Category Archives: Embryology

Embryology

Egg freezing is on the up but new research raises questions about how clinics advertise – The Conversation UK

More women in the UK than ever before are considering freezing their eggs, with the sharp rise in inquiries at some of Londons largest clinics attributed to the COVID-19 pandemic. No wonder perhaps, since social restrictions have impacted single people wishing to couple-up, making it significantly more difficult to go on dates or meet potential partners.

The current prolonged uncertainty about the future has exacerbated the concerns that many single childless women especially those in their mid-30s were already reporting, including anxieties about the ticking of their biological clocks and fears over age-related fertility decline.

Sarah, a 36-year-old HR manager who recently came out of a four-year relationship, feels the pandemic could not have come at a more costly time in her personal life. She told me: I have this constant underlying worry that by the time this all blows over and I can finally meet someone, I might have missed the boat to become a mother.

It is easy to see why women like Sarah might opt for egg freezing. Yet while this technology can certainly be useful for some women, new research reveals that it may not always be as straightforward as it appears.

Many aspects of egg freezing have been discussed in the media, yet to date, there has been almost no attention paid to the ways in which fertility clinics advertise, market and promote their egg freezing services on their websites, and the quality of information that is available to potential patients considering their options.

In order to address this gap, my colleague Emily Tiemann and I analysed the websites of the UKs 15 largest fertility clinics offering egg freezing. Our recently published findings make uncomfortable reading.

Our research suggests that fertility clinic websites in the UK, taken in general, provide a poor standard of information and, we argue, need to be urgently improved, for reasons of both medical ethics and consumer rights. Of course, as websites are dynamic entities some of them may have already improved or changed since we took our snapshot (in June 2019), but our findings nevertheless raise concerns for potential patients.

We found that most of the clinics we looked at presented what we believe is an unbalanced view of egg freezing on their websites, highlighting its potential benefits and failing to adequately discuss its potential risks. Clinics websites were also not sufficiently clear and transparent about the cost of an egg freezing cycle, with the average true cost exceeding the advertised costs by approximately a third (on average an additional 923).

Finally, we came to the view that clinics did not always provide accurate data or success rates. In fact, of the 15 analysed, we only rated one clinic website as good in terms of its quality of information.

We reached out to all 15 clinics for comment. Harley Street Fertility Clinic responded:

We welcome the Gurtin and Tiemann paper because it aims to improve the quality of information provided to patients. However, we do not necessarily agree with all the metrics and indicators used by the authors as part of their review [] As a clinic, we strive to be clear and transparent in our communications. Hence, we will use the suggestions made in the paper to improve our communications with patients.

IVI Midland responded by pointing out that since 2019, the clinic had been acquired by CARE Fertility and therefore the website we analysed is no longer active. CARE Fertility, meanwhile, replied:

The number of egg freezing cycles we carry out is very small, and as success rate data is only available once a woman returns for fertility treatment (often many years later), we have even less success rate data [] At the time of the study in June 2019, the egg freezing page of our website could have more clearly explained the costs involved with egg freezing, but we have since updated the page to further help patients access the information they need.

The other clinics we approached for comment did not respond. But it is welcome news that some have been working to improve their website content.

We have issued an urgent recommendation for clinic websites to be improved, but it is difficult for the Human Fertilisation and Embryology Authority (HFEA) to enforce such changes when much of the economic or commercial aspects of fertility treatments fall outside its remit.

But the issue is pressing, since we contend that the lack of good quality information compromises the ability of women like Sarah to make truly informed decisions, and leaves them inadequately informed or misinformed about crucial aspects, such as costs to plan for or potential risks to weigh up.

Justine*, a journalist who lives in London, froze her eggs two years ago, aged 38. She told me that although she went to some lengths to research the technology, she still felt unprepared for the reality of how it would feel to freeze her eggs.

Justine found herself in considerably more physical discomfort than she had expected, feeling bloated, uncomfortable and in pain despite having been told she would be able to go about her normal life before the procedure. Her physical discomforts continued and even worsened after egg collection:

As the hours passed, I still felt incredibly weak, bloated and short of breath. I called the clinic who just said if you continue to feel bad, then go to A&E. It was at that point I felt very alone.

