Because We Control Contraception, Doesn’t Mean We Can Control Conception
Anton Savage from Today FM speaks with CFC’s Mary McAuliffe about raising awareness of the link between age and fertility, especially amongst men and women in their twenties.
Listen to the interview here:
For further information on My Fertility Check, visit http://myfertilitycheck.ie/
It is 30 years since the first successful frozen egg pregnancy was conceived. For many years, egg freezing was considered to be a low-chance option for fertility preservation, needing 100 eggs to get one live birth.
For young women with cancer who were facing the near-inevitable sterility of chemotherapy or radiotherapy, the prospect of freezing their eggs, with even a low chance of genetic motherhood in the future was acceptable. The human egg, the largest cell in the body, is a tiny fluid-filled bubble and, during freezing, icecrystals form that can damage the delicate structures inside. The introduction of egg “anti-freeze”, vitrification (flash-freezing) and sperm micro-injection (ICSI) improved success rates.
Donor eggs are seen as the obvious solution for many women with age-related sub-fertility, but many would still prefer their own genetic child. Fertility clinics now have frozen egg banks where young, vitrified, eggs are available to match any racial or physical characteristic required by the recipients. Pregnancy rates from these frozen donor eggs, obtained from young women, are the same as those from fresh egg-donation cycles (50-70% per cycle).
This success has led to increased takeup of “social” egg-freezing because women want the opportunity to become a mother in a supportive, long-term relationship.
The decision by Facebook and Apple to offer social egg-freezing to female employees has reignited the debate about whether egg-freezing represents the ultimate type of family planning for today’s professional woman, or whether the prospect of having frozen assets really does offer the opportunity to safely defer and delay motherhood until the right time or the perfect partner arrives.
Unfortunately, the majority of women choosing to freeze their eggs have already left it too late to have a realistic chance of achieving a live birth from a single cycle of egg freezing. Just as with fresh eggs, successful pregnancies are more likely to be obtained using frozen young eggs.
The circumstances in which women choose to freeze eggs often reflect their social situation, in which they have either not found a partner who wishes to parent with them, or a long-term relationship that they assumed was heading towards parenthood has failed. It is unfair and unfortunate that at 38 (the modal age at which UK women seek egg freezing), she has two years to realistically achieve a healthy pregnancy whereas her similarly-aged partner has two decades.
Women seeking social egg-freezing are significantly committed to the conventional ideal family structure and regard single parenthood via the use of donor sperm as a poor last resort. By freezing their eggs they may believe they have bought a little biological time and the costs and small risks associated with the procedure may well be worth taking for that sense of empowerment.
However, at the present level of efficacy of oocyte freezing, it is vital that women, especially if they are over 35, are made aware that their frozen eggs do not represent an insurance policy against childlessness.
Source: Gillian Lockwood is medical director of the Midlands Fertility Centre
http://www.theguardian.com/society/2015/oct/24/social-egg-freezing-empowering-but-not-an-insurance-policy-against-childlessness
The advent of successful Pre-Implantation Genetic Diagnosis has been very encouraging for people at risk of passing on debilitating genetic conditions. PGD is an advanced fertility treatment which enables couples, who are at known risk of a specific genetic condition, to avoid passing it on to their children. The couple conceive by means of IVF treatment and embryos selected by the process are genetically tested, before being transferred to the woman’s womb.
Recently, a healthy baby girl was born in Cork, free from the life-limiting genetic disorder Smith Lemli Opitz Syndrome, after undergoing PGD at Waterstone Clinic. The girl’s parents were both carriers of the gene mutation concerned and became aware of this when their first child died as a result of Smith Lemli Opitz. When both parents are carriers for this and, other similar genetic disorders, there is a 25% chance that any child will be affected.
The rare disorder is caused by a mutation in the gene that codes for the enzyme involved in cholesterol production. Cholesterol is an essential component of all cells and so an affected person will have problems with many different organs. This was the first instance in Ireland of two people who are carriers of Smith-Lemli-Opitz Syndrome successfully using PGD to prevent it being transmitted to their child.
This is the third healthy baby born as a result of PGD at Waterstone Clinic. In April of this year, baby Megan O’Connor was the first reported case in the world of a baby born free from the rare genetic condition mucolipidosis, after PGD using Karyomapping. In July 2014, Bridget Belle Cooke was born free from cystic fibrosis, after her parents underwent PGD treatment at Waterstone Clinic. Bridget’s father has cystic fibrosis and her mother is a carrier for the disease.
