Pre-Implantation Genetic Testing

Pre-Implantation Genetic Testing:

 

PGD (Pre-implantation genetic diagnosis) was developed several years ago and is an excellent technique for diagnosing embryos that have a specific genetic disease such as cystic fibrosis or muscular dystrophy.  This helps people who have a strong family history of such conditions to consider only using embryos that are not affected by these conditions.

PGS (Pre-implantation genetic screening) on the other hand is a similar technique applied to embryos  in the hope of identifying changes in the numbers of chromosomes in the embryo.    Embryos with a normal pattern of chromosomes (euploid) have the best chance of developing into a healthy baby, whereas aneuploid  embryos, that do not have the correct number of chromosomes, are less likely to implant and, if they do, the pregnancy is more likely to end in miscarriage or the birth of a baby with a genetic condition.

In recent times, more and more clinics are offering PGS for couples undergoing fertility treatment.     The exact place of PGS has yet to be determined as there are still many questions to be answered about the technique.    While it can reduce the number of miscarriages and failed pregnancies, it has not yet been shown to increase the number of live births from an IVF or ICSI treatment.    There are no studies on the long term effects of this technique as it has just not been around long enough.     In addition, the results are not always straight forward.   A significant problem is mosaicism, where some cells have a normal number of chromosomes and others don’t.  In these cases, it can be difficult for geneticists to determine the likely outcome of such pregnancies.  There have also been cases of false positive and false negative test results.

For all these reasons, Merrion Fertility Clinic’s policy at present is to recommend PGS for certain of our patients but not for all couples undergoing IVF.   However, we are cognisant that this is an evolving issue and that, as more studies are done, hopefully, the true role of PGS and its place in fertility treatment will be established.

Recently the HFEA, the official regulatory body for Assisted Reproduction in the UK,  determined that PGS should be classified as a ‘red status IVF treatment add on’ i.e. that ‘there is no evidence that the treatment is effective and safe’.  This decision is controversial.  It certainly has merit but others in the field disagree.    For that reason Merrion Fertility Clinic, as described above, takes an individualised approach to patients when discussing the benefits and risks of PGS.

 

For more reading:

https://www.hfea.gov.uk/about-us/news-and-press-releases/2019-news-and-press-releases/pgs-rating-now-red-following-review/

https://www.hfea.gov.uk/treatments/explore-all-treatments/treatment-add-ons/pre-implantation-genetic-screening-pgs/

What is the IVF Process?

ivf process The IVF process is emotionally intense, physically draining and  expensive. But advanced medical knowledge and pioneering lab techniques are making the ‘take-home baby rate’ for women and couples better than ever, writes Danielle Barron.

Merrion Fertility Clinic featured in the Sunday Business Post and answered the most common fertility questions.

Keep reading to see full article.

 

 

The IVF Process

Whether it’s Intracytoplasmic sperm injection (ICSI) or standard In Vitro Fertilisation (IVF), the procedure is the same for the couple. Professor Mary Wingfield, a consultant obstetrician and gynaecologist at the National Maternity  Hospital, and clinical director of Merrion Fertility Clinic, outlines what a typical IVF cycle involves. “We try to get between ten and 15 eggs, and to achieve this the woman has to go on fertility drugs that she self-injects for ten to 15 days.”

The eggs are removed vaginally, and on the same day the man produces a sperm sample. The eggs and sperm are placed in culture, and by the following day, it will be obvious which eggs have been fertilised and are on their way to forming embryos.

Three to five days later, all proceeding well, an embryo is selected to be put back into the woman’s womb. Any extra viable embryos are frozen to be used in the future.

ivf process - newborn

IVF Success Rates

The good news is that there have been a number of incremental improvements in IVF over the years, which has seen the “take-home baby rate” soar from 10 per cent to 30 per cent on average, says Wingfield.

“It’s much better than it used to be. If the woman is under 35, then with one treatment it is 50 per cent – you can compare that to couples with peak fertility who will only get pregnant every third time they try.”