She felt that the clinic had relinquished all responsibility. I went to A&E and was admitted overnight, with a series of tests and observations confirming that I had OHSS, she said.

While Justine was unlucky to suffer from ovarian hyperstimulation syndrome (OHSS), a rare complication of the IVF and egg freezing processes caused by the production of too many eggs, she felt she lacked information about this potential risk and that the clinic didnt offer adequate follow-up care.

The fertility industry is becoming increasingly commercialised, a consideration that is particularly pertinent in the case of egg freezing, which takes place primarily in the private sector. This is an aspect that Lucy van de Wiel, a researcher at Cambridge Universitys Reproductive Sociology Research Group, focuses on.

Her new book, Freezing Fertility, draws attention to the potential conflicts between clinical decision-making or patients best interests on the one hand and business and profit motives on the other. Market forces in the fertility industry, political interests underlying regulations, and age-old cultural narratives of gender and motherhood play a role in our reproductive decision-making.

Given this, I would urge women considering egg freezing to look beyond the information on clinic websites. In particular, women may wish to ask clinics for specific and verified data regarding the number of cycles they have performed each year or their success rates.

They may want to ask questions about exactly what is and is not included in advertised pricing, and to consult the HFEA website for an unbiased discussion of the benefits and risks of the technology. It can also be extremely helpful to discuss egg freezing with others who have been through the process, to gain a realistic impression of what it involves.

Despite her difficulties, overall Justine feels a sense of comfort knowing that she has frozen eggs in storage, but she does offer a note of caution:

While the process is presented as being fairly straightforward, it does have powerful physical, emotional and psychological impacts so it is important not to gloss over it as a procedure and make sure you have support available.

*Name and identifying details have been changed.

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Egg freezing is on the up but new research raises questions about how clinics advertise - The Conversation UK

Embryology

Merck Foundation partners First Lady to mark World Cancer Day – The Point – The Point

Through this program, the Foundation provided scholarship of one-year Fellowship to Dr Fatoumata Jaiteh, Gambian doctor, at theTata Memorial Centre, India,to be the first oncologist in The Gambia.

Merck Foundation has provided scholarship of oncology training for more than 70 doctors from 24 African countries, many of them becoming the first oncologists in their countries.

We have also provided scholarships to more than 25 Gambian Doctors in different specialties including Diabetes, sexual and reproductive medicines, Biotechnology of Human Assisted Reproduction and Embryology, Respiratory medicine ones and Acute medicines and Fertility specialty training, said Rasha Kelej, CEO of Merck Foundation.

Launched in 2016, the Merck Cancer Access Program provides One-, two- and three-years fellowship, master degree, and Diploma programs for African doctors in India, Egypt, Kenya, and Malaysia.

Merck Foundation also recently introduced 2 years online PG Diploma in Cancer and Clinical Oncology from the UK.

Merck Foundation through its Merck Cancer Access Program has till date trained 70 Oncology Care Specialists from 24 countries such as Botswana, Burundi, Cameroon, CAR, Chad, DRC, Ethiopia, Gabon, Gambia, Ghana, Guinea, Kenya, Liberia, Malawi, Mauritius, Namibia, Niger, Rwanda, Senegal, South Africa, Tanzania, Uganda, and The Gambia.

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Merck Foundation partners First Lady to mark World Cancer Day - The Point - The Point

Embryology

Black History Month: Monumental moments at the WSU School of Medicine – The South End

Jaila Campbell, seen here as part of the Warrior Strong campaign, is a Wayne State University medical student and a graduate of the Post-Baccalaureate Program.

February is Black History Month through the United States. The Wayne State University School of Medicine has a storied history of African Americans of its own that dates back to a mere year after the medical school was founded. Joseph Ferguson, M.D., graduated from what was then Detroit Medical College, in 1869. He became the first Black man in Detroit and most likely in Michigan to earn a medical degree.

