For American Citizens: Risks of Overseas Donor-Egg IVF; Bizarre Policy for Women who Give Birth Abroad

May 10, 2012 by Leave a Comment

Apparently, the children of American women who conceive through IVF are not considered U.S. citizens unless the egg or sperm donor involved is an American citizen.   The paper follows the story of Chicago native Ellie Lavi, who gave birth to twin girls in Israel. She found that the U.S. State Department asked some surprisingly detailed questions when she went to the U.S. Embassy in Tel Aviv to apply for U.S. citizenship for her children.

 

Embassy staff wanted to know whether Lavi got pregnant at a fertility clinic. She said yes, and was told that her children would not be eligible for citizenship unless she could prove that the egg or sperm used to create the embryo was from a donor holding U.S. citizenship.  “I was humiliated and horrified,” Lavi said. “We’re talking about the children I gave birth to. Of course they’re my children.”

Dr. E Scott Sills, Medical Director at Pacific Reproductive Center’s IVF program in Irvine, California commented, “this is an unfortunate outcome. Our donor egg unit regularly counsels patients about the consequences of using foreign donors, although all of our anonymous egg donors must be U.S. citizens to qualify for further consideration.”

The incident highlights what critics consider a glaring inconsistency in U.S. citizenship regulations. A child adopted overseas by a U.S. citizen is eligible to become an American, and a baby born in the United States is automatically an American citizen, even if the parents are not.  But if a U.S. citizen obtains assisted fertility services at a clinic located outside the United States, and the subsequent delivery also occurs in a foreign country, the status of the baby is defined differently.

As demonstrated in the Ellie Lavi case, any child born to a U.S. citizen overseas through the increasingly common practice of donor egg and/or donor sperm IVF is not necessarily American, unless an American is one of the gamete donors. This can be difficult to prove since clinics may not reveal such things about their donors due to confidentiality agreements, immigration law experts say.

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The Rise of Twin Birth Rates in the USA

May 10, 2012 by Leave a Comment

Women having children at older ages and the growing availability of fertility treatments has led to a marked increase in the birth of twins. In 2009, one in every 30 babies born in the United States was a twin. In 1980, a twin birth occurred once in every 53 deliveries.

The findings, presented by Michigan State University’s Barbara Luke this week at the 14th Congress of the International Society of Twin Studies in Florence, Italy, have important health implications, including greater morbidity and mortality risks and higher health care costs.

“Prior to 1980, the incidence of U.S. twin births was stable at about 2% of all births, but it has risen dramatically in the past three decades,” said Luke, noting twin births increased for women of all ages, with the largest increases among women aged 30 and older. “Older maternal age accounts for about one-third of the rise, and two-thirds is due to the increased use of fertility treatments.”

Those fertility-enhancing therapies include both assisted reproductive technologies and ovulation stimulation medications. About 12% of U.S. women have had fertility therapies.

“With multiple births…there are greater health risks,” said Luke a researcher in the College of Human Medicine’s Department of Obstetrics, Gynecology and Reproductive Biology. “Continued research is necessary to improve outcomes.”

Luke, who first reported the numbers in a report with Joyce Martin of the Centers for Disease Control and Prevention, noted births for triplets and higher numbers also grew: one in every 651 babies in 2009 compared with one in 2,702 in 1980.

In other research presented at the conference, Luke reported early embryo loss is associated with the significantly increased likelihood of lowered birth weight for the surviving fetuses.

Previous findings have shown mothers using fertility treatments experience more adverse health outcomes than spontaneous-conception pregnancies. Luke and her team hypothesized the residual effects of fetal loss may impact the subsequent growth and birth weight of the surviving fetuses.

 

 

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Fertility Breakthrough – The possibility of producing an unlimited supply of human eggs

May 10, 2012 by Leave a Comment

Scientists hope to try to fertilize the first human egg cells grown in the laboratory from stem cells later this year. Such an attempt signifies the potential to produce an unlimited supply of human eggs, a “breakthrough” in fertility treatment. It could also lead to further developments in relation to alleviating conditions associated with menopause.

human egg cell Fertility Breakthrough The possibility of producing an unlimited supply of human eggs

University of Edinburgh researchers are working with a team from Harvard Medical School in Boston to be the first to produce mature human eggs from stem cells isolated from human ovarian tissue. They aim to request a license from the Human Fertilisation and Embryology Authority (HFEA), the UK fertility watchdog, to try to fertilize the lab-grown egg cells with human sperm to prove they are viable.

