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Risk and reward: Methods and morals in bio-preservation

3 November 2008
By Dr Peter Hollands
Senior Lecturer in Biomedical Science, University of Westminster
Appeared in BioNews 482
The recent correspondence on egg vitrification in BioNews (1,2), prompts me to wonder if the pioneering research spirit that started the IVF industry sometimes gets a little carried away in the reality of patient care.

At the start of the IVF industry the players were researchers and academics, and new techniques could be assessed quite easily because 'anything' was better than 'nothing'. Assisted reproduction today is fully established technology with up to three million births over the last 30 years. It has become a real industry and is quite rightly subject to quality regulations and licensing law. Nevertheless, quality control should not, I feel, be interpreted as it sometimes is: as being a boring 'chore', a static tick box system acting only as a shield against comebacks from management, regulators or patients. It should be a process that lets in proven best practice, whilst raising safety standards, for the best interests of the patient.

I would suggest that the clearest picture does not always get through to the patient or the doctor advising the patient, perhaps as a recent commentary piece discusses (2). To make the point generally: is a fraught patient able to understand, for example, the basis for comparing pregnancy success rates? Or whether international best practice is learned from and applied? Or whether the NHS has the actual wherewithal to provide IVF services sufficiently?

Single embryo transfer (SET) has emphasised the importance of freezing efficiency and the use of embryo freezing is increasing. In the US, the number of births following embryo freezing tripled between 1997 and 2006. Shouldn't we look at why some clinics get hugely different success rates to others? One lab in the US freezes approximately 55 per cent of patient's embryos (some more still). It gets day three cleavage embryos showing a 90 per cent survival on thaw cycles. The latest data from the Society for Assisted Reproductive Technology (SART) shows almost a 40 per cent live birth rate per frozen transfer with day three embryos. If I was a patient I would want to know about SET advantages and subsequent choices for freezing my embryos.

Furthermore, controlled rate freezing has thirty five years of practical results and some 350,000 births. By contrast, vitrification in IVF is an interesting new technology with a few dozen results and isolated reports of possible DNA damage. Controlled rate freezing has a capital cost, vitrification has a consumable cost, so they are probably equivalent from that point of view. Vitrification is the 'new kid' and, as such, is of technical interest, but is it in patients' interests?

I am not at completely 'anti-vitrification' - like controlled rate freezing, it is probably good in parts and may eventually prove to be the optimal method, especially for egg freezing. What I am is pro-patient. Patient interests aren't always put first. For example, there is a corollary in the stem cell area, where funds follow the research interest and are channelled into long term projects (possibly of great value) whilst the under-funded National Blood Service attempts to collect and store (probably) more imminently useful cord blood units.

In relation to my third question, a recent article in the Times newspaper (3) discusses the importance of SET and discloses that about a third of NHS trusts do not offer frozen back-up and 85 per cent do not provide the 'three full cycles' recommended by the National Institute of Health and Clinical Excellence (NICE) in 2004. No wonder that Dr Brison of the University of Manchester is reported to be endorsing SET whilst wondering about the reaction it will get because of clinic 'league tables'.

Public and media interest in the morality surrounding the treatment of embryos - for stem technology or IVF work - is high. The same type of concerned interest shown by the public in the debate (for example discarding embryos) should be carried through into private and public practice. I hate the thought of advocating more red tape, all that is needed is to apply the existing rules across the board properly. What I think is needed from the industry is perhaps a way of regaining some of that pioneering spirit. Not so much the gung-ho part - rather, more of that earlier transparency. I would like to rekindle the cooperative early spirit helping to improve techniques amongst all by comparing and sharing information in good practice and then actually implementing it - for the good of all.

1) 'Freeze and Share: An evolution of egg-sharing', BioNews, 22 September 2008.
|  19 January 2021
2) Egg sharing and cryopreservation: for whose benefit?, BioNews, 6 October 2008
|  19 January 2021
3) IVF success set to drop under single-embryo policy, The Times, 18 October 2008
|  19 January 2021
11 June 2012 - by Valerie Peddie 
Major professional bodies support the concept of providing every patient of reproductive age with accurate information about the potential risk of impaired fertility after treatment for cancer. In reality, the immediate emphasis is often on treatment, with little time available to discuss options for fertility preservation...
17 November 2008 - by Alison Cranage 
Three new independent studies have provided further evidence that embryos stored using slow-freezing techniques may be better than fresh for IVF. The studies were presented at the American Society for Reproductive Medicine conference in San Francisco, US, last week. The studies indicate that using frozen embryos rather...
6 October 2008 - by Dr John Parsons 
Nataly Atalla's uncritical advertorial 'freeze and share: an evolution of egg sharing' in BioNews 476 (week 15/9/2008 - 21/9/2008) did not address a number of important points. I would have expected some comment on the success rate of the vitrification technique in their hands. She cites 100,000...
2 October 2008 - by BioNews 
In BioNews 471 we published a story which used the term 'freezing' to describe a new embryo preservation technique known as 'vitrification'. It has been brought to our attention that 'freezing' is not an accurate description of the vitrification process, which in fact uses certain chemicals and processes to avoid...
22 September 2008 - by Dr Nataly Atalla 
The removal of anonymity in 2005 led to a reduction in the already-insufficient number of altruistic egg donors coming forward in the UK. This, combined with a strong trend towards parenthood at an older age, leads hundreds of British women to go abroad each year for treatment with donor eggs...
23 June 2008 - by Alison Cranage 
Research published last month in the journal Reproductive BioMedicine Online indicates that a new freezing technique to store human eggs is safe. The study, led by Dr Ri-Cheng Chian, of McGill University, Montreal, Canada, looked at children conceived using eggs frozen by vitrification, and showed that the...
24 April 2007 - by MacKenna Roberts 
Advances in egg freezing have leapt from the lab to the public, particularly in the US where clinics are unregulated, to offer assisted reproduction using frozen eggs despite the long-term effects being little known, according to the journal Science. A news article evaluated the reliability and significance...
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