Involuntarily childless couples could be helped with extra sperm analysis

New research findings from Lund University in Sweden show that a simple analysis of chromosomal breaks in sperms can facilitate choice of the most efficient treatment and, thereby, increase chances of successful assisted reproduction in involuntary childless couples.  

Sperm DNA Fragmentation Index (DFI) is a method for analysing semen quality that shows presence of chromosomal breaks in sperms. The method complements other more well-known analytical methods available for assessing semen quality, such as assessment of sperm number quantity, motility and morphology.

A new study, which is the largest study within this field of research so far, now shows that DFI analysis can be used for selecting the most efficient  treatment to involuntarily childless couples. The study is based on analyses of more than 1 600 such couples referred to the Reproductive Medicine Centre at Skåne University Hospital in Malmö for help. All the men who participated in the study underwent DFI analysis.

Chromosomal  breaksare more frequent in men with a high DFI, which is linked to lower fertility. The couples who participated in the study underwent assisted reproduction, either through the standard method called IVF (in vitro fertilisation) or the more advanced - ICSI (intracytoplasmic sperm injection).

In standard IVF the harvested egg is mixed with a large number of sperms in a test tube. The goal is that the fertilisation will succeed without further measures or assistance. ICSI involves selecting a single viable sperm cell that is then injected into the egg through a needle.

"In couples where the man had many chromosomal breaks, their best chance of becoming pregnant was to use ICSI rather than IVF. The DFI analysis thereby makes it possible to personalise treatment and increase the chances of having children", says Krzysztof Oleszczuk, PhD student at Lund University and senior consultant at Skåne University Hospital.

"We hope that the results will result in involuntarily childless couples being offered the most effective treatment right away. Undergoing unsuccessful assisted reproduction can be very stressful - both physically and mentally - especially when doing so on repeated occasions", explains Aleksander Giwercman, professor at Lund University and consultant at Skåne University Hospital.

In order to confirm these results a  follow-up multicentre study is currently underway, in which three hospitals in the greater Copenhagen area participate within the scope of the EU funded research collaboration in the öresund region on fertility - ReproUnion.

However, Aleksander Giwercman is looking forward to immediately transferring this new knowledge into practice at the Reproductive Medicine Centre at Skåne University Hospital in Malmö. For a long time, the clinic has emphasised the importance of conducting a thorough analysis, both in terms of research and treatment, of women and men in couples that are involuntarily childless:

"Traditionally the main focus has been on the woman in cases where couples have difficulties to conceive. But our research and experience show that it is important to thoroughly study both partners", says Aleksander Giwercman.

The study is published in the medical journal Andrology.

Specific genetic pattern in the womb could predict IVF treatment outcome

Fertility experts in Southampton and the Netherlands have identified a specific genetic pattern in the womb that could predict whether or not IVF treatment is likely to be successful.

Study co-lead Professor Nick Macklon, chair in obstetrics and gynaecology at the University of Southampton, said the discovery would help clinicians understand why IVF fails repeatedly in some women.

He said it could also lead to the development of a new test to help patients understand how likely they are to achieve a pregnancy before they embark on the treatment process - and to guide others on whether or not they should continue even after a number of unsuccessful cycles.

"Many women undergo a number of IVF cycles without success despite having good quality embryos and, up to now, it has been unclear whether or not the lining of the womb may be the cause of that," explained Prof Macklon, medical director of Complete Fertility Centre Southampton, which is based at the city's Princess Anne Hospital and part of the NIHR Southampton Biomedical Research Centre.

"We have now shown that an abnormal gene expression in the lining can be identified in many of these women and that a specific gene 'fingerprint', when present, is always associated with failure, which is very significant in aiding our understanding of IVF failure."

Patients were recruited for the study, published online in the journal Scientific Reports, at the University Medical Center Utrecht between 2006 and 2007 and at both Utrecht and the Academic Medical Center in Amsterdam between 2011 and 2013.

