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Issue 925 (06 November 2017)

 

Welcome to BioNews by email, published by the Progress Educational Trust, providing you with news, comment and reviews on genetics, assisted conception, embryo/stem cell research and related areas.

Visit the BioNews website at www.bionews.org.uk where you can subscribe for free to receive BioNews by email in one of three formats, and search the archive of more than 6,000 articles.

 

 

CONTENTS

Comment

News Digest

Reviews

 


 

Embryo adoption in the US: Any lessons for the UK?

06 November 2017

By Dr Lucy Frith, Dr Steve Lui and Professor Eric Blyth

Page URL: http://www.bionews.org.uk/page_904494.asp Appeared in BioNews 925

Once a couple or individual has finished their fertility treatment, the question of what to do with any remaining frozen embryos is often perceived as a difficult decision. There are, broadly, four options to choose from: keep the embryos in storage; allow them to be destroyed; make them available for research; or donate them to others to use for family-building. Recently we conducted a study of embryo donors and recipients of donated embryos who had pursued the fourth option through an American embryo adoption agency, Snowflakes. We were interested in exploring what kind of contact they had established with each other both during and after the donation process (Blyth et al, in press; Frith et al, 2017).

Embryo adoption is a form of conditional donation – donors can choose who receives their embryo(s) and contact between the parties can be negotiated. This has been pioneered by private agencies in the USA over the past two decades and, in a different form, New Zealand (Goedeke et al 2015). Embryo adoption agencies such as Snowflakes provide donors with information about potential recipients (ie details about their religious beliefs, education, interests and family life). Also, if the donors and recipients are agreeable, they can arrange to have contact with each other. This offers an alternative to fertility clinic-based, anonymous embryo donation programmes.

We found that the donors felt a sense of responsibility towards their embryos and wanted to make sure they went to a 'good home'. Both donors and recipients thought that being open with their children about their origins was important. One of the defining characteristics of embryo adoption is information exchange and the possibility of ongoing contact between donor and recipient families. Hence, our participants wanted to share information about the children and keep in contact with each other, and some donors and recipient couples had met face-to-face.

Our study showed how donors and recipients can acknowledge each other's role in the lives of their own family and establish meaningful relationships. While developing successful relationships within the context of this novel family form was not necessarily problem-free, most study participants reported mutually satisfactory arrangements and, on the whole, participants were happy with the amount and type of contact they had. All participants expected that existing inter-family communication and contact arrangements would develop. In cases where the contact did not yet involve the children, it was seen as a way of keeping the channels open. In the future, participants expected that the children would take a more participatory role and eventually take responsibility for the contact arrangements themselves. Our study suggests that this model of open embryo donation better addresses the needs of some potential embryo donors and recipients than anonymous embryo donation.

How such a model of donation might be realised in other contexts is an area for further research. For example, currently in the UK, although donor-conceived people may discover the identity of their donors once they reach adulthood, conditional embryo donation is not available. When a couple donate their embryo, they usually have no say in who receives it, and there is no contact between the donors and potential recipients. However, legally, there is nothing preventing clinics from starting such a programme since donation can take place between donors and recipients who know each other. Also, the Human Fertilisation and Embryology Authority, allows donors to put extra conditions on the use of their gametes or embryos, which, theoretically at least, gives the donors some potential say in choosing who gets their embryo(s) (Frith and Blyth, 2013).

Under UK legislation, there are some limitations on the potential extension of conditional donation. For example, the Equality Act prohibits discrimination on certain grounds, such as gender and sexuality. How clinics can and should monitor such choices is a difficult question, but one solution would be to counsel people with embryos to encourage choices that are not discriminatory.

There could also be practical difficulties regarding organisational arrangements and the associated costs involved. However, if there was sufficient demand for a conditional embryo donation programme, such practical difficulties could be overcome.

So should we begin to think about conditional embryo donation in the UK? Without any evidence to suggest that this form of embryo donation is harmful, there is no reason why it should not be offered. Conditional embryo donation could operate alongside, rather than replace, existing embryo donation programmes. This could give those who wanted it the opportunity to choose who they donate to and to have contact with them while the child is growing up. 

