times - Frozen IVF embryos produce healthier children, researchers claim

IVF produces healthier children when embryos are frozen and thawed before being transferred to the womb, according to new research.

Babies born from frozen IVF embryos are less likely to be born prematurely or underweight than are those conceived during fresh treatment cycles, three independent teams of scientists have found. One of the studies also recorded lower rates of stillbirth and early death among frozen-embryo babies.

The results, from researchers based in the United States, Australia and Finland, suggest that far from being riskier than conventional IVF, as is generally thought, cycles using frozen embryos may actually be safer.

The research is particularly significant because separate teams from three countries have reached the same conclusion, each using large samples including thousands of IVF cycles. A fourth team, from Denmark, also reported similar findings earlier in the year.

Scientists said the work would be important because women are increasingly encouraged to use just one fresh embryo during IVF, to guard against damaging twin and triplet births, and to freeze any that are left over for later use. It will dispel doubts about whether this policy trades the risks of multiple births for hazards associated with frozen embryos.

Allan Pacey, secretary of the British Fertility Society, said: “This all works to the advantage of single embryo transfer. It suggests it might be better from the point of view of a healthy child to go for frozen embryos, which is an integral part of the strategy. People shouldn’t be scared of frozen embryos.”

The studies, presented at the American Society for Reproductive Medicine conference in San Francisco, do not explain why babies born from frozen embryos seem to do better, but there are several hypotheses.

When fresh embryos are used in treatment, women may still be under the influence of powerful hormonal drugs used to stimulate their ovaries into producing extra eggs, or the anaesthetics used during egg collection. Either of these may interfere with the endometrial lining of the womb, and thus with the formation of the placenta.

Another possibility is that as some frozen embryos generally fail to survive thawing, this effectively “weeds out” those that are of poor quality. A third possibility is that women who produce lots of good quality embryos are more likely to have frozen cycles, and also have a lower risk of complicated pregnancies.

“These findings are really quite interesting,” Dr Pacey said. “It kind of defies logic to a certain extent. It seems to be an issue with the formation of the placenta, but how it has an effect isn’t known.

“This may be a bit of biology that has escaped most people. The assumption has always been that if the endometrium [the womb lining] is thick, it’s functional. In an IVF cycle, the endometrium looks normal on ultrasound, but perhaps there is something subtle going on.”

Despite their apparent health benefits, however, frozen IVF cycles are unlikely to supplant fresh ones as the routine option because they have a lower success rate. In Britain, 24.4 per cent of fresh cycles lead to a live birth, compared to 17.4 per cent of frozen cycles. There were 33,916 fresh cycles performed in 2006, and 7,911 frozen cycles.

“Frozen embryo transfers are not as successful as fresh ones in terms of getting a pregnancy,” Dr Pacey said. “So it may be that we have to balance the health of children against chances of success."

The first of the new studies, led by Suleena Kansal Kalra, of the University of Pennsylvania, compared 4,796 frozen cycles to 10,992 fresh cycles in which surplus embryos were available for freezing.

For singleton babies, fresh cycles were 50 per cent more likely than frozen ones to lead to low birth weight, and 10 per cent more likely to lead to premature birth. For twins, both risks were 25 per cent higher for fresh embryos than for frozen.

“Fresh embryo transfer is significantly associated with low birth weight and pre-term delivery in both singletons and twins,” Dr Kansal Kalra said.

In the Australian study, a team led by Professor Gordon Baker, of Royal Women’s Hospital in Melbourne, compared all IVF singleton births in the city’s IVF units between 1991 and 2004. It found that 11 per cent of fresh embryo babies were born underweight and 12.3 per cent were born prematurely, compared to 6.5 per cent and 6.9 per cent of frozen embryo babies. The rate of perinatal death was also higher among the fresh group, at 1.87 per cent compared to 1.16 per cent.

The Finnish study, from Oulu University Hospital, compared 2,052 frozen embryo singleton babies to 2,343 born after fresh IVF cycles, and found those in the latter group were 35 per cent more likely to be born prematurely and 64 per cent more likely to be born underweight.

“Frozen embryo transfer singletons have better outcomes compared with singletons born after fresh embryo transfer, when examining birth weight or gestational age at birth,” the scientists said.

Some scientists believe that frozen embryo transfer may also have advantages for IVF success, even though its pregnancy rates have traditionally been lower than for fresh cycles. A new cryopreservation technique called vitrification allows more embryos to survive thawing than the older slow-freezing method on which these comparisons are based, and using it could help by allowing doctors to transfer embryos when the womb is most receptive.

Mandy Katz-Jaffe, of the Colorado Centre for Reproductive Medicine, said: “In a normal IVF cycle, patients have their embryo transfer while the uterus is still affected by the drugs they take to stimulate the ovaries. Vitrification allows the patient’s body to get rid of the drugs, and to grow a new endometrial lining.”

nhs news - Complications of IVF

“Fears of complications with IVF babies dismissed in new study” is the headline in The Guardian. Research based on 1.2 million births in Norway looked at the babies of women who had conceived once by IVF and once spontaneously. It found little difference between the siblings, and concludes that the risks associated with IVF are likely to be related to existing fertility problems in the parents and not a result of techniques used during assisted fertilisation, the newspaper explains.
The Daily Telegraph also reported some of the results of this study, saying “babies conceived through IVF are much more likely to die at birth”. These results are consistent with many other studies looking at the outcome of assisted fertilisation pregnancies. The newspaper did not directly discuss the implications found in the comparison of IVF and non-IVF siblings.
This large study used complex statistical methods to try to tease out the risks related to the various factors. It is reliable and should be reassuring to women undergoing IVF. However, it is important to note that the risks of complications in an individual birth are in fact quite low (around 1% perinatal deaths in this study).
Where did the story come from? Dr Liv Bente Romundstad from the Department of Obstetrics and Gynaecology at St Olavs University Hospital in Trondheim, and other colleagues from around Norway, UK and France, carried out the research. The study was funded by the Trondheim Hospital and the Norwegian Research Council. It was published in the peer-reviewed medical journal The Lancet.
What kind of scientific study was this? This was a cohort study in which the researchers used data from the Medical Birth Registry of Norway. This has records of more than 2.2 million births, which occurred in Norway between 1967 and 2006. The researchers had information about pregnancy across the population as it had been recorded on standard forms by midwives or doctors within one week of delivery for all deliveries after 16 weeks gestation. This information included details about the mother’s health, antenatal and birth history, and it was linked to the “Statistics Norway” database. The researchers were able to identify outcomes for all the babies, because in Norway each baby is given a unique identification number.
From the data on 1,305,228 births from January 1984 to the end of June 2006, the researchers excluded records where there was missing data on the number of children, or if the mother was less than 20 years old or had had more than six children. Only single babies (not twins or other multiple births) who were born at 22 weeks or later, and weighed 500g or more, were assessed. After this process, they found 1,200,922 births following normal conception and 8,229 after assisted fertilisation.
First, the researchers assessed differences in birthweight, gestational age, and the chances that babies were born small for their gestational age, were born prematurely or died in the period around birth (perinatal death). They analysed the relationships between all these variables, using a model that looked at all mothers as a whole (the whole study population analysis). They also divided the mothers into groups for their year of birth, maternal age, and number of children, and assessed them separately.
"The adverse outcomes of assisted fertilisation ... could therefore be attributable to the factors leading to infertility, rather than to factors related to the reproductive technology." Liv Bente Romundstad, lead author
After this whole study population analysis, the researchers then looked at whether the risks associated with IVF were due to the IVF technique itself or whether they were due to other factors linked to the fertility of the parents. In order to do this, they compared the health of babies born to mothers who had experienced both an assisted fertilisation (IVF) conception and a normalone. There was information for 2,546 Norwegian women available for analysis. These “sibling-relationship comparisons” looked at whether there were differences between the brothers or sisters born to women after both assisted fertilisation and normal conception. The researchers also took into account the order of conception (if IVF occurred before spontaneous conception or the other way around). They adjusted the results for maternal age, number of previous babies, sex of the baby, time between pregnancies and year of delivery.
What were the results of the study? In the whole study population analysis, assisted-fertilisation conceptions were associated with lower average birthweight (a difference of about 25g), shorter duration of gestation (about two days), and an increased risk of babies being too small for their gestational age, or dying in the period around birth.
In the sibling-relationship comparisons, where spontaneously conceived babies were compared with their assisted-fertilisation conceived sibling, there was an average difference of only 9g in birthweight and 0.6 days in gestational age, and these differences were not statistically significant.
There was also no statistically significant difference in the rates of small-for-gestational age births and perinatal mortality when the assisted fertilisation babies were compared with the spontaneous conception babies in the sibling-relationship comparisons.
What interpretations did the researchers draw from these results? The whole study population results, which showed that the risk of adverse events is higher with IVF, are consistent with many other studies looking at the outcome of assisted fertilisation pregnancies compared with spontaneous pregnancies.
However, looking at the babies born to women who had conceived both spontaneously and after assisted fertilisation, there was no difference in birthweight, gestational age, risk of small-for-gestational-age babies, and preterm delivery between siblings.
The researchers conclude that adverse outcomes of assisted fertilisation seen in the general population could therefore be attributable to the factors leading to infertility, rather than to factors related to the IVF technique itself.
What does the NHS Knowledge Service make of this study? This study has successfully compared the outcomes in the babies of individual women who had become pregnant following both assisted (IVF) conception and a normal (spontaneous) conception.
This is a novel approach made possible by the large population-based database. As a large study, it has provided reliable results. Even so, the researchers say that the study was not large enough (powered enough) to study births that occurred before 32 weeks of gestation, or to study the perinatal mortality among women who had conceived both spontaneously and after assisted fertilisation.
It is possible that some of the conceptions were misclassified, i.e. recorded incorrectly, particularly for those women where conception occurred outside of Norway.
Overall, the study confirms that birthweight, gestational age, and risks of small-for-gestational-age infants and preterm delivery did not differ among brothers and sisters born to women who had conceived both spontaneously and after assisted fertilisation. This should provide reassurance to mothers that any adverse effects following assisted fertilisation are more likely to be due to underlying infertility

