Frozen just as good as fresh embryo when it comes to success in IVF, study shows

Written by Tallulah Thompson

Twenty-two years ago Li Peng Monroe and her then husband, were having trouble getting pregnant. Like many couples with fertility problems, they turned to in vitro fertilisation (IVF).

“It’s not an easy process to go through … the probability of falling pregnant was quite low back then through IVF, for me certainly,” Ms Monroe, 51, said.

“There’s a perception that fresh is better so you start with the fresh ones, and then if the fresh ones don’t take, you’ve got embryos that are frozen that you can use,” she said.

It was her frozen embryos that gifted her two daughters, Melissa, now 20 years old, and Ashley, 17. Frozen embryo transfer has come a long way in the past few years.

A new study now gives couples trying IVF peace of mind whichever method they choose, showing both fresh and frozen embryo transfers offer an equal chance of having a child.

In women without polycystic ovaries, the pregnancy rates and live births were comparable when implanted with either fresh or frozen embryos, according to the study published in The New England Journal of Medicine on Thursday.

Rates of ongoing pregnancy occurred in 36 per cent of the frozen-embryo group and 34.5 per cent in the fresh-embryo group, according to the study.

Live births were recorded in 33.8 per cent of the frozen-embryo group and 31.5 per cent of women in the fresh-embryo group.

The study included almost 800 couples undertaking IVF in Vietnam, who received either fresh or frozen embryo transfers on a randomised basis and was completed in under a year.

Michael Chapman, Professor of Obstetrics and Gynaecology at UNSW and President of the Fertility Society of Australia – who was not involved in the study – said the slight percentage difference in groups is not significant.

“Even with 800 odd patients in the study … [frozen-embryo transfer] may turn out to give an extra one or two pregnancies,” Professor Chapman, who is also a consultant at IVF Australia, said.

“It’s good that [clinicians] will be able to advise patients that frozen-embryo transfer is as good as fresh, because historically frozen has not been as good.”

Co-author Ben Mol, Professor of Obstetrics and Gynaecology at the University of Adelaide’s Robinson Research Institute, said the study was done after the development of a ‘quick-freeze’ vitrification method in recent years resulted in an increased uptake of frozen-embryo transfers.

But the study suggests it may not increase the chances of a live birth compared to fresh embryos in the study population.

“There are many examples in medical history where people jump to innovation and new things, and then after a while it turns out that the new thing is not necessarily so much better,” Professor Mol said.

Previous research conducted on women undergoing IVF with infertility problems linked to polycystic ovary syndrome (PCOS), found frozen-embryo transfer led to more live births.

But until now, it was not known whether this was also the case for women confronted with fertility problems due to other reasons.

Professor Mol said going down the path of frozen-embryo transfer can come at a cost.

“It’s not a lot, but it’s a couple of hundred of dollars that you’re talking about, so obviously that could be part of the choice [for patients],” he said.

“The other thing is that people want to have their baby as soon as possible, and frozen transfer means a delay of at least one month, so there are arguments for fresh transfer.”

Professor Chapman said one limitation of the study was applying the results to Australia.

“They only looked at day-three embryos, whereas the general practice in Australia today is day-five transfers,” he said.

But the research was the first of its kind to study fresh versus frozen-embryo transfers in such a large number of non-PCOS patients.

“It’s fantastic that Australian researchers are collaborating with other countries to get high class research coming out of Asia,” Professor Chapman said.

“Health systems in other countries make it more possible to do proper randomised control trials, so it’s excellent that we are getting those relationships built up.”

View original article here.

Queensland fertility rate hits low as women defer pregnancy

Written by Vanessa Marsh, The Sunday Mail (Qld)

QUEENSLAND’s plummeting fertility rate has hit a 13-year low, leading to fears we’re headed for an underpopulation-induced economic downturn if the decline isn’t addressed.

The end of the mining boom and high unemployment rates created economic uncertainty which, combined with the scrapping of the baby bonus and a new generation of career women delaying families, has resulted in a perfect storm.

Queensland’s fertility is at 1.822, the fifth lowest in history, and well below the desired replacement rate of 2.1 which keeps the population at a steady rate and stops the workforce and taxpayer base reducing and causing the costly dilemma of an ageing population.

The total fertility rate is calculated on the number of children that would be born to a woman over her lifetime.

Demographer and social researcher Bernard Salt said women were now pursuing higher education and corporate careers more than ever before which has seen birthrates for women in their 20s drop to a record low while women starting families in their 30s has doubled on the rate four decades earlier in 1976.

“The higher the level of female participation in the workforce, the lower the fertility rate will be,” he said.

“More women in Queensland are now going to uni and they tend to get a return on their investment by remaining in the workforce longer and having fewer children.”

The Government introduced the baby bonus in 2002 after the national fertility rate dropped to a record low of 1.7 in 2001.

It helped push Queensland’s birthrate to a 33-year high in 2009 with a 2.174 fertility rate which has been declining ever since, spurred on by the end of the mining boom in 2011 and unemployment rates above the national average.

