Banking on science for future fertility

From the moment a baby girl is born, her fertility clock begins the countdown. Though she has millions of eggs in her immature ovaries, by the time she's a woman, the viability of those eggs has already started to diminish.

By age 40, her chances of conceiving have declined, while her chances of having a child with chromosomal abnormalities have increased. And if she's like thousands of women in their 30s who have yet to meet Mr. Right and whose careers and personal choices don't include, for now, child rearing, she may find herself wishing that should could freeze time.

Actually, she may be able to. Although the procedure is still considered by many to be experimental, about 200 fertility centers around the country are using new technology to collect and freeze unfertilized eggs of women in their 30s for use in their 40s.

Until now, egg banking has been employed mostly by women about to undergo chemotherapy for cancer. What is new is who it is being marketed to: thirtysomethings who are postponing having families. They see it as a way to improve their odds of having healthy children.

For older women, fertility issues generally lie not with the uterus, but with the eggs.

"We can make the uterus do what we want it to do," said Dr. Mary Ramie Hinckley, a reproductive endocrinologist at Reproductive Science Center of the San Francisco Bay Area. "Egg quality is the problem."

Even though a woman in her 40s is capable of conceiving, she stands a greater chance of complications and of having a child with health issues. As she ages, the risk of bearing a child with certain chromosomal disorders increases. A 25-year-old woman has a 1 in 1,250 chance of having a baby with Down syndrome; at age 45, the risk is 1 in 30.

But if a woman preserves and banks her eggs when she is 35, then those are available to her if she decides to have a child at 45.

Hinckley said her group has recently begun offering the procedure to women who want to safeguard their fertility.

"Sperm freezing has been around for decades," Hinckley said, "followed by high success rates with embryo preservation. Now we're having a much better success rate for freezing and thawing unfertilized eggs."

While egg banking has so far drawn none of the controversy and ethical dilemmas that preserving embryos has, the success rate with the eggs has been low, Hinckley said. Eggs, she said, can be fragile, and when frozen, they can shatter like a glass bottle left too long in the freezer.

The chance of taking a frozen egg, thawing it, fertilizing it and having a successful implantation has been only about 5 percent. But new techniques have improved that number, increasing the probability of conception to 20 percent.

The odds are still low, Hinckley said, but improving.

The numbers are too low for some. The official position of the Society for Assisted Reproductive Technology is that the procedure should be limited to women whose fertility is threatened by illness and disease.

"It's something that isn't really ready to be offered commercially," said society spokeswoman Eleanor Nicoll, "because the success rates for it still aren't very good. It's still under development, and a lot of work is still needed."

She said the society is concerned that women might place the future of their fertility on a procedure that may not work for them. They could be banking on a pregnancy that will never happen while overlooking the obvious: getting pregnant in the traditional way.

While Hinckley and others readily acknowledge that egg banking is not for everyone and that it still has relatively low rates of success, it can offer a measure of security and insurance for some.

Reproductive Science Center, which has offices in San Ramon, Orinda, Fremont and San Jose, Calif., sets an age limit on using banked eggs. Women must undergo the implantation procedure before their 51st birthday.

The cost of collecting eggs is an expensive one, Hinckley said. Women undergoing the procedure receive a daily injection for eight to 10 days to stimulate egg production. Then 10 to 15 eggs are extracted in an outpatient process. The price is $6,000.

The eggs are then frozen and shipped to a storage facility in Minnesota, said Kristin Ivani, a reproductive biologist who oversees the lab for the Reproductive Science Center. Cost of long-term storage is about $1 a day.

Should a woman later decide to use the eggs, there is another fee for thawing, fertilizing and implanting.

Egg banking is a natural progression of reproductive science, Hinckley and Ivani said.

"It's next new thing," Ivani said.

Male contraceptive pill should not damage male fertility

Men who take a hormone-based contraceptive pill, which is thought to be about three to five years from hitting the market, can regain their full fertility in about four months after halting the treatment, a study has found.

A male hormonal contraceptive pill is in the works since drug companies are looking to give men a greater participation in f amily planning decisions. However, the problem of suppressed sperm production after taking such a male contraceptive pill has made men wary of using these preparations.

Additionally, these seemed to reduce s ex drive, something that no man wants to risk. Hence, the idea of a male Pill has received a lukewarm reception.

But the current study found that sperm production returns to near normal within three to four months after stopping this treatment. The lead author of the current study, Dr. Peter Y. Liu, of the Department of Andrology at Concord Hospital and ANZAC Research Institute of the University of Sydney, in Australia, admitted that an easily reversible method is an important requirement for any contraceptive.

He added that his team's findings, which appear in the April 29 issue of The Lancet, constitute "an important step in the development and widespread adoption of these methods."

According to researchers, androgen or androgen-progestin treatment works by suppressing sperm production. This means that sperm is either not produced at all in the semen or is produced in very low levels that are unlikely to lead to conception.