guardian - The fertility tourists

The fertility tourists
The ads are brazen: 'healthy young women - superovulated exclusively for you!'. The fees are half those of UK clinics ('flights and hotel included!'). And the industry is unregulated, leaving doctors free of legal and ethical constraints. No wonder more and more Europeans are going to India for fertility treatment. Raekha Prasad reports
Raekha Prasad
Wednesday July 30 2008
At the end of last year, Ekaterina Aleksandrova boarded a plane in London and flew to Mumbai. It wasn't her first trip there - she is a management consultant and often goes abroad on business. But this time she went to have five embryos implanted in her womb. A couple of days later she flew back to Europe. While on business in Hong Kong in January, she discovered she was pregnant with just one embryo.
For Aleksandrova, 42, this was the culmination of a six-year struggle to become a mother. She divorced at 29, and hadn't been in a serious relationship since she was 34. "I always wanted to have a child but the men kept saying, 'Why don't we travel?'" she says. "It wasn't that I was obsessed with my career, I just couldn't get men to be a father."
First, she tried to adopt in Germany, where she holds citizenship, but that didn't work out. Then, in 2004, she moved to the UK to take advantage of this country's more liberal attitude to single women who need IVF. She spent £18,000 in less than three years, trying and failing to conceive at a private Harley Street clinic. When she finally conceived in India, Aleksandrova was in a state of "shock and disbelief".
The baby she is due to give birth to in September has no genetic link with Aleksandrova. The colour of its eyes, length of its legs and slope of its nose will be determined by a man and a woman who are strangers not only to her, but also to each other. Her baby's biological parents live 7,000km apart, and are separated by language, culture and currency. All they share is their decision to ply their gametes in the global fertility bazaar where Aleksandrova shopped for the ingredients of life, perusing and eventually paying for eggs and sperm. Aleksandrova bought the sperm online from a Danish sperm bank retailing in New York. The $1,600 (£800) price-tag included shipping to Mumbai, where her Indian doctor helped get the tiny frozen container through customs unscathed. There, the Danish sperm was used to fertilise the fresh eggs of an Indian woman who was paid 40,000 rupees (£500).
Alexsandrova first began surfing foreign fertility clinics' websites in the winter of 2006/7. Impressed with the Indian doctor's responses to her email inquiries, she flew out to Mumbai for a couple of days the following April to investigate further. She then visited the Taj Mahal.
She brought home a Punjabi-style pyjama suit for the baby to wear if it was a boy, and bangles if it was a girl. India has a fascinating culture, she says, and she plans to bring the child to India to expose him or her to "50% of their background". The prospect of raising a mixed-race child doesn't faze her. The daughter of a diplomat, she was born in Pakistan and says she has fond memories of her childhood Pakistani friends. "I'm curious to know how the baby's going to look being Danish-Indian. I like coloured kids. I find them cute. I find mixed blood gives a bit of a boost."
She plans to tell the child the truth about the way he or she was conceived. "You can't lie to your child all your life," she says. But she hasn't yet thought about the fallout if the child wants to know more about its genetic parents. "It's preferable that they're kept anonymous. What's the meaning of finding out?"
Aleksandrova herself knows very little about the donors. Her baby's father, she learned from the bank's online catalogue, is 6ft 4in, an architectural student from a family of doctors and "musical". She knows even less about the baby's biological mother, the egg donor. They have never met and donor anonymity prevails in India. "The doctor asked me what I wanted. I said I wanted a young, healthy woman with a child. Because I'm Caucasian, I wanted a fair-skinned person. The doctor said 'she is good-looking with some education'. I'd love to know more. But I trust him. I don't think he picks someone off the street," she says.
In Britain, there is an acute shortage of women donors. Had she stayed here, Alexsandrova would have faced a long wait for eggs, a bill of £7,000, and a cap on the number of embryos planted in her womb - a restriction aimed to prevent high-risk multiple pregnancies but, in her eyes, a curb on her chances to have a baby.
It is different in India; there, the market rules. Clinics' websites offer "many healthy young fertile Indian women" who are "superovulated exclusively for you" in dollar rates payable online by credit card. Moreover, Aleksandrova's Indian clinic put more than double the number of embryos allowed in the UK into her body. "I understand multiple-births are not a good thing," she says. "But for women like me whose bodies reject embryos, the higher the number, the greater my chance."
Alexsandrova is part of a growing number of global fertility tourists from rich countries such as Britain who fish for cut-price genetic material from India's pool of highly trained, English-speaking doctors.
It is a phenomenon wholly distinct from medical tourism, where patients needing a hip replacement or heart bypass receive identical treatment minus the waiting list and the large bills. Reproductive holidays in India are a real getaway from conditions back home. Fertility tourists are often people desperate to break free from not only financial, but also legal and ethical constraints, in a bid to create life. And Indian clinics woo patients with the language of free choice and a can-do attitude.
Age, for example, rarely poses a barrier in India. Earlier this year, twin girls conceived by IVF in India were born in the Midlands to a British Indian couple with a combined age of 131. Their mother, thought to be 59, is one of the oldest women in Britain to give birth.
Ethnicity is no problem either. Those making the trip to India are not just people of Indian descent who want a baby who resembles them. Increasingly, they are white couples that have no problem with the idea of having brown babies.
India was the second country in the world after the UK to produce a "test-tube baby" - the Indian girl was born just 67 days after Louise Brown in 1978 - but it has yet to create a single law regarding infertility treatment. Instead, Indian IVF doctors are self-regulating and only have to refer to a set of guidelines, not work within them.
Meanwhile, Britain has spent the past 30 years reforming infertility laws through public debates. These began with the Warnock Committee in the early 80s, which examined the moral, scientific and religious issues raised by IVF and led to the establishment of the world's first statutory body of its kind - the Human Fertilisation and Embryo Authority - to license and monitor clinics.
Three decades of scrutiny of IVF techniques in Britain has resulted in a recognition of the emotional maelstrom inherent in the creation of life. The result is that not only do British doctors consider the scientific possibilities of having a child, but also the impact of assisted reproduction on a child's emotional wellbeing, human rights and racial identity. Just because you can do something does not mean you should, is the maxim in Britain. The opposite appears to be the case in India.
There, the growing number of white westerners turning up for fertility treatment is reported in the press not as an ethical dilemma, but simply as another example of how the country is "booming": it is a source of national pride that India is getting foreigners pregnant where their own countries have failed. "Move over yoga, Ayurveda, there's a new Asian hip trend starting up ..." begins a story in the Indian Express on a British couple at a Mumbai clinic.
Similarly, while Diane Blood faced years of legal challenge and moral handwringing in her quest to use her dead husband's sperm for IVF, her Indian counterpart, "Puja", became India's first woman earlier this year to conceive with her dead husband's sperm. There was no fanfare, legal wrangling or public debate; her pregnancy was simply reported as a happy ending to a sad story.
One of India's most vocal proponents of patient choice is Dr Aniruddha Malpani, a favourite among British fertility tourists. To get to his clinic, on the edge of Mumbai's upmarket shoreline, his foreign patients must travel from the shiny new airport, past glass towerblocks in the shadow of which ragged children play in fetid pools beside pavements where they sleep, before arriving in a street lined with palm trees. A lift carries them several floors up into the compact, white-walled clinic where nurses scuttle between clean, sparse private bedrooms.
More than half the clinic's patients are from abroad. Hundreds like Alexsandrova, who have had no success in their own country, come to the man who says "yes". Sitting behind his desk in a small office, Malpani is a fast-talking defender of patients' rights, and sees the people he treats as consumers of a technology that needs only the lightest of regulation. As long as people can pay, let them decide, he says. He rails against the "sociologists" who question whether science can act without ethical restraint. "In whose interests are we doing this stuff? Should there be someone sitting in judgment? It's best for the mother to decide what's best."
