Friday, May 16th, 2014
A study of insurance coverage of in vitro fertilization (IVF) in Canada has found that the more complete the coverage of the common fertility procedure, the fewer multiple births are recorded. Multiple births–twins, triplets, or more–often happen when multiple embryos are transferred into a woman’s uterus as part of IVF. And multiple-embryo transfers often happen when women have limited resources to pursue a number of IVF cycles. Reuters has more on the Canadian study:
Quebec’s universal health insurance started covering all IVF-related costs in mid-2010. The new research is based on data from the first full year of coverage.
“Multiple pregnancies have important health consequences for pregnant women and their babies,” said lead author Dr. Maria Velez, from the University of Montreal.
Multiple pregnancies have an emotional and economic impact on families and cost the health system, which is a delicate point to bring up with patients dealing with fertility issues, she told Reuters Health by email. Patients are often misinformed about the negative consequences of multiple pregnancies, she said.
“Our obligation as medical doctors is to place the health of our patients above all,” Velez said. “Our role is to prevent a patient choosing a treatment that may cause harm if there is a safer alternative.”
Five fertility centers offer IVF in Quebec. The new study compared data from the Canadian Assisted Reproductive Technologies Register from those centers in 2009, before IVF was covered, and in 2011.
There were 1,875 fresh IVF cycles performed in 2009, which rose to 5,489 cycles in 2011. The number of clinical pregnancies and projected live births increased, while the rate of multiple pregnancies decreased from 29 percent to six percent.
And although public coverage of IVF led to more government spending per treatment cycle, the cost per live birth decreased, according to results published in Human Reproduction.
Researchers said the rate of multiple pregnancies likely fell because in Quebec, as in other areas with covered IVF, public policy requires that only one embryo be transferred at a time into women under age 36, called single-embryo transfer (SET). There were no restrictions on the number of embryos transferred at one time before the public coverage policy.
Under the policy, women who undergo IVF can still have several eggs harvested and embryos produced at once, but only one fresh one is implanted. The rest are frozen, and if the first embryo does not survive, another can be thawed and implanted.
Single-embryo transfer was much more common under universal coverage: 32 percent of cycles were elective SET in 2011, compared to two percent in 2009.
“This confirms what a lot of IVF practitioners have held in the U.S., that with insurance coverage single-embryo transfers are more likely to be done which is going to lower multiple birth rates which is safer and less expensive,” said Dr. Bradley J. Van Voorhis, director of the IVF Program at the University of Iowa Carver College of Medicine in Iowa City.
Image: Test tubes, via Shutterstock
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Wednesday, February 12th, 2014
A new technique that takes 3D film of moving sperm could help doctors select those sperm that have the best chance of fertilizing an egg and leading to a successful pregnancy in cases where couples are undergoing in vitro fertilization (IVF) fertility treatments. More from The Optical Society, the professional scientific organization that published the research in its journal:
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Now doctors may soon have a new technique to help them sort the good sperm cells from the less viable ones: a tracking system, developed by a team of researchers from four European institutions, that takes 3-D movies of living sperm. In addition to showing the sperm’s movement and behavior in real time, the novel method simultaneously provides detailed 3-D imaging of the sperm’s form and structure to detect potential infertility-causing anomalies, such as the “bent tail” that prevents the cells from swimming straight.
The researchers say this is the first technique for collecting data on sperm cell motility—a key predictor of IVF success—in three dimensions and over time. They describe their method in a paper published today in The Optical Society’s (OSA) open-access journal Biomedical Optics Express.
Currently, sperm concentration and mobility in semen are assessed either by subjective visual evaluation or a process known as computer-assisted sperm analysis (CASA). While the latter provides more detail and fewer errors than the former, CASA still only allows tracking and imaging in two dimensions. In their new technique, the team of researchers from Italy and Belgium combined microscopy and holography—the creation of 3-D images—to visualize live sperm in not only two dimensions (the x and y positions) but according to their depth (z position) as well.
And, “by acquiring a video of the moving sperm in 3-D, we add a fourth dimension – time,” said lead author Giuseppe Di Caprio of the Institute for Microelectronics and Microsystems of the National Research Council (NRC) in Naples, Italy, and Harvard University in Cambridge, Mass.