SOURCES & REFERENCES
Blyth, E., Lui, S. and Frith, L. (in press) Relationships and boundaries between provider and recipient families following embryo adoption
Families, Relationships and Societies | 
 
Human Reproduction | 01 May 2017
 
Bioethics | 29 June 2013
 
Human Reproduction | 01 October 2015
 

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

16 October 2017 - by Dr Kay Elder 
Successful IVF treatment crucially depends on the culture systems used, which must provide an optimal environment for healthy embryo development. Yet most embryos arrest in culture; human embryo culture has long been based upon research into animal systems...
05 June 2017 - by Professor Vardit Ravitsky, Dr Juliet Guichon, Marie-Eve Lemoine, and Professor Michelle Giroux 
In his commentary, Professor Guido Pennings argues there is no empirical evidence to support the assumption that it is in the best interests of children to know that they are donor conceived. We would like to add another layer to the critique, by focusing on the conceptual foundation underlying the right of donor-conceived people to know their genetic origins...
03 October 2016 - by Antony Blackburn-Starza 
This collection of essays from leading lawyers, fertility professionals, social scientists, ethicists, and others documents the experiences of families engaging in assisted conception, adding to the growing body of empirical studies in this area...

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Fertility Fairness and the IVF postcode lottery

06 November 2017

By Sarah Norcross

Page URL: http://www.bionews.org.uk/page_907429.asp Appeared in BioNews 925

The campaign group Fertility Fairness has published data showing that access to publicly funded fertility treatment is inconsistent, and worsening, across England (see BioNews 924).

These findings have received widespread media coverage, with Sarah Norcross - Co-Chair of Fertility Fairness, and Director of the Progress Educational Trust (the charity which publishes BioNews) - giving numerous TV and radio interviews.

Watch Sarah interviewed on Good Morning Britain. (If you cannot see the film below, click here to view it.)

Also watch Sarah interviewed on ITV News, by clicking here.

Sarah has given interviews to more than 10 different local radio stations, discussing the fertility funding situation in their area. Click on the links below to listen to these interviews.

Sarah has also been quoted in numerous articles about the Fertility Fairness findings. See her quoted in the national media:

And in the local media:

SOURCES & REFERENCES

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

11 December 2017 - by Eleanor Taylor 
Despite concerted efforts to reduce the stigma surrounding fertility struggles, there still appears to be a 'facelessness' to this incredibly common issue, which suggests that fertility is still very much a taboo subject...

30 October 2017 - by Shaoni Bhattacharya 
Access to IVF in England has worsened considerably over the last five years, according to data obtained by Fertility Fairness...
14 August 2017 - by Dr Kimberley Bryon-Dodd 
Funding cuts by the UK's National Health Service has meant that 13 areas in England have restricted or halted IVF treatment since the start of 2017, according to Fertility Network UK...
27 March 2017 - by Rikita Patel 
New patients referred for infertility treatment by their doctors will now have access to three cycles of IVF on the NHS in Scotland...
20 March 2017 - by Sarah Pritchard 
Croydon has become the first Clinical Commissioning Group in London to cut funding for all IVF treatment, other than in 'exceptional circumstances'...
20 February 2017 - by Sarah Pritchard 
New proposals from Richmond Clinical Commissioning Group (CCG) could see NHS-funded IVF treatment available only in 'exceptional circumstances', such as for patients with HIV or cancer...

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Red wine improves women's fertility – an example of scientific misrepresentation in the press

06 November 2017

By Professor Joyce Harper

Professor Harper is director of education and head of the department of reproductive health at the Institute for Women's Health and founder of www.globalwomenconnected.com

Page URL: http://www.bionews.org.uk/page_907434.asp Appeared in BioNews 925

The American Society for Reproductive Medicine (ASRM) conference was held last week in San Antonio, USA. Several oral presentations of abstracts made it into the popular press and have added to the confusion and inaccurate information fed to the public.

The most worrying example of this was a study entitled 'Does alcohol intake impact ovarian reserve?' by Dr Ashley Eskew at Washington University et al.

As advisers to the Science Media Centre (SMC), myself and other professionals were asked to comment on the abstract.  Eight of us supplied quotes, all of which said the study was too small to draw any conclusions. Professor David Spiegelhalter, Winton professor for the public understanding of risk at University of Cambridge, summed it up: 'This is absurd – a weak conference abstract based on 135 women with a "trend towards significance".'

