Tag: embryo transfer

Bioethics News

Patient’s own menstrual blood stem cells used to treat Asherman’s syndrome

Infertility treatment.”The best option for endometrial regeneration in patients with Asherman’s syndrome.”

Asherman’s syndrome is an acquired uterine abnormality characterised by the presence of intrauterine adhesions, and which clinically causes infertility, recurrent miscarriages and menstrual changes. Its prevalence ranges between 2% and 22% of infertile women.

Several surgical and medical treatments have been proposed, but outcomes have been unsatisfactory. Now, a study published in Human Reproduction has proposed treating the condition with adult stem cells obtained from the patient’s own menstrual blood.

To date, seven infertile women with Asherman’s syndrome have been treated. All patients were of reproductive age (33.7 ± 1.5 years) and had suffered infertility for 4.8 ± 1.2 years.

Menstrual blood stem cells. The blood stem cells obtained on day 2 of menstruation were transplanted to the uterus, followed by hormone stimulation.

Another successful cell therapy with no ethical difficulties

Endometrial thickening and return to its normal morphology were observed in all patients. One patient became pregnant spontaneously; four others underwent embryo transfer and two of these became pregnant.

The findings of this study suggest that transplantation of adult stem cells obtained from the patient’s own menstrual blood may be one of the best options for endometrial regeneration in patients with Asherman’s syndrome.

This practice — from a bioethical point of view — merits a favourable assessment, since adult stem cells are used which, as we know, present no ethical difficulties for use.

La entrada Patient’s own menstrual blood stem cells used to treat Asherman’s syndrome aparece primero en Bioethics Observatory.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

IVF, Multiples, and Risk: Buyer Beware

Janet Farrell Leontiou reflects on her experience as an IVF patient who was misled into choosing several multiple embryo transfers.

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A recent article in The Guardian summarizes new research showing that the chance of becoming pregnant following in vitro fertilization (IVF) can be reduced by as much as 27% when more than one embryo is transferred. The reduced pregnancy rate was observed when two embryos were transferred, but only one of these embryos was of good quality. When two embryos of good quality were transferred the pregnancy rate was the same as for single embryo transfer. These facts, which support single embryo transfer, are important given the risks associated with multiple births following multiple embryo transfer.

Several months prior to this article, I had read in a New York Times article on IVF and multiple births that “Consumers can easily be overwhelmed by the available data and be unable to distinguish between good medical practices and a sales pitch.” The statement was attributed to Dr. Mark Sauer, a fertility specialist. As an IVF patient, I was surprised to read this, but the next statement was like a punch to the stomach. The doctor continued: “We all consider twin pregnancy to be an undesirable outcome that can be completely avoided if doctors and patients agree that a single embryo transfer is the right thing to choose.”

I went to a major teaching hospital in New York City for fertility treatment. I assumed that I would be treated by accredited professionals in good standing, not by charlatans.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Preimplantation genetic diagnosis. Does it improve the effectiveness of IVF?

PGD reduces the live birth rates when used with IVF

There is no doubt that a medical and ethical objective is to improve the effectiveness of in vitro fertilisation (IVF), i.e. improve pregnancy rates, but there appears to have been a failure to achieve this for now (see HERE), since these rates have remained very stable for some time (see latest data HERE).

In an attempt to improve the effectiveness of IVF, preimplantation genetic diagnosis (PGD) has been proposed to try to select the best quality embryos for transfer, especially to avoid the transfer of aneuploid embryos (embryos in which the number of chromosomes is not a multiple of 23).

preimplantation+genetic+diagnosisGenetic diagnosis and IVF

However, randomised prospective studies show that the live birth rate does not seem to be improved if PGD is previously used.

To try to evaluate whether or not to use PGD, a large study was conducted (see HERE) that analysed the results of 5,471 ovarian stimulation cycles in which PGD was used and 97,069 cycles in which it was not. The results show that the embryo transfer rate is virtually the same when PGD is used (64.2%) and when it is not (62.3%).

However, the birth rate per cycle start was slightly lower (25.2%) when PGD was used compared to non-PGD cycles (28.8%), which was also confirmed when the pregnancy rate was calculated from the number of embryo transfers (39.3% versus 46.2%). The number of miscarriages was practically similar in both groups (13.7% versus  13.9%).

