Woman gives birth to two healthy babies in separate pregnancies after ovarian transplant

For the first time, a woman has given birth to two children after her fertility was restored using transplants of ovarian tissue that had been removed and frozen during her cancer treatment and then restored once she was cured.

Following her ovarian transplant, Mrs Stinne Holm Bergholdt gave birth to a girl in February 2007 after receiving fertility treatment to help her become pregnant. But then, in 2008, she discovered she had conceived a second child naturally and gave birth to another girl in September 2008.

Her doctor, Professor Claus Yding Andersen, reports her case in Europe’s leading reproductive medicine journal Human Reproduction. “This is the first time in the world that a woman has had two children from separate pregnancies as a result of transplanting frozen/thawed ovarian tissue,” he said. “These results support cryopreservation of ovarian tissue as a valid method of fertility preservation and should encourage the development of this technique as a clinical procedure for girls and young women facing treatment that could damage their ovaries.”
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Evaluation of young adults conceived via IVF shows them to be “happy and well adjusted”

A study published on-line this month in the journal Fertility and Sterility shows that young adults conceived via IVF were generally as happy and well adjusted as their peers.

Researchers at Eastern Virginia Medical School’s Jones Institute of Reproductive Medicine questioned a cohort of young adults conceived in that program’s clinic between 1981 and 1990. The Jones Institute was a pioneering center for reproductive medicine, achieving the first IVF birth in the United States in 1981. Researchers contacted the young adults via their parents and received a 31 percent (n=173) response rate to their 90 item questionnaire.

The results showed that when compared to other young adults, the IVF conceived were found to be “healthy and well adjusted with no prevalence of increased susceptibility to chronic diseases.” However the reported incidence of clinical depression and especially ADD/ADHD were higher among IVF offspring.

“This is a significant study and one of a number of long term outcomes studies that are currently being done.” Said James Goldfarb, President of the Society for Assisted Reproductive Technology (SART). “It is comforting to see that the data bears out what we have believed, that children conceived via IVF are generally as healthy as other children, even as those children become adults. While the findings of increased depression and ADD/ADDH is notable, other studies have not shown these increases. We need to continue to do the research that will allow us to discover if there are any areas of concern for IVF children. ” Dr. Goldfarb added.

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Should obese, smoking and alcohol consuming women receive assisted reproduction treatment?

The European Society of Human Reproduction and Embryology (ESHRE) has published a position statement on the impact of the life style factors obesity, smoking and alcohol consumption on natural and medically assisted reproduction.

In a literature study the ESHRE Task Force on Ethics and Law summarised the negative effects of obesity, smoking and drinking on the natural reproductive potential of patients, on IVF results, pregnancy complications and outcomes and finally on the health of the future child. The paper was published online on 19 January 2010 in Europe’s leading reproductive medicine journal Human Reproduction. The group made five recommendations.

1) In view of the risks for the future child, fertility doctors should refuse treatment to women used to more than moderate drinking and who are not willing or able to minimize their alcohol consumption.

2) Treating women with severe or morbid obesity required special justification. The available data suggested that weight loss would incur in a positive reproductive effect, although more data was needed to establish whether assisted reproduction should be made conditional upon prior life-style changes for obese and smoking females.

3) Assisted reproduction should only be conditional upon life style changes, if there was strong evidence that without behavioural modifications there was a risk of serious harm to the child or that the treatment became disproportional in terms of cost-effectiveness or obstetric risks.

4) When making assisted reproduction conditional upon life style modifications, fertility doctors should help patients to achieve the necessary results.

5) More data on obesity, smoking and alcohol consumption as well as other life style factors were necessary to assess reproductive effects. Fertility doctors should continue research in this area.

ESHRE acknowledged that this was a complex issue due to personal, patient, professional and societal responsibilities and also in terms of what these responsibilities meant with regard to safety of mother and child and fair and equitable access to treatment. The respect for patient autonomy needed to be balanced with the moral weight of the interests of society and the future child.

Obesity

According to the group obesity negatively affected reproductive potential through interference with hormonal and metabolic mechanisms leading to lower ovulation frequency and reduced chances of conception. The risk of gestational diabetes increased from twofold in overweight women to eightfold for morbidly obese women. The infants of obese mothers were at risk of perinatal death, congenital abnormalities such as neural tube defects (80% increase) and cardiovascular anomalies (30% increase).

