Q: What can genetic testing screen for?
A: http://dnapolicy-content.labvelocity.com/pdfs/6/27376.pdf

Q: Is there information on children conceived through IVF?
A: The American Fertility Association and RAND Launch the First Longitudinal, Prospective Study of IVF Children 'Footprints' will track the health and welfare of children conceived through in vitro fertilization (IVF) NEW YORK, Oct. 20 /PRNewswire/ -- The American Fertility Association announces "Footprints: The IVF Children's Health Study," the first longitudinal, prospective, and scientifically objective study that chronicles the health and welfare of children conceived through IVF. "As part of our joint responsibility to follow the children born through IVF, The American Fertility Association, in collaboration with leading reproductive endocrinologists, has identified the need for 'Footprints,'" said Pamela Madsen, Executive Director and Founder of The American Fertility Association. There are at least 250,000 IVF children born in the U.S. to date. "Footprints" will deliver facts -- not hypotheses -- about the physical, emotional and intellectual development of this significant and growing population. Previous studies have been flawed: their data collection has been limited and their conclusions incomplete. The "Footprints" study will redress this information gap with high-quality, longitudinal data. "Footprints" is a partnership between The American Fertility Association (formerly The American Infertility Association) and the RAND Corporation, a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. The American Fertility Association and RAND Health have begun to work closely on the data collection strategies for this innovative research endeavor. This forward-looking study will track multiple gestations, birth weight, birth defects, surgical procedures, physical health, and developmental milestones for IVF children. It will also include at least one control group, the children of infertile couples conceived through Intrauterine Inseminations (IUI), and possibly others. Study methods will be designed to produce the most comprehensive and accurate data possible; implementation of the study design will be carefully monitored to ensure continuing data quality. "'Footprints' will provide patients trying to conceive, IVF parents and their children, physicians, and allied industry with important information about the health of IVF children," said Owen Davis, M.D., AFA Medical Director and Associate Director, The Center for Reproductive Medicine and Infertility at Cornell University. "It is critical to understand the effects of IVF on children and families. RAND is committed to working with The AFA to create a rigorous study design and oversee the integrity of its implementation. This will ensure that the data and findings from the study will be credible in the scientific community and useful to patients and their families," said Gail L. Zellman, Ph.D., RAND Senior Research Psychologist and the director of the RAND portion of the Footprints study. "It is appropriate for this study to be a patient-driven initiative conducted by The AFA," said Ms. Madsen. "Patients have no professional bias, so having a patient-driven study avoids potential conflict of interest from a medical- or industry-led initiative." "Given that infertility is a national public health issue, it is essential that the U.S. government provide funding to support 'Footprints,' said Richard T. Scott, Jr., AFA Scientific Director and Managing Partner of Reproductive Medicine Associates (RMA). "This study has the potential to benefit the current generation of IVF children and will also benefit future generations of these children as well." "Footprints" is supervised by a scientific advisory committee, which assists with the planning and monitoring of the study. Advisors include AFA medical and scientific committee members, RAND analysts, reproductive endocrinologists, patient advocates, mental health professionals, epidemiologists, pediatricians, and others. Serono, Inc. has provided The AFA with an unrestricted educational grant for "Footprints," which will serve as initial funding to assist with the development of the study design and the collection of pilot data from a cross-section of U.S. IVF centers. The AFA and the RAND Corporation will seek federal funding for "Footprints," enabling it to become an expanded national study. "'Footprints' is a bold first step and, as an IVF mother, this is the best gift I could ever give to my children," added Ms. Madsen.

