Posted on 06/23/2007 7:50:06 PM PDT by Coleus
TThe desperation of the infertile would-be mother knows no bounds. Lee Cowden, aching to conceive, was pumped full of hormones to make her produce more eggs. The result? A trip to hospital — but not to a maternity suite. "I was 25 and felt this excruciating pain in my chest," recalls Lee, a music therapist from Surrey. "I was rushed into intensive care in an ambulance, and it became pretty clear that, despite my age, I had suffered a heart attack. "I'd suffered a clot caused by the fertility treatment I had undergone. I remember lying in my hospital bed, desperately worried. Not for my health, but because I thought that they’d never let me have IVF again, and I'd never become a mother." Then there's Jane Edwards, a 36-year- old accountant from Manchester. She'd been trying for a baby for five years and was delighted when a course of drugs designed to stimulate her ovaries resulted in a harvest of 24 eggs. That delight, however, was short-lived. "As I was being wheeled out of the treatment room, my breathing became irregular and then stopped altogether," says Jane. "They couldn’t find a pulse and I had to be resuscitated in an emergency room. "I was suffering from what is known as ovarian hyperstimulation syndrome, and to make it worse the eggs were a no-go.
"So what did I do? Carried on with treatment, of course. I want to be a mum more than anything in the world." While these stories of self-sacrifice may sound extreme, a quick look at the myriad internet websites dedicated to the subject of IVF reveal they are far from unique. But what they also reveal is that while women continue to risk serious side-effects from the fertility treatments they undergo, they are also increasingly beginning to question what effects these procedures may have on any future child. "The drugs give me banging headaches, hot flushes and temper tantrums," writes one 33-year- old member of an online forum. "If they make me feel like this, what are they doing to my eggs?" Another asks: "I am so excited to be having IVF, but will any baby I have be OK?" She's not alone in asking. For while three decades have passed since the first test-tube baby was born in Britain, doubts persist about its longterm safety.
From the U.S. comes research that the common practice of storing fertilised embryos can provoke genetic changes that may develop into mental and behavioural disorders later in life; from Canada come claims that IVF can increase some birth defects tenfold; while from Denmark a study of young men finds those conceived through fertility treatment are 50 per cent more likely to be infertile themselves. Taken with the explosion in multiple births (with their own inherent health problems), is it any surprise that others are starting to echo the sentiments of fertility expert Professor Robert Winston? Can we really trust the science behind IVF, Lord Winston has asked. Or is it just a 'mass experiment' with desperate women as the guinea pigs — and the results a timebomb that future generations will have to defuse? Louise Brown, the world’s first testtube baby, was born in 1978 and became a mother herself last year. Her son, Cameron, was conceived naturally and this was hailed in some quarters as proof that IVF really 'works'. Others, however, caution against attributing too much significance to this happy event. The treatment that led to Louise’s birth, they point out, was very different from today's. Doctors waited until one of her mother Lesley's eggs had ripened, collected it and then fertilised it in a test tube with her husband's sperm before replacing it in her womb. Since then, procedures have moved on, with more than three million babies worldwide conceived through Assisted Reproductive Technologies (ART) — IVF, ovulation induction and intra-uterine induction. In Britain, ART accounts for 1.4 per cent of all births every year — 10,242 in 2004 — while many more women undergo treatment unsuccessfully (the success rate among women under 35 is 28.2 per cent, falling to 10.6 per cent for those aged 40-42).
The main developments in ART have focused on manipulating the production of a woman's eggs through the administration of fertility drugs. This has been both to control the timing of ovulation and to increase the number of eggs produced. The more eggs, the logic goes, the higher the chance of a successful pregnancy. Once harvested, the eggs are fertilised in the lab while the woman receives hormone drugs to ready her womb for implantation. It is then hoped a normal pregnancy will ensue. That's the theory — the practice is somewhat different. With relatively small provision of IVF on the NHS, the fertility business has developed into a multi-million-pound industry charging up to £5,000 for a single cycle. With all parties desperate for results, the tendency has been to use more drugs to produce more eggs and — hopefully — more babies. But critics claim this approach has resulted in increased risks to the mother (cancers, clots and hyperstimulation) and to the unborn child, as well as an explosion in multiple births.
Today, the twin birth rate is 23.6 per cent for IVF mothers, compared with between one per cent and two per cent in the general population. Not only are they more likely to be born prematurely and underweight, but there is also a greater risk that they will be stillborn or with a disability. Rules governing IVF mean that women under 40 in Britain can have two embryos implanted, while those over 40 are allowed three. But the Human Fertilisation And Embryology Authority (HFEA), which licenses fertility clinics, is running a public consultation to examine whether single-embryo implantation should become the norm. While this shift will address the problems associated with multiple births, it's not the end of the matter. For reasons that remain unclear, there are also higher incidences of post-birth difficulties with single IVF babies. Studies have shown that they are two-and-a-half-times more likely to have a low birth weight — and small babies are known to be more likely to grow up to develop vascular disease, diabetes, hypertension or osteoporosis.
