Pregnancy » News

New Guidelines For Elective Single Embryo Transfer In IVF Treatment

Just me — Thu, 04 Sep 2008 13:15:16 +0000

The British Fertility Society (BFS) and the Association of Clinical Embryologists (ACE) have issued new guidelines in the journal Human Fertility to help UK clinics introduce an elective single embryo transfer (eSET) policy for IVF treatment. The release of these guidelines coincides with the BFS Summer College 2008, taking place on 2-5 September in Liverpool.

Single embryo transfer is the only effective method to reduce IVF multiple pregnancy rate, the single biggest health risk to both mother and child associated with fertility treatment. UK practice in this area currently lags behind most of Europe and Australia, principally due to the lack of adequate state funding. For this strategy to be successful, it is crucial the funding situation is improved.

The Human Fertilisation and Embryology Authority (HFEA) recently asked clinics to reduce multiple pregnancy rates from an average of 24% to 10% over the next three years. Currently in the UK, most fertility treatments involve transferring two embryos into the womb, increasing the likelihood of multiple pregnancy and the associated risks. These guidelines are designed to help clinics meet the criteria set by the HFEA, while not compromising the live birth rate.

The guidelines recommend:

- Patients should be carefully examined to assess if eSET is suitable for them. In the UK, 87% of multiple pregnancies occur in the first cycle of treatment, in women aged under 37. If patients are carefully selected (e.g. women under 37, in their first IVF cycle who have several high quality embryos), eSET plus subsequent frozen embryo transfer can be as effective as double embryo transfer, and does not compromise the likelihood of conception.

- It is essential to combine an eSET policy with an effective frozen embryo replacement programme, to maximise cumulative live birth rates per stimulated cycle. This means spare high quality embryos harvested from an ovarian stimulation cycle can be frozen, stored and subsequently reimplanted if pregnancy does not result from the initial eSET. This avoids the need for women to undergo further costly cycles of ovulation stimulation to harvest more eggs. Urgent improvements in both facilities and funding in this area are needed to meet demand.

- Three mild stimulation IVF cycles (collecting less eggs, creating fewer embryos and electively replacing one embryo) are as effective as two conventional stimulation cycles, result in fewer complications, and have proved more cost effective in other health care settings if the costs of multiple pregnancy are included. As most Primary Care Trusts fund only one cycle, couples are currently unlikely to choose this treatment, as live birth rate per individual cycle is lower.

- Standard grading schemes for embryo quality could potentially greatly aid embryo selection. Although promising, new developments to assess embryo viability require more research before being introduced into clinical practice.

- A simple algorithm based on embryo quality can help select those patients who would benefit most from eSET. Extending culture of embryos to day 5 after fertilisation (blastocyst culture) may assist in embryo selection for eSET.

- To increase the eSET uptake, patient education is essential. Couples are more likely to accept eSET if state funding for more than one cycle of fertility treatment is readily available.

- The HFEA should review its fees and data presentation structure to encourage the eSET uptake.

- To reduce the multiple birth rate, it is absolutely critical that the Department of Health issues strict guidance to Primary Care Trusts to fully implement the NICE guidelines on fertility treatment. In overall terms, eSET will save the NHS money – extra spending on fertility treatment is more than counteracted by savings on treating the long-term health problems in both mothers and children caused by multiple births.

Mr Tony Rutherford, Chair of the BFS Policy and Practice Committee, said:

“The key to success with this strategy is more NHS funding. The British Fertility Society strongly believes that the health benefits to children, the reduction in distress for families and the enormous cost savings for society make an overwhelming case for single embryo transfer in certain situations. Transferring only one embryo to those women most at risk of having twins is the only effective method to reduce the multiple birth rate after IVF treatment. It is imperative that elective single embryo transfer is made the norm for these women in the UK, as it is elsewhere in Europe.”

“The only way in which this strategy can be effectively implemented for the benefit of both mothers and babies is for the NHS to increase funding to allow full implementation of the NICE guidelines on fertility treatment.”

Mrs Rachel Cutting, from the Association of Clinical Embryologists, said:

“New advances in embryology mean we can tackle the risks of multiple births much more effectively than ever before. These guidelines provide a clear, evidence based approach to judging embryo quality, the optimum time to transfer embryos, and the importance of an effective cryopreservation programme. The Association of Clinical Embryologists is committed to working towards a reduction in the number of multiple births, but this can only be achieved if adequate funding is provided by the state. Embryologists are key to helping to reduce multiple pregnancy.”