Fast forward more than 150 years, and the school hit another milestone in 2019 the 50th anniversary of the Post-Baccalaureate Program, founded in 1969 to ensure that qualified minorities continued to have the opportunity to enter medical school. It was the first of its kind in the nation. Initially launched to address the dearth of Black students entering medical schools, the free program now immerses first-generationstudents into a year-long education in biochemistry, embryology, gross anatomy, histology and physiology. Many who graduated from the program were accepted into the WSU School of Medicine, but the program also served for several years as a major pipeline for Black students into medical schools across the nation. Today, the program accepts students from a category deemed underrepresented in medicine, which includes African Americans, Hispanic/Latino, Native American and students from socio-economically disadvantaged backgrounds.

In between, the school continued to play a major role in addressing the physician workforce in America and bridging the gap in health disparities and health outcomes.

The WSU School of Medicine was founded in 1868 by four Civil War veteran physicians. At the same time, the first medical school in the county that was open to all people, Howard University Medical Department, opened in Washington, D.C., under the direction of Civil War veteran and Commissioner of the Freedmens Bureau, Gen. Oliver Howard. One year later, in 1869, the Detroit College of Medicine and Howard University graduated their first Black physicians.

Albert Henry Johnson, M.D., became the third Black graduate of the Detroit College of Medicine, in 1893. Dr. Johnson was one of the founders of Dunbar Hospital, the first Black non-profit hospital in Detroit.

In 1926, Chester Cole Ames, M.D., graduated from the Detroit College of Medicine and Surgery. He was the first Black physician to obtain an internship in Urology at a white hospital in Detroit, but he was never allowed to join staff. Dr. Ames was Detroit's first Black intern, resident and member of the Wayne University medical faculty. He cofounded three Black hospitals in Detroit, but was never granted privileges to practice his specialty in white hospitals.

Some 17 years later, Marjorie Peebles-Meyers, M.D., graduated from the Wayne University College of Medicine, the schools first Black female graduate. She was also the first Black female resident at Detroit Receiving Hospital, the first Black chief resident at Detroit Receiving Hospital, the first Black female appointed to the WSU medical faculty and the first Black female to join a private white medical practice in Detroit. After retiring, she began a second career as the first Black female medical officer at Ford Motor Co. World Headquarters. Dr. Peebles-Meyers received many awards and honors, including induction into the Michigan Womens Hall of Fame.

The same amount of time elapsed before Black physicians Thomas Flake Sr., M.D., Class of 1951; Addison Prince, M.D.; William Gibson, M.D.; and James Collins, M.D., were appointed to the staff at Harper Hospital, thereby integrating the Detroit Medical Center hospital staff.

Only five years later, Charles Whitten, M.D.,became the first Black physician to head a department in a Detroit hospital when he was selected clinical director of Pediatrics at Detroit Receiving Hospital. He was also a founder of the aforementioned Post-Baccalaureate Program.

In 1981, Alexa Canady, M.D., became the first Black neurosurgeon in the United States. Dr. Canady went on to serve as professor in the WSU Department of Neurosurgery. She was named one of the countrys most outstanding doctors by Child magazine in 2001.

Around 1988, two School of Medicine students Don Tynes, M.D. 95, and Carolyn King, M.D. 93, -- established Reach Out to Youth to introduce children 7 to 11 in underrepresented populations to the possibility of careers in science and medicine. Since then, the hands-on, workshop- and activity-focused program has been presented annually by the School of Medicines Black Medical Association, a chapter of the Student National Medical Association.

In 1995, Professor of Pediatrics and Sickle Cell Detection and Information Center Founder Charles Vincent, M.D., was appointed to the Membership Committee of the American Medical Association, making him the first Black doctor appointed to the committee in the AMAs 147-year history.

In 2017, Cheryl Gibson Fountain, M.D., F.A.C.O.G., a 1987 graduate, was named the president of the Michigan State Medical Society. The obstetrician/gynecologist served a one-year term as the societys first Black female president.