Malpani turns out to be master of medical propaganda. He calls his patients "reproductive exiles" from medical establishments that are hostile to their desire to have children. The people who come are not desperate, he says, they have been disempowered - and his team is intervening to allow them to "build families".
Malpani taps on the keyboard in front of him while we talk. When challenged on a point, he types rapidly and spins round the screen on which flashes the relevant web page to back up his argument. The impression is of a man in a hurry to prove the world wrong, with all the arguments at his fingertips.
In Britain, people conceived since 2005 by a donor have the right to information about their genetic parent once they reach the age of 18. Children conceived using donor eggs, sperm or embryos in India have no such right; there, donors remain anonymous. That's as it should be, insists Malpani: receiving an embryo from a stranger is no different from getting pregnant after a one-night stand, he says. "If someone just slept with someone and decided to have the baby, no one would ask her to reveal his identity. Just because it's a clinic, why do these questions get asked?"
Malpani also sees no problem with his clinic giving white patients the eggs and embryos of Indian donors, saying, "They've thought about it", before enthusing about how "alike" donor-conceived children's mannerisms are to their birth parents.
British medical thinking, he says, is not designed with the patient in mind. In Britain doctors and patients are encouraged to transfer a maximum of two embryos into the uterus. Any more and the risks of premature birth, smaller babies and children with language and behavourial disorders increases substantially.Malpani transfers up to five embryos. "We have the flexibility to give a woman the best chance," he says. "If they don't get pregnant at all, they are the ones to suffer."
By his own admission, Malpani is a libertarian. He is also a respected fertility expert - his IVF clinic has been named among India's best - with a CV boasting a string of awards and scholarships for his clinical skills.
His greatest advocates, however, are those patients he has enabled to have a child. Sitting on the sofa in their living room more than 6,500km away from Mumbai in Market Rasen, Lincolnshire, are Brian and Wendy Duncan. Wendy, 42, pulls her three-year-old daughter, Freya, on to her lap: the little girl was conceived with Malpani's treatment.
"Freya is just like me. I delivered her and experienced every moment of her growing," says Duncan.
What is striking on first meeting mother and daughter, however, is their difference: Duncan is the palest of redheads while Freya has the dark skin, black hair and brown eyes of an Indian. She looks nothing like her father, either, who is also white. To conceive Freya, Duncan had five fertilised embryos from an Indian couple implanted into her womb.
Duncan was denied IVF treatment on the NHS because she already had a daughter, now 22, and was both overweight and a smoker. So the Duncans went private, borrowing £8,000 for one IVF cycle, which failed. For their second attempt, in India, they spent half that amount, including flights and hotels. "I wanted a child. The system in Britain didn't allow me to have one, so I had to look for an honest alternative," Duncan says.
While ethical decisions in India are left in the hands of individual doctors, in Britain each proposed embryo or gamete donation is considered by a clinic's mandatory ethics committee made up of lay people, clinicians, nurses and counsellors. There is no blanket ban on interracial donation, says Pip Morris of The National Gamete Donation Trust, "but the donor would be matched as closely as possible to the recipient".
"For example, if you had two black recipients and a white donor then that would be questioned and refused. If there's any doubt about the welfare of the child, then a donation would not go ahead."
Duncan says Freya's racial difference is irrelevant to her. "I wasn't bothered when she was born and I'm not concerned now. What matters is that she gets all the love and care she needs growing up." But what if it's relevant to Freya? "Of course I'll tell her if she asks about it. But if she doesn't, I won't stick my neck out to tell her."
Duncan argues Freya's looming questions about the fact her genetic parents are from a different continent, culture and race will be little different from those of her eldest daughter, from a previous relationship, who is mixed race. "When I told my older daughter about her origin there was no problem and it shouldn't be too difficult for Freya to understand the dynamics of it."
In the global market of commercial fertility, India remains one of the cheapest places to buy gametes. In America the going rate for an egg from an Ivy League student is around $60,000 (£30,000). An Indian egg never fetches more than 40,000 rupees (£500), and in the country's small towns a woman is paid as little as 5,500 rupees (£70).
It is almost impossible to get an accurate picture of exactly who India's donors are. The issue is shrouded in secrecy. Part of the reason appears to be the social stigma of being a donor in a conservative society. When asked about the backgrounds of their donors, IVF doctors give a standard response: they are from lower middle-class families, and are all married, with at least one child. One says they might work as a secretary or in a shop and generally have "a little education". But all the doctors claim donors refuse to be interviewed.
Perhaps one unspoken reason for the secrecy is the ugly reality that some donors in a country as poor as India trade their eggs simply to stay afloat financially.
In a dusty rural hamlet near the city of Anand, in the western state of Gujarat, Pushpa clutches her seven-year-old daughter's hand and stares at the cement floor of her house. The 25-year-old sold one of her eggs to pay off crippling debts after the family was reduced to eating just one meal a day. Her husband earns 2,800 rupees (£35) a month labouring on a construction site. "A moneylender would have stripped us of whatever little gold we had. I could not let my last bit of security go," she says.
The emphasis placed on informed consent, rights and counselling for egg donors in rich countries are absent in Anand. Moreover, the medical risks associated with farming eggs, such as pelvic infection or ovarian hyperstimulation syndrome - which in severe cases can be life-threatening - are often hidden from donors."The doctor told me there were no risks; that donating was just selling something that will be wasted away from my body anyway," Pushpa says.
Of even more concern, say critics of India's unregulated IVF industry, is the way that some doctors try to maximise profits by overdosing donors with hormones to stimulate them. "The amount of drugs pushed into them is way above the recommended dose," says Dr Puneet Bedi, a Delhi-based consultant obstetrician and gynaecologist specialising in foetal medicine. "If guidelines say to give 10 shots, they'll give 20 to increase the harvest rate and optimise their conception rates. Because IVF is a completely commercialised industry in India, it's all about delivering to whoever's paying."
The result is that the risk to a donor's health is amplified, says Bedi. While in Britain there is officially a 1% to 2% chance of egg donors getting hyperstimulation syndrome, Indian donors face "a many, many fold risk" in comparison. "We don't really know what happens to these women. Who pays for her life-threatening treatment? Nobody cares. Nobody's answerable."
Pushpa is matter-of-fact about her decision. "You wouldn't ask me why I did it if you'd ever lived on one meal a day," she says bitterly. "Selling the egg was quite easy. I was given some medicine; they took it out. I got the money."
So lucrative was the 5,600 rupees (£70) she received for donating, she did it twice more. "I wanted to send my children to a good school. They will have a better future. This was only possible because of me - a woman. After all, men can't produce eggs," she says.
She doesn't know who bought her eggs. "I don't feel exploited; here, in the villages, every aspect of life is exploitative - where you can work, what you can eat, when you have sex. This is the best option available to me," Pushpa says.
Not all Indian egg donors come as cheap as Pushpa. At the top of the country's social ladder are urban college students, who sell their eggs to bankroll their penchant for new clothes and gadgets. Sipping a cappuccino on the terrace of a cafe in a bustling Mumbai business district, one 20-year-old physics student - who agrees to speak anonymously - explains why she sold her eggs to one of the city's infertility clinics for 20,000 rupees (£250).
Some of her friends had sold their eggs and so she began searching clinics' websites. "If I can earn more money than getting a part-time job, then why not?" she says. "I needed to buy a new mobile and wanted to go abroad on vacation with my friends. I have always had what I wanted in life. But for my own enjoyment, I can't ask my parents for money all the time."
Although she is dressed in jeans, a T-shirt and designer shades, like any other affluent student in India's financial capital, she is acutely aware of the stigma surrounding donation in India. "My parents must never find out. They wouldn't understand why I did it," she says. "They'll think I'll never be able to be a mother myself. It's in the best interests of the family to keep it a secret."
Time is up. She waves down a taxi and hops inside. "I couldn't afford this ride earlier and now I can," she says as the car pulls away. "What's wrong with that?"

