Artificial Conception

Jan-Feb 2007: Technological Conception

Study Shows Higher Rate of Birth Defects in Babies Conceived Through Fertility Treatment 

IVF Children May Suffer More Over-All Health Problems Than Naturally Conceived Children

IVF Can Lower Chance of Pregnancy

Study Finds IVF – Placenta Previa Increased Risk

Wanting Babies Like Themselves, Some Parents Choose Genetic Defects    

Study Shows Higher Rate of Birth Defects in Babies Conceived Through Fertility Treatment. A new study has provided further confirmation that babies conceived through fertility treatments are at a higher risk of having a birth defect than children who are conceived naturally.
 
The study was carried out by a medical team assembled in Ottawa, Ontario and is the largest of its kind to date. The study monitored 61,208 births in total of which 1,394 were of babies conceived through fertility treatments. The researchers took into account in their calculations the variable factors of age of the mother, sex of the child, whether the mother smoked and other relevant issues.
 
The final results of the study are to be presented at today’s meeting [9Feb] of the Society for Maternal-Fetal Medicine in San Francisco.
 
Some doctors assure women, even after looking at the facts of the study, that, while the risk of a birth defect is greater with a child that is conceived through artificial means, the risk is so minimal that it should not dissuade parents from choosing technological methods of conception. Dr. Mark Walker of the University of Ottawa and one of the study’s leaders said, "What's important and reassuring is that the absolute risks are still low."
 
However, the results of the recent study seem to portray a more alarming message. According to the study, nearly 3 percent of babies conceived through fertility treatments had a birth defect while just under 2 percent of babies conceived naturally were reported to have a birth defect.

Taking into account the relatively low number of children conceived through artificial means, that percentage translates into a 58 percent overall greater risk of a birth defect in artificially conceived children.
 
The study’s findings also showed that the more high-tech and complex the fertility treatment – the more likely it was that the child conceived would have a birth defect. Babies conceived through IVF had the highest rate of birth defects compared to a much lower rate for babies, for example, conceived with the assistance of medication to trigger a mother’s ovaries to produce eggs.
 
The most common defect found in artificially conceived children was in the gastrointestinal region and varied from defects in the structure of the abdominal wall to internal organs developing in the wrong place. Artificially conceived children were 9 times more likely to suffer such problems – which translates into 1 in 200 births versus 6 per 10,000 for children conceived naturally.
 
Cardiovascular defects were twice as high in artificially conceived babies – 90 per 10,000 versus 40 per 10,000 in naturally conceived children. Malformed limbs were slightly more common in artificially conceived children while problems such as spina bifida and a cleft palate had a similar rate of occurrence.
 
The researchers did mention in their study that such a high rate of malformations could also be caused by genetic and parental health factors which could be the underlying reason for the parents experiencing fertility problems and needing to seek fertility treatment in the first place.
 
To date, more than 1 million babies have been conceived through artificial means world wide and the technological methods of conception vary from in vitro fertilization (IVF), artificial insemination and intracytoplasmic sperm injection, in which a sperm is selected and forced into the ovum with a needle.
Related:
IVF Babies up to 40% More Likely to Suffer Severe Birth Defects
http://www.lifesite.net/ldn/2005/jan/05013107.html
[9Feb07, Ottawa, Jalsevac, LifeSiteNews.com]
  

 

IVF CHILDREN SUFFER MORE OVER-ALL HEALTH PROBLEMS THAN NATURALLY-CONCEIVED CHILDREN. Children conceived using in vitro fertilization technology appear to have worse over-all health than children conceived naturally, according to a study from Finland. DoctorNDTV reported in their November newsletter on findings from the National Research and Development Center for Welfare and Health in Helsinki, Finland, showing IVF children have increased rates of multiple health problems.

While increased rates of specific abnormalities have been known to be associated with IVF, such as brain abnormalities and defective urological systems, the new research showed an overall increase in poor health among IVF children, including single-birth children.

Multiple births resulting from IVF treatment have been associated with higher mortality rates, increased risk for hospitalization and cerebral palsy. However, single children born using IVF technology also showed increased hospitalization rates, as well as more birth complications.

The researchers called for additional studies to identify the cause of increased health problems in single-birth IVF children. increased risk for specific diseases was found.