Further, analysis of the records of some 60,000 deliveries in Ontario, Canada, during 2005 found the 1,394 babies born via ART were 60 per cent more likely to have defects than children conceived naturally. Gastrointestinal abnormalities were most common, though the babies also had a higher risk of bone, muscle and heart defects. Rightly, many will argue that the risk of birth defects remains low — affecting just 2.62 per cent of ART babies, compared with 1.87 per cent of naturally conceived babies. But there is a discrepancy. Is it caused by the drugs taken to induce ovulation? Or is it some asyetunidentified aspect of a couple’s infertility that is passed on and which affects their offspring? Equally intriguing is the fact that the research seems to suggest that the more far-reaching the intervention, the more likely there is to be some sort of long-term problem. Researchers in the U.S. say the common practice of storing fertilised embryos can provoke genetic changes that may develop into mental disorders. In the UK, embryos are often cultured for five to six days after fertilisation so they can start to divide and grow. Only the healthiest embryos survive to the 'blastocyst' stage — when they are a tiny ball of 60 cells — and are then handpicked to boost pregnancy rates.
Instead of implanting two or three embryos, couples can select the one which is showing the best potential. But this storage period could ultimately harm the baby, according to the study by scientists at the University of Pennsylvania. It examined the behaviour of mice whose embryos were stored in the laboratory before being implanted in the womb of a 'foster' mother. They were compared with those whose embryos developed naturally in the womb before being transferred. The mice whose embryos had been stored began to show behavioural abnormalities at four to six months. Another area causing particular concern is a procedure known as intracytoplasmic sperm injection (ICSI), which involves passing a single sperm directly into an egg. This technique is often used when the man has a very low sperm count or very poor sperm movement, both of which make normal fertilisation unlikely. Research has found that ICSI babies have three times the rate of birth defects of naturally conceived infants.
Could the actual process of injecting the sperm directly into the egg be damaging the child? And could the genetic defects that made the donor infertile in the first place be passed on to their children? This question of second-generation infertility is an area of particular interest, and given the relative infancy of the science of IVF, it is something that will become clear only in years to come. But, already, there is some cause for concern. A recent Danish study of 2,000 men compared the fertility of those whose mothers had needed help to conceive with those who were conceived naturally. The team, from the Rigshospitalet in Copenhagen, found that 47 men born as a result of treatment had lower fertility. Indeed, 30 per cent of these men had so few sperm that they were judged to be infertile by World Health Organisation standards — compared with 20 per cent of the men conceived naturally. On average, men conceived through IVF had 46 per cent fewer sperm, and those they did produce were more likely to be inactive and abnormally shaped. The men also had smaller testicles and lower levels of the male sex hormone testosterone.
The differences were more pronounced in 25 men whose mothers had hormone-based drugs. Their sperm counts were 60 per cent lower than normal. While it is not known what drugs the women took, the likely candidates-— clomifene, human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG) — are used by thousands of British women a year. Clomifene and HMG coax the body into producing more eggs, while HCG triggers their release. The researchers acknowledged that the results could partly be explained by genetics, with infertile couples passing on their problems to their offspring, but also raised the possibility that the female hormones in the drugs may harm the development of the sexual organs of any male foetus.
It is, of course, important to acknowledge that the risks remain small — in other words, if a natural child has a one-in-5,000 risk of a deformity, even if the risk doubles through IVF it remains a remote possibility. But medics insist it cannot be entirely ignored. "The risks certainly aren't so big that we should not use this technology, but we should use it cautiously," says Professor William Ledger, professor of obstetrics and gynaecology at the University of Sheffield. "My worry is that more and more people are turning to IVF almost as a lifestyle choice, as a convenience. In some instances, say because of their busy lives, couples may not be able to sleep with one another enough to conceive naturally.
"If one of them is working in the U.S. and the other in London, they see IVF as a surrogate for sex. "Alternatively, women are waiting to start a family until they are rather old, and then turn to IVF. They are not infertile in the sense of having a blocked tube or something similar — they have just left it too late to have a baby naturally."
Secondly, there is a growing school of thought that, given the uncertainties, IVF clinics should be attempting to provide as low a level of intervention as possible, reducing the risks to mother and child. Known as Natural Cycle or soft IVF, it centres on single- embryo IVF treatment involving minimal drug stimulation. The emphasis is on using high-tech scanning techniques to identify a few high-quality eggs, rather than using high drug dosages to stimulate the ovaries to over-produce. "Yes, you can get a lot of eggs with stimulation," explains Dr Geeta Nargund, head of reproductive medicine at St George's Hospital, London, "but 65 to 70 per cent tend to be abnormal. It is the quality, not the quantity, of eggs that determines a successful pregnancy."
Of course, not everyone is suitable for this treatment, but one woman who did benefit was Lee Cowden, 28. Following her heart attack in 2004, Lee — who was infertile after being diagnosed with polycystic ovary syndrome as a teenager — was told it was too dangerous for her to continue with conventional IVF. But after being referred to Dr Nargund, it was agreed she would try the low-dose approach, and within three months of starting treatment she became pregnant. "I cried my eyes out when the nurse finally said: "Your pregnancy test is positive." I was so happy."
Lee's daughter Molly was born last November and is doing well. "Following the heart attack, I kept thinking it was only a matter of time before doctors told me I'd never be able to have children. "I've been on a roller-coaster ride, with some agonising times. But I'm lucky — my story has a happy ending." That is something everyone can only hope and pray all the women whose lives have been touched and moulded by IVF will have, too.
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For later reading.
wow. A heart attack? That is disturbing.
Call the lawyers! <sigh
One can only wonder how these people who are too busy to conceive will have enough time to raise children.
The incidence of this disorder among boys has increased, to something like 1 in 90. PDDNOS in Google brings uf 81,000 results.
I’d rather have an imperfect baby than no baby at all. I will continue fertility treatments.
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