Q: Is single embryo transfer a good option?
A: Betting on single embryo in vitro not a bad gamble Procedure improves so couples need not risk multiple births By JULIE DAVIDOW SEATTLE POST-INTELLIGENCER REPORTER Four years into her quest to get pregnant, after she had decided to try in vitro fertilization, 35-year-old Lisa Goss had a decision to make. Did she want one or two embryos put back in her uterus? With two, she might have twins; with one, she might be reducing her odds of having a baby at all. Doctors used to routinely place two, three, four and five embryos after in vitro fertilization. Grant M. Haller / P-I Lisa and Erick Goss of Seattle check out their 3-month-old daughter, Greta, in her crib at home yesterday. Lisa opted for single-embryo transfer at Seattle Reproductive Medicine after four years of failed fertility treatments. The procedure worked. "I never knew if I made the right decision," Lisa said of getting just a single embryo implanted. "Until I got the pregnancy test, I was very nervous." But with better techniques for growing and selecting the best quality embryos, fertility specialists have started offering some patients the option of avoiding the complications of multiple births by betting on a single embryo. "Years ago when we were doing IVF, it seemed like the pregnancies were so few and far between you didn't worry," said Dr. Michael Soules of Seattle Reproductive Medicine, a private clinic opened last year by a crew of fertility specialists. "You transferred a bunch of embryos and hoped one would take." Since 1981, 114,000 babies have been born using in vitro, according to the American Society for Reproductive Medicine. The procedure involves combining egg and sperm in a lab dish to create embryos, which can then be transferred to a woman's uterus. Any extra viable embryos can be frozen for later use. Relatively young and trying in vitro for the first time, Goss was the ideal candidate for success with one embryo. Some studies suggest comparable pregnancy rates for young women who receive one or two embryos, but there's not enough data yet to give women a definitive answer. And although Goss' other embryos would be frozen, the fresh ones have a better chance at success. "I never knew if I made the right decision. Until I got the pregnancy test, I was very nervous," said Goss, who as a patient at Seattle Reproductive Medicine was enrolled in the single-embryo study. Her daughter, Greta, is now 3 months old. She's on the brink of sleeping through the night, but two hours of uninterrupted rest is all Goss can count on for now. She can't imagine having twins. "I think I'd ask my in-laws to move in," Goss joked. But the stress and additional work of caring for more than one baby is just one of the potential drawbacks of multiple births, say doctors. In a recent survey of 449 women being treated for infertility, 20 percent said they would prefer multiples to a single baby. Less than half were aware of the health problems associated with twins, including an increased risk of cerebral palsy and low birth weight, according to researchers at the University of Iowa, who published the results last March in the journal of Fertility and Sterility. Still, many couples, after years of waiting and hoping for a child, are more than happy to have twins. Unlike countries in northern Europe, where single-embryo transfers have been common for years and national insurance programs cover in vitro, couples in the United States must often pay for the $12,000 procedure on their own. Only 16 states (not including Washington) require insurers to pay for fertility treatments. The financial burden added to the emotional cost of repeated IVF cycles, which take weeks, including hormones and egg retrieval, can rapidly drain a couple's resources. Goss and her husband, Erick, were committed to one IVF cycle. "We said let's try this ... and if it doesn't work, let's go for adoption," Goss said. Because IVF is considered the last resort after years of failed attempts to have a baby, some women aren't willing to take even a slightly higher risk of failure, said Dr. Lori Marshall, a reproductive endocrinologist at the Center for Fertility and Reproductive Endocrinology at Virginia Mason Medical Center. Only a handful of women have opted for a single-embryo transfer in the two years since the clinic began presenting the option to patients, said Marshall. "We tell them, if we put two back in, there's a risk of twins. It may be 30 to 40 percent. And they say, that's fine. We'd love to have twins." While parents might not be concerned, doctors are feeling the pressure to reduce multiple births from within their profession, said Dr. David Adamson, medical director at Fertility Physicians of Northern California and a member of the board of the Society for Assisted Reproductive Technology, an organization of reproductive physicians. The American Society for Reproductive Medicine for the first time last year advised doctors to consider using one embryo for women who have the best chance of getting pregnant. In an increasingly crowded IVF market, some clinics are offering financial incentives they say could encourage women to try single-embryo transfers. Seattle Reproductive Medicine offers a more expensive plan with a partial money-back guarantee for patients who don't get pregnant with IVF. Adamson belongs to a national network of physicians that markets a package of IVF services, including a free frozen embryo cycle. And doctors at Virginia Mason, who handle egg retrievals and embryo transfers for patients at Madigan Army Medical Center, are putting together a proposal asking Madigan to cover a portion of the cost of IVF, Marshall said. Meanwhile, physicians at Seattle Reproductive Medicine say they've already been able to achieve high pregnancy rates for single-embryo transfers. By selecting the best candidates, including Goss, and transferring more mature embryos, called blastocysts, 76 percent of women with single embryos got pregnant, compared with 78 percent of those who received two. Most fertility specialists consider 50 to 55 percent pregnancy rates respectable. The clinic's data have not yet been accepted for publication. "We need to loosen our criteria and see how far we can back off and still get the same pregnancy rate," Soules said. P-I reporter Julie Davidow can be reached at 206-448-8180 or juliedavidow@seattlepi.com