Researchers examined the health of 4,559 children up to four years old who were born using IVF technology between 1996 and 1999. As a control group the study relied on more than 190,000 children who were conceived naturally during the same time period. [4Dec2006, Helsinki, Gudrun Schultz, LifeSiteNew.com]
Related: In Vitro Fertilization  
http://www.lifesite.net/features/invitro/
MOUNTING EVIDENCE OF IVF DEFECTS   http://www.lifesite.net/ldn/2003/mar/03032107.html
42

% of IVF Ova Carry Genetic Abnormalities New Studies Show   http://www.lifesite.net/ldn/2005/oct/05101905.html
IVF Three Times More Likely to Cause Genetic Brain Defects   http://www.lifesite.net/ldn/2006/mar/06031309.html
IVF Babies up to 40% More Likely to Suffer Severe Birth Defects   http://www.lifesite.net/ldn/2005/jan/05013107.html

 

IVF CAN LOWER CHANCE OF PREGNANCY. Thousands of women who take high doses of fertility drugs as part of IVF treatment may actually be harming their chances of ever having a baby, doctors are warning. Increasing reliance on such powerful drugs could be preventing women from getting pregnant and damaging their eggs, new studies suggest.

A conference of fertility experts this month will call on the IVF industry to rethink its approach. They say hormones used to "kickstart" the ovaries could cause chromosomal damage to more than half of eggs, rendering them useless. The treatments may also affect the womb lining, preventing embryos from implanting.

However, women who have failed previous IVF attempts may be able to improve their chances of conception by reducing the dose of fertility drugs.

Growing concern over the potentially damaging effects of such drugs will be discussed by fertility experts, including the "father" of IVF, Professor Bob Edwards, at the first annual meeting of the International Society of Natural Cycle Assisted Reproduction (ISNAR) in London in a fortnight.

Prof Edwards helped to create the world's first test-tube baby, Louise Brown, in 1978, using natural cycle IVF, in which egg collection is timed to coincide with ovulation, rather than drug-induced production of a large number of eggs.

Other specialists are calling for minimal-dose drug regimes to be used to produce fewer eggs but to improve the chances of a baby.

Another fertility pioneer, Robert Winston, the peer, said: "The trend is to get as many eggs as possible, but that may be counterproductive. From the research we've done, the main risk is that doing this produces chromosomal damage in at least half, if not 70 per cent, of eggs. New studies are needed to prove the drugs are causing the damage, but it is my strong suspicion that this is the case."

One in six British couples suffers infertility and a growing number are turning to IVF. About 30,000 women had treatment in 2005. The average age is 35, but the number of 40 to 50-year-olds seeking treatment has almost trebled in a decade, with nearly 5,000 women in this age group trying for a baby. These are the women usually targeted for higher drug doses because their chances of success may only be about 10 per cent.

The use of high doses of drugs also impacts financially on patients — nearly three-quarters of whom pay for their treatment. One attempt at IVF can cost more than £3,000.

In about five per cent of cases, women may suffer a life-threatening complication from fertility drugs, called ovarian hyperstimulation syndrome. There are also concerns — but no proof as yet — that IVF drugs may increase the risk of some cancers. [2Dec2006, Beezy Marsh, Sunday Telegraph]

 

STUDY FINDS IVF-PLACENTA PREVIA INCREASED RISK — A Norwegian study has found that IVF is linked to an increased risk of placenta praevia, a potentially dangerous pregnancy complication in which the placenta covers the cervix, blocking the baby's entrance into the birth canal.

The study, carried out at St Olav's University Hospital, Trondheim, investigated 845,000 pregnancies, and found that among users of IVF the risk was 16 in 1,000 as opposed to 3 in 1,000 for natural pregnancies.

The study also found a three-fold higher risk among mothers who had had two pregnancies, once conceiving naturally and once with assistance through IVF, or ICSI, in which a sperm is injected directly into an egg. The risk rose from seven in 1,000 births for women who had had two natural conceptions, to 20 in 1,000 births for women who had had one natural conception, and one assisted conception. The researchers took factors such as the age of the mother into account.

Prematurity
Placenta praevia can cause haemorrhaging in the mother, and increases the risk of a premature birth, and problems during delivery. Small studies have suggested in the past that placenta praevia is more common after the use of assisted fertility techniques.

The Norwegian study was much larger, considering data on over 845,300 pregnancies.

The researchers believe it is the first time an increased risk of placenta praevia has been directly linked to the reproductive techniques used.

Lead researcher Dr Liv Bente Romundstad focused on the 1,349 women in the study who had conceived spontaneously in one pregnancy and after assisted fertility in the other. 

