Comment:Interesting mix this week with links to articles suggesting maternal and paternal roles in child health, articles extolling the virtues of FET and others suggesting FET may lead to SGA babies! Some links to time-lapse concerns and concerns about IVF from Robert Winston that have some traction. Some links have comments attached in IVFCLINICMAIL - follow the red icon! Don`t forget to complete the 2014 census
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Birthweight percentiles by gestational age for births following assisted reproductive technology in Australia and New Zealand, 2002–2010
The comparison of birthweight percentile charts for ART births and general population births provide evidence that the proportion of SGA births following ART treatment was comparable to the general population for SET fresh cycles and significantly lower for thaw cycles. Both fresh and thaw cycles showed better outcomes for singleton births following SET compared with DET. Policies to promote single embryo transfer should be considered in order to
Maternal tract factors contribute to paternal seminal fluid impact on metabolic phenotype in offspring
These findings show that paternal seminal fluid composition affects the growth and health of male offspring, and reveal that its impact on the periconception environment involves not only sperm protection but also indirect effects on preimplantation embryos via oviduct expression of embryotrophic cytokines.
Chronic high-fat diet in fathers programs β:-cell dysfunction in female rat offspring
Here we show that paternal high-fat-diet (HFD) exposure programs β:-cell ‘dysfunction’ in rat F1 female offspring. Chronic HFD consumption in Sprague–Dawley fathers induced increased body weight, adiposity, impaired glucose tolerance and insulin sensitivity. Relative to controls, their female offspring had an early onset of impaired insulin secretion and glucose tolerance that worsened with time, and normal adiposity.
Deciding about fertility preservation after specialist counselling (FPC)
More attention should be paid to improving FPC care. Interventions aiming at improving patients' comprehension of the topic of FP and their feelings of being supported in decision-making are advisable.
Clinical outcomes following selection of human preimplantation embryos with time-lapse monitoring: a systematic review
While TLM has the potential to revolutionize clinical embryology, there are currently no high-quality data to support the clinical use of this technology for selection of human preimplantation embryos. Our recommendations for the adoption of this technique are thus limited by the available literature and the lack of robust prospective studies reporting clinical outcomes.
Factors associated with the donation and non-donation of embryos for research: a systematic review
Three iterative and dynamic dimensions of the IVF patients' decision to donate or not to donate embryos for research emerged from this review: the hierarquization of the possible options regarding embryo disposition, according to the moral, social and instrumental status attributed to embryos: patients' understanding of expectations and risks of the research on human embryos: and patients' experiences of information exchange and levels of trust i
Prognostic models for high and low ovarian responses in controlled ovarian stimulation using a GnRH antagonist protocol
In the Engage trial, 18.3% of patients had a high and 12.7% had a low ovarian response. Age, AFC, serum FSH and serum LH at stimulation Day 1 were prognostic for both high and low ovarian responses. Higher AFC and LH were associated with an increased chance of high ovarian response. Older age and higher FSH correlated with an increased chance of low ovarian response.
Relationships in oocyte recipient couples – a Swedish national prospective follow-up study
Conclusions: From a long-term perspective couples using oocyte donation treatment have a balanced and solid view of their relationship and treatment, having children or not after treatment did not affect the nature of the relationships.
A randomized clinical trial to determine optimal infertility treatment in older couples: the Forty and Over Treatment Trial (FORT-T)
A randomized controlled trial in older women with unexplained infertility to compare treatment initiated with two cycles of controlled ovarian hyperstimulation/IUI versus immediate IVF demonstrated superior pregnancy rates with fewer treatment cycles in the immediate IVF group.
Modifiable and non-modifiable risk factors for poor sperm morphology [Open Access]
Risk factors for poor sperm morphology, after adjustment for centre and other risk factors, included: (i) sample production in summer [odds ratio (OR) = 1.99, 95% confidence interval (CI) 1.43–2.72]: and (ii) use of cannabis in the 3 months prior to sample collection in men aged ≤::30 years (OR = 1.94, 95% CI 1.05–3.60).