Smoking

The risk of infertility was thought to be twice as high in smokers compared to non-smokers. Female smokers needed more time to become pregnant, were less likely to do so spontaneously and had a higher risk of miscarriage. Having an accelerating effect on oocyte depletion, smoking was suggested to lead to an increase in 10 years with regards to IVF outcome. Lower birth weight, a higher risk of oral facial clefts and Sudden Infant Death Syndrome were associated with maternal smoking. Male smokers were at risk of producing sperm of reduced quality and concentration.

Alcohol Consumption

Reduced conception, lower pregnancy rates and higher miscarriage rates were suggested as adverse effects of alcohol consumption. The known effects of alcohol consumption were summarised under Foetal Alcohol Spectrum Disorders (FASD) such as physical anomalies and behavioural and cognitive deficits. Other risks associated with prenatal alcohol consumption were foetal death, preterm labour and compromised foetal growth.

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Fertility Preservation Decision Making in Cancer Patients

Atlanta, GA – New research presented at the American Society for Reproductive Medicine today highlighted the obstacles facing patients as they make decisions about preserving their reproductive options.

Investigators from Brown University used focus groups to explore the feelings of breast cancer patients about fertility preservation. They found that four main themes emerged for these patients:

1) costs, including time, money and emotional costs,

2) safety of the patient and any offspring,

3) prospects for successful treatment, and

4) having sufficient time to process information about fertility preservation.

Researchers at New York University used a more quantitative methodology to examine similar questions. They enrolled 16 patients in a registry, 11 of whom sought fertility preservation treatments. They found 10 of the 16 felt having a child was the most important thing in their lives. Eleven of them were concerned about the impact of their cancer treatment on their fertility. And 11 were unsure about the level of risks they would undertake to achieve their reproductive goals.

Physicians and nurses have important roles to play in counseling cancer patients about their reproductive options. A team from New York examined the current perceptions and practices of oncology nurses. Using an on-line survey, they found that nurses who were knowledgeable about fertility preservation were more than twice as likely to discus the impact of cancer treatments with their patients. More than 90% of the nurses reported that having guidelines would facilitate better discussion of reproductive issues with their patients.

Physicians’ attitudes about the potential for posthumous parenting were explored by a team from Tampa, Florida. They found a slim majority (50.5%) reported not having a view about posthumous parenting, and only 13% supported it. However, less than a quarter (22.8%) agreed with the statement “Patients with poor prognosis should not pursue fertility preservation.”

“As fertility preservation options for cancer patients continue to improve, the demands for quality information sharing between patients and their doctors and nurses must continue to improve, as well,” said R. Dale McClure, MD, President of the American Society for Reproductive Medicine.

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Reproductive Health Findings for Bariatric Patients: Obesity at Young Age Increases Likelihood of Infertility and Polycystic Ovarian Syndrome; Chances of Pregnancy and Live Birth Are Good

In an observational study of the reproductive health of women undergoing bariatric surgery, researchers analyzed data from 1,538 patients treated at six US clinical sites participating in the Longitudinal Assessment of Bariatric Surgery (LABS) study, supported by the National Institutes of Health.

The participants were measured for height and weight and answered questions about their sexual history, pregnancy history, infertility history, history of polycystic ovarian syndrome (PCOS), history of contraceptive use, and plans for future pregnancy. The participants also completed a validated self-administered weight history, giving their weights at 18, 25 and 30 years.

The researchers found that women who became obese by age 18 were more likely to have a history of infertility and polycystic ovarian syndrome and less likely to become pregnant than women who became obese later in life. However, the overall percentages of LABS-2 participants who had at least one pregnancy (79%) and at least one live birth (74%) were comparable to the general US population.

While about half of the women surveyed between ages 18 and 44 and not reporting menopause, sterilization, partner sterilization, or other impediments to pregnancy said that they would never try to become pregnant after bariatric surgery, 30% of women in this category thought the possibility of future pregnancy was very important. Of those women, almost 33% planned to get pregnant within two years of having bariatric surgery.