Last November, an anti-racism educational effort led by School of Medicine Class of 2024 medical student Cedric Mutebi and third-year Internal Medicine-Pediatrics resident Selena Rodriguez, M.D., aimed at stopping racial disparities through reimagined medical education won a $10,000 grant from the Association of American Medical Colleges. The grant allowed the team to develop Healing Between the Lines, a sub-curriculum targeting upstream structural inequities that drive downstream disparities.

Today, the push for more diversity, more inclusion and the elimination of health disparities continue to shape the future of the School of Medicine, from student-led efforts to longitudinal research projects dedicated to the health of Black Americans.

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Black History Month: Monumental moments at the WSU School of Medicine - The South End

Embryology

Barbara Kay: Following the science in the controversy over when you became you – National Post

Article content continued

I sympathize with their mission. Not because I am ideologically pro-life (Im not). Only that I favour informed consent in all ethics-related decisions. And deplore any systemic dumbing down of such decisions gravity through pedagogical misdirection.

In an email exchange with the authors, they told me their organization is active on social media, where they have discovered that many young people believe an embryo is just a clump of cells. They have never heard, for example, of the 23 Carnegie Stages of embryology, the gold standard for accurate scientific facts in the sexual reproduction cycle of life, which in rudimentary form provide the plot line of When You Became You.

I favour informed consent in all ethics-related decisions

The book did not strike me as in any way controversial on a first, casual reading, but during a more focused re-read, the charged word human jumped out at me: It does not matter what you look like Or even if you arent born yet. You are a human being; And from the moment your life begins, you are the same human being throughout your entire life; Just like you used to be a toddler and an infant, before that, you used to be a fetus, and before that, you were an embryo; A human fetus is simply a special name that scientists call a pre-born human being from nine weeks until birth. Well, you can see why this book has ruffled some progressive feathers.

Stanton and West worked with their China-based, best-selling illustrator over a period of months, with her name on the cover throughout their collaboration. But when the author/publisher of her previous books got wind of the project, her American representatives told the authors they had to pull the illustrators name, as it was too controversial. Since they couldnt acquire the high-resolution images they needed otherwise, Stanton and West agreed. A shame because, as noted, the illustrations are magnificent.

The book launched in November. The first printing has sold out and a number of schools in the U.S. are using it. West informs me that only 34 per cent of Canadians believe life begins at conception. Hopefully, When You Became You will find its way to many Canadian homes (maybe even schools?) and help to nudge those numbers upward.

Email: kaybarb@gmail.com | Twitter: BarbaraRKay

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Barbara Kay: Following the science in the controversy over when you became you - National Post

Embryology

Human Fertilisation and Embryology Authority annual report and accounts: 2019 to 2020 – GOV.UK

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Embryology

The Promise and Peril of the Bio-Revolution by Matthias Evers & Michael Chui – Project Syndicate

Many of todays biological innovations are complex, and we need to understand them fully to gauge their impact on our lives and societies. Only by working together can governments, scientists, businesses, and the public unleash the power of biology for good while effectively managing the risks.

HAMBURG Last November, the world cheered the news that three gene-based COVID-19 vaccines one developed by German biotech company BioNTech in collaboration with Pfizer, another by US-based biotech firm Moderna, and a third by the University of Oxford and AstraZeneca had proved effective in clinical trials. But in October, researchers revealed that off-target effects of the CRISPR-Cas9 gene-editing tool used to repair a blindness-causing gene in the early stages of human embryo development often eliminated an entire chromosome or a large part of it.

The two announcements, coming just a month apart, illustrate the promise and peril of biological engineering.

As a recent report from the McKinsey Global Institute (MGI) makes clear, current breakthroughs in biological science and advanced data analytics could help us solve major human challenges, from reducing climate risk and strengthening food security to fighting pandemics. But realizing the revolutions potentially huge benefits will require us to think carefully about how to mitigate the potentially severe risks.

The scope of todays bio-innovation wave is large. Some 60% of physical inputs to the world economy are either already biological, or could be produced using biological processes in the future. Nylon, for example, can already be made using genetically-engineered yeast, rather than petrochemicals. Many such bioroutes to production potentially will use less energy and water, and generate fewer greenhouse-gas (GHG) emissions. Just 400 biological applications currently in the pipeline could reduce annual average GHG emissions by as much as 9% by 2050.