General information

Currently 1 in 4 IVF births in the UK results in twins or triplets, compared to 1 in 80 births following natural conception. Multiple pregnancy significantly increases the likelihood of miscarriage and death, prematurity and low birth weight in the infant. It can also lead to long term health problems for children, such as cerebral palsy, and risks to mothers such as pre-eclampsia, diabetes and heart disease. For more information see http://www.oneatatime.org.uk/

The NICE guidelines for fertility treatment state that infertile patients aged 23-39 should receive three full cycles of IVF, where a fully funded cycle includes cryopreservation and subsequent transfer of frozen-thawed embryos. Currently, these guidelines are fully implemented by less than 10% of Primary Care Trusts.

Notes

These guidelines will be published in full in the September edition of the journal Human Fertility 2008, 11(3): 1-16. DOI: 10.1080/146470802302629. Human Fertility is the official journal of the British Fertility Society. Human Fertility website: http://www.informaworld.com/HumanFertility

The British Fertility Society is a national multidisciplinary organisation representing professionals practising in the field of reproductive medicine. We are committed to promoting good clinical practice and working with patients to provide safe and effective fertility treatment. For general information, please visit our website: http://www.fertility.org.uk/.

The BFS Summer College 2008 is taking place on 2-5 September in Liverpool. For more information: http://www.fertility.org.uk/meetings/2008/summer/

The Association of Clinical Embryologists is the professional body of and for embryologists in the UK. ACE was founded in 1993 to promote high standards of practice in clinical embryology and to support the professional interests of embryologists working in the UK. For general information see: http://www.embryologists.org.uk/

ABSTRACT

Elective Single Embryo Transfer: Guidelines for Practice British Fertility Society and Association of Clinical Embryologists

Rachel Cutting1, Dave Morroll2, Stephen A Roberts3, Susan Pickering4 & Anthony Rutherford2 on behalf of the BFS and ACE

1Centre for Reproductive Medicine and Fertility, Jessops Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK, 2Reproductive Medicine Unit, Leeds Teaching Hospitals NHS Trust, Clarendon Wing, Leeds General Infirmary, Leeds, UK, 3Health Methodology Research Group, University of Manchester, Manchester, UK, and 4Edinburgh Fertility & Endocrine Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.

Assisted conception treatment is the single most important cause in the increase in multiple pregnancy and births over the last 25 years. Multiple births are associated with significant peri natal morbidity and mortality. Europe has led the way in reducing multiple births by widespread adoption of an elective single embryo policy, which in Belgium is linked to an increase in state funding. Randomized controlled trials suggest that an eSET policy must include the ability to cryopreserve and transfer any remaining quality embryos to obtain parity with a double embryo transfer. This document provides a review of the available evidence with guidelines for practice, to help facilitate the introduction of an eSET policy in the UK.

British Fertility Society

(source: Medicalnewstoday )

Poverty, not sex ed, key factor in teen pregnancy

Just me — Thu, 04 Sep 2008 13:05:31 +0000

Jonathan Zimmerman

Thursday, September 4, 2008

One side thinks adolescents should receive more “comprehensive” information about sex, including contraception. The others side favors a more didactic approach, with a simpler message: “abstinence only.”

Sound familiar?

Brace yourself for yet another round in America’s perennial teen-pregnancy wars. On Monday, GOP vice presidential nominee Sarah Palin confirmed that her 17-year-old daughter Bristol is five months pregnant. Faster than you could say “condoms,” liberals and conservatives lined up in predictable battle formations. To the liberal camp, of course, the news about Bristol Palin simply confirmed the need for comprehensive sex education in the schools. On the right, meanwhile, Palin’s pregnancy spurred new calls for abstinence-only instruction.

They’re both wrong.

Let’s start with conservatives, and their stubborn demand for abstinence-only education. Last year, an exhaustive five-year study confirmed that kids receiving this instruction are no more likely to delay sexual intercourse than their peers.

But the abstinence-only sex education program still draws $175 million in federal money and untold sums from states and localities. As governor of Alaska, indeed, Sarah Palin supported abstinence-only education and denounced “explicit sex-ed programs” in the schools.

Yet we still don’t have any evidence that these explicit programs work, either. As University of Pennsylvania sociologist Frank Furstenberg confirmed last year, in an exhaustive review of the literature, efforts to prove the effectiveness of comprehensive sex education are “generally unimpressive, to say the least.”

We know that these programs can enhance students’ knowledge about risky sex behaviors and change their attitudes toward these same behaviors. But can sex education actually influence what kids do? As best we can tell, it can’t.

There’s only one point on which both sides seem to agree: Teen pregnancy is a big problem. They differ on their solutions, of course, but everyone seems to believe that pregnancy hurts the life chances of teenage moms and their children.