“As the incidence of obesity increases in the United States, women’s health care practitioners are likely to care for a substantial number of patients who will undergo bariatric surgery. Studies like this one are extremely useful to help us determine how to advise these patients and best meet their needs,” remarked William Gibbons, MD, President-Elect of the American Society for Reproductive Medicine.

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A quick and accurate way of diagnosing endometriosis

A quick and accurate test for endometriosis that does not require surgery has been developed by researchers from Australia, Jordan and Belgium, according to new research published online in Europe’s leading reproductive medicine journal Human Reproduction .

Until now there has been no way of accurately diagnosing endometriosis apart from laparoscopy – an invasive surgical procedure – and this often leads to women waiting for years in pain and discomfort before their condition is identified correctly and treated.

Now researchers at the University of Sydney and Mu’tah University in Karak, Jordan, have discovered that if they take a small sample of the endometrium (the lining of the uterus), which can be done by inserting the device for taking the biopsy via the vagina, and then test for the presence of nerve fibres in the sample, they can diagnose whether or not endometriosis is present with nearly 100% accuracy.

Endometriosis, which has been estimated to affect 10-15% of women of reproductive age, is a chronic gynaecological disease in which cells from the endometrium establish themselves outside the uterus, within a woman’s pelvic area. Symptoms associated with it include infertility, painful periods, pelvic pain and pain during sexual intercourse. Once laparoscopy has identified endometriosis as the cause of these symptoms, treatment involves surgical removal (usually via laparoscopy) of the abnormally sited endometrial cells. However, laparoscopy itself can be associated with complications and can adversely affect fertility in women who do not have endometriosis.

In a separate study also published online in Human Reproduction, another research group from Belgium and Hungary has found that the density of nerve fibres in the endometrium was about 14 times higher in women with endometriosis than in healthy women, and that using specific markers to identify the presence of nerve fibres could predict with nearly 100% accuracy the presence of minimal to mild endometriosis.

In the first study, led by Professor Ian S. Fraser, head of the Queen Elizabeth II Research Institute for Mothers and Infants at the University of Sydney and Dr Moamar Al-Jefout, assistant professor in reproductive medicine at Mu’tah University, researchers took endometrial biopsies from 99 women who had consulted doctors about pelvic pain, infertility or both and who were undergoing laparoscopy for the condition.

The results from the endometrial biopsies were compared with the results of the laparoscopies, and the researchers found that in 64 women who had endometriosis confirmed by laparoscopy, all but one tested positive for the presence of nerve fibres in the endometrial biopsy. In the 35 women who were found not to have endometriosis by laparoscopy, no nerve fibres were found in 29 of the endometrial biopsies. In the other six cases, the biopsy found there were nerve fibres present; three of these women had severely painful periods and painful sex, and also a history of infertility, and of the other three, one had adhesions that were considered too slight to be endometriosis, while the other had a previous history of endometriosis.

Women with endometriosis and painful symptoms had significantly higher nerve fibre density in comparison with women with infertility but no pain (2.3 nerve fibres per mm2 compared to 0.8 per mm2 respectively). The mean average of nerve fibre density in the women with a laparoscopic diagnosis of endometriosis was 2.7 per mm2.

The study showed that testing endometrial biopsies for the presence of nerve fibres was able to diagnose endometriosis with 83% specificity (the proportion of negative cases of endometriosis correctly identified) and 98% sensitivity (proportion of positive cases correctly identified). This double blind study confirmed the results of a pilot study published in 2007 by the same group.

Dr Al-Jefout said: “This study has shown that testing for nerve fibres in endometrial biopsies is a valid and highly accurate diagnostic test for endometriosis. This test is probably as accurate as assessment via laparoscopy, the current gold standard, especially as it is unclear how often endometriosis is overlooked, even by experienced gynaecologists. Endometrial biopsy is clearly less invasive than laparoscopy, and this test could help to reduce the current lengthy delay in diagnosis of the condition, as well as allowing more effective planning for formal surgical or long-term medical management. It may be particularly helpful in cases of infertility.”

