Study finds association between the number of eggs and live birth in IVF treatment

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An analysis of over 400,000 IVF cycles in the UK has shown that doctors should aim to retrieve around 15 eggs from a woman’s ovaries in a single cycle in order to have the best chance of achieving a live birth after assisted reproduction technology.

The study, which is published online in Europe’s leading reproductive medicine journal Human Reproduction, found that there was a strong relationship between live birth rates and the number of eggs retrieved in one cycle. The live birth rate rose with an increasing number of eggs up to about 15; it levelled off between 15 and 20 eggs, and then steadily declined beyond 20 eggs.

One of the authors of the study, Dr Arri Coomarasamy, said: “This is the first study to look at the association between the number of eggs and live births. Some smaller studies have reported previously on the association between egg numbers and pregnancy rates, but not live births. This is also the first study to devise a graph that can be used by patients and clinicians to estimate the chances of a live birth for a given number of eggs.”

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IVF Babies’ Birth Outcomes are Influenced by Treatment Type and Diagnosis of Infertility

In a new study published in Fertility and Sterility, researchers observed that differences in obstetrical outcomes for singleton pregnancies in patients using assisted reproductive technology (ART) depend on which techniques the patients used and their infertility diagnoses.  These findings indicate that the uterine environment is perhaps the most important influence on the key outcomes of birth weight and length of gestation in ART pregnancies.

William Gibbons, MD and his colleagues Marcelle Cedars, MD and Roberta Ness, MD, MPH reviewed data collected by the Society for Assisted Reproductive Technologies (SART) for the years 2004 through 2006 and compared average birth weight and gestational age for singletons born as a result of standard IVF, IVF with donor eggs, and IVF with a gestational carrier.  The data were further analyzed in relation to the patient’s primary diagnosis and whether donor sperm or sperm from the patient’s partner were used.

They found that the birth weight associated with standard In Vitro Fertilization (in which the patient carried the embryo created with her own egg) was greater than that associated with donor egg cycles and less than that in gestational carrier cycles.  This finding held true even when other factors, including mother’s age, number of fetal heartbeats in the first trimester, and male factor were considered.  While a diagnosis of male factor infertility did not affect birth weight or gestational age, every “female” diagnosis was associated with lower birth weight and, except for “unexplained” infertility, a reduced gestational age.  Patients diagnosed with “uterine factor” had babies with the lowest birth weights and gestational ages.

The uterine environment as related to treatment type was also considered. In standard IVF an embryo is transferred to a woman who has just undergone controlled ovarian hyperstimulation, while in donor egg IVF and gestational carrier IVF, the embryo is transferred to a “natural” or unstimulated uterus.  Therefore the researchers looked at IVF utilizing frozen embryo transfer- in which an embryo created with a patient’s own egg is transferred to her own unstimulated uterus- for additional information. They found that babies born of frozen embryo transfer cycles had markedly greater birth weights than those born as a result of standard IVF.

R. Stan Williams, MD, President of the Society for Assisted Reproductive Technology, observed, “The study shows that many interrelated factors affect the health of babies conceived using ART.  Studies like this one increase our understanding and show us where further research may enable us to improve outcomes for our patients.”

Source: American Society for Reproductive Medicine

Nobel Prize for the development of human In Vitro Fertilization

Robert Edwards is awarded the 2010 Nobel Prize for the development of human in vitro fertilization (IVF) therapy. His achievements have made it possible to treat infertility, a medical condition afflicting a large proportion of humanity including more than 10% of all couples worldwide.

As early as the 1950s, Edwards had the vision that IVF could be useful as a treatment for infertility. He worked systematically to realize his goal, discovered important principles for human fertilization, and succeeded in accomplishing fertilization of human egg cells in test tubes (or more precisely, cell culture dishes). His efforts were finally crowned by success on 25 July, 1978, when the world’s first “test tube baby” was born. During the following years, Edwards and his co-workers refined IVF technology and shared it with colleagues around the world.

Approximately four million individuals have so far been born following IVF. Many of them are now adult and some have already become parents. A new field of medicine has emerged, with Robert Edwards leading the process all the way from the fundamental discoveries to the current, successful IVF therapy. His contributions represent a milestone in the development of modern medicine.

Infertility – a medical and psychological problem

More than 10% of all couples worldwide are infertile. For many of them, this is a great disappointment and for some causes lifelong psychological trauma. Medicine has had limited opportunities to help these individuals in the past. Today, the situation is entirely different. In vitro fertilization (IVF) is an established therapy when sperm and egg cannot meet inside the body.