irishtimes - Double trouble

Getting two for the price of one means twice the challenge, and the birth is only the beginning
THEY MAY not be average parents in any other way, but film star couple Angelina Jolie and Brad Pitt must have been very relieved to leave the hospital in Nice 10 days ago with two healthy babies. Getting two for the price of one inevitably increases the risks during pregnancy and delivery; twins are more likely to be premature and have a low birth weight.
But once the medical complications are behind you, the challenge of raising two children in tandem is just beginning. And only those who have gone through the experience of multiple births really know what it is like.
It’s hardly surprising then that Jolie and Pitt have reportedly been looking for advice from other parents in Hollywood circles who have had twins, such as Julia Roberts and Danny Moder, who have a son and a daughter, Phinnaeus and Hazel, now three.
At least celebrity couples are not short of helping hands. The latest additions to the Pitt-Jolie family, Knox Leon and Vivienne Marcheline, are likely to have at least one nanny each. With another four children in the household – birth daughter, Shiloh, who was born in Namibia in 2006, and three adopted children: Cambodian-born son Maddox, daughter Zahara from Ethiopia and Pax from Vietnam – there is plenty of work for an entire childcare team.
However, no matter how wealthy you are, early months with twins are tough. The hired help can only do so much. Jolie was reported to have breastfed Shiloh, but feeding twins is exhausting.
Charlotte O’Brien (41), the mother of twin girls Emilie and Lucy, managed it for six weeks and was then relieved to switch to bottles. “It’s too demanding with two of them, they don’t feed at the same time.”
But Corrinna Moore (37), whose twins boys, Cormac and Aran, were born six weeks early and spent 12 days in special care, says the hospital helped her by starting a routine where they were fed at the same time. “I don’t know if, left to my own devices, I would have achieved such a fine-tuned routine.”
When she left Queen Charlotte’s Hospital in London, where she was living at the time, she continued to do what she had been advised – when one woke to feed, she woke the other and put one to each breast at the same time.
“Otherwise you wouldn’t have a minute to yourself.”
Their tummies were so small, they were feeding every one-and-a-half hours so even nursing them simultaneously was a pretty constant business.
“One day I was determined to get out of the house,” Moore recalls. “But by the time I had them fed, then the bag packed and was out the door, they started to cry: they needed feeding again. I sat down and cried too.
“You can’t breastfeed twins in public. You need your couch and your feeding pillows.”
As for any parent of a new-born, it’s the feeding and the sleeping which are the biggest issues in the first few months – but with twins it’s undoubtedly at least double the trouble.
“I will never forget those first six months of no sleep at all,” says O’Brien. She and her husband, Ashley, look back and say “how did we do it?”.
“Emilie never slept through until she was a year old. At one stage she was waking every half hour. For the first eight weeks they were together in the same room. Then we put them in separate bedrooms and that was the first night Lucy slept through.”
Out of sheer exhaustion, the couple hired a night nurse three times a week for a while, which was a life-saver for them. The moment she came in the door, the nurse took charge of the babies and sent the O’Briens straight to bed. Those were the months of physical slog but now, with the girls aged two-and-a-half, there’s a whole new set of challenges.
“They are very strong willed, strong personalities,” O’Brien says of the two fair-haired girls as they confidently explore the home of the Moores who live near them in Dalkey, Co Dublin.
“But they are very different and have been since birth. Emilie is quite demanding; Lucy is quieter and will sit and do things on her own.
“They both want to be with me. It’s very hard when there’s two children, one grabbing at each leg, and you can’t explain why you can’t pick them up at the same time. The moment they started to walk, it became difficult.
“They have no sense of danger and I have only one pair of hands. If I go anywhere, they inevitably want to go off in opposite directions. I do use reins but they don’t like them, they like the freedom.
“I went to Imaginosity which is quite big, with open spaces and four floors. Within five minutes I had lost one of them. It is a bit uncomfortable if you lose one,” she says wryly.
Moore laughs and says with her twins now aged six-and-a-half, she had forgotten what that was like. She recalls losing Cormac in Kew Gardens one day but at least she had a friend with her who could mind Aran while she ran “like a headless chicken” looking for the missing boy, thoughts of abductors and ponds racing through her mind before she found him happily playing hide-and-seek with her.
Like O’Brien, Moore’s twins were her first children, but she has gone on to have two more, two-year-old Lorcan and baby Aoife who was born last month. “In terms of practicalities, having one child at a time is easier,” she says. “But once you get twins to about two or three, it is easier than having a second child 18 months behind.
“I am glad I had the twins first. With subsequent children, the twins are so focused on each other they don’t care who comes after them. The sibling rivalry is for each other.”
Although both mothers emphasise that their twin children are very different individuals, in each case their rate of development has been remarkably similar.
“At 16 months, they started walking the same day, within 20 minutes of each other,” says O’Brien. “Emilie stood up, she was the first born; the other one watched her and then stood up too. I couldn’t believe it!”
“Aran and Cormac both crawled, stood and walked on the same days,” says Moore.
Before the girls started to speak recognisable words, they developed their own language for communicating with each other.
“They were quite definitely conversing and I would not understand a word. I found it amazing. They still do it in the mornings and the evenings; you can hear them chatting away in their room.”
The next milestone is toilet training. “I have bought two potties and from next week I am going to see where it takes me,” says O’Brien.
Moore did it with one potty with Cormac and Aran, encouraging them to pee into it at the same time, but that’s boys for you.
From age three onwards, the emotional issues can become more apparent as they start to socialise. Moore says it was only when the boys started playschool, and found people getting confused about who was who, that they started to be aware of being twins.
She and her husband Richard have been careful not to lump them together, by not dressing them the same or by calling them “the twins”. Although not identical, it is hard to tell them apart. Luckily they support different football teams, so spot a Liverpool shirt and you can be sure it’s Cormac, while for Aran it’s all Man Utd.
Emilie and Lucy wear the same clothes out of choice. “Initially everybody gave me matching outfits but now they won’t wear different clothes,” explains O’Brien. “If one has a spillage and I have to change her, I have to change the other one too.”
While the girls will be starting playschool in September, the boys are already two years into their primary education in separate classes. All the received wisdom is to separate single-sex twins at school if possible, says Moore, especially boys as they are so competitive.
“They had started bickering and we felt they needed individual attention. It has been brilliant. Separating them has diluted the competition.”
For all their talk about the practical problems in raising twins, and their shared guilt about the lack of one-on-one attention they can give, both mothers stress the joy as well.
“It is special, no doubt about it,” says O’Brien. “For me it’s an instant family; they’re company for each other which I am pretty sure will continue.”
Moore agrees: “You get double the pain but more than double the love back.”

Telegraph - Two cycles of fertility treatment significantly increase chances of pregnancy

Receiving two cycles of fertility treatment can substantially increase a woman's chances of becoming pregnant, a new study shows.
The research will add to increasing pressure for women to receive more cycles of IVF on the NHS.
Most women in Britain are offered only one cycle by their local Primary Care Trust, despite a call from Patricia Hewitt, when she was Health Secretary, for all women to be offered three.
The new study showed that almost all women who would have become pregnant through a type of IVF, used in an estimated 40 per cent of cycles in Britain, did so on the first or second attempt.
A study of more than 6,700 patients shows that almost 80 per cent became pregnant on the first attempt with another 16 per cent on the second attempt.
Only 3.4 per cent of women became pregnant with their third cycle of treatment and less than one per cent on the fourth or fifth cycle.
There were no successful pregnancies beyond the fifth attempt, accordong the findings presented on Tuesday at the annual meeting of the European Society of Human Reproduction and Embryology (Eshre) in Barcelona.
The technique studied was intra-cytoplasmic sperm injection (ICSI), a treatment for male infertility which has been used since the early nineties.
The technique involves injecting an egg in a laboratory with an individual sperm.
It is used in an estimated 40 per cent of the 41,000 IVF cycles performed in Britain every year.
Simon Hong, from the Centre for Reproductive Medicine and Infertility at Cornell University in America said: "From our findings it appears that younger women undergoing two ART (assisted reproductive technique) attempts benefit from the highest chances of pregnancy."
Another study also presented at Eshre shows that using frozen instead of fresh embryos produces healthier babies.
Infants born from embryos which were frozen and then thawed before being implanted into a woman had a higher birth weight and were less likely to suffer abnormalities.
Fewer of the children were also twins or triplets.
Multiple births are known to increase the risk of complications as well as the danger to the mother.

Times - Frozen embryos 'make healthier babies than fresh ones'

IVF babies born from embryos that are frozen and thawed are less likely to be underweight or premature than those conceived during fresh treatment cycles, research has shown.
The findings show that the use of frozen embryos could soon be accepted as completely safe, doctors said.
Another team of researchers told the European Society of Human Reproduction and Embryology conference in Barcelona that IVF success rates could be improved by as much as 15 per cent with a “viability index” for selecting embryos with the best chance of a healthy pregnancy.
The Danish study into frozen embryos found that the average birth weight of those babies was 200g more than in fresh-embryo IVF.
The findings, from a team led by Anja Pinborg, of the Copenhagen University Hospital, are important because women are increasingly encouraged to use one fresh embryo — to avoid multiple births — and to freeze any others produced in the process for later use.
Dr Pinborg said it was highly unlikely that freezing improved the health of embryos. The figures could be explained because patients who froze embryos were generally young women with a good prognosis. Poor quality embryos were also more likely to die during the thawing process.
“These findings are reassuring,” she told the European Society of Human Reproduction and Embryology conference in Barcelona. “If our results continue to be positive, frozen embryo replacement can be accepted as a completely safe procedure, which can be used even more frequently.”
Scientists from Yale University told the conference that overall IVF success rates could be improved by as much as 15 per cent by a new “fitness test” that can predict which IVF embryos will implant into the womb up to 70 per cent of the time.
The non-invasive procedure examines chemical fingerprints in the culture media in which they grow in the laboratory. Scientists said the technology, known as metabolomics, should be ready for widespread use within two to three years, and predicted that the viability index could become a routine part of fertility treatment.
Denny Sakkas, who is leading the research, said: “The other side of IVF is that we probably fail to get patients pregnant about two thirds of the time we do an embryo transfer. One of the reasons is we’re not that good at picking the best embryo we have available.
“In the clinic, we would probably be looking at a 10 to 15 per cent improvement in pregnancy rates.
“It’s not going to make a bad embryo good, but it should help us to tell them apart. This definitely could make the difference between people getting pregnant or not.”
The average success rate for IVF in Britain is 21.6 per cent across women of all ages, and 29.6 per cent for women under 35.
There is no evidence that acupuncture during IVF treatment does anything to improve women’s chances of having a baby, the most extensive review yet has concluded. Sesh Sunkara, who led the research at Guy’s and St Thomas’ Hospital in London, told the conference: “If women come to me and ask if they should have acupuncture, I have to say there is no evidence that it helps.” She said more trials were needed to settle the issue