Sperm production falls to three million sperm per millilitre compared to a fertile level of 20 million that is generally accepted as a benchmark for conception. However, to ensure that this method is reversible, Dr Liu's team analyzed 30 studies on male hormonal contraceptives. The sperm levels were monitored every month in these studies until they reached normal levels.

The researchers reviewed data on 1,549 men and found that the average sperm recovery time was three to four months. Faster recovery rates were observed in older men, a shorter duration of treatment, in men of Asian origin and in men who had higher sperm concentrations before beginning the treatment.

The men were given progesterone, a fema1e hormone, as an injection that was repeated every three months. Progesterone plays an important role in inhibiting sperm production. A single sperm has a life span of 70 days and hence the injections must be taken at least three months before for maximal effectiveness.

In addition to progesterone, the male hormone, testosterone, is given as a sub-cutaneous implant. This implant is renewed every three months. Researchers speculate that the testosterone maintains an intact libido in men. It is reported that volunteers who tried this method out admitted to an increased libido.

"Men who use androgen-progestin male contraceptive methods can all expect that their sperm output will return back to levels consistent with normal fertility," Liu said. "This means that these hormonal methods are reversible."

A male contraceptive pill offered choices to men, said Dr. Christina Wang, co-author of the study, a professor of medicine at the General Clinical Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center. "It will allow men to participate in family planning decisions and share fami1y planning responsibilities."

"We are developing possibilities for short-acting, medium-acting and long-acting male contraceptives," Wang added. "There will be pills, injections, patches and implants, just like in women. We now have important safety information and a roadmap for future studies of recovery. This is an important step in allowing men to share more fairly the satisfaction and burden of fami1y planning."

Currently, v asectomy and the use of c ondoms are the only contraceptive methods available to man. The withdrawal method or the coitus interruptus is also an effective method, but is rarely successful. Some couples find that con doms are not a good choice, while vasecto my is not reversible. Hence, these methods are not widely employed and contraception has largely remained a fe male domain.

Several large trials are being conducted on the subject of a male contraceptive Pill. A large phase III trial involving androgen treatment and another, which is looking at a combination of androgen-progestin, is currently under way in China and Europe.

The fe male Pill is a combination of progesterone and estrogen and works by suppressing ov ulation. This must be taken almost at the same time everyday. However, there are a lot of side effects like moodiness, weight gain and pigmentation reported with the Pill. Some wo men regain fertility almost immediately on stopping the pill, but generally a period of six to eight weeks is the observed recovery time.

Male fertility is funny business

Male comics are revealing their most intimate details for good reason, writes Fiona Scott-Norman.

Audiences are used to comics mining their personal lives for material.

Drinking, shagging and humiliating stories from childhood are the mud and straw from which many a routine/adobe hut has been lovingly crafted. What sets a comic apart, however, and really engages a crowd, is the willingness to move beyond share-houses, dating and pulling bongs into truly intimate, emotionally charged, controversial territory.

Three performers this Melbourne International Comedy Festival have been prepared to put their most precious commodity - their, ahem, fertility - on the line, and the result is three very different shows that examine the issue from the male perspective.

Matt Black's Come With Me is a call for volunteers to donate semen to the Albury sperm bank. Damian Callinan's Spaznuts is an exploration of his own infertility. And Tasmanian Ben Payne's Duopoly of One looks at how enduring IVF, and then conceiving twins, impacted on his relationship.

It's the kind of stuff that traditionally makes men shuffle their feet nervously and start talking loudly about sport, but Callinan, who found out he was infertile shortly before his marriage ended, doesn't feel that revealing such personal material is a big deal. If anything, he seems relieved that a bright light is finally being directed at such a private part of his life.

"I'm just telling my own story, and I'm comfortable with that. Some friends came and said they loved the show, but found themselves wanting to use the word ‘brave', and then hating themselves for that. It just sounds so patronising.

"I'd rather the whole world knows about it so that people stop asking why my partner and I don't have children. Those conversations are the awkward ones."

Callinan's monologue is set in a sperm-delivery clinic, with Damian engaging in occasional "conversation" with other men in the waiting room. He wanted to broaden the show by including other men's stories, such as the man who has known for 10 years he's infertile, but whose wife won't give up on IVF.

Callinan, a comedy festival veteran, two-time Barry nominee and former star of Skithouse, has noticed that the sensitive and biographical nature of the show deepens his connection with his audience. "I think that there's something about telling your own story that people are more nurturing of - the connection is very strong.

Britons cautioned on foreign fertility treatment

LONDON (Reuters) - Britons were urged on Friday to think twice about going abroad for in vitro fertilization (IVF) and other types of fertility treatment.

The Human fertilization and Embryology Authority (HFEA), which monitors fertility clinics in England and Wales, said couples should think twice about the risks and implications before booking an IVF holiday.

"We know that a relatively small number of people choose to travel abroad to undergo fertility treatment and that sometimes the treatment is packaged as a 'holiday' where the patient can convalesce in the sun," said Suzi Leather, the chair of the

HFEA.

"However we are concerned that people who choose to have their treatment abroad should know about the potential risks," she added in a statement.