The authors concluded that the use of PGD reduces the live birth rates when used with IVF.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Preimplantation genetic diagnosis. Does it improve the effectiveness of IVF?

PGD reduces the live birth rates when used with IVF

There is no doubt that a medical and ethical objective is to improve the effectiveness of in vitro fertilisation (IVF), i.e. improve pregnancy rates, but there appears to have been a failure to achieve this for now (see HERE), since these rates have remained very stable for some time (see latest data HERE).

In an attempt to improve the effectiveness of IVF, preimplantation genetic diagnosis (PGD) has been proposed to try to select the best quality embryos for transfer, especially to avoid the transfer of aneuploid embryos (embryos in which the number of chromosomes is not a multiple of 23).

preimplantation+genetic+diagnosisGenetic diagnosis and IVF

However, randomised prospective studies show that the live birth rate does not seem to be improved if PGD is previously used.

To try to evaluate whether or not to use PGD, a large study was conducted (see HERE) that analysed the results of 5,471 ovarian stimulation cycles in which PGD was used and 97,069 cycles in which it was not. The results show that the embryo transfer rate is virtually the same when PGD is used (64.2%) and when it is not (62.3%).

However, the birth rate per cycle start was slightly lower (25.2%) when PGD was used compared to non-PGD cycles (28.8%), which was also confirmed when the pregnancy rate was calculated from the number of embryo transfers (39.3% versus 46.2%). The number of miscarriages was practically similar in both groups (13.7% versus  13.9%).

The authors concluded that the use of PGD reduces the live birth rates when used with IVF.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In The Journals – November by Christine Sargent

Hello trusty readers. Check out November’s haul for “In The Journals,” and be sure to check out the special issue of Science, Technology, and Human Values: Feminist Postcolonial Technosciences.

 

American Ethnologist:

Memory, body, and the online researcher: Following Russian street demonstrations via social media (open access)

Patty A. Gray

The Moscow street demonstrations of 2011–12 were the largest public gatherings in Russia since the collapse of the Soviet Union. They were also the largest-ever gathering of Russians on social media. While using the Internet to follow such large-scale social movements remotely, researchers experience social media as a context in which anthropology happens. They may think about “being there” in new ways that shift their focus to their own processes of memory making and sense of bodily presence. Experiencing and remembering social media in the body challenges the distinctions we might otherwise make between virtual and physical encounters.

Royal pharmaceuticals: Bioprospecting, rights, and traditional authority in South Africa

Christopher Morris

The translation of international biogenetic resource rights to a former apartheid homeland is fostering business partnerships between South African traditional leaders and multinational pharmaceutical companies. In the case of one contentious resource, these partnerships are entrenching, and in some instances expanding, apartheid-associated boundaries and configurations of power. The state and corporate task of producing communities amenable to biodiversity commercialization and conservation is entangled with segregationist laws and spatial planning. Rather than exclusion and the closure of ethnic boundaries, resource rights in this context foreground forced enrollment and the expansion of indigenous group-membership as modes of capitalist accumulation in an extractive economy.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Just What We Need: Slicker Infertility Marketing

The most unsettling line in the recent Forbes article on the ambitious infertility startup Prelude comes about halfway through. “The IVF industry in the United States,” writes Miguel Helft, “has everything private equity likes—scale (about $2 billion annually) and growth (more than 10% a year), along with being fragmented and having outdated marketing.” 

In an era with precious few opportunities for double digit returns, why not turn the reproductive health sector into the next big thing by furthering its consolidation and selling services using lifestyle content?  “Hey,” Prelude’s hipster-chic splash page calls out, “how’s your fertility doing?” 

If that piques your interest, scrolling down takes you on a kind of virtual stroll through the streets of Williamsburg, Wicker Park, or the Mission District, where you encounter edgily coifed, tatted, and bespectacled folk who presumably are spending as much time thinking about their reproductive fitness as they do their next Americano or Kimchi taco.  But you’ll find scant information about financial, psychological, or medical risks of egg retrieval (unless you count the presumed donor pictured alongside the quotation “I was worried about the discomfort, but seriously, it was no worse than a bikini wax—and for a much higher purpose”) or about failure rates after eggs are thawed and implanted.  Everything is upbeat and empowering, geared toward the “millennial mindset of health, wellness, and control.”

