the reasons i'm pasting these articles up is because The Independent archives their articles after awhile. and i want this for my own reference :P
but anyway, i remember some people asking about IVF and infertility treatments, so well, so i thought this would be easy reference.
it's so hard to get pregnant sometimes. i remember a former colleague of mine go through hell just to get a baby :( it's sad.
i have mixed feelings about all these new technologies, IVF, ICSI, and now this. i remember doing an attachment at a fertility clinic and seeing a woman who was 36 weeks pregnant coming in for a follow-up scan. 2 more weeks, and the baby would be ready for delivery. but the baby came up with bilateral pleural effusion and its complications (compression on the heart, etc.) the gynae performed a shunt immediately, but the baby died a few days later anyway. yeah, the baby was a result of infertility treatment.
being out of the medical line now, i guess i forget how fragile humanity can sometimes be. and yet, in the medical line, facing death and decay everyday, sometimes you get desensitized to it. just another body. just another death. how does one strike a balance sometimes?
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A cheap, painless alternative to IVF?
Breakthrough in fertility treatment as first British babies are born using new technique
By Jeremy Laurance, Health Editor
Published: 25 October 2007
A landmark in the development of fertility treatment was announced by doctors yesterday with the birth of the first babies to be conceived using a revolutionary technique that offers a safer, cheaper alternative to IVF.
The twin boy and girl, who were born on 18 October at the Radcliffe Infirmary in Oxford, were conceived using In Vitro Maturation (IVM), a method that dispenses with the use of costly fertility drugs, saving up to £1,500 on the normal price of treatment.
The technique is also safer for the one in three women among those seeking fertility treatment who have polycystic ovaries, a condition that puts them at high risk of dangerous side effects from fertility drugs.
Specialists said the development could make in vitro techniques available to more infertile couples by cutting the cost of treatment. Infertility is estimated to affect one in six couples in the UK but IVF costs around £5,000 a cycle and treatment is restricted on the NHS.
Tim Child, a consultant gynaecologist at the Oxford Fertility Clinic and senior fellow in reproductive medicine at Oxford University, who led the work, said: "I think it is a safer, cheaper alternative to IVF for all women. However, for many women the success rates are currently much lower. Research in the future will address this."
The Oxford Fertility Clinic is the only one in the UK licensed to use the technique: 20 cycles of treatment have been carried out and four other women are currently pregnant, giving a pregnancy rate of 25 per cent. This is expected to improve with further experience. In addition, without the need for drugs, repeating the procedure would be less taxing on the woman. For standard IVF, the Oxford clinic's pregnancy rate is 45 per cent.
The parents of the babies, who have asked to remain anonymous, were delighted, Mr Child said. At birth the boy, born first, weighed 6lb 11oz and the girl weighed 5lb 14oz. "The parents are ecstatic. They have got absolutely stunning twins. They went home on Tuesday to start their new life together. It is wonderful."
In standard IVF, the woman takes fertility drugs for five weeks to stimulate production of her eggs, which are then collected direct from her ovaries under the guidance of ultrasound, before being fertilised in the laboratory. The drugs cost between £600 and £1,500, with charges often higher in London.
The procedure is time consuming and uncomfortable and for the third of women with polycystic ovaries there is a one in 10 risk of severe ovarian hyperstimulation syndrome, a dangerous side-effect that in rare cases can prove fatal.
IVM avoids the use of drugs and instead involves collecting eggs from the ovaries while they are still immature. The eggs are then grown in the laboratory for 24 to 48 hours before being fertilised and replaced in the womb.
Mr Child said: "The main advantage is improved safety for women. Women with polycystic ovaries have a one in 10 chance of severe ovarian hyperstimulation syndrome. IVM completely takes away that risk. IVF is also expensive. With IVM the cost is reduced, meaning it could become a more accessible form of fertility treatment."
The technique was pioneered by the University of McGill in Montreal, Canada, where Mr Child spent two years researching and developing it before joining the University of Oxford in 2004. It has also been used in Seoul, South Korea, and Scandinavia. To date about 400 babies have been born worldwide using IVM compared with around two million by IVF.
