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Twins born through IVF "more likely to suffer problems"

Giving birth to twins through fertility treatment substantially increases the risk to both mother and children, new research finds

by Sarah Knapton

Twins born through fertility treatment and their mothers are far more likely to suffer problems than single births, new studies show. Until recently fertility clinics implanted several embryos to increase the chance of conception, but the practise led to women regularly having more than one child.

Now new research has shown that even giving birth to twins through fertility treatment, such as IVF, substantially increases the risk to both mother and children. They were five times more likely to need a Caesarean section and 10 times more likely to be born prematurely.

Prof Barbara Luke, at Michigan State University, looked at the birth outcomes for 6,000 single pregnancies and 2,500 twins. "And what we found was that being a twin versus a singleton at birth increased the risk for all outcomes except for of course large for age," she said. Multiple pregnancy is the single biggest risk of fertility treatment, according to the Human Fertilization and Embryology Authority.

It increases the risk of stillbirth, neonatal death and disability in children born. It also increases the risk of dangerous complications to the mother, such as late miscarriage, high blood pressure and pre-eclampsia.

On average, one-in-five IVF pregnancies are a multiple pregnancy compared to one-in-80 for women who conceive naturally. UK guidelines advise that wherever possible a single embryo only should be transferred, but some clinics still put back more – sometimes because the patient wrongly thinks it improves their chances. However, the research suggests that it is safer to transfer single embryos.

Dr Rebecca Sokol, president of the American Society for Reproductive Medicine, said: "We have long known the dangers of high order multiple pregnancies.

"This research shows us how risky even twin pregnancies can be. Clearly, the trend toward using single embryo transfer needs to continue."

The research was presented at the American Society for Reproductive Medicine annual meeting in Honolulu, Hawaii.

Data Source: Stork Fertility Center, 2011

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Women-Friendly Industry: Apple/Facebook offer to cover your egg freezing now!

Facebook, Apple offer to cover costs of freezing eggs for female staff

by Michelle Starr

Data source:, 2012

-- Apple and Facebook have updated their company benefits policies to include fertility treatments in a bid to retain female staff.

From January 2015, Apple will cover up to $20,000 for freezing eggs for both full- and part-time staff in the US, including the extraction procedure and storage costs, while Facebook has been offering the benefit up to the same amount from January this year.

"We continue to expand our benefits for women, with a new extended maternity leave policy, along with cryopreservation and egg storage as part of our extensive support for infertility treatments," Apple said in a statement. "We want to empower women at Apple to do the best work of their lives as they care for loved ones and raise their families."

The company also introduced extended parental leave, while Facebook offers four months of parental leave for both mothers and fathers, as well as adoption and surrogacy assistance, and other fertility services for male and female staff. Apple offers assistance for adoption, too.

"Egg freezing gives women more control," said Jennifer Tye, marketing lead for fertility app Glow. "When I turned 30, I had this notion that my biological clock was ticking, but I didn't know what my options were. These employers should be commended."

Warwick Business School professor of human resource management James Hayton, who researchers how companies attract and retain talent, noted that the policies, though bold, are likely to benefit those companies who are brave enough to offer them.

"Egg freezing is one in a long line of innovative HR practices intended to be attractive to educated people with many employment options, seeking a focus on flexibility in the difficult balance between work and life," he said.

"The costs appear to be moderate, although not trivial, at about 20 percent of average annual salary at these firms. The benefits, in terms of attracting and retaining employees, can be expected to significantly outweigh the costs. The positive PR will pay for itself by signalling these employers' values, with respect to women's control over this important life choice, to prospective female employees."

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Advances May Improve Success Rate for In-Vitro Fertilization

Two New Techniques Aim to Make It More Likely That a Single Embryo Will Lead to a Pregnancy

by Lisa Ward

New techniques offer the possibility of improving a patient's odds of having a baby through in-vitro fertilization. A single IVF cycle has about a 32% chance of resulting in a live birth, according to statistics from the Centers for Disease Control and Prevention. To improve the odds, doctors often implant multiple embryos in the uterus during a single IVF cycle, leading to a high rate of twins and triplets. Multiple births can lead to serious health complications for mother and child and significantly increase health-care costs, says Emre Seli, director of the Yale School of Medicine's division of reproductive endocrinology and infertility.
Two new techniques aim to improve the likelihood that implanting a single embryo will allow a patient to have a baby.