Researchers obtained biopsies of the lining of the womb from 43 women with recurrent implantation failure, which occurs when three or more transfers of high quality embryos or the placement of ten or more embryos in multiple transfers fail to result in pregnancy, and 72 women who gave birth after IVF or intra-cytoplasmic sperm injection (ICSI).

During analysis of the biopsies in Utrecht and Southampton, they found an abnormal gene profile in the lining of the womb in 80 per cent of women with recurrent implantation failure that was not present among women who had given birth after IVF treatment.

Professor Frank Holstege, head of the genomics laboratory at University Medical Center Utrecht, said: "What this tells us is that a large proportion of women who suffer recurrent implantation failure may be infertile due to a problem with the receptivity of their uterus.

"Their chances of achieving successful pregnancy are likely to be very small and this information gives clinicians much more clarity in counselling patients as to the wisdom of investing further time, effort and money in ongoing treatment.

"At the same time, those patients who have undergone a number of unsuccessful cycles of IVF but do not have the genetic pattern could be advised to persist as they have a much better chance of achieving a pregnancy."

Professor Macklon, a consultant gynaecologist at University Hospital Southampton NHS Foundation Trust, added: "While we believe this finding to be a very significant development in international fertility research, the next stage is to trial it as a clinical test to study its effectiveness on a wider scale."

India bans foreigners from hiring surrogate mothers

Move aimed at avoiding exploitation of Indian women for profit, but some call it discriminatory and fear potentially dangerous consequences.

India’s government has said it would ban foreigners from using surrogate mothers in the country, a move likely to hit the booming commercial surrogacy industry.

Ranks of childless foreign couples have flocked to the country in recent years looking for a cheap, legal and simple route to parenthood.

Health industry estimates put the size of India’s surrogacy business at 9bn rupees ($138m) and growing at 20% a year.

But critics have said a lack of legislation encourages “rent-a-womb” exploitation of young, poor Indian women. In an affidavit to the supreme court on Wednesday the government said it “does not support commercial surrogacy”.

“No foreigners can avail surrogacy services in India,” it told the court, which is hearing a petition regarding the industry, adding that surrogacy would be available “only for Indian couples”.

Thousands of infertile couples, many from overseas, hire the wombs of Indian women to carry their embryos through to birth.

India, with cheap technology, skilled doctors and a steady supply of local surrogates, is one of relatively few countries where women can be paid to carry another’s child.

Surrogacy for profit is illegal in many other countries.

The process usually involves in-vitro fertilisation and embryo transfer, leading to a rise in fertility centres offering such services.

A top fertility expert branded the government’s move discriminatory, while a leading women’s activist warned it could push the industry underground and out of reach of regulators.

“Banning commercial surrogacy will send some couples on to the black market and deprive other couples of the chance of children,” Ranjana Kumari, director of the Centre for Social Research, told AFP.

“Our research shows many surrogates do not have health insurance and are paid poorly, among other issues,” she said, adding that stronger regulation rather than an outright ban was needed.

The private petition to the top court seeks a halt to the importation of human embryos for commercial purposes.

Earlier this month the court in Delhi expressed its concern and ordered the government to spell out measures for regulating the industry.

The government’s affidavit, presented to the court by the solicitor general, Ranjit Kumar, said it would “require some time to bring the law in place”.                                                    

 “The government will prohibit and penalise commercial surrogacy services,” it said.          

The government has been consulting women’s groups and the health industry on a draft bill, the Assisted Reproductive Technology, that seeks to regulate the industry. Clinic owners denied ill-treatment of surrogate mothers, saying it is in their interests to treat the women well so they produce healthy babies.

Dr Nayana Patel, one of India’s leading fertility specialists, said the move discriminated against foreigners who were also desperate to have children.

“Yes, there need to be strict checks and counter checks but banning foreigners is not the answer. It’s inhuman,” Patel told AFP.

“There is no exploitation, it’s a voluntary contract between human beings involving an exchange of money. What’s wrong with that?”

“It’s a dignified earning. Instead of women working as maids, they can be surrogates,” said Patel, who runs the Akanksha fertility clinic in the western state of Gujarat.