Times - Risks of IVF twins exaggerated says US doctor Norbert Gleicher

Infertile couples who want more than one child should be encouraged to try for IVF twins in spite of the medical consensus that multiple pregnancies should be avoided, a senior American doctor said today.
The health risks of conceiving twins by IVF have been exaggerated by the medical profession, and a British initiative to cut the number of such pregnancies is “categorically wrong”, according to Norbert Gleicher, of the Centre for Human Reproduction in New York.
He told the European Society of Human Reproduction and Embryology conference in Barcelona that for many women who need IVF to conceive, the birth of twins is a “favourable and ethical” result.
Such pregnancies provide complete families at a stroke, and may often be safer than having two singleton IVF pregnancies, he said. Moves to persuade more women to use one embryo at a time during fertility treatment, as recommended by a UK national strategy launched last week, are thus misguided.
Professor Gleicher's comments were fiercely disputed by other senior doctors, who said that his opinions were based on a flawed analysis of the risks of multiple pregnancies to both babies and mothers.
Professor Peter Braude, of King's College, London, said that IVF twin pregnancies are well-established to be more hazardous than singleton conceptions, with dangers that include prematurity, stillbirth, low birth weight, cerebral palsy, pre-eclampsia, haemorrhage and maternal death.
“Couples should be extra cautious about interpreting this advice because it flies in the face of all other published data about the risks of multiple births,” he said.
The conference executive, which is encouraging IVF clinics across Europe to move to single embryo transfer to guard against multiple births, said in a statement: “There are significant risks to multiple pregnancies, and we should not be generating them deliberately. IVF babies also deserve the best start in life.”
A Human Fertilisation and Embryology Authority (HFEA) expert panel, chaired by Professor Braude, found in 2006 that twins have five times the usual risk of death in the first year of life and six times the risk of cerebral palsy. More than half are born prematurely, and 40 to 60 per cent require intensive care. Each twin costs the NHS 16 times as much as a singleton birth in the first year of life, and it is estimated that 126 deaths would have been avoided had all IVF twins born in Britain in 2003 been singleton births.
Multiple pregnancies are also dangerous for mothers. A quarter are complicated by problems such as high blood pressure, and the death rate is doubled for women expecting twins.
These dangers have led the HFEA and the British Fertility Society to launch a national strategy to reduce Britain's IVF twin rate from 24 per cent to 10 per cent by 2012. This is likely to require single embryo transfer in about 50 per cent of IVF cycles, compared to about 10 per cent at present.
Professor Gleicher, however, claimed that some of these risks had been over-estimated, because they have been calculated by comparing twin births with just one singleton pregnancy, not two. “When you ask infertile patients having treatment, a very large majority want more than one child,” he said. “The question is how you get two children, not one. When you add the risks of two singleton pregnancies together, many risks of twins disappear.
“For infertile patients, desirous of more than one child, twin deliveries represent a favourable, cost-effective and ethical treatment outcome, which in contrast to medical consensus, should be encouraged.
“Because the alleged excessive risks and costs of twin deliveries have been the primary motivation behind the recently increasingly popular concept of single embryo transfer, the clinical, ethical and economic validity of single embryo transfer should be seriously questioned.”
He added that much of the medical literature is based on comparisons between naturally conceived singletons and twins. This may be misleading because IVF twins have a lower risk than spontaneous twins of dying at or soon after birth.
In a paper published in the journal Fertility and Sterility, Professor Gleicher has suggested that when these factors are taken into account, IVF twin pregnancies are less risky than two singleton conceptions for complications including stillbirth, neonatal death and major birth defects.
Professor Braude and the conference doctors pointed out that even Professor Gleicher's adjusted figures show substantially raised risks of maternal death, low birth weight and pre-eclampsia, a life-threatening blood pressure disorder.
They added that for many risks, it is statistically misleading to compare twin pregnancies with two singleton pregnancies. Professor Mark Hamilton, the chairman of the British Fertility Society, said: “It is misleading, as he has done, to combine the risks of two single live births which are two independent events, each with a lower risk than that of a twin pregnancy.
“With singleton pregnancies, the chance of having a stillborn baby, or one that dies soon after, is about five per 1,000. In a twin pregnancy it's four to five times that. If your first singleton pregnancy was uncomplicated, your chance of a problem the second time round is even lower, probably less than one in a thousand. Multiple pregnancies unquestionably expose mothers and babies to increased hazards.”
Professor Gleicher's study has also ignored the long-term health risks of the low birth weights suffered by twins, and the psychological impact of multiple births on parents.
A separate study presented at the conference, from Helsinki University Central Hospital in Finland, has found that the mothers and fathers of twins suffer significantly more mental health problems, such as depression, anxiety and sleep disorders, than the parents of singletons.

Mail.co.uk - IVF experts should encourage twin births not cap them, says controversial doctor

Women could be denied the chance of having a baby by new restrictions on the number of multiple births, a leading fertility expert has warned.Norbert Gleicher, one of America's most successful IVF doctors, said the capping of twin and triplet pregnancies could result in fewer women fulfilling their dream of motherhood.The strategy, devised by Britain's fertility watchdog to reduce the risks associated with multiple births is 'categorically wrong' and 'dramatically misguided', he said.Instead of avoiding twin pregnancies, fertility clinics should be actively encouraging them, he added.Speaking at a fertility conference, Dr Gleicher said one twin pregnancy was no more dangerous than going through two separate single pregnancies.Having twins is also no more costly - and the increased earning power of two bodies rather than one may even benefit the economy in the long-term, his research suggests.What is more, having twins gives couples an 'instant family', removing the need for a woman who has struggled to conceive a first time to get pregnant again.But Dr Gleicher's comments, which are based on his review of more than 15 years of fertility studies involving thousands of twin and single births, have been hotly disputed by fertility doctors in the UK and abroad.
Fertility rowIn a joint statement, experts, including Professor Peter Braude, of King's College, London, said twins face 'huge obstetric complications', some of which can lead to a lifetime off suffering.Loss of one or both babies during pregnancy is a source of 'profound disappointment' which has no monetary value, they said.Concerns about the added risks of twin births has led to the country's fertility watchdog to the cap the number of embryos implanted at a time to one wherever possible.Twins are at much greater risk of stillbirth and cerebral palsy than their single counterparts. They are also much more likely to be born prematurely, placing extra pressure on an already cash-strapped NHS.Mothers are at a greater risk of developing pre-eclampsia, a life-threatening complication of pregnancy, and are three times more likely to die during childbirth.
With twin births accounting for one in four IVF pregnancies, The Human Embryology and Fertility Authority says the policy of single embryo transfer, which is due to come into from January 2009, will benefit both mother and child.But Dr Gleicher, of the Centre for Human Reproduction in New York, said the thinking behind the policy was fundamentally flawed because it simply compared the dangers of having twins to those of carrying a single baby.Factoring in the risks associated with becoming pregnant a second time cancels out the dangers of a twin pregnancy, he said.Medical costs are also unlikely to be higher in a twin pregnancy and women will benefit because they will only need to go through one set of IVF treatment.He told the European Society of Human Reproduction and Embryology's annual conference in Barcelona that limiting transfer to one embryo at a time would cut pregnancy rates, which are already lower than those in the US.'Single-embryo transfer does reduce pregnancy chances and therefore if the UK does go through with this process you will see a further decrease in pregnancy rates,' he said.'I and most of my colleagues are driven by what our patients are telling us. We strongly believe that nothing is more important to an infertile patient than getting pregnant and it is our principle responsibility to help them get pregnant quickly and safely.'But Professor Braude, who helped shape the HFEA's policy, urged caution, questioning Dr Gleicher's calculations and saying his conclusion 'flew in the face of all published data about the risks of twin pregnancies'.In a joint statement with other fertility experts, Professor Braude added that Dr Gleicher had not fully account for all the medical and emotional problems associated with twin pregnancies.'The saddest outcomes that we see in practice are those twin pregnancies where women go into very premature labour or lose both babies at around 25 weeks or less,' they said.'The disappointment and grieving that accompanies this loss is profound and cannot be calculated in dollars or pounds.'Whatever the hypothesis, which may be interesting for doctors to mull over and discuss, there are significant risks to multiple pregnancies and we should not be generating them deliberately.'IVF babies also deserve the best start in life.'