But this is not how the science correspondents of the UK's popular press reported the oral presentation. The Times headline was 'Women who have regular glass of red found to be more fertile'. The Daily Mail said 'Five glasses of red wine a month could HELP you get pregnant after medics find link between drink and healthier ovaries' and The Telegraph reported 'How a weekly glass of red could boost a woman's chances of becoming pregnant'.

The main problem with reporting any oral presentation from a conference in the press is that in the majority of cases, this is preliminary work that has not been published. Many oral presentations will never see the light of day as a fully published paper.

In this particular case there were several issues. The authors asked 135 women to complete a detailed questionnaire about their dietary habits and compared the alcohol they consumed to their antral follicle count.

The first issue is that the sample size is not large enough to reach any meaningful conclusions, and is too small to take into account confounding factors such as ethnicity, diet, lifestyle and fertility history. The authors only accounted for age and body mass index.

But the biggest flaw is that there is no evidence that measuring the antral follicle count has any clinical value. IVF clinics routinely measure biomarkers including antral follicle count, follicle stimulating hormone (FSH) and anti-Mullerian hormone (AMH) to check ovarian reserve (a measure of how many eggs a woman has in her ovaries) so they can decide which dose of fertility drugs they should give a patient. However there is no scientific evidence that this commonly marketed ovarian reserve test –the so-called 'fertility MOT'– can be used as a predictor of fertility potential, as confirmed in a study published two weeks ago by Dr Anne Steiner and colleagues at the University of North Carolina in Chapel Hill, North Carolina (see BioNews 922). 

I recently attended a science media training event at the Crick Institute in London. We were introduced to four science correspondents and the question was asked: 'How many of you have a science degree?'

You can guess the answer. We were told that journalists do not feel they need a science degree to report on science. One of them said that if they had been a war correspondent, we would not expect them to have been to war. Obviously the analogy is ridiculous. We need to ensure that science correspondents report accurate information on published scientific studies or official reports. As scientists – we hope that journalists will listen to our comments, such as those provided by experts to the SMC, and ask for our advice as much as possible.  

In the future, let's hope we can work harmoniously with journalists to engage the public about science.

SOURCES & REFERENCES

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Financial incentives in Australia change doctors' IVF advice

03 November 2017

By Georgia Everett

Page URL: http://www.bionews.org.uk/page_907161.asp Appeared in BioNews 925

Australian bioethicists have expressed concern that the country's assisted reproductive technology (ART) industry has become increasingly motivated by profit, causing a conflict of interest.

Research published last week in Human Fertility suggested that some fertility doctors are over-selling ART treatments, commonly offering IVF to patients who do not necessarily need it, or offering repeated IVF cycles to patients where it is known that the chances of success are minimal.

Lead author Dr Brette Blakely explained that by offering IVF to those who are better suited to less invasive treatments, such as intrauterine insemination, the clinicians are attempting to 'mislead future patients who might be tempted to seek unwarranted treatment by high-reported success rates based on women who do not represent the average IVF patient'.

The study, run by researchers at Macquarie University and Sydney University, interviewed eight individuals employed in the IVF industry, including clinicians and fertility counsellors. Most participants in the study expressed a belief that commercial and financial interests impact the level of patient commitment and care from the clinician.

The conflict of interest may risk a patient's physical health as well as being and emotionally and financially draining: ovarian stimulation and egg retrieval during IVF can have harmful side effects.

Dr Blakely, a bioethicist at the Australian Institute of Health Innovation at Macquarie University, explains that 'moderate to severe ovarian hyperstimulation syndrome may occur in one to five percent of treatment cycles and this may result in significant morbidity and can, in rare cases, be fatal'.

The authors also suggested that clinicians are misusing the Medicare system, whereby women whom are eligible for IVF can received an unlimited number of subsidised cycles. By encouraging the use of these unlimited cycles, the clinician appears to be promoting an affordable treatment, but in reality patients still face substantial out-of-pocket costs while clinicians receive large fees, plus extra income from additional services.

Professor Michael Chapman, president of Fertility Society of Australia, criticised the design of the study and said that there is no evidence of clinicians over-selling ART. Chapman argued in the Sydney Morning Herald that '[the] selection of only eight specialists seems likely to be biased given there are over 150 specialists practicing in Australia, and [the researchers] admit to being 'selective' in their comments to illustrate their argument'.