Fresh versus frozen embryo transfer: backing clinical decisions with scientific and clinical evidence
This review provides the basis for an evidence-based approach towards changes in routine IVF, which may ultimately result in higher delivery rates of healthier term babies.
Embryo catheter loading and embryo culture techniques: results of a worldwide web-based survey
Most centers (97 %) prefered a catheter with its orifice on top, with only 3 % preferring a catheter with the orifice on its side: 41 % preferred a catheter marked for clear ultrasound view. The most commonly-reported methods of embryo loading were medium-air-embryo-airmedium (42 %), medium in catheter with embryo at end (20 %) and medium-air-embryo (15 %). In 68 % of centers the final volume of the catheter was up to 0.3 ml, with only 19 % using
Fertility clinics are 'exploiting' some infertile women, claims IVF pioneer Lord Winston
A fertility expert has today hit out at the 'exportation' of infertile women by some clinics. IVF pioneer Lord Robert Winston told peers in the House of Lords, that regulation by the Human Fertilisation and Embryology Authority allowed for 'entirely unvalidated experimental treatment'.
Auxogyn receives clearance from FDA for Eeva System
Auxogyn, Inc. a leader in women's reproductive health, today announced that its first product, the Eeva System, received clearance from the U.S. Food and Drug Administration through its de novo classification process, a regulatory pathway for select novel, low- to moderate-risk medical devices that are first-of-a-kind. The Eeva System enables in vitro fertilization (IVF) clinicians to offer the proprietary Eeva Test, which is the first prognostic
Sperm size, shape in young men affected by cannabis use
Young men who use cannabis may be putting their fertility at risk by inadvertently affecting the size and shape of their sperm, according to new research. In the world's largest study to investigate how common lifestyle factors influence the size and shape of sperm, a research team found that sperm size and shape was worse in samples ejaculated in the summer months, but was better in men who had abstained from sexual activity for more than six da
Dutch researchers develop urine test for test tube baby success.
Researchers at Erasmus University’s teaching hospital have developed a urine test which they say shows if a women is likely to become pregnant following ivf treatment. The test involves looking for four bacteria in urine ahead of ivf treatment. Women who fail to become pregnant have a very specific volume of the bacteria in their urine which is completely different from those who do become pregnant. This bacteria shows how receptive the womb is l
Lord Winston criticises 'jungle' world of British fertility treatment
Fertility treatment in the UK is an unregulated "jungle" where anxious couples are routinely offered IVF and other methods of artificial reproduction that may actually lower rather than increase their chances of having a baby, according to Britain's leading fertility doctor.
Crowdfunding helps some couples afford costly fertility treatments
Knowing they would need at least $20,000 to cover the costs related to another round of IVF, the couple - who had already spent tens of thousands of dollars on previous treatments - was distraught. Then, a friend told them about GoFundMe.com. Though initially skeptical, Williams and her husband, who is serving in the U.S. Navy, eventually decided to share their story on the site and see what would happen.
Merck Serono Announces FDA Clearance for Auxogyn's Early Embryo Viability Assessment (Eeva(R)) System
Merck Serono, the biopharmaceutical division of Merck, today announced that the proprietary Early Embryo Viability Assessment (Eeva(R)) System of Merck Serono's strategic partner Auxogyn received clearance from the U.S. Food and Drug Administration (FDA) through its de novo classification process, a regulatory pathway for select novel, low-to-moderate risk medical devices that are first-of-a-kind. Merck Serono is the exclusive commercial partner
Staff Logbook. FertAid has developed an online activities logbook for all IVF personnel. There is a list of common procedures available but you are able to create a personalized activity list. You may log the number of cases each quarter and after authorization by your supervisor may be used for certification or competency by your clinic. There is no cost for this module.
FertAid has released the 2014 laboratory census. The aim is to provide clinics with a sense of what others are doing and how their activity compares to others.