To get pregnant naturally, around 15 million healthy sperm are needed, but for IVF you need about 100,000. Of course, just one sperm and one egg make a baby, but understandably with an IVF cycle they like to maximise your chances.

For more common causes of poor sperm production and motility (the movement and swimming of the sperm), urologists have a range of strategies and interventions that can help improve sperm quantity and quality.

Continue Reading the Full Article Here

IVF Clinics Face New Crackdown on add-on treatments

Add Ons

As a not-for-profit clinic, we at Merrion Fertility Clinic and the National Maternity Hospital are passionate about fairness and making our treatment as affordable as possible for all our patients. We urge patients and the general public to carefully consider all the information regarding different treatments and pricing.

And we encourage you to write to the Minister for Health advocating for public funding of IVF for all Irish patients.

https://www.theguardian.com/society/2019/sep/10/ivf-clinics-face-new-crackdown-on-add-on-treatments

Concern as IVF funding still not in place

funding

Despite the official government announcement last year that €1 million would be allocated for public IVF funding, these funds have still not been released. Those awaiting the much-needed financial and legal supports around assisted reproduction, as promised by the then Health Minister Leo Varadkar three years ago, continue to face uncertainty about when these funds will be made available and what criteria will be required to qualify for assistance.

The Government approved the IVF financial aid plans in October 2017 and a specific €1m fund was then announced by the Taoiseach last December.

In a statement, the Department of Health said a model of care for infertility, tied to long-awaited assisted human reproduction (AHR) legislation and the provision of financial assistance, was still being worked on by officials.

MFC continue to advocate for public funding of IVF for all Irish patients.

To read the Irish Examiner article, please see below:

https://www.irishexaminer.com/breakingnews/ireland/concern-as-ivf-funding-still-not-in-place-922418.html

HFEA report (May 9th 2019): “IVF more popular, successful and safer than ever but reasons for treatment are changing”

HFEA

The Human Fertility and Embryology Authority has just released its latest report on trends and figures in fertility treatment. Their findings have been welcomed by the British Fertility Society, who highlight the increased uptake of fertility treatment, improved success rates and confirmation that “IVF remains a safe and effective approach to address fertility issues”. Figures in the report also show that multiple births, the single biggest health risk from IVF, has now reached an all-time low of 10%, a sharp decline from 24% in 2008.

Other key highlights from the report include:

  • in 2017, more than 54,000 patients underwent around 75,000 fertility treatments in the U.K, with IVF treatment cycles increasing by 2.5% since 2016 and resulting in over 20,500 babies being born.
  • the average birth rate for women of all ages using their own eggs reaching 22%, while women under 35 using their own eggs have the highest birth rates (30% – fresh embryo cycle, 27% – frozen embryo cycle.
  • the fastest growing fertility treatment type is egg freezing, which has increased by 10% since 2016 to 1,463 cycles in 2017.
  • frozen embryo treatment cycle success rates (23%) have overtaken fresh embryo cycle success rates (22%) for the first time since records began, indicating that freezing embryos can give as much chance of success as a fresh cycle.

To read the HFEA press release and access the report, please follow the link below:

https://www.hfea.gov.uk/about-us/news-and-press-releases/2019-news-and-press-releases/ivf-more-popular-successful-and-safer-than-ever-but-reasons-for-treatment-are-changing/

For the British Fertility Society response to the HFEA report on trends and figures in fertility treatment, please follow the link below:

https://www.britishfertilitysociety.org.uk/2019/05/09/bfs-welcomes-latest-hfea-trends-report/

 

Boosting male fertility

Male Fertility

In at least 50% of cases of male factor infertility, the cause is unknown. A number of lifestyle factors have been shown to affect male fertility. These include diet and nutrition, body weight, levels of exercise, stress and use of tobacco and drugs. Tackling obesity, improving your diet and incorporating moderate-intensity aerobic exercise into your daily life can boost fertility, improve chances of conception, and allow you to be proactive about your role in conceiving a baby.  To read more please follow the link below:

https://edition.cnn.com/2019/04/25/health/male-infertility-food-drayer/index.html

18th World Congress of the Academy of Human Reproduction 2019

Merrion Fertility Clinic were delighted to participate in the 18th World Congress of the Academy of Human Reproduction, held in the Convention Centre Dublin on April 3-6th.