While the issue was investigated on a very small scale, the researchers hope that their 'findings have important conceptual and practical implications and set the terms for a more robust professional and public discourse'.

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

11 September 2017 - by Professor Alan Trounson and Dr Karin Hammarberg 
In Australia, almost four percent of children are born as a result of assisted reproductive technologies. The comparatively high rate of ART use is in part due to costs being covered by the taxpayer-funded health insurance scheme, Medicare...
29 August 2017 - by Shaoni Bhattacharya 
Treatment costs for IVF may be coming down in Australia as a result of a price war between fertility clinics...
08 May 2017 - by Dr Jane Williams 
Australia's key body for medical research released a new set of ethical guidelines last month on the use of Assisted Reproduction Technologies with a welcome and unusual surprise: a section on conflicts of interest...
21 November 2016 - by Rikita Patel 
A number of Australian IVF clinics are potentially misleading patients about their success rates, a consumer watchdog has warned...

HAVE YOUR SAY

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US surrogate fights for own genetic baby

06 November 2017

By Antony Blackburn-Starza

Page URL: http://www.bionews.org.uk/page_906912.asp Appeared in BioNews 925

A US surrogate has been united with her genetic child who she carried alongside the intended parents' embryo in an apparent case of superfetation. 

Jessica Allen acted as a surrogate for a Chinese couple through an agency called Omega Family Global, based in San Diego, for a reported fee of US$35,000 – with an extra US$5000 provided for a second child. While receiving money for surrogacy beyond reasonable expenses is illegal in many US states and also in the UK, commercial surrogacy is permitted in California.

Allen underwent an embryo transfer procedure using the intended parents' embryo in 2016 but was soon told by doctors that she was carrying twins. She told the New York Post that she had assumed the embryo had split into identical twins and handed both children to the intended parents at birth. However, doubts about the genetic parentage of the children were raised after the intended mother noticed differences between the babies and sent photographs to Allen. DNA testing later showed that one of the children was Allen's genetic son, who is believed to have been conceived with her own partner in an extremely rare case of superfetation – the simultaneous occurrence of a second conception during pregnancy.

Speaking to the New York Post, Allen claimed that the surrogacy agency told her that someone else was looking after her genetic son and that the intended parents would be seeking compensation. She also claimed that there was talk about putting the child up for adoption, and that the agency informed her that she owed fees for the expense of caring for the child. Omega Family Global has disputed the allegations.

Allen instructed lawyers and said that the agency then agreed to waive the fees. The claim for compensation was also reportedly dropped. Allen was later handed her son by a caseworker from the agency.

In a statement Omega Family Global said that it 'takes great pride in the care, attention and support that is given to all surrogates', but that due to legal reasons, it could not discuss the allegations in any further detail.

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

11 December 2017 - by Theofanis Michailidis 
A woman who acted as a surrogate for friends has sued the fertility clinic where they were treated, after it transferred one of the unused embryos made using her eggs to impregnate the same couple, without her consent...
13 November 2017 - by Sean Byrne 
A woman has been denied legal parenthood of her surrogate-born child because she is single, despite being the genetic mother...

23 October 2017 - by Dr Mary Yarwood 
A surrogate from Queensland, Australia has had her parental rights removed after a judge decided it was in the baby's best interests...
10 July 2017 - by Jennifer Willows 
A same-sex French couple have won a partial victory in their fight to be recognised as the legal parents of their child, who was born via surrogate in the US...
10 April 2017 - by Jennifer Willows 
A decision granting custody of a baby to a surrogate has been upheld by the Court of Appeal...
16 January 2017 - by Jennifer Willows 
Twin boys born to a same-sex couple through surrogacy do not have the legal status of brothers, according to an Italian court...

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AI test could be first screening tool for ovarian cancer

06 November 2017

By Isobel Steer

Page URL: http://www.bionews.org.uk/page_906938.asp Appeared in BioNews 925

Machine learning has been used to develop a promising screening test for ovarian cancer, a team of US-based researchers has said.

The researchers, based at the Dana-Farber Cancer Institute and the Brigham and Women's Hospital in Boston, used tiny RNA fragments called microRNAs as the basis for the artificial intelligence test, publishing their results in eLife. MicroRNAs are involved in gene activation and circulate in the blood. They act as the copyeditors of the genome.