If any embryos were produced they would then undergo “robust” scientific and genetic testing to determine that they are normal. Current methods mean only a small number of human egg cells are generated directly from the ovaries of women who have had hormonal stimulation.

Dr. Evelyn Telfer, a reproductive biologist at the University of Edinburgh, said: “With every experiment you don’t know the outcome. Even if we get an egg fertilized, we don’t know it will be normal. Any positive results could mean a breakthrough for fertility treatment. The exciting thing is these cells have been isolated and we have many more studies to do.”

The team hopes to conduct the tests at the IVF unit at Edinburgh Royal Infirmary this year once the license is in place.

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New research shows ovastacin blocks sperm binding

May 10, 2012 by Leave a Comment

photo human egg at fertization1 New research shows ovastacin blocks sperm binding

A study reported on the  Journal of Cell Biology‘s website (www.jcb.org) describes how an enzyme helps egg cells avoid being fertilized by more than one sperm.

Because polyspermy disrupts embryonic development, oocytes take several steps to ensure they only fuse with a single sperm. One key step is to prevent additional sperm from binding to the surface of an already-fertilized egg, a blockade that involves the release of secretory granules and cleavage of a protein called ZP2, a component of the zona pellucida matrix that surrounds eggs. ZP2 is cleaved at a site targeted by the astacin family of metalloendoproteases – enzymes that cut proteins into smaller fragments. Researchers from the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases therefore investigated the function of ovastacin, an astacin family member expressed in oocytes.

Ovastacin localized to cortical granules that were exocytosed after fertilization, and recombinant ovastacin cleaved ZP2 when added to zonae pellucidae. Mice lacking ovastacin failed to cleave ZP2 after fertilization, allowing sperm to continue to bind to the surface of early embryos. Female mice lacking ovastacin had slightly fewer offspring than wild-type animals but otherwise appeared normal.

The researchers found that ovastacin targeted several sites in ZP2. Senior author Jurrien Dean now wants to investigate how this proteolysis blocks sperm binding—a critical question because the molecular interactions between sperm and egg cells remain unknown. He also wants to examine how ovastacin is packaged into oocyte cortical granules and to identify other components of these secretory organelles.

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New test can better predict successful IVF embryos before transfer into the womb

May 10, 2012 by Leave a Comment

In Ireland about 32% of IVF cycles result in pregnancy, so the standard procedure involves the transfer of multiple embryos back into the womb to increase the potential success rate. But when more than one embryo is transferred back, there is an increased chance of multiple births like twins and triplets.

There are increased health risks associated with multiple pregnancies for both mother and infants, including an increased risk of miscarriages and preterm labor, leading to premature infants with admission to neonatal intensive care.

“In more recent years there has been an increase in the number of single embryo transfer (SET) as an effective way of reducing potential multiple births, but the widespread acceptance of SET is limited because there is no fully accurate method of embryo assessment and selection for transfer during IVF cycles.”

However, scientists at University College Dublin, Ireland, have discovered a new way of measuring the potential success rate of an embryo before it is transferred back into the womb during in vitro fertilization (IVF).

According to the findings published in the journal Fertility & Sterility, the fluid within a woman’s ovaries that surrounds the egg or oocyte holds metabolic information that can improve predictions on which embryo is more likely to lead to pregnancy.

“We analyzed samples of the follicular fluid surrounding the immature ovum or egg before it was retrieved for IVF,” says Dr. Lorraine Brennan, UCD Conway Institute, University College Dublin. ”We identified clear metabolic differences between the follicular fluids from women who successfully achieved pregnancy as a result of IVF to the fluids from the women who did not.”

The research involved almost 60 IVF patients and was conducted by a team of scientists from University College Dublin and the Merrion Fertility Clinic, Dublin (a not-for-profit clinic linked with The National Maternity Hospital in Holles Street, Dublin). ”Before the test can be regularized for use during IVF, our results need to be validated across a larger cohort of women undergoing treatment, and we are hopeful that the results obtained from larger samples will support our initial findings,” says Dr. Brennan.