A. Screening Chromosomes
The technique furthest along, and already used in select clinics around the world, is called preimplantation genetic screening. In this procedure, cells are removed from the embryo on day five (or day six) to see if the normal amount of genetic material is present. An embryo should have 23 pairs of chromosomes; those with extra chromosomes or missing chromosomes are considered less viable.

"Chromosome abnormality is the main cause of miscarriage," says Richard Scott, clinical and scientific director at Reproductive Medicine Associates of New Jersey, a fertility clinic and the reproductive endocrinology and infertility division of Rutgers University's Robert Wood Johnson Medical School.

(The process is different from searching for a specific disease or genetic disorder that is likely to manifest later in life, which is known as a preimplantation genetic diagnosis.)

Chromosomal screening has shown promise in three small, randomized studies. A study co-authored by Dr. Scott, for instance, found that transferring a single embryo after chromosomal screening resulted in a similar rate of live births as transferring two untested embryos.

Still, some experts say more research is needed.
"A major study with an adequate number of patients is needed to definitively determine the degree of benefit," says Christos Coutifaris, chief of reproductive endocrinology at the Perelman School of Medicine at the University of Pennsylvania, adding that this is especially true given the price tag. The procedure costs about $4,000—a hefty fee on top of an already expensive process that often is paid for out-of-pocket. The average IVF cycle costs about $12,400, according to the Society for Assisted Reproductive Technology.

B. Monitoring Cell Division

Time-lapse imaging, which costs about $1,500, is a less invasive method of evaluating embryos. It's already used in clinics around the world, but new types of time-lapse screening are just becoming available commercially. With time-lapse imaging, thousands of pictures are taken to record a fertilized egg cell dividing. Eggs dividing atypically are unlikely to survive.

"The embryo's fate can be determined very early in development," says Barry Behr, director of Stanford University Medical Center's IVF laboratory.

Dr. Behr co-wrote a study identifying three markers that determine if a four-cell embryo (on day two) is likely to reach blastocyst, a critical stage where it has divided into about 120 cells (on day five) and has a better chance of implanting in the uterus. The study created an algorithm to do the analysis automatically.

Auxogyn Inc., based in Menlo Park, Calif., and Unisense FertiliTech AS, based in Copenhagen, make devices that use time-lapse imaging. Both companies are coming to market with products that use algorithms to automate the evaluation process. Currently most clinicians analyze time-lapse imaging subjectively.

Time-lapse imaging may also work in tandem with chromosomal screening, since it provides information about an embryo's metabolisms unavailable through genetic testing. An initial study was promising.

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The Success Rate of Oocyte Donation Program in IVF

baby, child, father

Having a baby was so arduous when you could get only one or two eggs in every IVF program...

According to the statistical results made by Department of Budget and Accounting in Taiwan, the average age of women getting married was 29.4 in 2011. Late marriage becomes more common, and the percentage of pregnant women with advanced maternal age (>35 yrs) has reached 17.7% last year. Busy work and deteriorating environment are the main causes to the decline of female fertility, and they force the modern women to face the problems of premature ovarian function failure or embryo chromosome abnormalities.

To choose the oocyte donation program seems like an easier and more efficient way. 

Because young women provide their eggs with better quality and remarkable amount, the pregnancy rate of the oocyte-recipient group increases to 70% in many published data. Spanish researcher, Dr. Garrido and his team calculated the cumulative live-birth rate of 8,895 couples undergoing oocyte recipient program from 1998 to 2010. They also analyzed the effects of the maternal age, primary infertile cause, and date of embryo culture of these cases.

As Figure 1 displayed, a single transferred embryo generated the cumulative live-birth rate as 64.8% in oocyte-recipient program, and each additional transferred embryo increased the cumulative live-birth rate with 12.3%. The cumulative live-birth rate reached 85.2% when the amount of transferred embryos was 10, and it came to the maximum as 96.8% when the transferred number was 25.

Figure 1

Similar curves was obtained when the study group was separated either by the maternal ages (Figure 2), or by the infertile causes (Figure 3). Thus the advanced age and other clinical factors affected fertility seemed not that critical in the oocyte-recipient program.

Figure 2                                                    Figure 3

Then the curves generated by different dates of embryo culture showed the cumulative live-birth rate was better in Day 5/ Day 6 blastocyst group than that of Day 3 cleavage-embryo group (Figure 4). Therefore, accepting donated oocytes plus blastocyst culturing were strongly recommended for the women suffering with declined ovarian reserve and repeated IVF failure. 

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