MFC research was high on the agenda, with invited talks by both Prof. Wingfield and Dr. Allen, as well as six research presentations by clinical fellows Dr. Hartigan, Dr. Crosby and research officer Dr. Glover.

Congratulations to all!

https://hr2019.humanrepacademy.org/

“Guaranteed baby or your money back! Too good to be true?”

Treatments

As a not-for-profit clinic, we at Merrion Fertility Clinic and the National Maternity Hospital are passionate about fairness and making our treatment as affordable as possible for all our patients. An Irish IVF Clinic group has recently advertised an IVF refund scheme and other payment incentives for treatment. In the past, we have carefully explored such schemes whereby patients only pay for their IVF treatment if they are successful and have a baby. While some people will be lucky with such an arrangement, others will end up paying more than they need to. It is our considered opinion that such schemes do not reduce costs overall for the majority of patients and that they may even be unethical. We are not aware of any other branch of medicine where patients are asked to pay up front for several episodes of treatment – in case the first treatment does not work.

 

In 2017 in Merrion Fertility Clinic, for couples undergoing IVF where the woman was under 35 years, 45% had a livebirth on their first cycle of treatment and 79% of those also had embryos to freeze for the future. They paid for one cycle of treatment. If they had opted for a ‘no baby no fee’ scheme, each couple would effectively have paid an unnecessary €6,000-€7,000 for two fresh cycles they never needed and the clinic would have made a nice profit.  Incentive schemes are subject to medical review such that only patients with a good prognosis for success are deemed eligible and there is little transparency about the kind of clinical criteria that need to be met.  The schemes also discriminate against couples who do not have €10,000 to €17,000 to spend.  There are many other cost considerations also – for instance, Merrion Fertility Clinic does not charge for embryoscope or for sedation administered by Consultant Anesthetists. These services which are included in our base fee are not included in incentive schemes.

 

In multi-cycle fixed schemes, patients who do very poorly on their first cycle (e.g. get no eggs) will be locked into paying for two cycles, with no refund if they do not conceive. With a pay-as-you-go policy such as ours, such patients may decide to stop after one treatment and will only pay for that one treatment.

 

It is important to note that the companies offering these incentive schemes are commercial companies with shareholders who want to see a return on their investment. Their investment in fertility clinics reflects the sad but increasing commercialization of fertility treatment, with fertility care (in particular IVF) now being recognized internationally as ‘big business’ offering attractive financial returns.  We are not alone in raising questions about incentive schemes for treatment.  This recent article from Prof Nicky Hudson (Centre for Reproduction Research) discusses the growing commercialisation of fertility treatment in the UK and internationally, and what this means for the potential exploitation of patients.

https://ednaprojectblog.wordpress.com/2018/08/16/a-baby-or-your-money-back-old-dilemmas-new-questions-in-the-world-of-ivf/

We urge patients and the general public to carefully consider how they choose to pay for fertility treatment. And we encourage you to write to the Minister for Health advocating for public funding of IVF for all Irish patients.

 

Women still have to use their frozen eggs in 10 years – or lose them. Why?

 

Fertility specialists are advocating for a change in existing U.K. laws that require women who freeze their eggs to use them within 10 years. This time limit does not take into account the remarkable technological advances that have been made in the field, including the introduction of a greatly improved egg-freezing technique called vitrification. As a growing number of women pursue egg freezing in order to preserve their fertility, advocates argue that there is a growing need to update the current legislation around fertility.

To read more, please follow the link below:

https://www.theguardian.com/commentisfree/2019/jan/28/women-frozen-eggs-10-years-lose-them-fertility?CMP=share_btn_linkhttps://www.theguardian.com/commentisfree/2019/jan/28/women-frozen-eggs-10-years-lose-them-fertility?CMP=share_btn_link