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Central to the status of the human embryo and how to ethically address the issue of dealing with the hundreds of thousands of leftover embryos (and this number is steadily increasing) lies the question of when “life” begins and when/whether an early embryo should be regarded as being a person with unalienable “rights”.

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Plateauing IVF Pregnancy Rates in Europe a Stark Contrast to the US Rates, Says a Fertility Expert

LONDON: Sperm saved for a ''rainy day'' has given a British cancer survivor a daughter 22 years later, in a double first for IVF.

When Richard Pott developed testicular cancer at the age of 21, doctors advised that he freeze samples of his sperm before embarking on treatment that might leave him infertile.

As a university student, having children wasn't a priority but he took their advice. Two decades later, Mr Pott is profoundly grateful that he did after becoming a father to Vivienne in a remarkable first for IVF treatment in Britain.

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Vivienne, now 13 months old, was conceived using sperm frozen in 1987 – the oldest to create a child in Britain.

''I really want our story to give hope to other people who are in similar circumstances,'' Mr Pott said.

Once the embryos were created, using the thawed sperm, three were frozen before being transferred to the womb.

It is also thought to be the first time a baby has been born after this kind of double freezing.

Freezing sperm before having cancer treatment was relatively new in the 1980s but is now standard procedure for men.

Mr Pott, who works in banking, married Rebecca in 1999 and due to her problems with endometriosis in 2003 they were advised to start trying for a family soon. Despite his treatment, Mr Pott was able to produce fresh sperm and after two cycles of IVF, baby Henry, now five, was born.

The couple embarked on more IVF but after four failed cycles were on the verge of giving up. The couple then turned to what Mrs Pott called their ''rainy day sperm''. Dr Tarek El-Toukhy, of Guy's and St Thomas' assisted conception unit, in London, said: ''We believe this is the longest that sperm has been frozen and used successfully in Britain.''

Telegraph, London

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Just days after Mrs Waller gave birth in August 2000 following IVF treatment, Keeden suffered a massive stroke that caused severe brain damage and meant he was never able to walk, talk or go to the toilet.

The stroke was the result of a rare blood clotting condition known as antithrombin deficiency which Keeden inherited from his father.

Tragically, the Wallers did not know there was a 50 per cent chance that Keeden would have the defective gene.

They are now suing the IVF specialist who oversaw Keeden's conception – Wollongong-based Christopher James – in the NSW Supreme Court for what is known as ''wrongful birth'' and seeking compensation in the order of $10 million for the lifelong care of their handicapped son.

''We love Keeden now that he's here, but if we had the right information and the right options we wouldn't have gone ahead with the birth, not in the way we did,'' Mrs Waller said from her home in Kangaroo Valley.

''Had things been done right, Keeden would never have been here. He would never have to go through the suffering he goes through – the seizures and all.''

The case raises a number of legal questions and could set a precedent for other parents whose children have disabilities.

The Wallers told Dr James about Lawrence's blood clotting condition, and they claim he breached his duty of care to them by failing to take proper steps to find out whether it could be passed on by just one parent.

In the first day of the hearing yesterday, Justice John Hislop heard that Dr James did not seek to find out the answer himself, but handed the couple the name and phone number of a genetic counsellor at Wollongong Hospital on a post-it note. It is alleged the note was given to the Wallers in the context of a discussion about fertility not genetics, and that the phone number was the main switchboard for the hospital rather than the counsellor's direct line.

When the phone went unanswered the Wallers did not call back, and it is alleged that Dr James did not mention the genetic counsellor again, and began the IVF process.

''There was a duty of care on the part of Dr James to ensure that both he and the Wallers understood that this problem could be passed on and for there to be proper counselling and discussion about the other options they had, including the option of an anonymous sperm donor,'' counsel for the Wallers, David Higgs, SC, said.

It is not the first time the Wallers have been to court in relation to their son. In 2006, they launched an unsuccessful ''wrongful life'' case in the High Court on Keeden's behalf, in which he sought compensation for future loss of earnings and opportunity.

Lawyers for Dr James will argue it is not the responsibility of an IVF specialist to find out whether rare genetic conditions such as antithrombin deficiency can be passed on from father to son.

They claim that such responsibility as does exist was met by the referral of the Wallers to the genetic counsellor.