The HFEA said patients should consider what happens if something goes wrong, whether their information is kept confidential, the legal position of donors of eggs or sperm and how they are recruited, screened and compensated.

Leather said she has heard stories of foreign clinics offering treatments to patients that could be dangerous, such as implanting five embryos to increase the chances of a pregnancy.

Implanting two or more embryos can increase the odds of having a multiple birth, which can be dangerous for the mother and the babies.

"We would urge patients to think twice and consider the risks and implications before going abroad for treatment," Leather added.

'Forgotten' drug lets women have IVF without side-effects

HUNDREDS of infertile women could be spared the most distressing side effects of IVF by a drug regime too rarely used in Britain, a leading specialist said yesterday.

Newer fertility drugs that act quickly without triggering menopausal symptoms can be as effective as standard therapies but are offered by only one in twenty British clinics, according to Bill Ledger, Professor of Obstetrics and Gynaecology at the University of Sheffield.

Gonadotrophin-releasing hormone (GnRH) antagonists were developed in the 1990s and are used in 80 per cent of IVF cycles in Scandinavian countries. They halve the length of a cycle and avoid side effects of hormonal drugs such as hot flushes, night sweats, mood swings and insomnia.

They also significantly lower the risk of ovarian hyperstimulation syndrome, the most dangerous complication of IVF apart from multiple births.

Despite these advantages, GnRH antagonists are unpopular with British fertility doctors, who consider that they slightly reduce the chances of a successful pregnancy compared with traditional long-protocol IVF drugs. Professor Ledger said that many clinics were too frightened of falling in the success-rate league tables.

Early clinical trials of GnRH antagonists found that they produced an average of 1.0 to 2.3 fewer eggs and 0.2 to 0.5 fewer good-quality embryos in each cycle. Pregnancy rates were slightly lower, but not statistically significant. Professor Ledger said the studies took place before most doctors had experience of the new drugs.

Success rates in clinics that regularly use GnRH antagonists are now comparable to those using older drugs. The one trial that examined clinics experienced in the new regime had found no appreciable difference in pregnancy rates. “The uptake of these drugs has been slower because of the conservative nature of IVF in Britain,” he said. “Clinics are terrified of a drop of a few points in their success rates if they switch.”

IVF involves stimulating ovaries to over-produce eggs, so that a dozen or so can be harvested and fertilised at the same time. For this to happen, it is necessary first to stop the normal menstrual cycle using drugs that block the action of GnRH, traditionally done with a class called GnRH agonists.

These drugs stimulate a flare in hormone levels before they fall, and must be given for two to three weeks before the ovaries can be stimulated and egg collection can begin. This long period is responsible for the menopausal symptoms.

GnRH antagonists work differently, neutralising the hormone’s action completely so that the pituitary gland cannot respond. There is no hormone spike and a cycle is “downregulated” much more quickly.

This means that GnRH antagonists can be given six days after a woman has started taking drugs to stimulate her ovaries. Treatment continues only for the critical period in which downregulation is essential, about five days, and does not continue for long enough to cause side effects.

Early births could prompt IVF restrictions

Senior doctors today called for new regulations on fertility treatment in order to cut the number of premature births.

Assisted conception that involves transferring multiple embryos into a patient's womb should be limited as it increases the risk of babies being miscarried or born prematurely, according to two obstetricians from King's College London School of Medicine.

The proposal is one of several measures to reduce the rising number of premature births that Andrew Shennan, professor of obstetrics, and consultant obstetrician Susan Bewley put forward in the latest British Medical Journal (BMJ).

11.45am Early births could prompt IVF restrictions Friday April 21, 2006 Senior doctors today called for new regulations on fertility treatment in order to cut the number of premature births. Assisted conception that involves transferring multiple embryos into a patient's womb should be limited as it increases the risk of babies being miscarried or born prematurely, according to two obstetricians from King's College London School of Medicine. The proposal is one of several measures to reduce the rising number of premature births that Andrew Shennan, professor of obstetrics, and consultant obstetrician Susan Bewley put forward in the latest British Medical Journal (BMJ). Article continues The obstetricians expressed concern at rising rates of premature birth across Europe, warning that the trend could have serious financial and social consequences. "The total health burden of the population will not change unless the number of premature deliveries can be reduced," they said. They urged doctors to question the wisdom of inducing labour and allowing elective caesareans, both of which processes can be used to deliver babies early. The obstetricians noted that premature babies often require intensive hospital care, and have lifelong health problems. A fifth of babies born before 25 weeks' gestation have severe mental and physical disabilities, while those born earlier than 28 weeks spend 85 times longer in hospital in the first five years of their lives than full-term babies do. The editorial in the BMJ follows a Danish study published earlier this year showing a 22% increase in Denmark's premature delivery rates between 1995 and 2000. The researchers found that even among low-risk women aged between 20 and 40 in Denmark, there had been a 51% increase in early deliveries. Factors known to increase the likelihood of premature birth include being obese or underweight, and smoking. Ethnic origin and social class also play a role. However, most premature births followed spontaneous labour, in a sequence of events about which knowledge was lacking, the obstetricians said.