The latest move comes after India issued new rules in 2012 barring foreign gay couples and single people from using surrogate mothers to become parents, drawing sharp criticism from gay rights advocates and fertility clinics.

The existing rules say foreign couples seeking to enter into a surrogacy arrangement in India must be a “man and woman [who] are duly married and the marriage should be sustained at least two years”.

The cost of surrogacy in India generally ranges from about $18,000 to $30,000, of which around $8,000 goes to the surrogate mother.

Woman gives birth to granddaughter after surrogate pregnancy at Plano hospital

PLANO – For three years, Kelley McKissack and her husband tried to have a baby. Three times, McKissack miscarried.

The 28-year-old from Wylie talked with her fertility specialist about using a surrogate, but she had questions about potential legal issues.

Then she asked her doctor, what about my mother?

On Wednesday, 54-year-old Tracey Thompson, McKissack’s mom, gave birth to a healthy baby girl at The Medical Center of Plano.

And on Thursday, McKissack showed off her rosy-cheeked daughter, all 6 pounds and 9 ounces, with Thompson beaming by her side.

The pregnancy inevitably had its unusual moments, Thompson said.

Sometimes, strangers would stare. First at Thompson’s face, then at her belly.

Her husband would jokingly tell people the baby wasn’t his and walk off, leaving Thompson to explain it was their daughter’s.

“The looks we got were quite funny,” Thompson said.

The baby’s name is Kelcey — a combination of Kelley and Tracey.

“Say hi to the world!” McKissack told Kelcey, tucking her tiny arms in a mint-colored blanket as a camera shuttered in their hospital room.

Thompson, who lives in the rural community of Nevada, was already seven years past menopause when she began the pregnancy, but her health was excellent, doctors said at a press conference. She was implanted with an embryo remaining from her daughter’s final round of in vitro fertilization.

Though noteworthy, Thompson’s pregnancy was no medical breakthrough. Surrogates as old as 61 have given birth to children in Chicago and Japan in recent years, each time on behalf of their daughters.

Overall, Thompson had “a great pregnancy,” said Dr. Joseph Leveno, an OBGYN at The Medical Center of Plano. However, a complication toward the end led to a C-section.

“It was a beating,” Thompson told reporters about her surrogacy. “It really was…It’s been many years since I’ve been pregnant.”

Thompson has two adult children. McKissack’s brother is 30.

Doctors said Thursday that Thompson first went through a comprehensive medical evaluation. Her family also had to sit down with a counselor to check for any emotional problems. Once it was determined that Thompson’s uterine cavity was normal, she started taking hormones to prepare for the implantation of a 5-day-old embryo.

“Pregnancy is a heavy load on a woman,” said Dr. Ali Guerami, McKissack’s fertility specialist, who has an office in Frisco. “We have to make sure that their heart can accept it, and then we have to make sure the patient understands that when they’re older there’s much more chance you’ll have an operative procedure like a C-section.”

With older women, there’s also a higher possibility of complications, Guerami said.

Surrogacy is not a path one should pursue based on feelings alone, the doctor added. He pointed to legal and emotional challenges on top of the physical ones.

“Just because the patient wants it, or there is a surrogate available, doesn’t mean they should go ahead and do it,” Guerami said.

Surrogacy was not a decision Thompson and her husband came to lightly. They talked to their church pastor, among other trusted friends, seeking advice.

Whether the surrogacy was part of God’s plan wasn’t a discussion, said John Spencer, pastor of Lone Star Cowboy Church in Nevada. He knew about the difficulty of the couple’s daughter and son-in-law to have a baby.

“God uses medical channels to heal, or in this case, bring new life,” Spencer said.

Tracey Thompson’s close friend Trisha Sheffield visited the hospital Thursday on her lunch break as staff was setting up for the press conference.

“When I walked in, her papa [Ben Thompson] was holding the baby, and he couldn’t be more proud,” she said.