The bonus was scrapped in 2014 and fertility rates the year after dropped to 1.842.

Mr Salt said people were less likely to have children when economic conditions were uncertain.

Brisbane mum Melissa Gibbons is one of the many women who delayed having a baby until her 30s, giving birth to Bastian in February at the age of 31 after establishing her career and travelling the world.

Mrs Gibbons, an aviation civil engineer, said she and her partner Luke waited until they were financially stable before starting a family.

“We’re really glad that we took the time to get ourselves set up and glad we did a lot of travelling,” she said.

“A lot of my friends have waited until that age to have children and … it’s becoming more common.”

It’s OK to take your time

THEY say first comes love, then marriage and finally a baby. But for new mum Anita Cullum a good education, career success and financial stability came before any of that.

Mrs Cullum is part of a new generation of Queensland women who are waiting until their 30s to start a family.

Mrs Cullum, 31, who works in sales and procurement for a health care IT company, gave birth to her first baby, Arthur, in April this year.

“It was really important to me to make sure that I was established in my career and in my role before I had Arthur,” she said.

“I felt like I wanted to be at a certain point where I could take some time off and not really fall behind with regards to career progression so that was one of the main drivers for waiting a little bit longer to have him.”

The Greenslopes mum, who has two degrees, said many of her friends had delayed having children in favour of establishing a career and saving money.

“My family are immigrants so, growing up, my family worked really hard to provide us with what we need, but there wasn’t really a lot extra for luxuries,” she said.

“So for me it was really important to be financially stable before having kids.

“My circle of friends are in a similar position, they want to give their kids the best opportunity they can and part of it is being financially secure.”

Original article here.

Adelaide Uni study finds folic acid supplements far into pregnancy raise childhood allergy risk

Written by Tim Williams, The Advertiser

TAKING folic acid supplements into the late stages of pregnancy could raise the risk in some children of developing allergies, Adelaide University research has found.

Folic acid is important before conception and in the first trimester to minimise risk of fetal defects and aid development of the central nervous system.

But animal testing suggests that continuing the supplement could reduce the natural protection from allergies that some babies have as a result of a common complication in about 10 per cent of pregnancies.

“Taking a folic acid supplement during the first trimester of pregnancy is important to reduce the risk of neural tube defects,” Dr Kathy Gatford, from the uni’s Robinson Research Institute, said.

“However, continued supplementation with folic acid into the later stage of pregnancy doesn’t reduce that risk, and there’s growing evidence that this may increase the risk of allergies in offspring.”

The neural tube develops into the brain and spinal cord. Australian guidelines recommend a daily supplement of folic acid, a type of vitamin B, at least one month before and three months after conception. Guidelines do not make recommendations beyond the first trimester.

Previous studies have shown that a pregnancy complication called intra-uterine growth restriction – growth restriction in the womb often resulting in low birthweight, and in the worst cases stillbirth – could have a protective affect against allergies such as asthma and food allergies. Various allergies affect up to 40 per cent of the population.

Dr Gatford’s research team has found that sheep born from growth-restricted pregnancies are less likely to be susceptible to developing allergies to egg white proteins — ascertained by injecting the allergen followed by skin prick tests — than those from normal pregnancies.

But when sheep with growth-restricted pregnancies were fed folic acid supplements late in pregnancy, their offspring lost that advantage.

“Studies in animal models like this allow us to directly investigate these effects of the environment before birth on later allergy,” Dr Gatford said.

“While the results help us to better understand the potential allergy risk in humans, more research is needed before any recommendations about the right timing of supplementation should or could be made in humans.”

The study will be published in the American Journal of Physiology.

Original article here.

Nicotine replacement in pregnancy: Safer than smoking

Nicotine replacement therapy (NRT) is safer than smoking and Australian doctors can be confident about prescribing it for their pregnant patients, according to the authors of a Narrative Review published online by the Medical Journal of Australia.

“Clinicians report low levels of prescribing NRT during pregnancy, due to safety concerns and low levels of confidence in their ability to prescribe NRT,” wrote the authors, led by Dr Yael Bar-Zeev, Public Health physician and Tobacco Treatment Specialist, PhD candidate at the University of Newcastle and head of the Centre for Smoking Cessation and Prevention at Ben-Gurion University in Israel.

“In a recent survey of Australian general practitioners and obstetricians, 25% of participants stated that they never prescribe NRT during pregnancy,” Dr Bar-Zeev and co-authors Associate Professor Gillian Gould, Professor Billie Bonevski, Associate Professor Maree Gruppetta and Ling Li Lim added.

Current Australian and New Zealand guidelines recommend the use of NRT by pregnant women who have been unable to quit smoking without medication, the authors wrote. However, these guidelines, and others from around the world,deliver mixed messages by imposing caveats such as “only if women are motivated”, “only give out 2 weeks’ supply” or “under close supervision”.