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IVF doctor faces $10 million lawsuit

Deborah and Lawrence Waller are suing their IVF doctor for the wrongful birth of their son. Picture: Stephen Cooper Source: PerthNow

A NSW couple are suing the doctor who provided their IVF treatment for $10 million because their 11-year-old son was born with a rare genetic defect and will suffer a lifelong handicap.

Debbie and Lawrence Waller, of Kangaroo Valley, 152km south of Sydney, told Fairfax they love their 11-year-old son Keeden but believe he should never have been born.

Days after Keeden was born in August 2000 he suffered a massive stroke causing brain damage and leaving him unable to walk, talk or go to the toilet unaided. The stroke was the result of a rare blood clotting condition he inherited from his father.

The Wallers are now suing IVF specialist Christopher James – who oversaw the conception of Keeden – in the New South Wales Supreme Court for what is known as “wrongful birth”.

They are seeking $10 million compensation for the lifelong care of their handicapped son, claiming the doctor breached his duty of care by not advising them of the risks of the clotting condition.

“We love Keeden now that he's here, but if we had the right information and the right options we wouldn't have gone ahead with the birth, not in the way we did,” Debbie Waller said. “Had things been done right, Keeden would never have been here. He would never have to go through the suffering he goes through – the seizures and all.”

This is the second damages claim against doctors brought by the Wallers. In 2006, the High Court rejected a “wrongful life” claim made on behalf of Keeden against Debbie Waller's two obstetricians and her IVF clinic.

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Wollongong IVF doctor faces $10 million 'wrongful birth' case

Lifelong suffering … Debbie Waller says her disabled son, Keeden, 11, would not have been born if she had been warned about the chance of his hereditary condition. Photo: Quentin Jones

DEBBIE and Lawrence Waller love their 11-year-old son, Keeden, but they believe he should never have been born.

Just days after Mrs Waller gave birth in August 2000 following IVF treatment, Keeden suffered a massive stroke that caused severe brain damage and meant he was never able to walk, talk or go to the toilet.

The stroke was the result of a rare blood clotting condition known as antithrombin deficiency which Keeden inherited from his father.

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Tragically, the Wallers did not know there was a 50 per cent chance that Keeden would have the defective gene.

They are now suing the IVF specialist who oversaw Keeden's conception – Christopher James – in the NSW Supreme Court for what is known as ''wrongful birth'' and seeking compensation in the order of $10 million for the lifelong care of their handicapped son.

''We love Keeden now that he's here, but if we had the right information and the right options we wouldn't have gone ahead with the birth, not in the way we did,'' Mrs Waller said from her home in Kangaroo Valley yesterday.

''Had things been done right, Keeden would never have been here. He would never have to go through the suffering he goes through – the seizures and all.''

The case raises a number of legal questions and could set a precedent for other parents whose children have disabilities.

The Wallers told Dr James about Lawrence's blood clotting condition, and they claim he breached his duty of care to them by failing to take proper steps to find out whether it could be passed on by just one parent.

In the first day of the hearing yesterday, Justice John Hislop heard that Dr James did not seek to find out the answer himself, but handed the couple the name and phone number of a genetic counsellor at Wollongong Hospital on a post-it note. It is alleged the note was given to the Wallers in the context of a discussion about fertility not genetics, and that the phone number was the main switchboard for the hospital rather than the counsellor's direct line.

When the phone went unanswered the Wallers did not call back, and it is alleged that Dr James did not mention the genetic counsellor again, and began the IVF process.

''There was a duty of care on the part of Dr James to ensure that both he and the Wallers understood that this problem could be passed on and for there to be proper counselling and discussion about the other options they had, including the option of an anonymous sperm donor,'' counsel for the Wallers, David Higgs, SC, said.

It is not the first time the Wallers have been to court in relation to their son. In 2006, they launched an unsuccessful ''wrongful life'' case in the High Court on Keeden's behalf, in which he sought compensation for future loss of earnings and opportunity.

Lawyers for Dr James will argue it is not the responsibility of an IVF specialist to find out whether rare genetic conditions such as antithrombin deficiency can be passed on from father to son.

They claim that such responsibility as does exist was met by the referral of the Wallers to the genetic counsellor.

‘‘There is no question that Debbie and Lawrence Waller have experienced a tragedy event and that Keeden Waller situation is extremely sad,’’ counsel for Dr James Jeremy Kirk SC said.

