Pushing the envelope on fertility care

  • Niall Hunter, Editor

Infertility treatment and embryo technology is a medical field that constantly needs to move forward in terms of what it can do for couples who need help, according to one of the international experts in this area, Dr Simon Fishel.

Dr Fishel is Managing Director of Care Fertility in the UK, and he was in Ireland recently for the launch of its associated facility in Ireland at the Beacon Clinic, Sandyford, Dublin.

He says the technology in the infertility field is now so advanced that not only can it offer new ways of helping couples start a family, but it can go much further than that.

There are now newer technologies such as pre-implantation genetic diagnosis (PGD), which can assist couples who have a child with a genetic disorder but who do not want this to be repeated if they have another child.

The technology can also be used to allow stem cells from the cord blood of a subsequent child to be used to save the life of a sick sibling.

The Beacon CARE fertility clinic plans to introduce this procedure to Ireland.

PGD, while recognised as a major medical and social advance advance, is not without controversy and has fallen foul of 'pro-life' campaigners.

The Irish Medicines Board  told irishhealth.com that it had not issued any authorisation yet here which includes the activity of pre-implantation genetic diagnosis, and a go-ahead would only be given if those carrying out the procedure complied with tissues and cells legislation.

Back in the 1970s, Simon Fishel worked in Cambridge with Prof Robert Edwards, who eventually led the team that assisted the birth of the first IVF or 'test tube' baby in 1978.

Later, Dr Fishel was appointed Deputy Scientific Director of the world's first IVF clinic at Bourn Hall in Cambridge. He has since been at the forefront of a number of scientific firsts in the field of embryology and infertility.

He told irishhealth.com that when he started off in this field nearly 40 years ago, he would not have begun to envisage the advances that would be made. "The real vindication for all of the work done over the years was when Robert Edwards won the Nobel Prize for Medicine last year for pioneering IVF technology. It has been truly remarable how we have moved along to the point where we are today."

However, he says, in addition to offering the newer technologies to couples, you have to be able to offer excellence in the more routine procedures such as IVF and ICSI. This is the aim of the new Beacon facility, he says.

Outlining the procedures on offer at the new Beacon clinic, Simon Fishel says there are essentially two types of sub-fertile couples seeking help. "One group is those who seek IVF and maybe they have had it before and failed, and there is another group for whom until recently there have not been any treatments."

"In terms of those who have been through IVF before without success, we have to try to understand why their attempts have failed."

One thing it is important to understand, he says, is that up to 70% of eggs procured are non-viable by nature in any case.

"So we have to understand whether that is the singular cause of the problem for those couples that have failed and that is where our chromosome testing or Array CGH, technology is important. It should be remembered that the largest single cause of IVF failure or early miscarriage is chromosome problems, and this goes for both IVF and natural conceptions."

"We also know that embryos can be rejected by the woman's immune system, and we also have therapies at the clinic that can overcome that."

The new Dublin clinic also offers reproductive imaging, which can provide important visual answers on why an embryo may be non-viable.

Another emerging opportunity for some couples, says Simon Fishel, is a newer and more efficient way of freezing embryos, known as EVES

"Until recently we couldn't freeze embryos very efficiently. We would freeze eggs for emergency situations such as where a woman has cancer and is trying to preserve her fertility.

EVES is particularity suited, he says, to women who want to postpone starting a family until they are older but who want to avoid difficulties with getting pregnant and the danger of a child having a chromosome abnormality associated with later motherhood.

This, Dr Fishel says, is particularly appropriate for Ireland, which has an ageing population and which tops the table internationally for the age of women starting a family.

Perhaps the most innovative procedure on offer at the new Dublin clinic is pre -implantation genetic diagnosis, or PGD.

This involves testing embryos at a pre-implantation stage for inherited genetic disorders such as haemophilia or cystic fibrosis.

Says Dr Fishel: "the patient goes through conventional IVF and we allow the embryo to develop. Beforehand, we will already have lined up special genetic probes for those patients specific for their familial disease and by testing early placental cells we can check at the pre-implantation stage as to whether the embryo carries the genetic defect."

"This service is aimed at parents who are fertile but who carry a familial genetic problem where they may already have one child with a devastating genetic disease or a child that may have died from such a disease and they do not want to repeat that if they have another child."

"We now have the technology to help them embark on a pregnancy where the future child will be free of genetic disease, and these children will not carry on that defect when they have children. In the procedure, the precursor placental cells surrounding the embryo can be removed and tested without touching it."

Dr Fishel says this is not only a huge benefit for the couples involved but is a powerful tool in terms of reducing the current costs to economies and societies of genetic disease.

He says PGD technology can also be used in what is called 'save your sibling' tissue-typing.

This had been pioneered in the UK and was deemed by the House of Lords to be a fullly acceptable procedure, which is now done routinely, he said.

This can be used in cases where couples already have a child who has a condition which will lead to either death or a very sick life, where a potential cure is to have bone marrow stem cell transfusion. However, this needs to be tissue matched with the recipient.

Traditionally, if matching tissues from other tissue banks cannot be found there is nothing that can be done, Dr Fishel said.

However, using PGD, scientists can also test to see whether or not an embryo would be a tissue match for the sick sibling.

"There is a certain hypocrisy out there where some medical specialists still tell these patients the only chance for your child if you have more children and try to have one that is tissue matched."

"If they try to 'roll the reproductive dice' in this way, they are more likely to produce another child with genetic disease or children that are healthy but are not tissue matched, while they watch their other child die."

"We can help couples embark on a pregnancy where their next child is free of disease and tissue- matched so the stem cells from their cord blood may be able to be used to save the life of the sick sibling."

Dr Fishel said he believed this type of procedure can be done in Ireland and he believed there were no legal or regulatory constraints surrounding it.

"Irish patients are currently travelling to the UK for this. I would rather that they be offered the procedure locally."

Simon Fishel admits that the cost of both advanced infertilty treatment on top of basic treatments are high. "You are basically paying for the technology plus you have the cost of conventional IVF/ICSI in the first place."

For example, the total cost of ICSI fertility treatment plus array CGH chromosome screening at the Beacon comes to €8,200. IVF treatment on its own costs €4,500.

See also: Irish clinic to offer new embryo test

 


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