CRISPR-Cas9 stands out as an increasingly accessible technology for manipulating genetic material, and is complemented by rapid and low-cost genetic sequencing and advances in data analytics that enable scientists to understand biological processes better. Our deepening knowledge of biology genes, microbiomes, and neural signals is making it increasingly possible to engineer life.

But modifying biology is inherently risky. With CRISPR kits now available for sale on the internet, anyone with some degree of biological knowledge could potentially create and release a new living entity, including harmful bacteria or viruses.

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Biological organisms are self-replicating, self-sustaining, and interrelated. Moreover, as the rapid global spread of COVID-19 has demonstrated, they do not respect political borders. For example, so-called gene drives applied to infectious-disease vectors (such as Anopheles mosquitoes in the case of malaria) could save many lives, but we may not be able to control them. The next generation of genetically-edited mosquitoes in one field experiment in Brazil were supposed to die, but are still breeding five years later.

Another concern is data privacy. The rapid spread of digital technologies has triggered an intense debate about technology companies use of personal data, such as that relating to purchasing habits and social-media activity. But access to biological data from our bodies and brains represents another level of intimate knowledge.

Moreover, the bio-revolution could entrench inequality, at least while applications such as breakthrough therapies, performance enhancements, and reproductive selection remain expensive and thus accessible only to the well-off. MGI estimates that about 70% of the reduction in disease in the next 10-20 years could be in high-income countries, despite the fact that they collectively account for only around 30% of the global disease burden.

Thus, unless managed carefully, the risks of some new biological applications may outweigh the potential benefits. Scientists cannot pursue innovation in a vacuum: societys concerns matter, and innovators must exercise consistent and effective oversight. Fortunately, they have a track record of doing so.

Back in 1975, for example, prominent scientists, lawyers, and medical professionals gathered at the Asilomar Conference in California to draw up voluntary guidelines to ensure the safety of recombinant DNA technology. More recently, the American biochemist Jennifer Doudna, who, together with French microbiologist Emmanuelle Charpentier, was awarded the 2020 Nobel Prize in Chemistry for inventing CRISPR, responded to the tools use to gene-edit twin human embryos by calling for stricter regulation of the technology.

Governments that regulate bio-innovations and the businesses that develop and use them need to be part of the sustained conversation on risk. In fact, we estimate that as much as 70% of the bio-revolutions potential impact will be in uses that fall under existing regulatory regimes.

Regulation today is uneven. For example, as of late 2019, the American Society for Reproductive Medicine largely was leaving it up to clinics and parents to decide what genetic testing and diagnosis is permissible in identifying defects within embryos before they are implanted. But the United Kingdoms Human Fertilisation & Embryology Authority regulates the procedure tightly, permitting its use only for medical purposes and, even then, only for certain disorders.

Ideally, citizens also need to be involved in the debate, because their level of comfort with how science is applied influences regulators. In the UK, for example, the independent Nuffield Council on Bioethics was established in 1991 to advise policymakers and stimulate public debate on bioethics.

Many of todays biological innovations are complex, and we need to understand them fully to gauge their impact on our lives and societies. Only by working together can governments, scientists, businesses, and the public unleash the power of biology for good while effectively managing the risks.

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The Promise and Peril of the Bio-Revolution by Matthias Evers & Michael Chui - Project Syndicate

Embryology

Study of Early Postoperative Doppler Changes Post Living Donor Liver T | IJGM – Dove Medical Press

Ahmed Salman,1 Amany Sholkamy,1 Mohamed Salman,2 Mahmoud Omar,1 Amr Saadawy,3 Ahmed Abdulsamad,4 Mohamed Tourky,5 Mohamed D Sarhan,2 Hossam El-Din Shaaban,6 Nesrin Abd Allah,7 Mohamed Shawkat8

1Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 2General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 3Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 4Surgical Oncology, Alzahra Cancer Center, Dubai, United Arab Emirates; 5General Surgery Department, Omm Elmisrien General Hospital, Cairo, Egypt; 6Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; 7Anatomy and Embryology Department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt; 8Internal Medicine Department, Faculty of Medicine, Minia University, Minia, Egypt