McKissack and Thompson, wearing black leggings and matching winter boots, held hands as they replied to a volley of questions from reporters.

Mom and daughter said they have always been close. They recalled a conversation they had when McKissack was 13. The teen asked her mom, “If I can’t carry my own baby, would you carry it for me?” Thompson said yes, never dreaming she would be in that position.

Barely a year after her last miscarriage on Christmas day, McKissack held Kelcey close to her chest, studying her face and rocking her gently.

“No one could give someone a greater gift,” McKissack said. “Ever.”

Scientists get 'gene editing' go-ahead

UK scientists have been given the go-ahead by the fertility regulator to genetically modify human embryos.

It is the first time a country has considered the DNA-altering technique in embryos and approved it.The research will take place at the Francis Crick Institute in London and aims to provide a deeper understanding of the earliest moments of human life.It will be illegal for the scientists to implant the modified embryos into a woman.But the field is attracting controversy over concerns it is opening the door to designer - or GM - babies.DNA is the blueprint of life - the instructions for building the human body. Gene editing allows the precise manipulation of DNA.In a world-first last year, scientists in China announced they had carried out gene editing in human embryos to correct a gene that causes a blood disorder.Prof Robin Lovell-Badge, a scientific advisor to the UK's fertility regulator, told the BBC: "China has guidelines, but it is often unclear exactly what they are until you've done it and stepped over an unclear boundary."This is the first time it has gone through a properly regulatory system and been approved."

Groundbreaking

The experiments will take place in the first seven days after fertilisation.During this time we go from a fertilised egg to a structure called a blastocyst, containing 200-300 cells.The work will be led by Dr Kathy Niakan, who has spent a decade researching human development.Earlier this year, she explained why she had applied to edit human embryos: "We would really like to understand the genes needed for a human embryo to develop successfully into a healthy baby."The reason why it is so important is because miscarriages and infertility are extremely common, but they're not very well understood."Out of every 100 fertilised eggs, fewer than 50 reach the early blastocyst stage, 25 implant into the womb and only 13 develop beyond three months.And at the blastocyst stage, some cells have been organised to perform specific roles - some go on to form the placenta, others the yolk sac and others ultimately us.How and why this takes place is unknown - but some parts of our DNA are highly active at this stage.It is likely these genes are guiding our early development, but it is unclear exactly what they are doing or what goes wrong in miscarriage.The researchers will alter these genes in donated embryos.The regulator, the Human Fertilisation and Embryology Authority (HFEA), has given its approval and the experiments could start in the next few months.Paul Nurse, the director of the Crick, said: "I am delighted that the HFEA has approved Dr Niakan's application."Dr Niakan's proposed research is important for understanding how a healthy human embryo develops and will enhance our understanding of IVF success rates, by looking at the very earliest stage of human development."Dr David King, the director of Human Genetics Alert, said: "This research will allow the scientists to refine the techniques for creating GM babies, and many of the government's scientific advisers have already decided that they are in favour of allowing that."So this is the first step in a well mapped-out process leading to GM babies, and a future of consumer eugenics."

Dr Sarah Chan, from the University of Edinburgh, said: "The use of genome editing technologies in embryo research touches on some sensitive issues, therefore it is appropriate that this research and its ethical implications have been carefully considered by the HFEA before being given approval to proceed.

"We should feel confident that our regulatory system in this area is functioning well to keep science aligned with social interests."

The baby was born from the oldest frozen sperm in the world

Almost 25 years ago in the beginning of 90^th 20 century 15-year old resident of the United States was diagnosed with oncological disease. Before the treatment teenager donate his sperm which was stored in liquid nitrogen 23 years and didn’t lost its properties.

Despite that cryopreservation method used in reproductive medicine for the past several decades its exceptional reliability never stops to amaze. Many years ago 15 year old teenager was diagnosed with megakaryoblastoma, malignant tumors of the lymphatic tissue.

The boy had to take a few courses of powerful chemotherapy and radiation therapy what could well deprive him of the ability to have children because of the side effects.