The ground-breaking technique has been very successful to date. 46% of couples treated using the complex technique at Waterstone Clinic have gone on to have a baby. PGD however is expensive and the cost is prohibitive for some couples.
In the UK, clinics licenced to carry out PGD can apply for funding for a couple needing the treatment, provided they meet the appropriate medical criteria. There is no reason why we could not have a similar programme in Ireland.
Preventing the inheritance of conditions like cystic fibrosis and muscular dystrophy would not only ease the pain and suffering of many children, but would also help reduce the spend on future healthcare services.
It is my sincere hope that the new government will take steps towards providing financial assistance for couples at risk of passing on genetic disorders who would benefit from PGD treatment.
Dr. John Waterstone
Matt Cooper discusses a new test that can double IVF success rates to over 80% with Prof. Dagan Wells from Reprogenetics, Oxford, UK. This test could be hugely beneficial for would-be parents who often face multiple disappointments and considerable expense going through repeated IVF treatment cycles.
Listen back to the interview, (minute 17):
http://www.todayfm.com/player/shows/The_Last_Word_with_Matt_Cooper/7/24118/20th_October_2015_-_The_Last_Word_with_Matt_Cooper_Part_3
Waterstone Clinic, one of the only two centres in Ireland to provide Pre-implantation Genetic Diagnosis (PGD) and Pre-implantation Genetic Screening (PGS) treatment, and the only centre to have a recognised successful programme in place, have an established relationship with Reprogenetics, Oxford, UK. Reprogenetics are recognised leaders and provide PGD and PGS services to fertility centre’s worldwide. Together we continue to innovate to help achieve the best outcomes for our patients.
Working in collaboration with Reprogenetics enables our patients to avail of an established PGD and PGS programmes locally. The additional stress and expense incurred with travelling abroad for treatment can now be eliminated as patients benefit from local expertise in familiar surroundings.
Reprogenetics has the largest PGD experience in the world performing diagnosis of over 42,000 PGD cycles, their record is unmatched by any other Preimplantation Genetics Diagnosis reference center.
Performing PGD since 1991, Reprogenetics were the first to develop PGD tests for aneuploidy and translocations, the only lab in Europe to offer PGD for single gene disorders using Karyomapping and the first to offer aneuploidy detection in embryos using Next-Generation Sequencing.
These cutting edge technologies along with their vast amount of experience enable us to offer our patients PDG treatment that is unmatched by any other PGD reference centre in the world.
Experts have discovered that the levels of a particular type of DNA in a developing embryo are a crucial factor in whether a pregnancy will be successful and a simple test can be used to select the most viable embryos.
The development has the potential to revolutionise the success rate of fertility treatment, which currently stands at about 35 per cent of IVF cycles resulting in a pregnancy. Some 50,000 women undergo IVF treatment in Britain every year.
Clinical trials conducted in New York using the new technique, which was developed by researchers at Oxford University, resulted in a pregnancy success rate of around 80 per cent.
Professor Dagan Wells, the Oxford specialist who led the research team, told the Press Association that the test could be hugely beneficial for would-be parents who often face multiple disappointments and considerable expense going through repeated IVF treatment cycles.
The new technique focuses on mitochondria, the part of the cell that is its main energy provider and plays a key role during the development of an embryo.
The Oxford researchers, who have been shortlisted for two prizes in the field of fertility research as a result of their work, found that some embryos have excessive levels of mitochondrial DNA – or mtDNA – and will consequently not produce a viable pregnancy.
Prof Wells said those undergoing IVF treatment already faced an uphill struggle because the majority of embryos created in the process of harvesting eggs and artificially fertilising them with sperm have “no chance at all” of becoming a baby.
The success rate for IVF is rising by about one per cent a year but Prof Wells said that progress was “painfully slow” and woman who, for example, produces eight embryos may have only one that will result in pregnancy.
He said: “You are potentially putting your patient through eight embryo transfers before you get to the one embryo that is viable. For the patient repeatedly having negative pregnancy tests, that’s brutal.
“Any test of the embryo that will result in a baby is therefore highly desirable.”
