted to confirm the first clinical pregnancy using vitrification in Ireland.

Vitrification is a new technique for cryopreserving embryos which involves freezing the embryo about 600 times faster than ever before. This ultrarapid process is so fast that it literally allows no time for intracellular ice formation – which can cause trauma to the embryos. In conventional (slow) freezing only 70% of embryos survive the freeze-thaw process, and those that do survive have less likelihood of generating a pregnancy. In contrast, embryos which have been ‘vitrified’ have a greater than 90% freeze-thaw survival rate, and a pregnancy generating potential that is comparable to treatment cycles carried out using fresh embryos.”

The Irish Medicines Board approved the introduction of vitrification services at several Irish fertility clinics earlier this year, allowing them to provide patients with an improved chance of success using frozen embryos.

Waterstone Clinic is exceptionally proud of the contribution Dr Waterstone and his team have made to clinical research and development in the field of assisted conception, since the clinic first opened in 2002.

In 2007, the clinic was the first in Ireland to introduce an ‘Elective Single Embryo Transfer’ (E-SET) policy which, to date, has produced a live birth rate of 60% per embryo transfer. The policy was developed to reduce the number of multiple pregnancies resulting from assisted conception treatment. Its continued success, along with the introduction of this new vitrification freezing technique, will significantly increase the chances of a successful outcome for patients going forward, without raising the cost of IVF treatment.

Irish Examiner

By Claire O’Sullivan

A fertility clinic in Cork is the first in Ireland to introduce a service which promises a 90%-plus survival rate for frozen embryos, as they will be frozen 600 times faster than before.

The new process, known as vitrification, will improve outcomes for couples who are undergoing intracytoplasmic sperm injection (ICSI) or in vitro fertilisation (IVF).

Generally, as part of the IVF process, several embryos are generated, with one transferred to the womb and the remaining embryos are often frozen.

Vitrification “avoids trauma” to the embryo because of the speed at which freezing takes place compared to traditional, slower, freezing.

The process leads to better quality embryos, which are more likely to lead to a pregnancy.

Already, one woman has become pregnant with twins using vitrification, according to the Waterstone Clinic.

Susan Waterstone of the Waterstone Clinic said the vitrification process was so fast it allowed no time for intracellular ice formation.

“As a result, vitrification avoids trauma to the embryos. In conventional slow freezing, only 70% of embryos survive the freeze-thaw, and those that do survive have less likelihood of generating a pregnancy compared to fresh embryos.

“In contrast, vitrified embryos have a better than 90% freeze-thaw survival rate, and a pregnancy generating potential that is comparable to fresh embryos.”

An embryo is described as the product of human conception after it is implanted in the uterus wall. It remains an embryo until the eighth week of development in the womb, after which it is a foetus.

One of the challenges of modern assisted reproduction is how to minimise the likelihood of twins without compromising the chances of a woman giving birth.

The transfer of two embryos to the womb, increasing the likelihood of one pregnancy, has been the norm in fertility clinics for 25 years, but has a 25% incidence of twins.

However, if, due to age or health reasons a couple would rather a single pregnancy, vitrification is being seen as a good method to increase successes rate without running the risk of a multiple birth.

“Couples who fund their own treatment and are desperate for success are more likely to agree to single embryo transfer if it is supported by a highly successful frozen embryo transfer programme,” said Dr Waterstone.

“The live birth rate of our blastocyst elective single embryo transfer programme for the past three years is 60% per transfer. Vitrification will further encourage more couples to opt for single embryo transfer.”

Vitrification will not raise the cost of IVF treatment at the Waterstone Clinic. IVF at the clinic costs €3,750 and ICSI €4,250.

http://www.irishexaminer.com/ireland/health/fertility-process-raises-pregnancy-hope-197827.html