'Before a gene gets transcribed into a protein, [microRNAs] modify the message, adding proofreading notes to the genome,' said Dr Kevin Elias, from Brigham and Women's Hospital's department of obstetrics and gynecology, lead author of the study.

The team gathered information on microRNAs in blood samples from 135 women before they had surgery or chemotherapy. They used this to train a computer program to differentiate cases of ovarian cancer from benign tumours and healthy tissue.

This program was first tested on data from 859 women with and without ovarian cancer. The sensitivity (not missing any cancers) and specificity (not flagging up healthy people) were better than the current tests for ovarian cancer.

The test was then used to predict the diagnoses of 51 patients in Poland. The test gave results with 91.3 percent sensitivity and 78.6 percent specificity. In other words, if the test says you have cancer, there is around a 1 in 10 chance that it's wrong; if the test says you are healthy, there is a 1 in 5 chance that it's wrong. This level of accuracy is similar to that of a Pap smear test for cervical cancer. 

At the moment, ovarian cancer is typically diagnosed late, which is one of the main reasons for patients' poor survival rate. No FDA-approved screening techniques exist for ovarian cancer. Current early-detection tests have a high false positive rate, resulting in many women being mistakenly told they have cancer when they don't. These tests, such as ultrasound or detection of the protein CA125, are so ineffective that clinical trials have indicated that they have no effect on survival rates.

'The key is that this test is very unlikely to misdiagnose ovarian cancer and give a positive signal when there is no malignant tumour. This is the hallmark of an effective diagnostic test,' said senior author Dr Dipanjan Chowdhury, chief of the division of radiation and genomic stability in the department of radiation oncology at Dana-Farber.

The team will now plan a long-term study following a group of healthy women, to see how their microRNAs change as some develop ovarian cancer. The scientists hope that the test could be used for general population screening, as well as for women at high risk of ovarian cancer.

SOURCES & REFERENCES
eLife | 31 October 2017
 
The Spectator | 11/2017
 
Dana-Farber Cancer Institute | 31 October 2017
 

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

09 October 2017 - by Dr Loredana Guglielmi 
A major breakthrough in understanding how mutations in the BRCA1 gene raise cancer risk has been made by researchers in the USA...
21 August 2017 - by Dr Loredana Guglielmi 
US researchers have developed a new blood test to detect cancer-related DNA alterations before patients experience symptoms...
26 June 2017 - by Lea Goetz 
A study of almost 10,000 women carrying BRCA mutations has revealed the best estimate yet of their risk in developing breast and ovarian cancer...
12 June 2017 - by Dr Loredana Guglielmi 
A drug treatment for ovarian cancer has shown success against inherited breast cancer...

HAVE YOUR SAY

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Twenty-seven genes that suppress cancer discovered

06 November 2017

By Julianna Photopoulos

Page URL: http://www.bionews.org.uk/page_906975.asp Appeared in BioNews 925

Scientists have found 27 new tumour suppressor genes. The discovery, made using a new statistical model, could help develop cancer treatments that target these genes.

'Using this powerful toolkit, we've uncovered rare tumour suppressor genes that when lost in mutated cells cause cancer,' said author Dr Jonas Demeulemeester of the Francis Crick Institute in London. 'This could pave the way for the development of personalised cancer treatments.'

Human cells normally contain two copies of tumour suppressor genes, which help prevent them from turning cancerous. When both of these copies are lost, cells grow and divide uncontrollably forming tumours.

These double-gene abnormalities are hard to identify in cancer cells because tumours often contain both healthy and cancerous cells in unknown proportions. This makes it difficult to determine whether just one or both copies of the gene are missing.

The scientists developed a model that identified single nucleotide polymorphisms across the genome. This allowed them to analyse 2218 tumours across 12 cancer types, including breast, lung and bowel cancer. In every sample, they compared cancerous cells with healthy ones to find out how many copies of each gene there were in the unhealthy cells.

Their findings revealed 96 gene deletions among the tumours, which included 43 suppressor genes. From these, 16 were previously known while 27 were completely new. In addition, the scientists found harmful deletions to have a different 'DNA footprint' than smaller, non-harmful ones.