‘‘But they are intelligent adults who were advised to speak ro a genetic counsellor. They chose not to take up that advice.’’

The Waller's solicitor, Bill Madden from Slater and Gordon, said that the compensation claim was largely made up of the costs of accommodation, food and caring for the Keeden full-time.

“Neither parent have been able to work much, they've had to modify their home – the financial impact of something like this is huge.”

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More recently in the U.S., methods such as timing intercourse, assuming different positions during sex, and (relatively recently) employing rapid sperm centrifugation in an attempt to separate male chromosome-bearing sperm from female sperm prior to artificial insemination were proposed. The fact is that none of these (as well as many other) such anecdotal assertions have been shown to have any real validity.

Currently, in spite of several well described medical approaches, the indisputable fact has emerged that it is only by way of IVF that reliable sex selection can be achieved. This allows for embryos to be screened for gender through preimplantation genetic diagnosis prior to transferring the embryo(s) of the desired gender to the uterus.

Nevertheless, it is an inescapable reality that the very idea of medical sex selection challenges moral and ethical beliefs at their very foundation. Many hold that the growing popularity of gender selection solely for the convenience of altering a family’s gender balance represents an unwanted example of how assisted reproductive technology is subject to abuse…and thus it should be outlawed. They also see it a an example of a disturbing trend towards “designer babies” where genetic engineering could be used to manipulate the intellect, body configuration, build, height, and the talents of future offspring. This assertion is commonly followed by the tantalizing question as to where all this would end and whether we as a society “would really want to live in such a world.”

There is, however, one clear exception to the apparent across-the-board opposition to sex selection that is well worthy of mention. This applies in cases where sex selection is used to avoid the occurrence of a serious medical disorder that selectively affects one gender or the other (e.g., Hemophilia, a life threatening bleeding disorder that selectively affects male offspring).

EVALUATING CURRENTLY USED METHODS FOR SEX SELECTION

Sperm Gradient Method (highly unreliable)
This is one of the simplest methods that still (unfortunately) remains in widespread use. Here sperm is rapidly spun down (centrifuged) in the hope of separating the male sperm (those with Y-chromosomes) from the female sperm (those with X-chromosomes). It relies on the assumption that the X chromosome makes sperm heavier, allowing for separation of male from female chromosome-bearing sperm. Though this method is often touted as a low cost method for sex selection, the truth is that it simply does not work!

Flow Cytometry-The Microsort Technique (has certain problems)
This method employs the use of a fluorescent dye that adheres to genetic material within the sperm. Because X-bearing sperm contain more genetic material, these sperm are supposed to pick up more dye than Y-bearing sperm. Thereupon, X and Y bearing sperm are then separated into two groups and used for intrauterine insemination (IUI) or IVF. This method has been touted as yielding a 60% to 70% accuracy rate with IUI. Some swear by this method, but my personal experience with its efficacy and reliability in the IVF setting has been rather disappointing. Significant to note is that approval of the Microsort method is still under review by the FDA and in the meantime, has only been granted approval for use in cases where it is necessary to prevent sex-linked or sex-limited genetic diseases in children.

Preimplantation Genetic Diagnosis (PGD)
Preimplantation Genetic Diagnosis is the only approach that offers virtually a 100% chance of obtaining the desired gender. In PGD, one cell is removed from each “potentially competent” early embryo, and then DNA based genetic analysis is performed in highly-specialized laboratories. We recommend comparative genomic hybridization (CGH) using paternal/maternal controls (GSN) in such cases because it not only determines gender but also helps identify the most “competent” embryos (those that have the proper number of chromosomes) and thereby significantly enhances success per embryo transferred. CGH has all but replaced fluorescence in-situ-hybridization (FISH) for PGD because, while the latter accurately can determine gender, it lacks sufficient sensitivity/specificity to optimally identify competent embryos for transfer.

Upon completion of the GSN-CGH analysis, which takes about 24-36 hours, the couple can select which embryo(s) they will transfer to the uterus. If pregnancy results, there is almost a 100% chance it will result in the desired gender. This method is particularly helpful for couples where the risk of having a male child with an X-linked genetic disease is significant.