In laboratory studies nicotine has been shown to cause damage to the lungs and central nervous systems of the fetus; however, “human studies … did not find any harmful effects on fetal and pregnancy outcomes compared with placebo, but the evidence is limited due to the small numbers of participants in the meta-analysis (combining all studies together)”.

Bar-Zeev and colleagues provided a practical guide for general practitioners for prescribing NRT to their pregnant patients.

“As many pregnant women reduce on their own the number of cigarettes they smoke, using measures that rely on number of cigarettes per day may be less effective,” they wrote. “We suggest using the strength of urges to smoke (SUTS) and the frequency of urges to smoke (FUTS) scales as practical guides to the decision to initiate or increase the NRT dose … If the women report experiencing strong or frequent … urges to smoke, this suggests the need for additional support.

“The most important guidance for NRT in pregnancy is to use the lowest possible dose that is effective. However, to be effective, women should … use as much as needed to deal with cravings. Physicians should encourage using oral NRT regularly throughout the day to substitute for cigarettes; for example, a woman smoking ten cigarettes a day should be instructed to use one piece of gum every 1.5 hours regularly, even if she is not experiencing a strong craving at this time.

“In addition, physicians should encourage the use of oral NRT in anticipation of cravings; if a woman knows she is going to be in a situation where the urge to smoke will be strong (eg, going out with friends who smoke), doctors should encourage the use of oral NRT 20 minutes beforehand. Physicians should proactively review … on a weekly basis and adjust dosage as needed.

“Further, women should be encouraged to use NRT for at least 12 weeks, or longer if required, in order not to relapse.”

Bar-Zeev and colleagues concluded that “nicotine may not be completely safe for the pregnant mother and fetus, but it is always safer than smoking”.

“A risk and benefit analysis needs to be done to help pregnant women (and their partners) judge whether to use a clean source of nicotine such as NRT, which might help cessation, and whether this is preferable to continuing exposure to the nicotine and other chemicals present in combustible cigarettes.”

Original article here.

National endometriosis plan delivers hope for women with debilitating pain

Written by Justin Huntsdale

A long-term advocate for endometriosis awareness has lauded a Federal Government national plan for the disease as a game-changing move that validates a painful condition that affects one in 10 women.

Anna Chaplin has been trying to get people to understand endometriosis for years, but she said it was a topic people did not want to confront, and women were suffering in silence.

The disease of the uterus can cause immense pain throughout the body, debilitating period pain, and a range of psychological and social side effects.

“Just today I had an important holiday event I was going to in Sydney and I can’t go because I can’t drive in a car for a few hours due to the pain,” she said.

It is a condition that brings her busy life to a grinding halt on a regular basis, but she now hopes people will get a better understanding of what her and thousands of women are going through.

Federal Government announces action

This week in Canberra, Health Minister Greg Hunt, flanked by endometriosis awareness campaigners, formally apologised to women with endometriosis for not helping sooner, and announced a national plan to address the condition.

The plan includes a research grant of $160,000 for the National Health and Medical Research Council, as well as a campaign for education and awareness.

There will also be a targeted call for endometriosis research under the Medical Research Future Fund.

While it may not be news of a cure, Ms Chaplin said the fact it had been put on the agenda by the Federal Government was enough to make her “emotional and overwhelmed”.

“I can’t believe it’s finally happening because for so long it’s been endometri-what?” she said.

“No one’s known what we’re talking about, but over on our end we’re talking about one in 10 women who are affected.

“It should be nationally recognised and finally more voices are being heard and something is happening.”

Advocacy group wants workplace education

At the announcement at Parliament House, Endometriosis Australia director Donna Ciccia called for workplaces to educate employees about endometriosis.

She is aware of one workplace that has helped support a worker with endometriosis, and she wants to see it become the norm.

“This has also led to an internal acceptance for more flexibility in the workplace for those affected,” she said.

“As recently as last week, [an employee] had to take time off because of an endometriosis attack.

“The response from her male supervisor was ‘We’ve got you covered’, and that didn’t happen before.”

Validation proves it’s not ‘all in the head’

Ms Chaplin spent five years wondering what was wrong with her.

“I’d been told everything from it being a digestive issue to [being caused by] gluten to it’s all in my head and I’m neurotic,” she said.

“If it happened to me, it happened to millions of other women.

“People suffer in silence and they think it’s normal, but no one deserves to be in life-altering pain.”

Ms Chaplin said greater awareness would hopefully lead to earlier diagnosis.

According to Mr Hunt, at the moment endometriosis is a condition that takes about nine years to diagnose.

“This condition should have been better acknowledged and acted upon long ago, but today we are taking action so the struggle that women face will no longer be silent or their battles private,” he said.

Ms Chaplin said Mr Hunt’s apology for not acting sooner was a welcome recognition for the frustration people with endometriosis had felt, along with the pain.

“I appreciate an apology because it validates our experiences,” she said.

“I think of the bad experiences of feeling helpless and going to a doctor and not getting answers. At least now we’re being told now it’s not our fault.”

Original article here.