FertAid opens an annual laboratory census on the activities of an IVF laboratory.
Comment
You are invited to complete the activity of your laboratory. When completed, you can review the results both for all replies and for your own country.
Title
Relationships in oocyte recipient couples – a Swedish national prospective follow-up study
Summary
A study looking at the long term relationship outcomes from using donated oocytes found that the relationship remained strong and healthy 2-5 after treatment.
Comment
The authors reported `At acceptance for treatment the couples in the two groups assessed their relationships as being very solid on all dimensions and that the women receiving treatment with oocyte showed a higher satisfaction compared to women treated with own gametes. For couples that did have a child, the group of women who had been through the oocyte donating program reported a better quality of their relationship than women in the control group. There were no significant differences in perceived relationship quality between men in the different groups, whether they had a child or not.'. It would seem that accepting oocytes from another female had no impact on the relationship regardless of outcome. Couples that failed to have a child appear to be reconciled to infertility while if a child was achieved, its origins were of no impact on the relationship. It is often thought that pregnancy was more important to women than the eggs. The study did not followup on couples who had separated so in a way, the results were somewhat predictive. Also one would like to know the opposite study, what was the impact of donating oocytes to other couples particularly if the donating female remained childless. Finally,
Title
A randomized clinical trial to determine optimal infertility treatment in older couples: the Forty and Over Treatment Trial (FORT-T)
Summary
Apart from starting a new acronmym with a pun (FORT-T), this article addresses an issue for all clinics in what to recommend to new clients over 40 years of age. Do you act conservative or aggressivel
Comment
If I read the article correctly, the authors split 150+couples into 3 treatment groups- clomid/IUI, stimulated IUI and IVF. Most couples completed treatment more so in the IUI cycles than the IVF cycles but after the first two treatment cycles, an amazing 49% of clients are pregnant after IVF compared to ~20% for both IUI treatments (Clomid was better than FSH!!). However 85% of all pregnancies arose from IVF cycles, pretty good considering only 64% of IVF couples completed treatment (actually 32/51). This is an interesting study, limited by sample size but worthwhile in intent since the real problem for IVF Clinics who receive new clients over 40+years is how to approach a treatment strategy. Some see going straight to IVF somewhat commercial and offering IUI a more gentle approach. But older clients do suffer from poor prognosis for older women where time is important. This study, although still small, provides ammunition to clinics to explain why going straight IVF offers them the best of chance of pregnancy. Finally, after all treatment, 71% of clients were pregnancy with 46% leading to a live birth. This is a fairly impressive but cautionary pregnancy outcome given the increased risk of miscarriage with older women. On average about 25% of all pregnancies (both natural and after IVF) fail, so clinics do need to point out that even pregnancy may occur, live births are still precarious
Title
Modifiable and non-modifiable risk factors for poor sperm morphology
Summary
A large lifestyle survey was plotted against sperm morphology (by CASA) and except for abstinence, cannabis use and season, other lifestyle factors has little or no impact on sperm shape.
Comment
In all clinics, a question asked by either partner when informed the male has poor sperm morphology (Quality) is what can we do about it, how can we make it better? This study suggest there is little they can do to improve the quality apart from possible abstinence for longer than 6 days (contrary to most advice) and maybe avoid cannabis use for a reasonable period prior to attempted conception. Other factors (see report-body mass index, type of underwear, smoking or alcohol consumption or having a history of mumps) were unrelated. This is not to say that a better life style may have other positive outcomes say for instance on the health of any child or miscarriage rates so suggesting they do nothing may not be wise advice. It nevertheless allows clinicians, etc to not make the male partner suffer guiltily by being a smoker,etc. Clinics may suggest in a report that cannabis use may be detrimental without necessarily asking the question since the reply will always be unreliable. Incidentally, the authors point out that since the morphology was performed by computer (CASA), the actual values may not relate to the standard visual inspection range. Interesting comment.