Correspondence: Ahmed Salman Tel + 201000468664Email awea844@gmail.com

Background: Adult-to-adult living donor liver transplantation (LDLT) has been a common practice because of the deficiency of deceased donor liver transplants. Liver hemodynamics differ substantially between cases with end-stage liver disease undergoing LT because of various degrees of hepatic affection, nature of implicated causative factors, and pathogenesis of the hepatic disorder. The present retrospective study primarily aimed to study the early postoperative doppler changes after adult to adult LDLT. The secondary aim was to assess these hemodynamics impact on early in-hospital deaths and small for size syndrome (SFSS) development.Methods: This retrospective work was done on 123 adult cases with end-stage liver disease for whom adult LDLT was performed after exclusion of pediatric patients and those with vascular complications.Results: Postoperative (PO) mean portal vein velocity (PVV), hepatic artery (HA) peak systolic velocity (PSV), and HA resistivity index (RI) declined gradually but significantly post adult LDLT. Phasicity of hepatic veins changes towards the triphasic waveform gradually in the early PO period. There is a notable negative relationship between PO mean PVV with PO mean HA PSV. Higher PO HA RI affected PO mortality, while higher PO PVV and lower HA PSV increased the incidence of SFSS.Conclusion: Early postoperative Doppler changes post-LDLT (PO PVV, HA RI, and HA PSV) can affect both mortality and SFSS development.

Keywords: postoperative doppler, LDLT, small-for-size syndrome, mortality

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License.By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Study of Early Postoperative Doppler Changes Post Living Donor Liver T | IJGM - Dove Medical Press

Embryology

Embryo freezing is revolutionary for those who can’t conceive – Palatinate

By Caitlin Painter

In October 1992, an embryo was frozen by an anonymous couple. It remained frozen for over 27 years until thawed by the National Embryo Donation Centre (NEDC) in Knoxville, Tennessee, and transferred into the uterus of a woman unable to conceive naturally. Born in October 2020, Molly Gibson is believed to hold the record for the longest frozen embryo to result in a birth.

The embryo remained frozen for over 27 years until thawed

Embryo freezing has been practised since the early 1980s, but it was initially unclear how long they could be frozen. The typical duration is 10 years, but as proven by Molly Gibson, decadesold embryos can still lead to successful births. The majority of stored embryos that can be adopted have been donated by individuals who have undergone in vitro fertilisation (IVF), after a successful implantation.

IVF is a popular technique available to help people with fertility problems become pregnant. After hormone treatments, a womans eggs are collected and fertilised, and the highest quality embryos can then be implanted, with unused ones typically frozen for further IVF attempts.

As proven by Molly Gibson, decades-old embryos can lead to successful births

A standard freezing process involves replacing water in the cells with a cryoprotectant, and then freezing the embryo extremely quickly to temperatures around -200C (known as vitrification) to prevent ice crystals forming. However, IVF creates a surplus of embryos, and the parent(s) have the decision of what becomes of them. Many choose to discard them. Some are donated for research and training purposes, whilst others are stored for embryo adoptions.

Dr Fiona MacCallum of the University of Warwick believes that the term embryo adoption is misleading, arguing that viewing embryo donations akin to adoptions could shift the public perspective of embryos more towards personhood status.

Dr Fiona MacCallum believes the term embryo adoption is misleading

This could have a great impact on stem cell research, where embryos are frequently used and subsequently destroyed. With this attitude, there is the possibility that embryos could undergo pre-implantation genetic screening. This is currently applied to check an embryo for specific genetic conditions, but could be misused to determine the future characteristics of the child.

Under the Human Fertilisation and Embryology Act of 2008, it is illegal in the UK to select the sex of embryos for non-medical purposes, whether during IVF with a persons own embryos or adopting them. It is common, however, for prospective parents to choose donated embryos of the same ethnicity as themselves, as well as from donor parents they share features with. It was only after they had chosen their desired embryos that Molly Gibsons parents discovered when they had been frozen.