Q: Could a frozen cycle be better than a fresh cycle?
A: Frozen embryos may yield better pregnancy outcomes Last Updated: 2005-07-01 11:40:42 -0400 (Reuters Health) NEW YORK (Reuters Health) - Low birth weight (LBW) and preterm birth are more frequent in babies born through assisted reproductive techniques (ART), a study from Australia shows. The study also shows that use of fresh rather than frozen embryos appears to be one risk factor for these outcomes. The number of births after the use of ART has increased steadily around the world, especially in developed countries, Dr. Michael Chapman of the University of New South Wales and colleagues note in the journal Fertility and Sterility. "The benefits of ART are evident in that almost 1 in 50 births were associated with ART procedures in Australia in 2001," they write. However, ART has been tied to an increased number of adverse birth outcomes, most notably multiple births and preterm and LBW deliveries Chapman's team set out to investigate the frequency of premature births following ART pregnancies in Australia, and to identify any maternal characteristics or fertility procedures that might increase the risk. Their analysis included 17,726 infants born after 15,035 cycles of ART. They compared outcomes to all Australian births for 1999. Nearly one third of the ART infants were born preterm, and one quarter were LBW, the researchers found. Both preterm birth and LBW were more common in singletons and twins born through ART, and were also more common among nulliparous women (those delivering their first child). They also observed that preterm birth was 30 percent more likely among infants conceived with fresh compared to frozen embryos, while LBW was 50 percent more common with fresh rather than frozen embryos. Both LBW and preterm birth were also more common among couples with female-factor infertility compared to male-factor infertility. The better results seen with frozen embryos may have been due to higher quality embryos being chosen for freezing, the researchers note, as well as the fact that couples having excess embryos available for freezing may have had better-quality eggs to start with. SOURCE: Fertility and Sterility June 2005. Copyright © 2005 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world. Another source: The success rate with frozen embryo transfer (FET) varies widely from program to program and depends on many factors. The more cells present in the embryo and the healthier it appears, the more likely it will survive the freezing and thawing process. About 65-75 percent of healthy-appearing embryos will survive the freezing process. Although it is called a frozen embryo transfer, we always thaw them and evaluate quality before transfer. Luckily, if the embryos are damaged by the freezing process, it is an all-or-nothing phenomenon -- either the embryo survives or it doesn't. I am not aware of any studies suggesting a higher rate of chromosomally abnormal offspring from transferring surviving frozen embryos as compared to fresh. The implantation rate per embryo is somewhat lower with frozen embryos when compared to fresh, so we often transfer one more embryo than we might if transferring fresh embryos. We have noted an ongoing pregnancy rate of about 20 percent if three frozen embryos are transferred. Improved laboratory techniques should enable us to grow the embryos in the labs for a longer period before freezing. After four to five days, only the most fit embryos will appear healthy (viable) and will be frozen. As a result, fewer embryos will be frozen, but rates for survival and implantation will be better than with embryos frozen at earlier stages.

Q: Are blasts better to transfer?
A: Day-3 or Blastocyst-stage Embryo Transfer? Most IVF programs transfer embryos on the third day after fertilization, when embryos usually have reached, what is called, the 6-cell to 8-cell stage. Some investigators have, however, for a number of years been propagating the transfer of embryos on days 5 or 6, when they reach the so-called blastocyst stage. The longer embryos are cultured in the laboratory, the fewer embryos survive. Longer embryo culture, therefore, is presumed to lead to the survival of the fittest embryos, a process often called naturalembryoselection. Proponents of blastocyst-stage embryo transfer (BCS-ET) have, therefore, argued that BCS-ET will result in higher pregnancy rates per embryo transferred than day-3 transfers and, consequently, allow for high pregnancy rates with even single embryo transfer. Single embryo transfer, in turn, will successfully reduce the high multiple pregnancy rates associated with IVF (see also below).

Resource: CHR

 

Q. What are the pros of an open adoption?