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Vitamin D Shrinks Fibroid Tumors

May 4, 2012 by Leave a Comment

Vitamin D Shrinks Fibroid Tumors

Treatment with vitamin D reduced the size of uterine fibroids in laboratory rats predisposed to developing the benign tumors, reported researchers funded by the National Institutes of Health.

Uterine fibroids are the most common noncancerous tumors in women of childbearing age. Fibroids grow within and around the wall of the uterus. Thirty percent of women 25 to 44 years of age report fibroid-related symptoms, such as lower back pain, heavy vaginal bleeding or painful menstrual periods. Uterine fibroids also are associated with infertility and such pregnancy complications as miscarriage or preterm labor. Other than surgical removal of the uterus, there are few treatment options for women experiencing severe fibroid-related symptoms and about 200,000 U.S. women undergo the procedure each year. A recent analysis by NIH scientists estimated that the economic cost of fibroids to the United States, in terms of health care expenses and lost productivity, may exceed $34 billion a year.

Fibroids are three to four times more common in African-American women than in white women. Moreover, African-American women are roughly 10 times more likely to be deficient in vitamin D than are white women. In previous research, the study authors found that vitamin D inhibited the growth of human fibroid cells in laboratory cultures.

“The study results provide a promising new lead in the search for a non-surgical treatment for fibroids that doesn’t affect fertility,” said Louis De Paolo, Ph.D., chief of the Reproductive Sciences Branch of the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, which funded the study.

First author Sunil K. Halder, Ph.D., of Meharry Medical College in Nashville conducted the research with Meharry colleagues Chakradhari Sharan, Ph.D., and Ayman Al-Hendy, M.D., Ph.D., and with Kevin G. Osteen, Ph.D., of Vanderbilt University Medical Center, also in Nashville. The findings appeared in the journal Biology of Reproduction.

For the current study, the researchers tested the vitamin D treatment on a strain of rats genetically predisposed to developing fibroid tumors. After examining the animals and confirming the presence of fibroids in 12 of them, the researchers divided the rats into two groups of six each: those that would receive vitamin D and those that would not.

In the first group, small pumps implanted under the skin delivered a continuous dose of vitamin D for three weeks. The researchers then examined the animals in both groups. Fibroids increased in size in the untreated rats, but, in the rats receiving vitamin D, the tumors had shrunk dramatically. On average, uterine fibroids in the group receiving vitamin D were 75 percent smaller than those in the untreated group.

The amount of vitamin D the rats received each day was equivalent to a human dose of roughly 1,400 IU. The recommended amount of vitamin D for teens and adults age 70 and under is 600 IU daily, although up to 4,000 IU is considered safe for children over age 9, adults, and for pregnant and breastfeeding females.

“Additional research is needed to confirm vitamin D as a potential treatment for women with uterine fibroids,” said Dr. Al-Hendy. “But it is also an essential nutrient for the health of muscle, bone and the immune system, and it is important for everyone to receive an adequate amount of the vitamin.”

Fatty fish such as salmon, mackerel and tuna are the best natural sources of the vitamin. Very few foods naturally contain vitamin D. Fortified milk and other fortified foods provide an additional source of the vitamin. Vitamin D is also produced when ultraviolet rays from sunlight strike the skin.

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Women Cannot Rewind The ‘Biological Clock’

May 4, 2012 by Leave a Comment

Yale Study: Women Cannot Rewind The ‘Biological Clock’

Many women do not fully appreciate the consequences of delaying motherhood, and expect that medical science can reverse their aged ovarian function, Yale researchers reported in a study published in a recent issue of Fertility and Sterility.

“There is an alarming misconception about fertility among women,” said Pasquale Patrizio, M.D., professor in the Department of Obstetrics & Gynecology at Yale School of Medicine and director of the Yale Fertility Center. “We also found a lack of knowledge about steps women can take early in their reproductive years to preserve the possibility of conception later in life.”

The report stemmed from the observations Patrizio and colleagues made that more women are coming to the fertility clinic at age 43 or older expecting that pregnancy can be instantly achieved, and they’re disappointed to learn that it can’t be done easily. “We are really seeing more and more patients ‘upset’ after failing in having their own biological child after age 43 so we had to report on this,” said Patrizio. “Their typical reaction is, ‘what do you mean you cannot help me? I am healthy, I exercise, and I cannot have my own baby?’”