"Regardless of whether it was the first or second pregnancy that was conceived through assisted reproductive technology, we found a nearly three-fold higher risk of placenta praevia. This suggests that a substantial proportion of the extra risk may be attributable directly to factors relating to the reproduction technology."

"A substantial proportion of the extra risk may be attributable directly to factors relating to the reproduction technology." — Dr Liv Bente Romundstad

Positioning
The underlying mechanism causing the placenta praevia is not clear. It is possible that IVF may trigger contractions, leading to embryos implanting lower down the uterus than in natural conceptions.

Alternatively, doctors may position

the embryo lower down the uterus in order to improve implantation rates. The researchers are calling for fertility clinics to record the position of every transferred embryo.

Dr Peter Bromwich, from the Care fertility clinic in Northampton, described the study as "fascinating". He said: "I have not come across this suggestion before. I already do measure the position of transferred embryos, but I will start to record it too now." However, he added: "Placenta praevia is a rare condition, and the fact that it might be a little less rare in IVF pregnancies should not be a cause for concern for people having the treatment."

Dr Mark Hamilton, chairman of the British Fertility Society, said: "Patients who are considering IVF treatment should discuss concerns with their gynaecologist in advance of treatment and those who are pregnant might want to discuss this with their obstetrician."  Britain's Human Fertilisation and Embryology Authority has said its Scientific and Clinical Advances Group will consider the research. [Human Reproduction; BBC Health, 24 May06, http://news.bbc.co.uk/1/hi/health/5009634.stm; 25May06, www.spuc.org.uk; www.lifeissues.org]

 

WANTING BABIES LIKE THEMSELVES, SOME PARENTS CHOOSE GENETIC DEFECTS. Wanting to have children who follow in one’s footsteps is an understandable desire. But a coming article in the journal Fertility and Sterility offers a fascinating glimpse into how far some parents may go to ensure that their children stay in their world — by intentionally choosing malfunctioning genes that produce disabilities like deafness or dwarfism.

Should doctors honor requests from parents who wish their children to be born with genetic defects?
The article reviews the use of preimplantation genetic diagnosis, or P.G.D., a process in which embryos are created in a test tube and their DNA is analyzed before being transferred to a woman’s uterus. In this manner, embryos destined to have, for example, cystic fibrosis or Huntington’s disease can be excluded, and only healthy embryos implanted.

Yet Susannah A. Baruch and colleagues at the Genetics and Public Policy Center at Johns Hopkins University recently surveyed 190 American P.G.D. clinics, and found that 3 percent reported having intentionally used P.G.D. “to select an embryo for the presence of a disability.”

In other words, some parents had the painful and expensive fertility procedure for the express purpose of having children with a defective gene. It turns out that some mothers and fathers don’t view certain genetic conditions as disabilities but as a way to enter into a rich, shared culture.

It’s tempting to see this practice as an alarming trend; for example, the online magazine Slate called it “the deliberate crippling of children.”

But a desire for children with genetic defects isn’t new. In 2002, for example, The Washington Post Magazine profiled Candace A. McCullough and Sharon M. Duchesneau, a lesbian and deaf couple from Maryland who both attended Gallaudet University and set out to have a deaf child by intentionally soliciting a deaf sperm donor.

“A hearing baby would be a blessing,” Ms. Duchesneau was quoted as saying. “A deaf baby would be a special blessing.”

Born five years ago on Thanksgiving Day, the couple’s son, Gauvin, was mostly deaf, and his parents chose to withhold any hearing aids.

Controlling a child’s genetic makeup, even to preserve what some would consider a disease, is the latest tactic of parents in an increasingly globalized society where identity seems besieged and in need of aggressive preservation. Traditionally, cultures were perpetuated through assortative mating, with intermarriage among the like-minded and the like-appearing.

Modern technology has been adopted for this purpose; for example, a quick Web search reveals specialized dating services for almost any religious or ethnic subgroup. Viewed in this context, the use of P.G.D. to select for deafness may be merely another ritual to ensure that one’s children carry on a cultural bloodline.

Still, most providers of P.G.D. find such requests unacceptable. Dr. Robert J. Stillman of the Shady Grove Fertility Center in Rockville, Md., has denied requests to use the process for selecting deafness and dwarfism. “In general, one of the prime dictates of parenting is to make a better world for our children,” he said in an interview. “Dwarfism and deafness are not the norm.”