At present the Oxford Fertility Clinic is only offering the treatment to women with polycystic ovaries, but in the long term Mr Child said he hoped to offer the procedure to all women. "When we see patients we say these are the options and it is up to them to decide. We are not offering it to women with normal ovaries at present because we don't get enough eggs from them. It depends on the number of resting follicles and with normal ovaries you don't get so many.
"On average we get four eggs from a woman with normal ovaries compared with 16 from one with polycystic ovaries. The procedure involves a process of attrition – two-thirds mature and two-thirds of those fertilise – so you need a decent number to start with."
Research on developing the culture medium in which the eggs are matured in the laboratory could reduce the attrition rate so that fewer eggs are needed. The technique could then become suitable for women with normal ovaries, Mr Child said.
A second drawback of the procedure was that eggs grown in culture had a harder outer shell than those matured in the ovary and were more difficult for sperm to penetrate. The eggs had to be fertilised by ICSI – injecting a single sperm directly into the egg. "We hope to develop the culture medium so the egg doesn't mind being grown in the laboratory and we can use ordinary insemination [mixing eggs and sperm so fertilisation occurs naturally]. But in most IVF clinics, 50 per cent of patients are treated with ICSI anyway," he said.
A spokesman for the Human Fertilisation and Embryology Authority said IVF was expensive for most couples and a minority got treatment on the NHS. But it was too soon to tell whether IVM would replace IVF.
"Anything that reduces the cost of IVF, provided it is safe, means treatment could be available to more people. But this is an emerging technology – it is very early days. The most important thing is that patients get proper information so that they can make a decision on what is best for themselves."
~The Independent, 25 October 2007 14:11~
A revolution in the making - now it's up to the scientists
By Jeremy Laurance, Health Editor
Published: 25 October 2007
Over the past 25 years around two million babies have been born by IVF around the world. Yet the technique has always suffered from a major drawback – it meant dosing the woman with powerful drugs to stimulate her ovaries to produce extra eggs.
No one wants to be pounding their body with powerful drugs. It is uncomfortable, time consuming and costly, as well as dangerous for women with polycystic ovaries – one in three of those in fertility treatment.
If there is a safe way of avoiding the drugs but which achieves the same results, it would be welcomed by thousands of women. It is too soon to declare In-Vitro Maturation (IVM) the answer to their prayers. But it is a significant step in the right direction.
Avoiding the use of powerful drugs would bring a second important benefit – reducing the cost of treatment by at least 20 per cent off the average price of £5,000 per cycle. Cost is a major barrier for thousands of infertile couples denied treatment on the NHS – they cannot afford to go private and lose the chance to have a family.
The major shortcoming with IVM is its low success rate. A 25 per cent pregnancy rate will not be enough to attract most couples, although on a total of just 20 cycles it is a near-meaningless figure. Compared with IVF success rates of 45 per cent and more, it is a powerful disincentive, even if the risks are lower. But these are early days. When IVF first became widely available in the 1980s, live birth rates were around 14 per cent. They have grown from there and the expectation is that IVM success rates will grow similarly.
Specialists were cautious yesterday about IVM's prospects, saying much more evidence of its safety was needed. As part of its horizon-scanning work, the Human Fertilisation and Embryology Authority has been scrutinising the research in Montreal and Seoul, the two centres that have pioneered the technique, since early 2006.
Its advisory group concluded there was no evidence to suggest it was dangerous and no evidence that it increased the risk of birth abnormalities – a concern because of the use of immature eggs. But it warned that the oldest children conceived by the technique were little more than toddlers and long-term experience was lacking.
The HFEA granted a licence to perform IVM to the Oxford Fertility Clinic in January this year, the first and only licence it has so far issued, on the grounds that Tim Child, the consultant, had spent two years researching the technique in Montreal. He had demonstrated he was skilled in maturing the eggs in the laboratory.
The test now is whether he can refine the technique to improve the success rate – and whether other clinics can follow his lead. Researchers in Leeds are understood to be interested in the method. If he and they succeed, they could usher in a revolution in fertility treatment.
~The Independent, 25 October 2007 17:12~