Source:http://www.independent.co.uk/life-style/health-and-families/health-news/ivf-new-treatment-could-more-than-double-success-rate-to-over-80-per-cent-a6700461.html
When it comes to fertility there is one certain enemy: time. As women age, the quality of their eggs deteriorates and the quantity decreases as eggs are released every menstrual cycle. Eggs are also vulnerable to attacks on the body, which is why health practitioners have been offering egg freezing to women undergoing chemotherapy for many years. But it is only recently with the development of new quick freezing methods that women have been voluntarily opting for egg freezing in a major way.
Although figures about egg freezing are hard to come by, some sources suggest that demand for the procedure has increased by 400% in private clinics in the UK, and the age of women enquiring about the procedure appears to be falling. The procedure is now also being endorsed by Silicon Valley companies, with both Facebook and Apple announcing last year that they would pay for any employees wishing to freeze their eggs in a move to ‘empower women’.
It is easy to see the appeal of the procedure. Egg freezing is pitched as the ultimate ‘insurance policy’ for women. Women are getting married and having children later than previous generations, but our bodies haven’t changed. At first glance, egg freezing would seem to offer women the ultimate freedom from the constraint this change in lifestyle may create; Women can have their eggs frozen, halting the biological clock in its tracks, get their education and careers on track, and wait for the right time and person to come along before having a baby. It sounds so simple – too good to be true. So, obviously, it is.
For an ‘insurance policy’ for women there is currently very little data about what the chances of actually having a baby are. The Human Fertilisation and Embryology website shows that up to December 2012 around 18,000 eggs have been stored in the UK, but only around 20 live births have been reported. Similarly, the American Society for Reproductive Medicine reported in 2013 that the chance of getting pregnant from a single thawed egg ranged from four to 12.5 per cent and was consistent with standard IVF rates.
This makes the assurance of actually having a child seem dubious. The idea that egg freezing pauses the biological clock is a myth, and that could be one reason for the lack of success. The freezing process preserves the IVF success rate at the age at which you freeze your eggs, meaning eggs frozen in your twenties are more likely to be fertilised than those frozen in your thirties and forties. Yet how many women in their twenties are likely to want to pay about £3,000 for an invasive 6-week long procedure, and around £300 a year for the storage of frozen eggs which they may never need? Fertility is also not just a matter of eggs. It could still be difficult for a woman in her late thirties or her forties to become, and remain, pregnant using an egg frozen in her twenties or thirties, because older mothers have a higher rate of pregnancy complications.
These figures hardly make it surprising that both the British Fertility Society and the Royal College of Obstetricians and Gynaecologists solely endorse the procedure for medical reasons, and not as a lifestyle choice. But these technologies are not just dubious for their promises to women of having a baby; they are doubly dubious for their claims that egg freezing provides women with a ‘choice’ over when they can start a family.
The expansion of egg freezing as a lifestyle choice to some extent removes the decision about whether women want to have children altogether. With its rhetoric of insurance and freedom, egg freezing is made to seem like the sensible option for all women: You may not want children now, but at least if you freeze your eggs you will always have the option. But the decision about when to conceive should be solely the domain of the woman, and it is disturbing that with companies now backing egg freezing – with the expressed intention of letting women delay having babies – there is now an explicit notion that delayed motherhood is the best motherhood. Apple and Facebook may preach the rhetoric of freedom and individual choice, but in reality the process of egg freezing presents women with a whole new social pressure, which is not to have babies – yet.
Source: http://www.varsity.co.uk/comment/9026, by Charlotte Taylor
Couples at risk of passing on certain genetic conditions to their children should be provided with financial support from the Government to undergo the advanced fertility treatment, PGD, a leading fertility doctor has claimed.
PGD (pre-implantation genetic diagnosis) allows people with a specific inherited condition the option of trying to avoid passing it on to their own children.
People who are candidates for PGD include carriers of single gene defects, such as cystic fibrosis (CF), or people who themselves are affected by chromosomal disorders such as Duchenne muscular dystrophy, myotonic dystrophy, haemophilia A and fragile X syndrome.
However, according to Dr John Waterstone, medical director of the Waterstone Clinic, PGD is an expensive treatments and ‘the Government should provide financial support for couples at genetic risk’.
He made his comments following the birth of a baby girl, who is the first in Ireland to be born free of a rare genetic condition, despite both her parents being carriers of the gene that causes it.
The baby was born in mid-September free of Smith-Lemli-Opitz Syndrome, a rare inherited disease which can lead to major physical abnormalities and profound intellectual disabilities.