When young Alex Powell was on his way to his small town in the train, his mother had a conversation with a random fellow traveler and told him about their serious family problem. The man apparently understands the medicine as advised Alex to go to the clinic of reproductive medicine, to donate his sperm for cryopreservation. Next day Alex went to the clinic and after had long months of treatment in the oncology clinic. Alex Powell wins his fight with the cancer but become infertile.

Not long time ago 38 years old Alex Powell went to the same sperm Bank. He got married in late 30^th and year ago him and his wife decided to try for a baby using 23 years old sperm. First attempt was successful and recently, Alex and his wife had a perfectly healthy boy, who was named Xavier (Xavier Powell).

The previous record belonged to the English Richard Pott (Richard Pott), which is in 2012 became a father with the help of sperm that was stored in liquid nitrogen for 22 years. His story is almost identical to the life of Alex Powell, the only difference is that in the late 80's of the 20 century he was diagnosed with Hodgkin's disease.

Photos and videos can be taken from here:

http://www.dailymail.co.uk/news/article-3348138/Meet-world-s-oldest-baby-Newborn-Xavier-Powell-conceived-using-sperm-frozen-23-YEARS-ago-father-cancer-treatment-infertile.html

Cancer and pregnancy: how to give a birth after chemotherapy?

The question of "whether there is a pregnancy after cancer 'no longer sounds like "Is there life on Mars". Over the past couple of years, scientists have moved far in this direction. We have not yet learned how to prevent cancer, but we learn how to negotiate it.

For example, chemotherapy use to be a verdict to infertility but not anymore! The only task that oncologist’s patients decide for themselves is to use genetic material or the donors. We consider both options.

Using own genetic material

Chemotherapy drugs cause an artificial menopause to women and for men reduced levels of total and free testosterone and termination of pulse secretion. The causes and mechanisms of occurrence of such changes is now closely examines. And it is very likely that soon such side effects of anticancer drugs will not carry.

If the treatment of cancer occur up to 30 years old the resumption of fertility is possible. In later age isolated cases of recovery. But even in this case, doctors are advised to refrain from pregnancy for 3-5 years if the sperm or egg cells were susceptible to chemotherapy drugs.

There is a very reliable way to preserve the reproductive function is to think about freezing eggs and sperm before go through chemotherapy. This is very important information, we would advise to distribute among friends and acquaintances. To the fact that there are cases where doctors do not warn patients about the loss of fertility. Sometimes you meet such people, speak to them and understand how simple medical negligence can ruin the families and dreams about having children. But the only thing what should be done by doctor is to fully inform the patient of the consequences of the treatment and prevention opportunities. Modern technologies allow to store their genetic material in the cryo-chamber, and use it when needed by IVF.

Donor’s genetic material

To conceive a child you can use donor eggs and sperm. In what cases it would be the best option:

·        If a woman's body still weak after cancer treatment

·        If the egg fence was held after 29 years old.

·        If you don’t have your own eggs or sperm.

Donor egg is fertilized artificially, and your endometrium is ready for replanting. 5 days after embryo can be implanting and wait for the pregnancy to develop.  The quality of patient egg is worse than donor egg. And that means a high probability of multiple attempts at fertilization and the likelihood of miscarriage. Modern methods of cancer treatment allow a woman to live a full life but health after treatment is still weak. And doctors often advise against exposing the body to such a test, as multiple IVF attempts.

Statistics of successful birth of a healthy child with donor eggs is very encouraging – from 50 to 70% success rate with the first attempts. These excellent results are due to a perfect health and young age of the donor. According to the standard annual research institutes and clinics of reproduction, till 29 years old chances to successfully conceive and bear with the use of donor eggs grip at around 70%. And probability that a child will be born healthy gets to 100%, as the donor material is checked for a set of criteria. By the age of 42 they reach the level of 7%.

Anyway, in matters of reproduction cancer is no longer a judgment. Share this information - perhaps for some it will be an occasion to reflect on the creation of a "genetic insurance fund" for themselves. After all sometimes full information can save people's lives.