Dr. Yury Verlinsky of the Reproductive Genetics Institute in Chicago, who also refuses these requests, said, “If we make a diagnostic tool, the purpose is to avoid disease.”

But both doctors said they would not oppose sending families to other doctors who might consent.

Today, parents increasingly use medical procedures to alter healthy bodies. In 2003, for example, the Food and Drug Administration granted approval to Eli Lilly to market human growth hormone for “idiopathic short stature,” or below-average height in children — to make them taller, purely for social reasons. Theoretically, almost a half million American boys qualify for treatment. Why, some may argue, should choosing short stature be different?

Mary Ellen Little, a New Jersey nurse with dwarfism, had her first daughter before a prenatal test for achondroplasia was available. For her second child, she had amniocentesis. “I prayed for a little one,” meaning a dwarf, she told me.

The wait, she recalled, was grueling, since “I figured I couldn’t be blessed twice, but I was.” Both her daughters, now 11 and 7, are “little people.”

The major barrier to Ms. Little’s simply choosing her children’s height is ease. To her, P.G.D. to select for dwarfism is too invasive; however, if having dwarf children were simply a matter of trying to conceive at a certain time of the month or taking a pill, she said, “I would do that.”

Barbara Spiegel, a homemaker in Maine who has dwarfism, had a first pregnancy that ended in miscarriage. She underwent genetic testing during her second pregnancy, and because of a laboratory mix-up involving petri dishes, was told that her child would grow to normal height. She would have loved the child, she said, but in an interview, she recalled thinking, “What is life going to be like for her, when her parents are different than she is?”

She worried that the child would be teased excessively. Ms. Spiegel’s best friend, who has average height, has a daughter with dwarfism, and the child sometimes comes to Ms. Spiegel for support; maybe an average-size child would also go to others for motherly advice. For a brief time, Ms. Spiegel grieved because she felt a dwarf baby would have been “just precious.” But after a week, the mix-up was detected and she got her wish.

Genetic testing for dwarfism has an extra ethical wrinkle. When both parents are dwarves, their embryos have a 25 percent chance of normal height, a 50 percent chance of dwarfism, and a 25 percent chance of what is called a double dominant mutation, which is usually fatal soon after birth. Because many dwarf mothers worry that their fetuses might have the fatal mutation, those who conceive without assistive technology, like Ms. Little and Ms. Spiegel, often undergo amniocentesis or chorionic villus sampling to detect double dominant mutations. Many consider abortion if the test is positive — but many would carry either a dwarf or an average-height child to term.

Preimplantation genetic diagnosis can identify embryos with double dominant mutations, so they can be discarded before implantation, while preserving embryos destined for either dwarfism or average height. In dwarves, then, P.G.D. could help avoid many doomed pregnancies if double dominants were never implanted. But then a choice would have to be made, since the genes are known. And many dwarves might select embryos for dwarves — although others might choose those for average-size children.

Dr. Stéphane Viville, who first reported P.G.D. for dwarfism in 2003 in France, used it to eliminate embryos with dwarfism among couples where one member was a dwarf and the partner had average height. Interestingly, if confronted with a situation where both parents were dwarves, Dr. Viville says that he most likely would implant only an embryo destined for normal height — and forbid not only double dominants but also dwarf embryos.

I think Dr. Viville fears that P.G.D. could be used willy-nilly to make genetic freaks. Yet the same fears pervaded the issue of in vitro fertilization decades ago. The small number of P.G.D. centers selecting for mutations doesn’t bother me greatly. After all, even natural reproduction is an error-prone process, since almost 1 percent of all pregnancies are complicated by birth defects — often by more disabling conditions than dwarfism or deafness.

More important, as a physician who helps women dealing with complex fetal diseases, I’ve learned to respect a family’s judgment. Many parents share a touching faith that having children similar to them will strengthen family and social bonds.

Of course, part of me wonders whether speaking the same language or being the same height guarantees closer families. But it’s not for me to say. In the end, our energy is better spent advocating for a society where those factors won’t matter.

Dr. Darshak M. Sanghavi is pediatric cardiologist at the University of Massachusetts Medical School and the author of “A Map of the Child: A Pediatrician’s Tour of the Body.” [5Dec2006, D.M. Sanghavi, M.D. http://www.nytimes.com/2006/12/05/health/05essa.html?_r=1&ref=science&oref=slogin]