Senior author Dr Peter Van Loo of the Francis Crick Institute said: 'Our study demonstrates that rare tumour suppressor genes can be identified through large-scale analysis of the number of copies of genes in cancer samples.

'Cancer genomics is a growing area of research, and the computational tools we use are a powerful way to find new genes involved in cancer.'

The study was published in Nature Communications.

SOURCES & REFERENCES
The Frances Crick Institute | 31 October 2017
 
Nature Communications | 31 October 2017
 
Medical News Today | 11/2017
 

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

30 October 2017 - by Annabel Slater 
Two studies have discovered 72 new genetic variants associated with the risk of developing breast cancer...
19 October 2017 - by Charlott Repschlager 
Between one and 10 mutations are required for a healthy cell to turn cancerous...

HAVE YOUR SAY

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Male infertility care 'insensitive' says survey

06 November 2017

By Lea Goetz

Page URL: http://www.bionews.org.uk/page_907066.asp Appeared in BioNews 925

Men with infertility experience stigmatisation and a lack of support, a first survey on the subject found.

In spite of male infertility being the cause in 40 percent of cases of couples who can’t conceive, fertility care is often 'female-focused' according to the charity Fertility Network UK, which carried out the study with researchers at Leeds Beckett University.

'Men are half of the fertility equation; when they cannot create the family they long for without medical help they suffer and struggle physically and mentally just as women do,' said Susan Seenan, chief executive of the charity.

Of the 41 men completing the survey, about half had a diagnosis of male infertility. However, only 39 percent had sought support, feeling unable to talk to their partners, family and friends. On average, they had been trying to conceive for five years, and 93 percent reported that this had affected their wellbeing. Men said they felt worthless or 'less of a man'.

'Fertility and fatherhood are really important traditionally for men and masculinity, so men's identity and self-esteem is deeply affected by the process of infertility,' said study author Professor Brendan Gough at Leeds Beckett.

With infertility treatments based around women, men felt marginalised. 'The whole experience has been focused towards my wife… even consultants' letters about my genitalia are addressed to my wife,' said one man.

Furthermore, men reported that their infertility was not being treated like other medical conditions, and that they had encountered 'rude' and 'insensitive' healthcare professionals. 'It's still quite a taboo subject - made even worse when you're made to feel like you're wasting NHS time and resources,' Gareth Down, a patient who started a support group, told the BBC.

The men said they want to see a change in how society views fertility issues.

'In light of the findings from the study, we really need to think more about how men might be supported better when they're going through infertility so that they're able to access the advice and information they might need,' said Dr Esmée Hanna, one of the team at Leeds Beckett.

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

16 October 2017 - by Annabel Slater 
An expert in male fertility has called for urgent research into the stark decline reported in Western sperm counts...
21 August 2017 - by Shaoni Bhattacharya 
Cells from genetically infertile male mice have been turned into sperm, and used to produce healthy pups...
31 October 2016 - by Dr Ashley Cartwright 
The US start-up Episona has produced an epigenetic sperm test, which it claims can determine whether sperm will produce 'good' or 'poor' quality embryos...
14 December 2015 - by Ayala Ochert 
Men who have been diagnosed with infertility have a higher risk of developing heart disease and type 2 diabetes, as well as other general health problems, including alcohol abuse and drug abuse...

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Offer all prospective parents genetic screening, says study

06 November 2017

By Ruth Retassie

Page URL: http://www.bionews.org.uk/page_907108.asp Appeared in BioNews 925

Genetic testing for cystic fibrosis, fragile X syndrome and spinal muscular atrophy is recommended for all would-be parents by a study in Australia.

The research is based on data from the Victorian Clinical Genetics Services (VCGS) which began to offer genetic testing in 2012 for these common and severe disorders.

Researchers anaylsed screenings of 12,000 individuals, and discovered that about 5 percent of them - 610 - were carriers of these diseases. This rate is on par with the population risk for Down's syndrome, and supports the stance that people should be routinely tested for these conditions, they said. Of the carriers, 88 percent had no family history and had no reason to suspect they were carrying these genetic disorders.

'There is also a misconception that these types of disorders are only relevant where there is a family history of the condition...but most parents who have a child with one of these disorders have no family history,' said senior author Professor David Amor, who is at the VCGS and Murdoch Children's Research Institute.