thisisnottingham - Colwick parents hit jackpot with triplets

Life changed beyond belief the day Sze Kane gave birth. After ten years trying for a baby - and on her tenth IVF attempt - she found out she was having triplets.She discovered the startling news during a six week scan."They saw three heartbeats - that was quite a shock," said the former buyer for the Co-op.Sze, 48, and husband Jim, 57, set about buying three of everything - cots, car seats, high chairs and so on.The non-identical triplets were born at Nottingham City Hospital by Caesarean section at 32 weeks.Jak was first, weighing 3lb 12oz, Megan next, at 4lb 1oz and Joshua last, at 3lb 4oz.The operating theatre was packed as each baby had to have its own midwife, paediatrician and neo-natal nurse, in addition to the surgeon, anaesthetist and all the other health professionals.The triplets spent two weeks in the neo-natal unit before being allowed home to Colwick - and that's when the enormity of having triplets really struck the couple.Help from the authorities is only available for quads, so the couple got through the endless feeding and changing routine with help from Sze's mum, Jean Lam.Sze (pronounced Sue) said: "They needed feeding every three hours and it took around two-and-a-half hours to feed and change them, giving us 30 minutes between feeds."You had to try and get them in as tight a routine as possible or the small gap you've had disappeared and you'd get no sleep."The triplets got through 150 nappies a week and 18 bottles of milk a day, requiring two sterilisers and two kettles to keep up with demand."It was exhausting but exhilarating," said Sze."We spent ten years trying for a family so we really did hit the jackpot getting the triplets and no matter how hard it gets we would not change it for anything."The sudden expansion of the family meant that the Kanes had to have an extension built and buy a bigger vehicle to accommodate three car seats.And the 4ft-wide pram made getting out and about a real challenge."The first time I ventured out to Broadmarsh I couldn't get in the lift. Even at hospital appointments at the QMC I couldn't get it in the lift," said Sze.Food shopping was another problem. Asda was the only supermarket at the time which had a trolley suitable for three babies. Morrison's only had room for two, so the third baby's car seat had to go inside the trolley, leaving no space for food.A holiday in Majorca when the triplets were 18-months-old presented another problem."My mum had to come too because there had to be one adult per child on the plane," said Sze.They family usually opt for self-catering accommodation because few hotels have a family room big enough for two adults and three children.Jim, who used to work for a funeral company, quit work to become a house husband so Sze could return to work but when she was made redundant she looked after the children while Jim found work in a shop.The triplets are now five and last September started at St John the Baptist Primary in Colwick.They are all in the same class and because it is a small school are likely to remain together until they move to secondary school.Sze said: "They are quite insular in a way because they have got each other."When Megan broke her arm and didn't go to school for a few days the boys were upset."They always have someone to play with - but they still get bored."All three have friends for tea quite often."I do feel conscious when they go somewhere else as people who have one child are not geared up to their noise level," said Sze.But while it is treble the work, it's also three times the pleasure.Each child has their own distinct personality.Jak is the bossy one, Megan is typically girly and Joshua is the most sociable.The family are involved with Nottingham Trent Twins and Multiple Births Club and have made many friends, through the mother and baby groups and outings.Sze said: "Given the time we spent trying, having one baby would have been beautiful but finding we were having three was worth all that heartache."It's a very special thing for us."

The Telegraph - Drive to cut number of IVF twins hampered by lack of NHS funding

The drive to reduce the number of dangerous twin pregnancies resulting from IVF is being hampered by a lack of NHS funding, experts warned.
The chances of conceiving twins or triplets is 20 times higher after having IVF treatment than naturally and the risks to both mother and children are much greater.
Mothers are more likely to suffer complications in pregnancy and to die if they are carrying more than one baby and the children are at greater risk of being born premature and small, requiring expensive intensive care, and have more birth defects and lifelong disabilities.
Fertility doctors and patient groups have launched a national strategy to reduce multiple pregnancies by implanting fewer embryos in the womb when treating some women.
The majority of women currently have two embryos implanted when undergoing fertility treatment and more should have just one, it was said.
Younger couples who have a good chance of achieving a pregnancy and who have several high quality embryos will be selected to have one embryo implanted in the womb.
The rest should be frozen and if the fresh cycle fails these can be thawed and implanted one at a time until a pregnancy is achieved.
It is vital that the NHS funds the full cycle, including all frozen embryo transfers, otherwise patients will not accept a move to single embryo transfer, it was warned.
Currently only 30 per cent of primary care trusts fund the full cycle of IVF and the more than 90 per cent do not meet current guidelines of providing eligible couples with three cycles.
Targets set by the fertility regulator the Human Fertilisation and Embryology Authority mean all clinics should ensure the proportion of multiple births should not exceed the current level of 24 per cent from 2009.
Around 40 per cent of clinics currently have a higher multiple birth rate than this.
After three years the HFEA expects the multiple birth rate to be brought down to 10 per cent and will inspect clinics to ensure they are working to reduce the rate of twins. In extreme cases clinics could have conditions put on their licence or have it revoked it they refuse to act to reduce multiple births, Trish Davies, director of regulation at the HFEA said.
Choosing the right patients for single embryo transfer, growing the embryos for longer in the lab and using sophisticated techniques to select the best quality embryo will reduce the number of twins without harming the chances of a successful pregnancy in those couples, it was argued.
Alun Elias-Jones, consultant paediatrician and Fellow of the Royal College of Paediatrics and Child Health, said the NHS should invest in funding three full cycles of IVF for couples which would reduce the number of multiple births as it would save money in the long run.
He said: "Every set of averted premature twins will fund many many cycles of IVF."
Dr Mark Hamilton, chairman of the British Fertility Society, said the success of bringing down the multiple pregnancy rate depends on improving NHS funding.
He said: "It is absolutely imperative that the funding issues are addressed in collaboration with initiatives like this."
Jane Denton, director of the Multiple Birth Foundation said: "While there a very understandable perception that twins are an absolute delight we very much underestimate things like bereavement and disability which is very much hidden.
"Through the One at a Time campaign and its website we hope to give professionals, patients and the public authoritative information about multiple pregnancy and birth to help them understand the risks and consequences."
Claire Brown, chief executive of the Infertility Network UK said: "Single embryo transfer is only for those patients most at risk of having a multiple pregnancy. We totally understand patients worry about anything that might affect their chances of a successful pregnancy and think twins means completing their family in one go and mean they don't have to go through IVF again. But we have to think about what is best for the mother and the child.
"If patients know they are going to get the three full cycles funded on the NHS they are going to be much more accepting of single embryo transfer."
Tamba Chief Executive Keith Reed said: “The views of patients and doctors have been completely ignored by the HFEA and the national strategy group. During the HFEA’s recent consultation, only 3 per cent of respondents supported what the National Strategy Group are proposing. In the face of such overwhelming opposition, it beggars belief that they have decided to carry on regardless.
“As a result of this deeply unpopular and misplaced strategy, patients will be left out of pocket and out of choices. They must think again.”

ukpress - Society in funding call on IVF

A drive to cut the number of twins born from IVF could be affected by a lack of funding for treatment on the NHS, experts have warned.
The fertility watchdog and key doctors have joined forces to launch a national strategy urging clinics to cut the number of multiple births.
Currently, 24% of IVF births involve twins or triplets but experts have been calling for this to be cut to 10% over a three-year period.
Multiple pregnancies are linked to health problems for both mother and babies, with around half of twins requiring specialist hospital care.
Dr Mark Hamilton, chairman of the British Fertility Society, pointed to "very patchy" funding for IVF across England.
He said it was "imperative that the funding issues around IVF" were addressed in collaboration with the launch of the new strategy. "The funding issue is very, very important," he added.
Many NHS trusts offer women just one cycle of IVF, leaving some patients wanting to have two embryos implanted at the same time in one cycle to maximise their chances of success.
Some doctors also argue that older women have a higher chance of success if they have several embryos transferred, without an associated high risk of a multiple birth.
In 2004, the National Institute for Health and Clinical Excellence recommended that women should get access to three cycles of IVF on the NHS. Former health secretary John Reid reduced this to one but the Government has since said NHS clinics should work towards implementing the guideline on three cycles in full.
Dr Hamilton said 60% of primary care trusts currently offer one cycle, 30% offer two cycles and just 5% offer three. He said it was "absolutely essential" that women were allowed to use any spare frozen embryos if their one cycle with a fresh embryo had failed.

Evening Standard - Postcode lottery blocks free IVF to infertile couples

Infertile London couples desperate to become parents are being denied full fertility treatment by the NHS, new figures reveal today.
Thousands in the capital face a postcode lottery over free IVF because health trusts are using "haphazard" eligibility criteria.
Some London health trusts are refusing childless women treatment because their boyfriend has children from a previous relationship. However, other trusts will treat mothers with as many as four offspring from previous relationships.
Infertility campaigners and experts today condemned this randomness over free fertility treatment as "cruel".
National guidelines published four years ago said trusts should provide three free cycles of IVF for patients up to the age of 39.
But a government survey show London trusts are still not funding all three cycles. Only four out of 31 in the capital plan to offer full IVF treatment but this will not be available until next year. Eighteen provide just one cycle of IVF - the minimum level. Less than half pay for women to have their embryos frozen - a technique which increases greatly a patient's chance of becoming pregnant.
This failure to fund IVF could jeopardise a new campaign by doctors to cut multiple births. The British Fertility Society and the Association of Clinical Embryologists will tomorrow urge IVF clinics to put back only one embryo in women at high risk of conceiving twins.
This is in response to a huge rise in multiple IVF births which can endanger women and their babies. But experts who back single-embryo
transfer also warn it will only work if trusts fund three treatment cycles and pay to freeze embryos.
Professor Peter Braude, who headed an official consultation into multiple births, accused the Government of "hypocrisy". The fertility expert from King's College said: "The Government is against patients paying for top-up care for cancer treatment. But they let women having NHS fertility treatment pay to have their embryos frozen."
Dr Allan Pacey, secretary of the BFS, said: "It's a national disgrace that fertility treatment is not being funded properly. Other countries do it."
Infertility Network UK will highlight the "haphazard" eligibility criteria used by many trusts at a conference marking national infertility day next month. Clare Brown, the charity's chief executive, will call on health trusts to increase the level of free treatment for infertile couples as recommended by Nice.
She said: "Refusing to treat women until the age of 35 or 37 is just totally unacceptable, not cost-effective, and worst of all not good clinical practice."
The Government IVF findings are based on a survey of primary care trusts carried out last year. They show variations in age criteria used by trusts. For example, women as young as 20 in Hillingdon can obtain treatment. But those living in Barnet are only sent to the front of the queue if they are older and in Greenwich female patients must be between 28 and 35 at referral.