These women delay pregnancies in their most fertile years for a variety of reasons, such as focusing on careers, lack of financial stability, or not having a partner. They are vaguely aware that fertility decreases with age, but it is only when they experience age-related infertility firsthand that they begin to understand the reality of their situation, note the researchers.

The growing popularity of advanced fertility treatments has given women the impression that female fertility may be manipulated at any stage in life, notes Patrizio, who says the problem is exacerbated due to images of celebrities who seem to effortlessly give birth at advanced ages.

According to the Society for Assisted Reproductive Technologies, the number of in-vitro fertilization (IVF) cycles performed for women under age 35 increased by about 9% between 2003 and 2009. During this same time period, the number of IVF cycles performed for women aged 41 and older increased by 41%. But this procedure doesn’t always result in success.

“Even though the number of women turning to ART has increased, the number of IVF cycles resulting in pregnancy in women above age 42 mostly remained static at 9% in 2009,” said Patrizio. “If pregnancy is achieved at an older age, women then face higher risk of pregnancy loss, birth defects, and other complications.”

Patrizio hopes to prevent age-related infertility by combating these misconceptions with education.

“As clinicians, we should begin educating women more aggressively,” Patrizio said. “Women should be given the appropriate information about postponing fertility, obstetric risks, and the limited success of ART in advanced age to allow them to make informed decisions about when, if at all, they hope to become pregnant.”

Patrizio said that one of the techniques women should take advantage of is oocyte (egg) freezing, which appears to be the best strategy for women who want to postpone motherhood but really care about having a child with their own genetic material. Alternative options such as egg donation, which leads to the highest pregnancy rates reported for any ART method, are also available.

“There is an urgent need to educate women that reproductive aging is irreversible and, more importantly that there are options to safeguard against he risk of future infertility,” said Patrizio. “These techniques are valid options for women and should not be viewed as experimental,” he added. “Doctors and health professionals must begin the discussion about fertility preservation in their patients and make certain that young women truly understand all their options.”

 

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Formaldehyde Exposure May Affect Fertility in Men

May 3, 2012 by Leave a Comment

Formaldehyde Exposure May Affect Fertility in Men

Occupational exposure to formaldehyde in Chinese men may be linked to reduced fertility, reports a paper in the May issue of Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM).

Dr. Dang-xia Zhou of Xi’an Jiaotong University in Xi’an, China, looked for evidence of fertility problems among approximately 300 married men exposed to formaldehyde at a wood processing facility in China. Key reproductive outcomes were compared for the wives of men with and without occupational formaldehyde exposure.

The wives of formaldehyde-exposed men had longer times to pregnancy (TTP) than the wives of men not exposed to formaldehyde. With adjustment for other factors, the rate of prolonged TTP was nearly three times higher for wives of men exposed to formaldehyde. Formaldehyde exposure was also associated with a higher rate of miscarriage (spontaneous abortion). After adjustment, the risk for miscarriage was nearly twice as high in women whose husbands were exposed to formaldehyde at work.

The reproductive toxicity appeared “dose dependent,” with higher rates of fertility problems for wives of men exposed to higher levels of formaldehyde. Other reproductive outcomes — such as preterm birth or birth defects — were unrelated to formaldehyde exposure.

Formaldehyde is an important chemical used in many different industries. In recent years, China has surpassed the United States as the world’s largest producer and consumer of formaldehyde. Most previous studies of formaldehyde’s possible reproductive toxicity have focused on women, with inconsistent results.

Together with recent animal studies, the new results suggest that formaldehyde could be a contributor to well-documented reductions in sperm quality worldwide. However, the researchers emphasize that further studies — including data on the direct correlation between formaldehyde exposure and sperm quality — would be needed to address this issue.

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Artificial Womb Unlocks Secrets of Early Embryo Development

March 16, 2012 by Leave a Comment

A research team, led by University of Nottingham tissue engineer Kevin Shakesheff, has published some important findings on reproductive physiology in the journal Nature Communications.

