- Massive study outlines success for assisted reproductive technology

- Sublimis Argentina offers fertility treatments abroad such as IVF, ICSI and Egg Donation

East Lansing, Mich. — A groundbreaking study of nearly 250,000 U.S. women reveals live birth rates approaching natural fertility can be achieved using assisted reproductive technology, where eggs are removed from a woman’s ovaries, combined with sperm and then returned to the woman’s body.

The research, led by Michigan State University’s Barbara Luke and published in the New England Journal of Medicine, highlights what factors help or hinder getting pregnant using assisted reproductive technology, or ART. The results indicate that when there are favorable patient and embryo characteristics, live birth rates with ART can approach those of natural fertility.

“This is good news for women who are trying to have a child,” said Luke, a researcher in the College of Human Medicine’s Department of Obstetrics, Gynecology and Reproductive Biology.

The number of ART treatments has more than doubled in the past 10 years, and live birth rates traditionally have been reported per cycle, or per one course of treatment. While that is easily calculated and is the method used by national registries across the world, Luke’s team sought to estimate cumulative success rates with continued treatment.

“Women and families want to know the overall chances they will get pregnant, not necessarily whether they will get pregnant during a specific cycle,” Luke said.

Data were obtained from the Society for Assisted Reproductive Technology’s Clinic Outcome Reporting System for women undergoing treatment between 2004 and 2009. The system contains data on more than 90 percent of all clinics performing ART treatments in the United States.

The study of 246,740 women revealed 57 percent of women achieved a live birth via ART treatment, and 30 percent of all ART cycles resulted in a live birth. Success rates declined with increasing age for women using their own eggs, especially for those ages 38 years and older, but not for women using donor eggs.

The estimated natural fertility rate of the general population is about 20 percent per month, and estimated rates of conceiving spontaneously are 45 percent, 65 percent and 85 percent after three, six and 12 months, respectively.

The study looked at factors such as patient age, diagnosis, response to treatment, cryopreservation and the stage at which embryos were transferred. Two major factors that influence ART success are favorable patient characteristics (specifically age) and good embryo quality. Among older women, live birth rates can be substantially improved with continued treatment and a change to donor eggs.

“Although the decision to use donor eggs is a very personal one, these analyses provide information regarding the likelihood of a live birth using this option,” said Luke.

These results also could guide regulations governing health insurance coverage for infertility treatment. The number of treatment cycles covered by insurance is typically limited to two or three. The findings demonstrate that when using a woman’s own eggs, the success rates continue to rise beyond two to three cycles; additionally, the study may help providers and women decide when it is appropriate to change to donor eggs.

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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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.

For more information about In Vitro Fertilization (IVF) please do not hesitate to contact us.

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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USA and International Trends in Assisted Reproductive Technology (ART)

Atlanta, GA – Data released at the American Society for Reproductive Medicine Annual Meeting in Atlanta compares ART trends in the US with those around the world. Using data collected through the International Committee Monitoring ART (ICMART), investigators examined data from 2000- 2004. They found that delivery rates in the US were stable at 31% while they improved in Europe from 16% to 22%.

The delivery rate was maintained in the US even as the number of embryos transferred declined from 3.0 to 2.7 embryos per transfer, and the US triplet rate was cut in half from 4.3% to 2.6%. Only Sweden saw a marked reduction in its twin rate over the period, going from 21.8% to only 5.6%.

The same investigators used 2004 data to examine how economic factors influence the risk and benefit calculations of patients and physicians. They found that in countries where government provides free access to Assisted Reproductive Technology (ART) treatment, the utilization rate for those treatments is much higher. For example, in France there were 2,008 cycles for every million inhabitants, while in the US there were only 357 cycles per million people. Improved access not only raises the utilization rate, but changes outcomes, as well. The number of embryos transferred per cycle and the resulting high order multiple births are highest in those countries that do not provide free access.

This relationship was seen within countries, as well. In the USA, individual states with mandatory insurance coverage for IVF treatments saw different results than states without such a mandate. Researchers at the Yale University School of Medicine found that the number of embryos transferred per cycle, cancellation rate, twin rate and multiple live birth rate were all higher in mandated states than in non-mandated ones.

“These studies make it clear that policies that promote access to infertility treatment also promote making those treatments safer and more effective,” stated Elizabeth Ginsburg, MD, President of the Society for Assisted Reproductive Technology (SART).

Contact us for more information about Assisted Reproductive Technology (ART) treatment; Doctor Andrés Juárez Villanueva and Doctor Gustavo Gallardo will be glad to help you.