Prelude is targeting 20 to 30 year olds and the main product it’s selling them is their own eggs and sperm on ice.  The site proclaims, “If you are in your 20s or early 30s, there is no better time than now to bank your eggs and sperm.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Failed surrogate conceptions: social and ethical aspects of preconception disruptions during commercial surrogacy in India

During a commercial surrogacy arrangement, the event of embryo transfer can be seen as the formal starting point of the arrangement. However, it is common for surrogates to undergo a failed attempt at pregnanc…

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Failed surrogate conceptions: social and ethical aspects of preconception disruptions during commercial surrogacy in India

During a commercial surrogacy arrangement, the event of embryo transfer can be seen as the formal starting point of the arrangement. However, it is common for surrogates to undergo a failed attempt at pregnanc…

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Some data on assisted reproduction in Europe do not agree with those given in the brochures of assisted reproduction clinics

IVF LIVE BIRTH RATE. After one stimulation cycle varies around 20% of births and after three between 30% and 40%

The European Society of Human Reproduction and Embryology (ESHRE) has published a new report, the latest, on the outcomes of assisted reproduction in Europe, corresponding to the year 2011 (SEE our previous report).

It includes data from 33 countries, two more than in 2010, from 1064 clinics, which total 609,973 ovarian stimulation cycles. Of these, 138,592 correspond to in-vitro fertilisation (IVF) and 298,918 to intracytoplasmic sperm injections (ICSI). Frozen embryos were used on 129,693 occasions, and donor eggs on 30,198. Preimplantation genetic diagnosis to select the best embryos was used 6,824 times. Artificial insemination using the husband or partner’s semen was performed on 174,390 occasions, and using donor semen on 41,151.

The most interesting thing about this report, however, is undoubtedly the outcomes obtained. The pregnancy rate in the first IVF cycle per aspiration and per embryo transfer was 29.1% and 33.2 %, respectively, while these rates were 27.9% and 31.8% when ICSI was used.

IVF LIVE BIRTH RATE LOWER THAN IN PREVIUOS YEARS

The live birth rate — the main figure to take into account since it reflects the number of women who had a child after one stimulation cycle — was 19.2%, lower than in previous years, since this was 20.6% in 2010; 20.2% in 2009; 21.7% in 2008; 22.3% in 2007 and 20.8% in 2006.

IVFOne possibly more interesting fact is to know the percentage of women who had a child after several IVF attempts, since this is ultimately the real success rate.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Pushing the 14-day limit on human embryo research

Françoise Baylis calls for a better alignment of the science and ethics of human embryo research.

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Scientific and political elites have long known the day would come when scientists would challenge the 14-day limit on human embryo research. Indeed, Sir Robert Edwards, one of the pioneers of IVF, suggested that the limit should be 21 days. And, in Canada, as far back as 1995, the government-sponsored “Discussion Group on Embryo Research” (which endorsed the internationally accepted norm of 14 days) also noted that “this limit should be subject to modification should there be new and compelling ethical or scientific justification to do so.”

This week, two research teams – one at Rockefeller University in the United States and the other at the University of Cambridge in the United Kingdom – have reported research involving human embryos kept in vitro for 12-14 days. Prior to this there were no reports of human embryos cultured in vitro beyond nine days.  This scientific breakthrough has prompted a call to revisit the 14-day limit on human embryo research. But is this technological prowess sufficient to warrant a change in law or policy?  That is, do we have “new and compelling ethical or scientific justification” to change the 14-day rule?

The 14-day rule was initially recommended by the Ethics Advisory Board of the United States Department of Health, Education, and Welfare. Its 1979 report in Support of Research Involving Human In Vitro Fertilization and Embryo Transfer stipulated that human embryos should not “be sustained in vitro beyond the stage normally associated with the completion of implantation (14 days after fertilization).” 

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.