Genetic screening is typically done before pregnancy, but can be done during the first 12 weeks of gestation. Couples who are carriers of cystic fibrosis or spinal muscular atrophy have a 25 percent chance of having a baby with that disorder. Women who are carriers of the fragile X syndrome have a 50 percent change of passing on that mutation.

'It's important that all carriers are given the option of genetic counselling so they can discuss the implications of their results with an expert,' said Dr Alison Archibald at the VCGS, and joint first study-author.

Professor Amor added: 'Some couples will decide that [carrier screening] is not for them…but we know from experience that a lot of couples want this type of information.'

The study was published in Genetics in Medicine.

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

20 November 2017 - by Nina Chohan 
The New York fertility clinic Reproductive Medicine Associates is facing two lawsuits from couples whose children, conceived using donor eggs from the centre, have Fragile X syndrome...
20 November 2017 - by Catherine Joynson 
The new 'reflex' method of antenatal screening for Down's, Edwards' and Patau's syndromes was described last week as a 'transformational advance'. It might be cheaper than other approaches, but it could come at the cost of informed choice for pregnant women and couples...

18 September 2017 - by Professor Becki Bennett 
A public event held on 11 September 2017, Manchester by the Progress Educational Trust...
04 September 2017 - by Dr Rachel Huddart 
Current prenatal chromosome screening tests could miss rare chromosomal abnormalities and lead to inaccurate results...
08 February 2016 - by Antony Blackburn-Starza 
A woman is suing healthcare professionals in the USA for failing to detect that she was a carrier of cystic fibrosis...
25 November 2013 - by Dr Felicity Boardman 
I was struck by a recent article that pushed to free Down's syndrome from inappropriate, negative language - that of 'disease', of 'risk' and of 'defect'...

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Transferring just one embryo doubles IVF success

06 November 2017

By Helen Robertson

Page URL: http://www.bionews.org.uk/page_907202.asp Appeared in BioNews 925

Using just one embryo during IVF results in a much higher chance of a healthy pregnancy and birth, according to a study presented at the annual meeting of the American Society for Reproductive Medicine.

The study by scientists at the University of Colorado and Duke University, found that there was twice the likelihood of success if just one embryo was used, after controlling for other factors that influence IVF.

'The most impressive finding that has relevance for all patients undergoing IVF is that performing the transfer with one embryo greatly increases the chance of a healthy baby, the desired objective in IVF,' said Dr Alex Polotsky of CU Advanced Reproductive Medicine, who led the study.

The researchers examined data reported to the Society for Assisted Reproductive Technology from 30,000 patients in the USA who underwent IVF using donor eggs between 2012 and 2014.

The most significant finding was that double and triple embryo transfers were much more prevalent among cycles using fresh eggs, which led to a higher incidence of multiple pregnancies. It is well known that multiple births can be associated with complications for the mother and the child – including premature birth and low birth weight.

The study was also the first to compare success rates of IVF using fresh and frozen eggs. Although implantation rates of embryos were slightly better using fresh donor eggs, there was no difference in the chance of a healthy birth using either fresh or frozen eggs.

In traditional IVF using fresh eggs, the donor egg is immediately fertilised and inserted into the uterus of the recipient. For this to result in successful implantation, the hormonal schedule of the egg donor and the recipient need to be aligned.

Using frozen donor eggs offers a cheaper and more convenient way of carrying out fertility treatment. The practice of freezing eggs and cryogenically storing them for use in IVF is becoming increasingly popular.

Irrespective of the source of the donor egg, the most important factor identified as resulting in a healthy pregnancy and birth was to transfer one, instead of multiple, embryos.

'We encourage patients and physicians alike to set their focus on the horizon of achieving a healthy birth outcome. Just achieving a pregnancy is not sufficient,' said Dr Polotsky.

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TV Review: Inside Out London - Eggs on ice

06 November 2017

By Eleanor Taylor

Page URL: http://www.bionews.org.uk/page_907590.asp Appeared in BioNews 925

Inside Out London: Eggs on Ice

BBC1, Monday 23 October 2017

Presented by Anna Williamson

'Inside Out London: Eggs on Ice', BBC1, Monday 23 October 2017


As a 33-year-old single woman, who also happens to work in a fertility clinic, babies are unsurprisingly never far from my mind. I spend a lot of time wondering whether I should freeze my eggs. A lot. I am very aware that if I do decide to, the sooner that I do it, the greater the likelihood of success. However, without the guarantee of a future child it still feels like too much of a gamble for my risk-adverse nature.