Title
Seasonal impact on sperm morphology.
Summary
In addition to the previous summary, another factor was the seasonal impact on morphology.
Comment
The authors reported that samples produced in summer were more likely to show impaired morphology. The most likely candidate is increased temperatures however questions relating to underwear or previous fever supported this observations. The observation was consistent over all ages. The reason for a seasonal impact on sperm morphology may be more indirect. Since morphology and sperm DNA fragmentation are closely related, it would be interesting to see if seasonal impacts on DNA dysfunction are also present or if pregnancy rates vary over the seasons. Is it possible, human have a remnant seasonal reproductive history in our history? Maybe sperm should be frozen during the cooler months if IVF is to be attempted at the height of summer.
Title
Maternal tract factors contribute to paternal seminal fluid impact on metabolic phenotype in offspring
Summary
Using seminal plasma free [SP] males (surgically excision), insemination resulted in abnormal implantation and liveborn MALE offspring.
Comment
This paper caught my eye because it attempt to evaluate the role of seminal plasma in implantation and foetal development. There have been several papers over the years to imply a role of seminal plasma in IVF success rates. Many have argued that IVF has demonstrated that exposure to SP at conception is not important since we do just fine without it. Expect for same sex and single women, couples having IVF are in part always exposing the cervix to SP. The results for the exceptions above are the same as for heterosexual couples do support this perception. Yet IVF continues to produce rates well below parity and many transfers fail so the subject of this paper should be viewed with an broad mind. What caught my eye was that the effects were expressed in male offspring!! The authors also report `Absence of seminal plasma was accompanied by down-regulation of the embryotrophic factors Lif, Csf2, Il6, and Egf and up-regulation of the apoptosis-inducing factor Trail in the oviduct.` The up-regulation of an apoptitic factor should also spark some interest. Having said this, implantation is different in the mouse where the seminal plasma fills the uterine horns after coitus unlike in humans. Still!
Title
Negative effects of non-exposure of seminal plasma in mice
Summary
The other aspect of this paper was that the male offspring suffered obesity, hypertension and impaired glucose metabolism but in males only.
Comment
Of interest is that part of the problem arises from alteration the immune regulation of the endometrial lining. However, the transfer of in vitro embryos to a uterus not exposed to seminal plasma produced offspring that also showed impaired development. However, the real issue for me was the gender difference. Other studies showing the effect of high fat paternal diet only on female offspring (in rats) raises all sorts of questions on what is happening. Almost certainly, the long term health of IVF children in relation parental health is only just being explored but in relation to exposure to seminal plasma unlikely.
Title
Fertility clinics are 'exploiting' some infertile women, claims IVF pioneer Lord Winston
Summary
Robert Winston argues (according to the Daily Mail!!) that the activity of some parts of the IVF industry in the UK are worrying.
Comment
The IVF Industry is continuing to grow and mature. As more doctors turn into businessmen(or women), more practices may confront some practitioners and patients. Examples Robert Winston gave included advertising inappropriately, providing services via satellite clinics outside one countries regulations and the increasing use of genetics to test embryos via PGD/PGS. It is difficult to see how any of these and other practices can or should be stopped but what may happen is that is less conservative management is explored, the risk of litigation will start to rise. The other thing that may occur is the withdrawal of dissemination of information as more and more businesses will start to seek rewards for their own research and increasingly cease presentation in public forums like publication or meetings. Furthermore, scientists working for IVF businesses will increasingly be required to work more secretively.
Title
COOK Medical - European Field Product Specialist - ART
Summary
COOK Medical have a vacancy for a European Field Product Specialist - ART (male/female)
Comment
see attached PDF
Title
Embryo catheter loading and embryo culture techniques: results of a worldwide web-based survey
Summary
The results of a international survey on embryo transfer technique show some surprising results.