telegraph.co.uk - IVF 30 years on

When the first test-tube baby was born, it wasn't just the beginning of a new life but of a whole new approach to infertility. Olga Craig talks to some winners and losers in the IVF lottery and asks where do we go from here?
A single word, splashed across the front page of a national newspaper, said it all: superbabe! In a photograph below, swathed in a soft blanket, was the baby whose birth had healed the heartache of her childless parents and brought hope to millions of infertile women: Louise Joy Brown, the world's first test-tube baby, who was born in Oldham General Hospital minutes before midnight on July 25 1978.

The IVF lottery is an emotional experience
Delivered by caesarean section and weighing just 5lb 12oz, little Louise was the daughter of John and Lesley Brown, a Manchester couple. She was conceived by in vitro fertilisation, during which her mother's eggs were fertilised by her father's sperm in a test tube and she became, to her parents' delight, the first child to be born using the procedure pioneered by the British fertility experts Robert Edwards and the late Patrick Steptoe.
As she proudly showed off her day-old daughter, Mrs Brown, who, at 29, had endured nine anguished years trying to conceive naturally, described her as her 'cherished little angel'.
'Louise is, truly, a gift from God,' she told assembled television reporters, her voice breaking with emotion. 'Every woman who has yearned to hold her own child in her arms, and then been flooded with the love that only motherhood brings when that longed for dream comes true, will understand what I mean.'
Next month Louise, now herself the mother of a lively two-year-old, Cameron, who was conceived naturally, will celebrate her 30th birthday. She and husband, Wesley, live quietly in Bristol where they will hold a family birthday party. Guest of honour is likely to be Prof Edwards, the man who, all those years ago, made the dramatic breakthrough that has, for millions of women worldwide, ended the prolonged and crushing misery of childlessness. For Edwards it will be a momentous occasion.
'I'm extremely proud to have been involved in Louise's birth,' he says. 'In my many years working in this field I have seen the devastating effect infertility has on the lives of sufferers.'
Prof Edwards knows all too well, and at first hand, the misery these couples endure. In the 30 years since Louise's birth IVF has become increasingly widely available. In the mid-1980s, as doctors honed and refined their techniques, more and more couples opted for fertility treatment. By the mid-1990s about 3,000 babies were being born annually in Britain thanks to IVF.
Today that figure has more than doubled. Currently, some 8,000 babies are born annually to the 30,000 British women who opt for IVF, with the infants now making up one per cent of our annual births. While IVF's success rate is still reasonably low - even for those under 35 it is only 28 per cent - and while those who do go on to have healthy babies are likely to have undergone numerous cycles of IVF before becoming pregnant, for the three and a half million women in Britain who currently have trouble conceiving its existence can prove to be nothing short of miraculous.
We have all heard the happy-ever-after stories of countless women for whom IVF has made motherhood a possibility. But what few women realise is that IVF treatment has become increasingly aggressive: so much so that there are very real risks involved.
Take the case of Temilola Akinbolagbe. Just two days after she began fertility treatment she suffered a massive heart attack at a south London Tube station. She was rushed to hospital where, five days later, her life-support machine was switched off. She had been a healthy young woman who had simply yearned for a child. But her body reacted fatally to the drugs she was given to stimulate her ovaries.

Dr Geeta Nargund offers 'soft' IVF
Granted, such deaths are rare but the fact is that they do happen. And, worryingly, up to 10 per cent of women, particularly those under 35, react badly to the hormonal drugs they are given. They are used initially to shut down the reproductive system and then to stimulate the ovaries to produce multiple eggs instead of a single one, which can then be surgically collected and fertilised with the father's sperm.
Back in 1978, when Steptoe and Edwards carried out the treatment that led to Louise's birth, IVF was very different to the aggressive form in use today. They waited until one of her mother's eggs had ripened, collected it and then fertilised it in a test tube with her husband's sperm before replacing it in the womb.
But in the past two decades the liberal use of drugs and the practice of returning multiple embryos to the womb has been the norm in Britain. All that, however, may be about to change. At a fertility conference in London last month a revolutionary new form of IVF, which involves fewer drugs - thus reducing drastically the side effects - was hailed as the future for IVF. Known as 'soft' or 'mild' IVF, it interferes much less with the body's natural chemistry.
It involves only low drug dosages, and just one, single healthy embryo is replaced: thus it removes the risk of unpleasant side effects and the danger of multiple pregnancies. Who, for example, can forget the premature birth and subsequent death of Mandy Allwood's eight babies in 1996. Allwood, who decided against selectively aborting some of the babies created with fertility treatment, went into labour at just 19 weeks and lost all of them.
While many leading experts acknowledge certain advantages to the mild treatment, they stress that, with women leaving motherhood later and later, the majority come to clinics clamouring for the most aggressive treatment to increase their chances of conceiving swiftly. 'The couples we see have been using contraceptives for years and believed the woman would get pregnant within weeks of coming off the pill,' says one. 'Now in their late thirties they are experiencing problems. Thus they want to maximise their chances of a child in as short a time as possible.'
For those like Prof Bart Fauser, the head of reproductive medicine at the University Medical Centre in Utrecht in the Netherlands, however, there are more important issues, namely safety. He believes the mild option is generally safer and as successful. Consequently, he has been urging the use of mild IVF for the past three years.
In a study three years ago Prof Fauser compared the outcomes for 200 women given mild IVF and a single embryo transfer with those of 200 women who had the conventional regime and two embryos put back in the womb. Those having the mild version were given four shorter treatments, while the others had three.
Over the course of a year 45 per cent of both groups ended up with a healthy child. 'The evidence indicates that this mild approach significantly reduces risks,' he says. 'And we have shown that it is just as successful. Compared with the traditional method we had the same birth rate.'
Since almost 80 per cent of women seeking fertility treatment do so at private, and highly expensive, clinics it seems surprising then that more clinics do not opt for the mild version. The traditional mindset seems to be that more drugs mean more embryos put back in the womb - resulting in more babies and higher places in the league tables compiled by the regulator, the Human Fertilisation and Embryology Authority.
Prof Fauser believes the reality is that the huge costs charged (a single cycle of IVF costs about £3,000) has meant that there is fierce competition among the clinics. 'With all the commercial pressure and all the money involved,' he says, 'it is easy to understand. But it is not to the benefit of the patient.' With all parties desperate for results, the tendency has been to use more drugs to produce more eggs and, hopefully, more babies. Thus IVF has become a multi-million-pound industry.
A quick perusal of the finances involved speaks volumes. Last month the fact that London's most high-profile fertility doctor, Mohamed Taranissi, made £8 million in the past year was headline news. His London practice quadrupled its profits in just six years. According to its most recent accounts the company made a pre-tax profit of almost £8 million - based on charging £2,500 for a single round of treatment - and has £20 million in the bank. Mr Taranissi is far from alone. An investigation by the London Evening Standard newspaper in May revealed that quite a few fertility doctors have become millionaires.
It is cold comfort for the women desperate to conceive. As Prof Fauser points out, since the mild version is much cheaper (about £1,500) couples can afford more rounds of treatment. And because it is less severe on the body fewer women drop out after a single failed attempt. 'With the more aggressive treatment women give up because they have suffered so much,' he says.
In Britain Dr Geeta Nargund, the head of reproductive medicine at St George's Hospital in London and medical director of Create, a private clinic, is one of just a handful of doctors who offer the new treatment. 'It's safer for women to use no drugs or fewer drugs to achieve a pregnancy,' she says. 'It is safer for her own health, her eggs and any embryos that are created. Being a woman, I feel strongly that we should look after women's health. The single most serious complication of IVF cycles is ovarian hyperstimulation syndrome, which can be avoided by using mild IVF.
'I don't come from a rich family myself and I work in south London where I see a lot of couples who don't have much money and who go to the private sector,' she says. 'We have really got to stop that.'