Basic research bears fruit

The British scientist Robert Edwards began his fundamental research on the biology of fertilization in the 1950s. He soon realized that fertilization outside the body could represent a possible treatment of infertility. Other scientists had shown that egg cells from rabbits could be fertilized in test tubes when sperm was added, giving rise to offspring. Edwards decided to investigate if similar methods could be used to fertilize human egg cells.

It turned out that human eggs have an entirely different life cycle than those of rabbits.  In a series of experimental studies conducted together with several different co-workers, Edwards made a number of fundamental discoveries. He clarified how human eggs mature, how different hormones regulate their maturation, and at which time point the eggs are susceptible to the fertilizing sperm. He also determined the conditions under which sperm is activated and has the capacity to fertilize the egg. In 1969, his efforts met with success when, for the first time, a human egg was fertilized in a test tube.

In spite of this success, a major problem remained. The fertilized egg did not develop beyond a single cell division. Edwards suspected that eggs that had matured in the ovaries before they were removed for IVF would function better, and looked for possible ways to obtain such eggs in a safe way.

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IVF Kids Are Healthy, Smart and Well-Behaved

Atlanta, GA – Research presented at ASRM’s 65th Annual Meeting addressed questions about how Assisted Reproductive Technology (ART) might affect the development of the children who result.

Surveying parents, University of Pennsylvania researchers found that children conceived with In Vitro Fertilization (IVF) showed the same number of abnormal childhood behaviors as children conceived without IVF as measured by a validated behavioral assessment instrument. Women who delivered a child at the University of Pennsylvania Hospital between 2000 and 2005 were invited to answer a questionnaire and the Child Behavior Checklist. In total, those who responded had 105 IVF-conceived children and 108 control children. The groups were not different with respect to child age, pregnancy complications, birth weight, gestational age or maternal education. There were statistically significant differences in parental age and family size that are not clinically significant. There were no significant differences between the groups in the prevalence of individual behavioral symptoms. The prevalence of any behavioral symptom was similar between children conceived with (10.5%) and without IVF (10.2%).

In the largest report on achievement test performance of IVF-conceived children to date, researchers from the University of Iowa used scores from the Iowa Tests of Basic Skills (ITBS) to compare achievement test performance of singletons, twins and triplet children conceived through IVF. The IVF database at the University of Iowa Hospital Center was mined for cycles resulting in children presently between eight and 17 years old. Questionnaires on the childrens’ health and education and parents’ education were mailed to parents and 295 couples having 462 children agreed to participate. Of the children, 49% were singletons; 40% were twins and 11% were triplets. Third grade ITBS scores were used to compare the performance of singletons, twins and triplets. Although multiple gestation appears to have a slight detrimental effect on standardized test performance, the overall scores were high and the differences between singletons, twins and triplets were small.

Parents’ infertility influences birthweight and size whether their children are conceived through IVF or spontaneously. Although research suggests that babies born as a result of IVF are smaller and have more adverse outcomes than spontaneously conceived children, the underlying health of the parents may play a role in their offspring’s health regardless of the mode of conception. In a retrospective study, researchers at the University of Washington School of Medicine analyzed data from patients receiving an infertility diagnosis who had a live singleton birth at the hospital between 1999 and 2009. Well-dated spontaneous conceptions were analyzed along with pregnancies from ovulation induction (OI) and from fresh, non-donor IVF cycles. They found that the ART-conceived babies were larger in early gestation than OI and spontaneously conceived babies yet in mid-gestation, ART babies were smaller than spontaneously-conceived and equal in size to OI babies. By the time of delivery, OI conceived babies were smaller than babies conceived spontaneously or through ART. Ultimately, singleton IVF babies were not smaller compared to singletons born to spontaneously conceiving infertility patients.

Elizabeth Ginsburg, MD, President of SART, remarked, “The health and development of children born through ART has always been of great concern. While further study is needed on the ways parents’ underlying conditions and fertility treatments may affect children’s development, we can be reassured that overall, ART children appear to be healthy.”

In vitro maturation (IVM) of eggs is a developing technique which allows IVF to be done without ovarian stimulation. Because data are limited on the outcomes for children born from this treatment, French researchers have embarked on an ongoing prospective observational study.

Thirty-five children born from 32 IVM pregnancies were included in the group and compared to IVF/ Intracytoplasmic Sperm Injection (ICSI) children matched for maternal age, gestational age and singleton or twin birth. Children were clinically examined at one year of age. The researchers found that at one year of age, children resulting from IVM procedures do not differ significantly in developmental or clinical respects from children conceived using IVF/ICSI.

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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