Comment
The on-line survey on embryo transfer technique showed almost a uniform use of front loading catheters as opposed to side loading. There was some variation in the way the embryos were loaded varying between using air-fluid interfaces to contain the embryo to not using an air bubble. Less than half used catheter visible with ultrasound!! The problem with not using an air bubble is that if held vertically, a bubble may form at the tip of the catheter that may contain the embryo is an easily lost. Bubbles on the other hand have the potential to capture the embryo by hydrostatic pressures such that the embryo will track where the bubble moves to. Also there were differences in the volume injected from 0.3ml to 0.7 ml. It may have been expected the volumes were a lot smaller. It all goes to show that even after 35+ years, diversity remains.
Title
Merck Serono Announces FDA Clearance for Auxogyn's Early Embryo Viability Assessment (Eeva(R)) System
Summary
Of interest is Merck Serono's involvement with Auxogyns embryo monitoring system.
Comment
It is interesting that Merck Serono is moving into the field of laboratory technology. I can assume that while the market continues to grow, there is more competition in the supply of r-FSH, with low dose or mild or mini IVF, move to use FET cycles more productively, etc. I am sure Serono will be able to use data from Eeva to fine tune stimulation regimens etc. One problem though is that grading blastocysts from early cleavage remains challenging for many reasons not the least that using cleavage times to predict viability fails to accommodate that during ICSI and during IVF, eggs are fertilise at different times. How does one set zero time for each embryo? A recent study found that many poor quality embryos that gave rise to pregnancy were discarded using time-lapse imagery for failing to reach developmental benchmarks. How many lost babies will occur with Eeva and its equivalents. Maybe clinics would do better to focus on improving embryologists performance. From Fertaids EQA programme, much more needs to be done. COMMENTS??
Title
Crowdfunding helps some couples afford costly fertility treatments
Summary
Costs are an issue everywhere.
Comment
An interesting story of a innovative couple trying to fund their IVF treatment. My guess is that only the first few will get the funding they need. The real aspect of this story is the cost of IVF. Most couples can afford their first attempt somehow but it is the repeat cycles that drain one purse. Increasing commercialisation of IVF will make it unlikely cheaper versions will occur. Does the IVF industry have a duty of care to ensure that it will not only be available to the wealthy? In a clinic I was associated with, a subsidised treatment was offered to couples who applied for help, The scheme was limited to a set number of cycles per year and was equivalent to 3% of gross income ~ about 20 cycles/year. Not a lot but it helped some. Is this sort of thing a good idea of just plain stupid. Comments?
Title
Clinical outcomes following selection of human preimplantation embryos with time-lapse monitoring: a systematic review
Summary
This timely update on time-lapse embryo grading is spot on. While there is a lot of interest, whether this will improve rates overall remains unclear.
Comment
Personally, I think time-lapse embryo selection is fantastic insofar as embryos do not need to be removed from an incubator and quickly checked and one can review cleavage continuously. The concern is on several fronts. One that some commercialisation has already occurred with Eeva being promoted as a selection tool for blastocysts and the the algorithms developed by different clinics may end up excluding embryos because of a theoretical poor viability. The net result is that many viable embryos may be discarded and cause couples to return to IVF prematurely. Time-lapse definition of embryo quality may come to be seen by couples as a marker that their embryos are rubbish when in fact the only test is transfer. No doubt, in time, its contribution will become clearer. There is a cost to purchase the time-lapse incubators and use of specific dishes and while it provides advantages, there is also increased staffing costs. Lastly, it may spawn a new generation of embryologists who actually believe what an instrument tells it!
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Vit Kit - Warm NX is an adaptable, cost-effective system for use in the thawing of oocytes, pronuclear zygotes, cleavage stage embryos, and blastocyst stage embryos. Unlike many vitrification kits that feature a mono-buffered system and M199 base med
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S-Cryolock is the slimmer version of the original. It is a versatile, simple and efficient vitrification device that is intended for the holding, cryopreservation and storage of oocytes or embryos in liquid nitrogen.
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