Currently, diagnosing endometriosis via laparoscopy involves the woman being booked into hospital for the surgical procedure, an anaesthetic, and the presence of doctors, nurses and expensive equipment. In some countries there are long waiting lists for operations. In contrast, taking an endometrial biopsy is relatively quick and easy to organise and perform, and results are available within about three days. However, Dr Al-Jefout said: “It needs to be emphasised that this test requires a carefully collected endometrial biopsy and an experienced immunohistochemical pathology laboratory to confirm or exclude the presence of nerve fibres.”

He continued: “Our results indicate that a negative endometrial biopsy result would miss endometriosis in only one percent of women. Performing a planned laparoscopy only on a woman with a positive endometrial biopsy result would result in endometriosis being confirmed in eighty to ninety percent of these women. Thus, using this diagnostic test in an infertility workup would significantly reduce the number of laparoscopies performed without reducing the number of women whose endometriosis is diagnosed and surgically treated.”

In addition, he said it could be particularly useful in teenagers with spasmodic symptoms but a family history of endometriosis. “The usual diagnostic delay in this special group is greater than in older women. An endometrial biopsy to confirm or exclude the diagnosis of endometriosis will help initiating earlier treatment and possibly preventing the progress of endometriosis, thus improving life style and protecting their future fertility.”

The researchers plan to continue using the test in patients and to search for other markers to help refine the test further. “Ideally, we would like to develop a blood test as an even simpler means of providing early information on the presence or absence of endometriosis in order to assist doctors in early diagnosis. However, this endometrial biopsy test has proven so effective that it is currently the only test which appears to have equivalent efficacy to a diagnostic laparoscopy carried out by an experienced gynaecologist,” he concluded.

In the second study, led by Professor Thomas D’Hooghe, coordinator of the University of Leuven Fertility Centre (Belgium), researchers looked at 40 endometrial samples, half taken from women with minimal to mild endometriosis diagnosed by laparoscopy and histology (microscopic examination of tissue), and half from women without the condition. They analysed the tissues for several markers indicating the presence of four types of nerve fibres (sensory C, A?, adrenergic and cholinergic nerve fibres).

Dr Attila Bokor, a doctoral fellow at the University of Leuven, who did the study as part of his PhD project said: “We observed nerve fibres in the endometrial samples of ninety percent (18 out of 20) of the women with endometriosis. The density varied throughout the samples, with few specimens showing counts above 30 per mm2, and with most between 0 and 10 per mm2. None, or very few, nerve fibres, were detected in any of the samples from women without endometriosis. The density of the small nerve fibres was about 14 times higher in endometrium from patients with minimal to mild endometriosis when compared with women with a normal pelvis.”

Prof D’Hooghe said: “Our data show that the combination of three different neural markers increases the sensitivity, specificity and diagnostic accuracy of this method of testing for endometriosis. The test diagnosed endometriosis with 95% sensitivity and 100% specificity.”

Dr Bokor and the team of Prof D’Hooghe will do a blinded validation study in September 2009 to confirm the results of their research. “If this confirms our findings, we believe our research can be a solid base for a simple, reliable and relatively cheap method for non-invasive diagnosis of minimal and mild endometriosis, since trans-cervical endometrium sampling and immunohistochemical analysis are routine gynaecological and pathological procedures. Our research programme is also aimed at discovering new biomarkers that can enable a blood test for endometriosis to be developed,” said Prof D’Hooghe.

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Source: eshre.com

Céline Dion Pregnant with Embryo Frozen for Eight Years

 Céline Dion, known for belting out pop songs with window-rattling power, will be fine-tuning her repertoire of lullabies with the news today that she’s pregnant with her second child.

It’s an arrival Dion mused about almost nine years ago when she was expecting her first baby, Rene-Charles.

When Rene-Charles was conceived through in vitro fertilization at a world-renowned New York clinic, Dion told interviewers at the time that a sibling was already in the works.

The pop megastar and her husband, Rene Angelil, got the good news of the latest infant on Monday after undergoing another round of fertility treatments.

“Celine is very, very happy,” Murielle Blondeau, a spokeswoman for Dion, said today when she confirmed the pregnancy.

“Celine and Rene are full of joy. It’s been a big dream for Celine to have a second child.”

Although Rene-Charles and the new baby are siblings, fertility experts say they are not twins. Identical twins are created from a single embryo that splits in the womb while fraternal twins come from different embryos that are carried at the same time.