Embryo freezing is the most effective way to preserve fertility, more than freezing eggs

For parents who are unable to conceive, embryo donations provide the opportunity of experiencing pregnancy and birth, with a 75% success rate of donated embryos surviving thawing and transferring. Of these embryos, 25 to 30% are implanted successfully, according to the NEDC.

Embryo freezing is also used by women about to undergo cancer treatments that may result in infertility, but who want a child afterwards. The UKs Human Fertilisation and Embryonic Authority evidences that embryo freezing is the most effective way for women to preserve fertility, more so than freezing eggs. Hence some women choose to freeze their fertilised eggs to increase their chances of a successful pregnancy later in life.

Older mothers are at a much greater risk of complications during pregnancy

Women may choose to postpone pregnancy until they feel more secure in their job and personal life, and having the means to do this has significantly increased womens reproductive freedom. A womans fertility decreases naturally with age, however, the advances in fertility treatments mean its increasingly common for older women to become pregnant. Despite this, older mothers are at a much greater risk of complications during pregnancy, prompting the discussion of whether those who otherwise would not be able to conceive and safely carry a baby should, just because it is scientifically viable.

Conversely, reproductive rights defined by the World Health Organisation (WHO) state that everyone has the right to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so. For most cases, there is a 10- year limit on freezing embryos, leaving people with a difficult decision once this time is up: destroying their embryos or beginning fertility treatment.

For some, 10 years later is still too soon to have a child. If we know embryos can survive for at least 27 years, why is this arbitrary limit still imposed? Does it really increase womens reproductive freedom as much as we think? Despite this, fertility Science & Technology treatments are life-changing, and the law rightly allows infertile couples and individuals the chance of having a family with their own or donated embryos. These treatments also provide the chance for same-sex couples to have children through means other than adopting, by using donated embryos or donated eggs/sperm. In December 2020, a 61-year-old gave birth to her own granddaughter by acting as a surrogate for her son and his husband.

A 61-year-old gave birth to her own granddaughter by acting as surrogate

The scientific advancements made during the last 40 years regarding fertility treatments have given many parents the chance of having a child. The record-breaking case of Molly Gibson has highlighted the prevalence and importance of these treatments being a possibility in todays society, meaning embryo adoption could become much more popular.

Image: Amber Conway

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Embryo freezing is revolutionary for those who can't conceive - Palatinate

Embryology

Raising Pro-Life Kids: 4 Ways to Teach the Sanctity of Life – Christianheadlines.com

Raising Pro-Life Kids: 4 Ways to Teach the Sanctity of Life

It was Nicks golden birthday. He turned seventeen-years-old on October 17th, and we celebrated in style. My wife made a special teriyaki chicken dinner at Nicks request. The decorations were Notre Dame football Nicks favorite team. The plates, napkins, tablecloths, and helium balloons were Fighting Irish top to bottom. The cake, naturally, featured a Notre Dame endzone scene complete with goalposts. Amid all the party goodies and celebration, my wife and I were thankful for our pro-life family and attitudes toward the sanctity of life that had given us Nick.

As the festivities progressed, the conversation around the table became boisterous. Along with a small cache of wrapped presents, the premier gift for Nicky was that two of his older siblings made it home from college for his big day. Much ribbing and laughter went along with celebrating the birthday boy.

When we got to the cake, the conversation ebbed. Nick stood up. He motioned for quiet, and we gave him our attention. I have a prepared speech for you, he said. Its my birthday, and I want to say that I am thankful for my life and that I was born. I know a lot of kids like me dont get to be born. I am glad that my parents decided to give me my life so that I could have a birthday.

Nick has made this declaration in various forms on different occasions over the years, but it never gets old. You see, Nick has Down syndrome. He is well aware that many kids with Downs are aborted before they ever see the light of day. Nicks right to celebrate his precious life a life fearfully and wonderfully made by God (Psalm 139:14).

On the other hand, the gratitude he expressed was hardly necessary. As do his six siblings, Nick knows that my wife and I would never have chosen abortion for any of our preborn children. My kids know that with absolute certitude, and theyve always known that.