A Personal Opinion On the Use of Sex Selection for “Family Balancing”

Sex selection done simply for family balancing remains controversial, raising concern that if it became widely accessible and freely available, such practice could distort the natural sex ratio, leading to a population gender imbalance. However, for this to happen, there would have to be a significant population preference for sex selection. In reality, the contrary seems to apply, since studies conducted in western societies discount these concerns. In fact, the relatively high cost of IVF with the added cost of gender selection in the United States makes it unlikely that the demand would ever become large enough to impact overall population gender balance. In addition, several studies done in Western countries have shown that the majority of people do not seem to be concerned about the gender of their offspring, and that with a few notable exceptions, gender preference does not appear to be slanted in the direction of either male or female. Thus, from a practical standpoint, such concerns are overstated.

So, given that in the United States most do not care about the sex of their offspring, and only a minority are interested in selecting the sex of their children, it is my opinion that freedom of choice should prevail. As such, a service for sex selection for non-medical reasons should be freely available.

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It is mainly the chromosomal integrity of the egg, rather than the sperm that determines whether the embryo will be “competent” (i.e. have the potential to develop into a normal baby). It is the age of the woman that most profoundly impacts the likelihood that the mature egg will have a full contingent of chromosomes (a “euploid” egg), necessary to achieve embryo “competency.” By way of example, up until about 35 years of age, fewer than 50% of a woman’s mature eggs will be euploid, and thus upon fertilization, more than half will have an irregular chromosome component (i.e. “aneuploid”) and thus be “incompetent.”

Incompetent embryos either will fail to develop normally, fail to attach (implant) in the uterine lining, miscarry, or even result in a chromosomally abnormal baby (e.g. Down syndrome). As a woman ages beyond her mid-30’s the incidence of egg/embryo aneuploidy increases such that by the time she reaches her mid forties, more than 90% of her eggs/embryos will be aneuploid and incompetent.

To make matters worse, the older the woman, the closer she gets to the time that her ovaries run out of eggs and she stops ovulating and menstruating (i.e. menopause). The 6-8 years prior to menopause (i.e. the climacteric or pre-menopause) which is characterized by 1) diminishing ovarian reserve (DOR) with an associated progressive reduction in the number of available number of mature eggs at the time of egg retrieval, and 2) building resistance to fertility drugs.

To complicate matters further, it becomes ever more difficult in the face of DOR, to protect developing eggs during stimulation with fertility drugs in the hope of minimizing the incidence of egg/embryo aneuploidy. This is why, unless a very customized and individualized approach to ovarian stimulation is used in older women and those with DOR, the incidence of egg/embryo aneuploidy may even approach 100%. It also serves to explain why IVF success rates plummet with diminishing ovarian reserve and with advancing age, and why the relentlessly ticking biological clock often creates in them a profound sense of urgency and even desperation to have a baby before their time runs out.

Confronted with the reality that advancing age and diminishing ovarian reserve will inevitably reduce the likelihood of an IVF pregnancy, as well as increasing the risk of miscarriage, in all probability, come at considerable emotional and financial cost, many such women often choose to undergo IVF using the eggs derived from a younger egg donor.

Embryo banking offers many older women an those with DOR a realistic and cost-efficient alternative to IVF with Egg Donation: The recent introduction of Embryo Banking at SIRM now offers an alternative to egg donation for many older women, as well as those with prematurely diminishing ovarian reserve (DOR) who otherwise would have a very small chance of having a baby with their own eggs. This is provided, of course, that they still have an ability to produce some ovarian follicles in response to fertility drugs.

Embryo banking involves a process whereby several blastocysts are accumulated (stockpiled) over two or more IVF cycles. After each such cycle, the embryos are biopsied for CGH analysis, taken to the blastocyst stage of development and then vitrified (ultra-rapidly frozen and banked). All biopsy specimens accumulated over several such cycles are held for as long as it takes to complete the scheduled IVF egg retrieval cycles, whereupon they are collectively dispatched for a single CGH analysis (to reduce testing costs). When the results return, the “incompetent” (CGH-abnormal) embryos are discarded while the “competent” ones are stored (cryobanked) for a subsequent embryo transfer. With this method, the transfer of even a single “competent” embryo is capable of achieving almost a 70% chance of a viable pregnancy, regardless of the age of the woman.

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Mother 'too fat for IVF' dropped five dress sizes and fell pregnant

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