In an attempt to gain some clarity around this issue I have been seeking out the experiences of other women who have taken the decision to freeze their eggs, or who are considering it. A recent episode of the BBC documentary series Inside Out London has provided me with some food for thought as presenter Anna Williamson investigates why 'record numbers of women are putting their eggs on ice'.

Despite the feature only lasting a brief nine minutes of the programme, the producers have managed to create a comprehensive and engaging overview of the social egg freezing process. Viewers are introduced to three women who are at very different stages of their egg freezing journey.

Natasha Jouhl, a 41-year-old opera singer, is seen undergoing the egg retrieval procedure and describes her frozen eggs as her plan B - a form of insurance should plan A not work. Whereas 32-year-old Sharon Jones is considering freezing her eggs because she believes that doing so will 'buy her time'. At the end of the feature, viewers are introduced to 48-year-old Claire Fenelon who has a three-month-old baby, from an egg frozen nine years previously.

These first-hand accounts are complemented by interviews with the medical practitioners and scientists who are providing egg freezing services in London. Taken together, these diverse perspectives are able to capture the biological, emotional and financial complexities that muddy the decision-making process: to freeze, or not to freeze?

The main objective of the programme seems to be educating the public about what the process of egg freezing entails. The motivation that drives women to freeze their eggs is explored, which predominantly seems to be the absence of a secure relationship – a narrative shared by all three women featured in the programme. The physical process of retrieving and freezing eggs is explained and finally, the viewers are shown how the frozen eggs can be used in the future to potentially create a family.

Williamson does a commendable job throughout the programme of trying to strike a balance between highlighting the positive and the negative aspects of egg freezing. However, possibly due to time constraints, the potential pitfalls of the process are often only superficially examined.

Indeed, one of the main things that struck me about the feature is that both the medical professionals and the women having their eggs frozen seemed to be largely unperturbed by the low success rates and the financial costs of the procedure. The success rates of fertility treatment using frozen eggs is currently around 14 percent, although it is thought that this will increase now that the techniques used to freeze eggs have improved. Nevertheless, it is unlikely to greatly surpass the success rates of standard IVF treatment.

There seems to be a disparity in how women view their chances of becoming a mother in the future using their frozen eggs compared with their actual statistical likelihood of success. It is unclear whether this difference comes from the way in which the egg freezing procedure has been explained to these women or whether there is an element of unwavering belief that they will be the one to beat the odds.

The optimistic language that both Natasha and Sharon use throughout the feature jars with the truly uncertain nature of the procedure. Claire's story of freezing her eggs at 39 and becoming a mother at 48 may be exactly why some women gain a false sense of security about their chance of success using frozen eggs. Yes, the likelihood of having a baby from a frozen egg is low, especially if the eggs were frozen after the age of 35. However, it can happen and the promise that it just might work is incredibly seductive. The influence of these miracle stories may also be strengthened by the fact that there are very few alternative fertility-preservation methods. Sometimes taking a leap of faith seems like the best option.

For me, I'm still undecided about whether I should freeze my eggs or not. What I would like to hear, and what the programme may have benefited from, is the perspective of someone whose egg freezing experience was unsuccessful, someone who had frozen their eggs but did not become pregnant when they opted to use them later in life. The programme hinted at the many points where the treatment process could fail. Natasha’s first attempt at freezing her eggs didn't work because the clinic wasn't able to retrieve any eggs. Out of the 11 eggs that Claire thawed, only one went on to create an embryo that could be used in treatment.

It would be both interesting and useful to know how people feel about social egg freezing when it hasn't worked for them. Do they regret their decision? Do they feel they had sufficient information before embarking on treatment? What would they recommend it to other women thinking about freezing their eggs?

Even without this, the programme is undoubtedly interesting, well made and incredibly easy to watch. I would recommend it to anyone who has an interest in fertility issues and especially to women who are considering freezing their eggs.

SOURCES & REFERENCES
BBC iPlayer | 23 October 2017
 

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