Thursday, May 1st, 2014
The multibillion dollar fertility industry tracks data on success rates and other measures of its work with women who are struggling to conceive a child, but the data–which tends not to get regulatory enforcement from the CDC and other agencies–may be difficult to decipher. More from The New York Times:
This is a multibillion-dollar industry, and there is financial pressure for clinics to claim frequent success. “Clinics are competing with each other based on pregnancy and live birthrates,” said Dr. Vitaly Kushnir, a reproductive endocrinologist in New York who researches success rates. The clinics do not want give out negative data that might drive away patients.
Nationally, the data suggest that a 38- to 40-year-old woman using her own unfrozen eggs has on average a 21.6 percent chance per cycle of having a baby by means of assisted reproductive technology. The average treatment cost per cycle rings in at $12,400, according to the American Society for Reproductive Medicine.
A cycle, which can take on average from 60 to 90 days from the time of the initial consultation, typically starts with hormone injections, followed by egg retrieval, fertilization and then embryo transfer. But the national success rate does not distinguish between pregnancies occurring in the first cycle or a second, fifth or later cycle. The number of cycles needed to achieve a successful pregnancy makes a big difference to would-be parents in terms of money, time and emotional strain.
The clinics also are not required to report babies born full-term or not, or those born with birth defects. “The outcome data should be included to reflect the most important goals and measures of success in I.V.F. — a healthy baby and healthy mother,” said Dr. Kushnir. Moreover, success rates at individual clinics may vary widely, depending in part on the populations they serve. Some clinics have been known to turn away women who may be difficult cases — older women or those with existing medical conditions, for example — to avoid depressing their success rates.
To potential patients browsing online, it may not be clear how these clinics define success. “Someone might think the success rate is the number of live births, when really the clinic is reporting the number of clinical pregnancies,” said Jim Hawkins, a law professor at the University of Houston who has studied the claims made on the websites of fertility clinics.
Dr. Kushnir and other researchers have pushed for more public information on the health of babies and mother after I.V.F. At the moment, potential patients can check reported success rates online, with the Society for Assisted Reproductive Technologies and the C.D.C., which separates the data by pregnancy and live births.
Image: Pregnancy test, via Shutterstock
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Thursday, April 17th, 2014
The protein mechanism that allows a sperm and egg to connect to each other and fertilize to become an embryo has been identified by British scientists. More from Reuters:
Fertilization takes place when an egg cell and a sperm cell recognize one another and fuse to form an embryo. But how they recognize each other in order to hook up had remained a mystery.
Researchers said on Wednesday they have identified a protein on the egg cell’s surface that interacts with another protein on the surface of a sperm cell, allowing the two cells to join.
This protein, dubbed Juno in honor of the ancient Roman goddess of fertility and marriage, and its counterpart in sperm, named Izumo after a Japanese marriage shrine, are essential for reproduction in mammals including people, they said.
This new understanding of the role of these two proteins could help improve the treatment of infertility and guide the development of new contraceptives, the researchers said.
“By identifying this interaction between Juno and Izumo, we now know the identity of the receptor proteins found on the surface of our father’s sperm and our mother’s egg that must interact at the moment at which we were conceived,” said Gavin Wright of the Welcome Trust Sanger Institute in Britain, one of the researchers in the study published in the journal Nature.
The researchers are now screening infertile women to try to determine whether problems with the Juno receptor are to blame.
“It is remarkable that about 20 percent of infertility cases have an unexplained cause,” said Enrica Bianchi of the Sanger Institute, another of the researchers.
“We are now asking whether Juno is involved in these cases of unexplained infertility,” Bianchi added.
Wright said that if defects in the Juno receptor are in fact implicated in human infertility, a simple, non-invasive genetic screening test could be developed to identify affected women.
“This then would allow us to guide the fertility treatment,” Wright said, letting affected women proceed directly to a procedure called intracytoplasmic sperm injection involving direct injection of sperm into an egg obtained from in vitro fertilization.
Image: Sperm and egg, via Shutterstock
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Monday, March 24th, 2014
When it comes to getting pregnant, there’s the old saying, “Stop worrying. It will happen once you stop trying.” Well, now there is a new study to back it up. During the study, those with high alpha-amylase levels (a sign of long-term stress) had double the risk of infertility. The New York Times reports:
Over four years, 401 women who were stopping contraception and trying to have a baby underwent saliva testing for two stress-related substances: the enzyme alpha-amylase, and the hormone cortisol. The women provided a saliva sample upon enrollment in the study, and then another at their first observed menstrual period, so that comparisons between the women could be made from the same starting point.
Researchers analyzed the samples and then followed the women to see how long it took them to become pregnant. Women who became pregnant during the first month of the study (before they could give a second saliva sample) were also included in the analysis.
The scientists defined infertility as a failure to become pregnant after 12 months of unprotected intercourse. During the study, published Monday in Human Reproduction, 347 women became pregnant and 54 did not.
There was no association of cortisol with fertility. But those whose alpha-amylase levels were in the highest third, a sign of longstanding stress, had more than double the risk of infertility. The scientists controlled for age, race, income and other health and socioeconomic factors.
The lead author, Courtney D. Lynch, director of reproductive epidemiology at Ohio State University, said that if a woman was having difficulty becoming pregnant, it would be harmless, and might be helpful, to consider stress-reduction techniques.
“Yoga, meditation, mindfulness have been successful in other health outcomes,” she said, “and might be helpful for fertility as well.”
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Image: Young caucasian girl sitting and checking pregnant test over white via ShutterStock
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Thursday, February 27th, 2014
A fertility treatment in which the genetic material of three different people are combined to create an embryo that is free of certain genetic defects is under scrutiny by the Food and Drug Administration amid claims that the therapy could amount to creating “designer babies.” More on the ethically complex method from The New York Times:
The agency has asked a panel of experts to summarize current science to determine whether the approach — which has been performed successfully in monkeys by researchers in Oregon and in people more than a decade ago — is safe enough to be used again in people.
The F.D.A. meeting, on Tuesday and Wednesday, is meant to address the scientific issues around the procedure, not the ethics. Regulators are asking scientists to discuss the risks to the mother and the potential child and how future studies should be structured, among other issues. The meeting is being closely watched. The science of such therapies has advanced significantly in recent years, and many scientists are urging federal regulators to ease requirements for study in humans.
The procedure in question involves mitochondria, the power producers in cells that convert energy into a form that cells can use. Mitochondria with defects that could be passed to a fetus are replaced with healthy mitochondria from another woman. This is done either before or after an egg is fertilized.
Scientists have already experimented with combining genetic material from cells of three people. In 2001, researchers in New Jersey did so using material from the cytoplasm, the material that surrounds the nucleus of the egg and directs its development after fertilization, from fertile women into the eggs of infertile women. More than 17 babies have been born this way in the United States.
The practice raised questions and eventually led the F.D.A. to tell researchers that they could not perform such procedures in humans without getting special permission from the agency. Since then, studies have been confined to animals.
But a researcher in Oregon, Shoukhrat Mitalipov, has performed the mitochondrial procedure in monkeys and has said that it is ready to be tried in people.
Such genetic methods have been controversial in the United States, where critics and some elected officials wonder how far scientists plan to go in their efforts to engineer humans, and question whether these methods might create other problems.
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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.