The IVF Baby Grows Up

By Emma Pomfet; Barry Nelson report

What was once science fiction became science fact 30 years ago today when a remarkable baby was born. Emma Pomfet and Barry Nelson report

AMID the popping of champagne corks and global praise for the doctors who rewrote infertility history, the world?s very first ?testtube? baby, Louise Brown, will celebrate her 30th birthday today.

However, despite huge technological advances and the publication of Government guidelines on state-funded IVF treatment in 2004, many patients still face a postcode lottery in the very country that pioneered this life-changing procedure 30 years ago.

Infertility now affects a staggering one in six couples in the UK, but on top of the obvious suffering and deep emotional distress this condition brings, many of these couples will also have to fight the on-going battle of unequal access to NHS treatment.

?The recent National Infertility Day recognised how IVF treatments, which 30 years ago were seen as possibly going beyond the mark, are now recognised treatments for infertility, ? says Clare Brown, chief executive of Infertility Network UK. ?It?s a shame that inmany areas the NHS still, after 30 years, does not seem to see them as such. ? Indeed, the NICE guidance issued four years ago recommends that all eligible couples should receive up to three cycles of NHS treatment each, including frozen embryo transfers. In the North-East every primary care trust has agreed to pay for two NHS cycles of IVF treatment, but North Yorkshire PCT will still only pay for one.

?Sadly, the PCTs are currently following their own rules meaning that access to treatment very often depends on where you live, and in some cases couples can find themselves receiving just one cycle while others attending the same clinic could have access to three, ? explains Susan Seenan of the National Infertility Awareness Campaign (NIAC).

?In addition to this, some PCTs do not fund frozen embryo transfers at all, but with the recent move towards single embryo transfer (SET), it is even more important to allow patients access to the treatment promised to them by the Government. ? IVF ? In Vitro Fertilisation ? literallymeans ?in glass?, and is amethod of assisted reproduction that involves combining an egg with a sperm in a laboratory dish.

If the egg fertilises and begins to divide, the resulting embryo is transferred back into the woman?s uterus where it will hopefully implant and develop. ?Happily, we can treat the majority of couples with IVF these days, ? explains Dr Simon Fishel, managing director of CARE Fertility Group. ?The only really impossible cases are mainly men who do notmanufacture sperm, because if even the basic stem cells for sperm are not there they cannot be treated for their own genetic child.

?Similarly, we can make women whose ovaries have stopped functioning, or who are in the menopause, pregnant with donor eggs, but not with their own genetic eggs.

?What to expect from IVF largely depends on the type of infertility that is being treated and the age of the woman, because at 30 years old the chances of conception are 50 per cent and above per attempt, but at 40 years old this drops to around 12 per cent per attempt.

?The clinic which they attend is also very important as experience, techniques available and how treatment is practised varies widely, as do the results, sadly, ? he adds.

?Ethics, regulation and legislation have evolved dramatically, and very differently, across the world and the improvements in IVF treatment over the last 30 years have been significant. ? For example, IVF patients used to spend ten days in the clinic doing urine samples eight times a day in order to pinpoint the timing of ovulation, according to Dr Fishel. ?Now this is simply an outpatient procedure where the patient may spend just an hour in the clinic for egg retrieval, ? he reveals.

?In our early work the natural cycle was used, and Louise Brown was born as a result of this, but it meant that ovulation could occur anytime of the day or night ? and it did!

?These days, however, we can programme cycles so that a patient knows within one or two days when egg retrieval is likely to occur, months or even a year in advance. ? In addition to this, embryology methods have also improved dramatically and the entire procedure for egg harvesting has become much easier over the years, according to Dr Fishel.

?Egg collection has changed from aninvasive and much more debilitating laparoscopy, to using ultrasound to collect the eggs which ismuch simpler, ? he explains.

Dr Fishel estimates that problems concerning low sperm counts and immobile sperm represent roughly half of all the infertility cases that CARE sees every year. ?However, ICSI ? intracytoplasmic sperm injection ? has revolutionised the treatment of the vastmajority ofmale factor cases, ? he says.

Before 1992, 95 per cent ofmen only had donor sperm as an option for their partners to conceive, whereas now around 95 per cent of men have the opportunity to have their own genetic child. ? Dr Fishel believes that the use of egg, sperm, embryo donation and surrogacy provide the opportunity to treat nearly all cases of infertility, even the more difficult cases such as women with absent wombs, severe heart conditions, or malfunctioning ovaries.

?Now we can also use alternative, advanced technologies such as ?embryo screening? to help patients who have immune problems relating to their reproductive processes or those with chromosome problems which can reduce the chance of conceiving a ?normal? child, ? he explains.

?More recently considerable advances have also been made in eggfreezing technology that makes it almost as successful as using ?fresh? eggs and embryos.

?This not only provides great opportunities for fertility preservation for clinically imperative cases, such asthe effects of cancer or surgery, but also for women to preserve their fertility for lifestyle options. ? Professor Alison Murdoch, head of the Newcastle Fertility Centre at the Centre for Life, says her work is deeply satisfying, but challenging.

?It combines the most stressful times with the most happy times. Because having babies is such a fundamental thing and not every one is successful, we have to help patients through the difficult times as well as celebrate success, ? she says.

The time it takes to get IVF treatment varies in the North-East, with some couples still facing waits of two to three years, but extra investment by the NHS in the last year means that the waiting list should be down to an incredible 18 weeks at the Newcastle treatment centre by the end of the year.

Philip Taylor, consultant gynaecologist and obstetrician at the assisted conception unit at James Cook University Hospital in Middlesbrough says the results from IVF treatment have gradually crept up by about one per cent a year.

During 2006 the success rate for under 35s at James Cook was an impressive 34.9 per cent.

ButMr Taylor believes thatmay decline as a result of new rules designed to prevent too many multiple births which willmean that IVF doctors will only be allowed to put a single fertilised embryo back into the woman?s womb, rather than two at present.

?Currently about 30 per cent of our patients have twins, but that is likely to reduce, ? he adds.

One of the happiest occasions was when dozens of successful IVF patients brought their babies back to the hospital for a party.

?We had a party for our IVF patients a few years ago, ? recalls Mr Taylor.

?Of course it is lovely to see them, but the people who remain as patients are the ones who haven?t got pregnant. ?

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