 

This new laboratory culture method has allowed scientists to see critical aspects of embryonic development that have never been seen in this way before, and could lead to treatments for conditions such as heart defects. For the first time, it has been possible to grow embryos outside the body of the mother, using a mouse model, for just long enough to observe in real time processes of growth during a crucial stage between the fourth and eighth days of development.

 

Shakesheff says: “Using our unique materials and techniques we have been able to give our research colleagues a previously unseen view of the incredible behavior of cells at this vital stage of an embryo’s development.

 

“We hope this work will unlock further secrets which could improve medical treatments that require tissues to regenerate and also open up more opportunities to improve IVF. In the future we hope to develop more technologies which will allow developmental biologists to understand how our tissue forms.”

 

In the past it has only been possible to culture a fertilized egg for four days as it grows from a single cell into a blastocyst, a ball of 64 cells comprising stem cells that will form the body, and extra-embryonic cells which form the placenta and control stem cell development as the embryo develops.

 

But scientists’ knowledge of events at a cellular level after four days, when, to survive, the blastocyst has to implant into the mother’s womb, has up to now been limited. Scientists have had to rely on snapshots taken from embryos removed from the living uterus at different stages of development.

 

Now, thanks to the Nottingham team’s newly developed culture environment, scientists at Cambridge University’s Gurdon Institute have been able to observe and record new aspects of the development of the embryo after four days.

 

Most importantly they have been able to see at first hand the process which is the first step in the formation of the head, involving pioneer cells moving a large distance (for a cell) within the embryo.

 

They have observed clusters of extra-embryonic cells which signal where the head of the embryo should form. To track these cells in mouse embryos they have used a gene expressed only in this ‘head’ signaling region marked by a protein which glows.

 

In this way, they have been able to work out that these cells come from one or two cells at the blastocyst stage whose progeny ultimately cluster together in a specific part of the embryo, before collectively migrating to the position at which they signal head development. The cells that lead this migration appear to have an important role in leading the rest and acting as pioneers.

 

This new breakthrough is part of a major research effort at Nottingham to learn how the development of the embryo can teach us how to repair the adult body. The work is led by Shakesheff with funding from European Research Council.

 

Shakesheff adds: “Everyone reading this article grew themselves from a single cell. With weeks of the embryo forming all of the major tissues and organs are formed and starting to function. If we could harness this remarkable ability of the human body to self-form then we could design new medical treatments that cure diseases that are currently untreatable.

 

“For example, diseases and defects of the heart could be reversed if we could recreate the process by which cardiac muscle forms and gets wired into the blood and nervous system.”

 

 

 

 

 

 

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Discovery of Cdk1— a New Molecule Initiating Egg Maturation

March 16, 2012 by Leave a Comment

Women with eggs that fail to mature can’t become pregnant, and this problem cannot be remedied by in vitro fertilization (IVF). Now researchers at the University of Gothenburg, Sweden, have identified a molecule called Cdk1 that has an important function for mammalian egg maturation. In the future this could lead to an increased rate of successful IVF.

Up to 15% of all women of reproductive age struggle to become pregnant. In vitro fertilization (IVF) can help these women become mothers. However, women who are infertile because their eggs do not mature properly cannot be helped medically, because immature eggs cannot be fertilized even with IVF.

In the future, such patients might be helped as a research group at the University of Gothenburg has found that the Cdk1 molecule has an important function in mammalian egg maturation. Their results have now been published in the journal Human Molecular Genetics.

“This is the first functional evidence that Cdk1 is a key molecule in mammalian egg maturation. If the results can be translated into clinical settings, it could possibly improve the chances of successful IVF treatment for women who today are not becoming pregnant because their eggs do not mature” says Kui Liu, professor at the Department of Chemistry and Molecular Biology, the University of Gothenburg, Sweden.

Kui Liu and his colleagues performed experiments on tissue-specific knockout mice. The results show that when the Cdk1 molecule was removed from eggs of mice, the egg maturation stopped. When the molecule was added again, maturation resumed.

Professor Liu is a professor in molecular biology at the Faculty of Science, University of Gothenburg, since February 2011. His research group specializes in studying the development of female germ cells. In the last few years he has been working on making his results useful for humans.

“We are eager to start tests on human eggs. Hopefully we can apply this in clinics within ten years” says Liu.

 

 

 

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