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Shortage brings call to let sperm donors father more children

The government should consider increasing the number of children that sperm donors can legally father to tackle the critical shortage of donated sperm in the UK, according to an expert report from the British Fertility Society.The report calls for a national strategy to tackle the shortage of donated sperm, which is preventing numerous patients at fertility clinics from getting pregnant. The government's decision in 2005 to remove the right to anonymity for sperm donors led to an immediate drop in the number of women treated using donor sperm, from 2,727 in 2005 to 2,107 in 2006. The demand for donor insemination is about 4,000 women a year, which would need about 500 donors to register each year. In 2006 there were 307 donors.One way to make better use of existing donors would be to ease the limit on the number of children they can sire. Currently, this stands at 10 families. The limit is intended to lower the chance that offspring from the same sperm donor will have children together themselves without knowing they are closely related. However, the report, which is published in the journal Human Fertility, says the limit is overly conservative. "The current limit of 10 families is arbitrary and not evidence-based, and a large safety margin probably exists given the size of the UK population and dispersal patterns," write Dr Mark Hamilton at the University of Aberdeen and Dr Allan Pacey of the University of Sheffield in a commentary on the report in the British Medical Journal.The Netherlands, for example, which has a population a quarter the size of the UK's, has an upper limit of 25, while in France the limit is five. "A more flexible approach that allows donors and recipients to determine their preference on family numbers could be facilitated," write Hamilton and Pacey.A majority on the working group that produced the report say that increasing the limit to 20 families would be acceptable, although they say that the impacts on children from donor insemination should be investigated. "We are suggesting there should be a debate in society about this," said Hamilton, who is chair of the British Fertility Society, which represents professionals in reproductive medicine.Overall, the BFS working group is advocating a "national coordinated strategy" to improve donor recruitment across the country. They advocate designating 14 regional centres, with numerous local centres that provide linked donor services and plug geographical holes in coverage. Currently, potential donors in some areas must travel considerable distances to find a licensed centre.The working group says more effort needs to be focused on early donor care because 35% of potential donors are lost between their first contact with a centre and giving a donation.HealthHealth policyguardian.co.uk © Guardian News & Media Limited 2008 | Use of this content is subject to our Terms & Conditions | More Feeds

Frozen embryos safer for health of IVF babies, studies say

Using frozen rather than freshly collected embryos during IVF treatment reduces the risks of stillbirth and premature delivery, according to three separate studies published yesterday.The findings, from the US, Finland and Australia, suggest the act of stimulating a woman's ovaries with powerful drugs and then collecting the extra eggs she produces temporarily disrupts any IVF attempt conducted shortly afterwards. The researchers said the results argue for more IVF cycles to be completed using frozen embryos, which goes against current practice. The most recently available UK figures show that, in 2006, 29,304 patients under 35 received IVF treatment cycles using fresh embryos, while 6,894 were treated with frozen cycles. The new data suggests this preponderance of fresh cycles puts IVF babies at higher risk of being born prematurely and underweight, or dying soon after birth.The new data poses a dilemma for IVF clinics, because fresh cycles tend to be more successful at resulting in pregnancies - 31% of fresh cycles in 2006 for under 35s resulted in a birth, compared with 20.1% for frozen cycles."Frozen embryo transfers are not as successful as fresh ones in terms of getting a pregnancy. So it may be that we have to balance the health of children against chances of success," said Dr Allan Pacey from the University of Sheffield, who is secretary of the British Fertility Society."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. This allows the patient's body to get rid of the drugs, and to grow a new endometrial lining," said Dr Mandy Katz-Jaffe, of the Colorado Centre for Reproductive Medicine.In the Australian study a team lead by Prof Gordon Baker at the Royal Women's hospital in Melbourne analysed data from all Melbourne's fertility centres collected between 2001 and 2004. They found 469 (11%) of the 4,279 attempts using fresh embryos resulted in babies with a low birth weight (less than 2.5 kg), compared with 163 (6.5%) of the 2,510 IVF cycles using frozen embryos. Similarly, the fresh cycles had a higher proportion of babies dying within 28 days (1.87% to 1.16%) and more pre-term births (12.3% to 9.4%) - defining pre-term as earlier than 37 weeks."These results suggest that adverse birth outcomes of assisted reproductive therapy are associated with fresh embryo transfers," the authors wrote. Using frozen embryos also has benefits for the mother. One risk posed by drugs used to stimulate the ovaries is a condition called ovarian hyperstimulation syndrome (OHSS), which can be fatal in rare cases. At present, if patients begin to develop symptoms, fertility doctors typically abandon an IVF attempt using fresh embryos because the hormonal disruption of pregnancy can make OHSS worse.Medical researchHealthguardian.co.uk © Guardian News & Media Limited 2008 | Use of this content is subject to our Terms & Conditions | More Feeds

'Road map' test can predict when the menopause will start

A test to predict when a woman will go through the menopause has been developed by scientists who believe it will provide a 'road map' of fertility for older would-be mothers.The breakthrough will also help women prepare mentally for losing their fertility and allow those in their late 30s and 40s who are considering trying for a baby pinpoint just how long they have left to conceive.One of the country's leading experts in fertility and women's health last night welcomed the test as a genuine and important breakthrough. 'The menopause is not an illness. But it is a big life event which has big implications for women's lifestyle and quality of life,' said Bill Ledger, a professor of obstetrics and gynaecology at the University of Sheffield. 'This test seems to be reasonably predictive of menopause. Lots of people want to know when it's going to happen so that they can plan their life and work and their children, if possible, and this test would give them an idea of that. 'It would give them an idea of where their body is in relation to the menopause, how soon it's coming.'We live in an era when people want to know more about their bodies and what can go wrong with them, and this test reflects that. This test could let women plan how they are going to cope with menopause and help them understand what's happening in their own body.'The test measures three hormones in a woman's blood to calculate how many eggs are left in her ovaries. International researchers led by MaryFran Sowers, a professor of public health at the University of Michigan, found that changes in the levels of anti-Müllerian hormone (AMH), the follicle-stimulating FSH and inhibin B concentrations, in more than 600 women studied, foretold when they would enter menopause. The team found AMH fell to a very low or non-measurable level five years before a woman has her final period. By then she is likely to have so few eggs that her fertility is increasingly questionable, says the study published in the Journal of Clinical Endocrinology and MetabolismThe findings are significant, because while these hormones have been measured before doctors have not been able to connect diminishing levels of them to fertility or to the menopause because of a lack of data. Between 400,000-500,000 women a year in Britain experience the onset of menopause, many with symptoms including hot flushes, mood swings, disturbed sleep and a loss of libido. 'The information [in the test] provides a road map as to how fast women are progressing through the different elements of their reproductive life,' said Sowers. 'People really want information about "how long do I have?" and "when will I have my final menstrual period?"'Now we are beginning to say, "If you have a specific FSH level, combined with your age, this is the likelihood that you are in this reproductive stage". We finally have numbers from enough women evaluated over a long time period to describe the reproductive ageing process.' About 200,000 women in Britain at any one time are suffering from menstrual dysfunction in their 40s. Some 2,000 get such severe problems that they have a hysterectomy or similar procedure. If the test proves successful, it could mean at least some of them can avoid surgery.Medical researchHealthWomenguardian.co.uk © Guardian News & Media Limited 2008 | Use of this content is subject to our Terms & Conditions | More Feeds