Wednesday, January 15th, 2014
A group of 9 women have undergone successful womb transplant surgeries in Sweden, and their next step will be to attempt to become pregnant via in vitro fertilization (IVF)–a medical first, if successful. More from Time.com:
The women, mostly in their 30s, who were either born without a uterus or had it removed because of cancer, are part of the first major experiment to see if a woman with a transplanted uterus can become pregnant and give birth to the child. The women received wombs donated from relatives. Women from two previous womb transplant attempts–in Turkey and Saudi Arabia–both failed to carry a baby.
Scientists in several countries are working on similar operations, but the Swedish group is the most advanced, the AP reports. Dr. Mats Brannstrom, chair of the obstetrics and gynecology department at the University of Gothenburg, will hold a workshop next month on how to perform womb transplants and publish their findings.
Image: Surgeons, via Shutterstock
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Thursday, December 5th, 2013
A rise in the number of multiples–triplets or even more–born in the U.S. is being attributed in a new study to a number of fertility treatments. Though many believe multiple births to be a result of multiple embryos being transferred during in vitro fertilization (IVF) procedures, the study, published in the New England Journal of Medicine, attributes the phenomenon more to drugs given to women to encourage them to produce more eggs. The Associated Press has more:
Multiple births raise medical risks and hospital bills for moms and babies. Guidelines urging the use of fewer embryos were strengthened following the 2009 “Octomom” case, in which a California woman had octuplets after her doctor transferred 12 embryos made from an IVF treatment.
But most cases of infertility are treated not with IVF but simpler measures such as drugs to make the ovaries produce eggs. The first step often is a pill, Clomid, to spur hormones that aid conception. If that doesn’t work, more powerful drugs can be given in shots, but those bring a much higher risk of multiple eggs being released.
Doctors are supposed to use ultrasound and blood tests to monitor how many eggs are being produced and advise couples against trying to conceive that month if there are too many, to minimize the risk of multiple births. But that monitoring often isn’t done, or done well, and couples eager for a baby may disregard the advice.
“It’s very easy to demonize this dumb doctor who didn’t do the right thing. That may not always be the case,” said Dr. Nanette Santoro, obstetrics chief at the University of Colorado in Denver. “Frustrated people who don’t get pregnant after a couple cycles will think more is better. It’s the American way.”
The new study examined trends over several decades and finds that the rate of triplet and higher-order births peaked in 1998 and has been declining since then.
From 1998 to 2011, the estimated proportion of twin births due to IVF increased from 10 percent to 17 percent, while the proportion of triplets-and-more declined.
During the same period, the estimated proportion of triplet and bigger multiple births from non-IVF treatments such as fertility drugs increased from 36 percent to 45 percent.
Image: Infant sleepers on clothesline, via Shutterstock
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Friday, November 1st, 2013
A team of researchers from a number of top Boston medical institutions are working together on new research that could help the best sperm from a man’s sample travel better through fluid, increasing its chances of successfully finding and fertilizing a woman’s egg. The research, if successful, could increase the chances of success for couples who undergo in vitro fertilization (IVF). More from Boston.com:
Physicist Erkan Tuzel works in a field that seems just about as far removed as possible from delicate questions about human reproduction; his lab at Worcester Polytechnic Institute develops algorithms to describe the behavior of complex fluids. But after he heard a talk by Harvard Medical School bioengineer Utkan Demirci, who carves microscopically small channels and then allows fluids to flow through them, the two began to talk about collaborating. Their common ground? Designing technology that could cull the healthiest, fastest-moving sperm from the slowpokes.
Doctors trying to help couples reproduce through in vitro fertilization would like to have an easy way to identify and isolate the sperm most likely to result in a baby. Figuring out how to reliably do that, however, may have as much to do with physics as it does with biology.
In real-world experiments, sperm can swim through tiny channels created by Demirci at Brigham and Women’s Hospital. Computer modeling by Tuzel could be used to understand how to design those channels so that they select the right sperm.
“Sperm cells interact with each other when in confined geometries,” Tuzel said. “Just like birds when they fly in formation like a flock, similarly through the fluid, the sperm cells interact with each other and they synchronize their tails—they start beating in phase. … How can we use this information to learn from it and utilize it?”
Tuzel was recently awarded a $300,000 grant from the National Science Foundation to build computational tools that could help design systems that sort sperm in real life.
Image: Sperm collection container, via Shutterstock
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