The parents only discovered that they were both carriers of the gene when their first baby died of the syndrome.
While this is the first baby born free of Smith-Lemli-Opitz Syndrome as a result of PGD, she is the third healthy baby born at the Waterstone Clinic as a result of this fertility treatment.
However, this latest success has prompted Dr Waterstone to call for more financial support for couples.
“The advent of successful PGD has been very encouraging for people at risk of passing on debilitating genetic conditions. PGD however is an expensive treatment. I believe the government should provide financial support for couples at genetic risk.
“Preventing the inheritance of conditions like cystic fibrosis and muscular dystrophy would not only ease the pain and suffering of many children, but would also help reduce the spend on future healthcare services,” he noted.
He pointed out that in the UK, clinics that are licensed to carry out PGD can apply for funding for a couple if they meet the appropraite medical criteria.
The PGD technique involves generating a number of embryos via IVF (in vitro fertilisation). With IVF, a woman’s eggs are fertilised with sperm outside the body in a test tube and the resulting embryo is placed back inside her womb.
In the case of PGD, before the embryos are put into the womb, they are biopsied, which means one cell is carefully removed from each cell. These biopsied cells are then analysed.
Only those embryos that are diagnosed as being unaffected by the particular condition are selected for transfer into the womb of the woman.
http://www.irishhealth.com/article.html?id=24961
An Irish couple who discovered they were both carrying a potentially fatal gene when their first baby died have become proud parents of a girl free from an inherited disease.
The couple had underwent a revolutionary diagnostic process prior to an embryo being implanted.
The baby girl is the first child to be born free from SmithLemliOpitz Syndrome in Ireland after undergoing PreImplantation Genetic Diagnosis (PGD) for the rare inherited disease. The couple, who are in their late 30s and early 40s and from Kerry, underwent PGD at the Waterstone Clinic after they discovered they were both carrying the gene which affects the production of cholesterol and which in turn leads to problems with organs like the heart and kidneys.
The couple learned they were carriers of the mutation gene when their first child died of the genetic disorder. But specialists at the Waterstone Clinic were able to prevent them passing the condition to their second child after undergoing PGD.
The centre’s head of research and development, Dr Xiao Zhang, said it was an important milestone and it follows two cases of children being born – in one case without cystic fibrosis and in the other without another genetic condition, Mucolipidosis, after undergoing PGD at the clinic. “We are really delighted for the couple. It is so important for us here at the clinic to be able to offer an effective PGD service, which requires a number of complex lab techniques to all function perfectly. The ultimate measure of PGD success is a healthy baby,” he said.
The success of the technique has prompted the centre’s medical director, Dr John Waterstone, to urge State funding for the treatment which can be quite expensive. It starts at about €10,000 for cystic fibrosis screening and then increases for rarer genetic conditions
“Preventing the inheritance of conditions like cystic fibrosis and muscular dystrophy would not only ease the pain and suffering of many children, but would also help reduce the spend on future healthcare services,” said Dr Waterstone.
Barry Roche
http://www.irishtimes.com/news/ireland/irish-news/couple-celebrate-birth-of-child-free-of-rare-inherited-disease-1.2373320?mode=print&ot=example.AjaxPageLayout.ot
Scientists recently suggested that even if a woman wanted to have only one child she should not wait past the age of 32 to become a mother.
The so-called fertility calculator was drawn up by scientists in the University of Sheffield who crunched fertility data on more than 58,000 women.
In response, Dr John Waterstone of the Waterstone Clinic said he feels strongly that women in Ireland should be aware of the results revealed by the fertility calculator.
Young people here should be educated on fertility issues while they are still at university and college, he suggested.
He wants to dispel the myth that it is possible for women to wait until they are in their 40s, have IVF fertility treatment and be guaranteed to have a baby.
Women in Ireland are leaving it later in life to have a baby and this is increasing their risk of failing to have children..
Eurostat revealed that 52.7pc of first-time mothers in Ireland are aged between 30 and 39, making them amongst the oldest in Europe.
But older motherhood has its advantages, according to IVF broadcaster Robert Winston.
He says he sees benefits in delaying motherhood.
They have had time to gain skills and education as well as built strong relationships which can provide children with a more stable upbringing.
Health & Living, Irish Independent 28th September 2015
http://www.independent.ie/life/home-garden/irish-experts-fertility-calculator-warning-31558154.html