Dr Nargund believes that mild IVF is particularly good for older mothers, who produce few eggs whatever the treatment, so subjecting them to high doses of drugs is pointless and more likely to compromise the result.
Siobhan McLernon, 40, and her fiancé, Shaun, 43, were among the couples who opted for mild IVF at the Create clinic. When McLernon discovered her fallopian tubes were blocked she initially sought help from the NHS. Shocked to discover she faced a two-year waiting list, she decided that, at their age, that was time she and Shaun didn't have.
'The minute I heard about mild IVF I knew it was right for me,' she says. 'I didn't want to pump myself full of hormones and we also couldn't afford the £8,000 some clinics charge. Soft IVF felt like a lifeline. The process was simple. After some blood tests to check my hormone levels, I began a seven-day course of injections and didn't experience any side effects. By the second week I was convinced it hadn't worked. So when the pregnancy test was positive I couldn't believe it. I was the happiest person.'
Nine months later the couple were the delighted parents of a baby daughter, Cara-Mae. 'I just can't imagine life without her. She is an amazing gift,' she says. 'I would definitely recommend soft IVF. If we had chosen a more expensive option, we would have been under more pressure and it would have been more stressful.'
Those who support mild IVF have a firm supporter in Prof Edwards. He has never been in favour of massive doses of drugs. Even when he began working on the treatment in the early 1970s he was worried, he says, about the effect on a woman's body of hormonal drugs on top of the hormone surge that comes with ovulation. 'In those early days we were experimenting,' he says. 'We would use the lowest hormone doses we could and get four or five beautiful, ripe eggs. We always thought that was enough for one time.'
Prof Bill Ledger of Sheffield University, who heads the assisted conception unit at the NHS Royal Hallamshire hospital, worked with Prof Edwards in the late 1980s. 'If we got anybody pregnant, we all went to the pub, including the woman, her partner and the nurses - because it was a very precious thing in those days,' he says. 'The availability of IVF doctors to help people has become so much better. So now we can start looking a bit harder at safety. It is much safer for women to have mild IVF. And safer for the baby, too.'
But while more and more clinics are considering offering the option of the new treatment, not all fertility experts are convinced. Adrian Lower, a consultant gynaecologist at Barts in London who is also medical director of the Isis fertility centre in Colchester, has yet to be persuaded, although he does agree that mild IVF may be better for older women. And his argument is a powerful one in the light of the desperation felt by some infertile women.
'The fundamental problem in this country at the moment is that we feel a responsibility to the patients, most of whom are paying for treatment themselves, to give them the best chance of success. It seems the best chance of getting pregnant is having drugs.'
'IVF worked for us' Natalie Viking, 33, is a finance director. She lives in Oxfordshire with her husband, Steve, 34, a chef, and their daughter, Lucie, one
Steve had always worried he might be infertile because he's a chef - it's common among male chefs due to the heat of the kitchen. So when we hadn't conceived after six months we went to the doctor. Tests revealed that Steve had a low sperm count and that I had polycystic ovaries. I spent six months taking fertility drugs and, when they didn't work, we paid for a private cycle of IVF. The night after my treatment I woke up with a strange sense that it was working. Two weeks later I did a pregnancy test, and it was positive. The pregnancy went smoothly and Lucie was born a perfect little girl.
'We've given up trying for a baby' Clare Daynes, 44, works as a nursery-school assistant. She lives in Bedfordshire with her partner, Nick, 47, a civil servant
We didn't start trying for a baby until I was 35, and it was another three years before I tried drugs to stimulate ovulation. After 18 months without success, I found myself en route to IVF. I underwent five attempts and, after my fourth, I had counselling. My GP signed me off work for three months with depression. When I turned 42 I was running out of emotional energy and IVF had begun to feel like a punishment. We had one more attempt, which, in April 2007, also failed. I decided I had to make changes in my life. I left my job in television and found work as a nursery assistant. Being around children helps me to cope.
'We're still trying' Jess Lucas, 34, is a shop manager. She lives in Newcastle with her husband Peter, 36, who works in telecommunications
My husband's sperm are abnormally shaped and have poor motility. We started on IVF with the NHS two years ago, but after two failed attempts I had ICSI treatment [IVF in which one sperm is injected into one egg]. I produced 25 eggs, two of which were good enough to fertilise with Peter's sperm and implant into me. But within a fortnight we'd realised the embryos hadn't attached to the wall of my womb. We both cried. We've now turned to private treatment and plan on using £10,000 in savings on more attempts at ICSI. I don't want IVF to bleed us dry, financially or emotionally. The most important thing is to keep living our lives.
Case-study interviews by Natasha Courtenay-Smith. Some names have been changed.

Daily Mail - Hospital denies claims that British couple dumped newborn twins 'because they were girls'

A hospital today denied claims that a couple who had received IVF in India had then dumped their twin babies after finding out they were both girls.
It had been claimed that the mother aged 59 and the father 72, had abandoned the babies after telling medics they were the 'wrong sex' because they wanted boys.
However Wolverhampton hospital today said that the parents were being 'attentive' to the babies' needs .
A spokesman said: "The parents are visiting their daughters whilst they are being cared for in hospital and are attentive to their needs."

Abandoned: The babies were delivered by Caesarean at New Cross Hospital in Wolverhampton, West Midlands
It had been claimed that the babies, who are now less than two weeks old, were abandoned soon after birth and have not been visited once by their parents.
The couple travelled to India for fertility treatment but returned to Britain for the birth. The twins were born by Caesarean Section at New Cross Hospital in Wolverhampton.
Their mother - one of Britain's oldest - reportedly discharged herself against the advice of doctors who told her she should stay in hospital for a week after her operation.
She and her husband are thought to be of Indian descent but British residents living in the West Midlands.
Aftter the birth in Wolverhampton, the children were transferred to another hospital in Birmingham.
A spokeswoman for New Cross Hospital said today: 'We can confirm a pair of twins were born at New Cross Hospital. They were healthy and well.
'They were born here because the maternity (facility) where the parents were living was busy, so a few days later they were transferred to a Birmingham hospital, where the parents were living.'
In certain Asian cultures, sons are more highly prized than daughters because it is believed they will work from a younger age and carry on the family name.
In India, girls are considered an economic burden as their parents traditionally need to provide a dowry payment for them when they get married - often resulting in financial ruin or extreme hardship for many families when the women marry.
Last year, research revealed that between 1990 and 2005, about 1,500 fewer girls were born to Indian mothers living in England and Wales than would have been statistically probable for this group.
In the Nineties, 112 boys were born for every 100 girls. Between 2000 and 2005 this rose to 114 boys for every 100 girls.
A report last year revealed Indian women in Britain are travelling to the subcontinent to use the services of IVF doctors who for 4,000 rupees (about £49), will reveal the sex of an unborn child and recommend someone who can terminate the pregnancy.
It is thought that the couple may have travelled to India for IVF due to their late ages. In Britain, women are given IVF on the NHS between the ages of 23 and 39.
There is no absolute age limit for IVF in Britain, but the NHS will not fund it for women aged over 40. Most private clinics have an upper age limit of 55. Many other older women have gone abroad for IVF.
Britain's oldest mother, Patricia Rashbrook, paid £10,000 for IVF treatment in Russia using a donor egg.
Child psychologist Dr Rashbrook became pregnant under the supervision of Italian fertility expert Professor Severino Antinori, and her son JJ was born by elective caesarean.
IVF treatment has sparked an emotive debate over the rights and wrongs of giving women who are many years past their natural childbearing age the ability to reproduce.
The controversy was again in the spotlight last year after Carmela Bousada, an unmarried Spaniard then aged 67, became the world's oldest mother.
She gave birth to twins after lying about her age to doctors at a private clinic in Los Angeles which refuses to treat women over 55. Miss Bousada, who came close to death during a difficult pregnancy, went through the menopause 19 years ago.
Last night, a spokesman for New Cross Hospital said: 'We have no comment to make due to data protection reasons.'
In 2006, it was revealed a businesswoman dumped her new-born twins in a cardboard box in a hospital car park because they were the product of an affair.
The married 44 year old, who has three grown-up sons, said she could never reveal the truth of the twins' birth to her family because of the devastation it would cause.
The babies, born a month premature had to be put in incubators because they were so cold and were named Holly and Joseph by nurses.

Daily Mail - Fertility doctor makes staggering £8million in ONE YEAR off couples desperate for a baby

A fertility doctor made £8million in one year, it has emerged.
Mohammed Taranissi's private London-based IVF practice has quadrupled its profits in six years, according to its accounts.
His company made a pre-tax profit of almost £8million - based on charging £2,500 for a basic IVF treatment - and had £ 20million in the bank.
Other clinics making millions include that of Harley Street fertility pioneer Professor Ian Craft, with £5million a year and almost £850,000 in the bank.
The profits, revealed in an investigation by the London Evening Standard, highlight the growth in demand from childless couples.
An estimated one in six couples experiences problems conceiving.
On average, an IVF cycle from a private clinic costs £3,500 with hormone drugs costing an extra £2,000.
But patients typically need two or three attempts to fall pregnant.
Mr Taranissi's profits are based on his work at the Assisted Reproduction and Gynaecology Centre.
According to accounts for the year to August 2006, he has paid himself £2million in a year as director of the practice.
Treatments on offer include egg freezing for £2,000, donor sperm at £110 a sample and surgical sperm retrieval for £1,250. The initial IVF consultation alone costs £150.
This year the Human Fertilisation and Embryology Authority warned clinics to outline their rates from the start amid fears patients are unaware of the potential bill.
A spokesman said: "It is like a taxi fare meter. It is rising but you do not know what it will cost at the end of the journey."