Dr. Seang Lin Tan, a world-renowned fertility expert at the McGill University Reproductive Centre in Montreal, said there are documented cases where frozen embryos have been successfully used after two decades.

“There have been babies born who are healthy after the embryos have been frozen for 20 years,” he said.

Dion’s first pregnancy was well-documented, unlike that of fellow music megastar Shania Twain, who virtually disappeared while waiting to give birth around the same time.

The revelation that Dion was pregnant with Rene-Charles followed a jaw-dropping announcement that she would retire from performing to have a family.

She gave interviews about her pregnancy in which she chatted about how the frozen eggs might one day become a “brother or sister” to Rene-Charles, and she appeared in a series of photos showcasing her protruding belly.

Dion has said that she and her husband turned to medical science to help conceive because Angelil had been diagnosed with cancer in 1999.

After a neck tumour was removed, he was treated with radiation and chemotherapy which are known to affect fertility. Angelil’s cancer went into remission.

Dr. Zev Rosenwaks, who counselled the couple on their fertility options, told The Canadian Press in a 2000 interview that Dion had an intracytoplasmic sperm injection, in which a single sperm is injected into the egg.

Rosenwaks, who works with the Weill Cornell fertility clinic, said in the interview that Angelil had previously frozen his sperm.

The second fertilized egg was frozen five days after conception and stored at the New York clinic, Dion said in the television interview.

Tan said there is no real concern about Dion giving birth at age 41 and he noted the embryos were also frozen when she was much younger.

He said he hopes Dion’s pregnancy will draw attention to in vitro fertilization.

“Apparently when she got pregnant the first time, the popularity of in vitro in Canada went up quite a bit,” he said.

Source: thestar.com

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Accelerated Fertility Treatment Leads to Shortened Time to Pregnancy and Charge Savings

For couples beginning infertility treatments, an accelerated path to IVF omitting the gonadotropin-stimulated artificial insemination cycles that conventionally precede assisted reproductive technology results in a shorter time to pregnancy. The accelerated treatment program also results in lower average charges per delivery.

Couples with unexplained infertility seeking treatment at Boston IVF or Harvard Vanguard Medical Associates were screened for eligibility to participate in the randomized, controlled trial. Eligibility criteria included: trying to conceive for 12 months without prior fertility treatment (excepting up to three cycles of clomiphene without intrauterine insemination (IUI)); a female partner 21 to 39 years old with sufficient ovarian reserve and without pelvic pathology; and adequate sperm concentration in the male partner.

Couples enrolled in the study followed either a conventional course of treatment or an accelerated course until they achieved pregnancy or elected to stop treatment. The conventional treatment included three IUI cycles stimulated with clomiphene citrate for ovulation induction, followed by three FSH-stimulated IUI cycles, then up to six cycles of IVF. The accelerated treatment plan omitted the FSH-stimulated cycles and went to IVF after three clomiphene-stimulated IUIs. The couples were followed from the date of their enrollment until the closing date of the study. Charge data obtained from insurers included all healthcare items and services for women during the trial- from the time of randomization through hospital discharge of mother and baby after delivery, or until one year after completing treatment without pregnancy.

Of 503 couples enrolled, 64% delivered at least one baby by the end of the study. Babies were born to 150/247 couples in the conventional treatment group and to 171/256 couples in accelerated treatment. The time to pregnancy was significantly shortened for the couples in the accelerated arm of the study. Those couples achieved pregnancy in an average of eight months compared with an average time to pregnancy of 11 months for couples in the conventional arm.

Insurance charge data were collected for 448 participating couples. Average charges per delivery were $9,800 lower in the accelerated arm than for conventional treatment. Savings of $2,624 per couple were observed in the accelerated treatment arm.

Foregoing gonadotropin-stimulated IUI eliminated not only the charges for that treatment from overall charges, but also reduced the risk of multiple conception and the increased charges associated with multiple pregnancies and births.

Elizabeth Ginsburg, President of the Society for Assisted Reproductive Technology, commented, “This is a very important study that will likely influence physicians to reduce the number of stimulated inseminations for patients with unexplained infertility. Adoption of such an accelerated course of treatment could result in many patients conceiving in less time with less expense.”