Again, the data suggest otherwise. As Furstenberg has shown, bearing a child as a teenager doesn’t hurt a woman’s prospects for education, job advancement or marriage. Ditto for her kids, who don’t suffer any measurable consequences from having a teenage mother.

Instead, they suffer for a much more basic reason: They’re poor. About two-thirds of teenage mothers live at or below the poverty line at the time they give birth. The less income and opportunity that you have, the more likely you are to become a teenage parent.

So Americans have it exactly backward. Teen pregnancy doesn’t deprive our kids of life chances; instead, kids who lack those chances are the ones who get pregnant. Why? Nobody knows for sure. But it seems that young women who have a sense of power and confidence in their lives are more likely to use contraception. Impoverished girls often lack that confidence, so they don’t take measures to protect themselves. They are also less likely to have abortions, which are often too expensive or heavily tabooed in poor communities.

And so the war rages, largely untethered by facts. For in the end, this struggle isn’t really about facts at all. It’s about rival views of sex itself. Left-leaning Americans view sex as a normal part of human development, so they want to give adolescents the information that will help them make responsible decisions about it. But social conservatives think sex should be reserved for one population alone: married people. Everyone else should abstain, especially if they’re teenagers.

That helps explain why Sarah Palin – in revealing Bristol’s pregnancy – also announced that her daughter will marry Levi Johnston, the 18-year-old father of Bristol’s unborn baby. To drive the point home, Johnston has joined the Palins at the GOP convention. It’s a family affair, and now he’s a part of it.

The decision won immediate acclaim from conservatives, who regard unwedded childbearing as the greatest plague on the land. And there’s a significant body of research showing that children raised by two parents do better than those in single-parent homes.

But we also know that so-called “shotgun” marriages – that is, unions forged in response to a pregnancy – are heavily prone to divorce. That’s one reason why divorce rates are so much higher in so-called red states, where young people are more likely to marry after conceiving a child.

All things being equal, of course, it’s still best for our teenagers – and for their offspring – to delay parenthood. But all things are not equal, and that’s the whole point here. The hype over teen pregnancy diverts us from the truly serious problem in American society, which is the growing poverty of teenagers themselves. Last year, for example, UNICEF ranked the United States second to last among 21 developed Western nations in child health, safety and material well-being. Changing the teen pregnancy rate won’t change any of that.

So don’t feel sorry for Bristol Palin or her unborn child, who will probably turn out OK. So did Ann Dunham, who bore a son when she was just 18. You’ve probably heard of him: Barack Obama. He seems to have done pretty well, too.

Instead, think about the teen parents who lack the social and material advantages that you do. Remember that in most cases they’re parents because they’re poor, and not the other way around. The more we fight about teen pregnancy, the less we’ll focus upon teen poverty. And that’s bad news for all of us.

Jonathan Zimmerman teaches history and education at New York University. He is the author of “Innocents Abroad: American Teachers in the American Century” (Harvard University Press).

This article appeared on page B – 7 of the San Francisco Chronicle

Move to reduce multiple pregnancies

Just me — Thu, 04 Sep 2008 12:58:44 +0000

Fertility clinics have been issued new guidelines to help cut the rate of multiple pregnancies.

The aim is to encourage a policy of only transferring single embryos to the wombs of women undergoing In-Vitro Fertilisation (IVF) treatment whenever possible.

Currently, most assisted conception in the UK involves transferring two fertilised embryos into the womb. This is intended to raise the chances of a successful pregnancy, but it also heightens the risk of multiple pregnancies.

Becoming pregnant with twins or triplets significantly increases the likelihood of miscarriage, stillbirth, premature birth and low birth weight.

It can also lead to long-term health problems in children, such as cerebral palsy. Mothers bearing multiple pregnancies face dangers too, including the potentially life-threatening pregnancy condition pre-eclampsia, diabetes and heart disease.

The Human Fertilisation and Embryology Authority (HFEA), the fertility regulatory body, is asking clinics to reduce general multiple pregnancy rates from an average of 24% to 10% over the next three years.

The British Fertility Society (BFS), which represents clinics, and the Association of Clinical Embryologists (ACE), responded to the call by issuing new guidelines.

The proposals, published in the journal Human Fertility, set out ways in which IVF clinics can introduce an elective single embryo transfer (eSET) policy.

A key recommendation was for clinics to institute a system of carefully assessing patients to see if they are suitable for single embryo transfer.

Most of these patients will be relatively young. In the UK, 87% of multiple pregnancies occur in the first cycle of treatment in women under the age of 37. Under the guidelines, eSET is considered appropriate for women younger than 37 who have several high quality embryos.

(source: Google.com )