I think this is at the heart of raising kids who know the sanctity of life: The witness of moms and dads who are utterly and unequivocally committed to protecting human life from conception until natural death. That witness can take a variety of forms. It just happened to be the case that the primary pro-life witness weve made in our family is Nick himself. His presence in the world and his rich and full life are testimony of Gods providence and grace. After you meet Nicky and see his smile, genuineness, and enthusiasm, youll have no doubt that the world is a better place because hes here. And thats absolutely true for all boys and girls with Downs. Ask their parents. Ask their siblings. Theyll be delighted to tell you.

But what if youre not blessed to have a child with Down syndrome, either by birth or adoption? How can we form passionate pro-life hearts in our children? This seems especially difficult in a world that seems obsessed with solving problems by destroying life instead of nurturing it. Here are 4 ideas that weve found helpful in our family. See if they resonate with you!

Talk about abortion a lot. Is it uncomfortable? Awkward? Only at first. Around our dinner table, hot topics like abortion come up frequently. We rarely attempt to curb discussion of controversial issues. Younger kids benefit by hearing the terms and the debate, which will generate interest and a desire to probe further.

To be sure, we managed those discussions to ensure age-appropriate themes. We always urged our kids, no matter their age, to ask for clarification if they didnt understand what we were talking about. Moreover, as parents, we made certain that we were thoroughly informed and up to date on the issues, which can be a daunting task. There are plenty of reliable resources to do that, including the organization National Right to Life, but Id advise you to rely primarily on local or state pro-life organizations. That way, youll be connected with a supportive group of folks whove been there with their own sons and daughters, and they can tell you what worked and what didnt in their own pro-life family formation.

Caring for the poor might seem like an odd prescriptive for raising pro-life kids, but I promise you its essential, especially as your kids grow into adolescence. Theyre going to hear that pro-lifers only care about babies (and their moms) beforebirth, not afterward, and you have to counter that argument with concrete action.

Its not enough to spout statistics about the charitable outreach the Christian community extends to moms and families in need. Instead, we need a family culture oriented to care for the poor. There are two ways to create this culture. The first way is through the checkbook. Let your kids see you giving money away to both organizations and individuals in need. The second way is to serve directly like volunteering at soup kitchens and food pantries, especially pregnancy care centers and homes for pregnant moms in distress.

A frightened mother is considering abortion

You can help her choose life through the power of an ultrasound.

Save Babies from Abortion Year-Round

Being a public witness takes the conversation from inside the home to outside of it. Like the suggestion to care for the poor, it further concretes our words into action. The reality of abortion may and probably should prompt us to do things that will make us plenty uncomfortable but will teach our children that defending the sanctity of preborn human life is serious business. Examples include a peaceful, prayerful protest at abortion centers in your community and even participation in pro-life family marches especially on the January 22 anniversary of Roe v. Wade in Washington D.C.

If our goal is to form our children in a pro-life mindset one that recoils at the idea of abortion and embraces the intrinsic, infinite value of all human life, no matter what then what better object lesson can we give than welcoming life ourselves?

Besides, what greater gift can we give our children than another brother or sister? Certainly, our greatest gift to our son Nicholas was his little sister, Katharine.

Adoption would be included under this rubric of family expansion as an expression of our love for life. There are also other less permanent forms of hospitality welcoming aging parents or other relations whod otherwise end up in nursing homes, for example. These kinds of steps entail tremendous risk and lots of unknowns, to be sure. But whats our goal? If we wish to ingrain a thorough pro-life perspective in our children, then theres no better way to demonstrate that than by incarnating sacrificial love in another family member!

Note that the previous four ways of demonstrating the sanctity of life altruism, education, activism, and radical hospitality do not depend on a Biblical worldview or Christian commitment. Clearly, its compatible with Biblical values. However, the four ways to teach the sanctity of life and create a pro-life family are defensible independent of any particular philosophy or faith orientation.

Thats crucial because, lets face it, there is a good chance that at least some of your own children may stray from the faith (at least temporarily) as they grow older. This is a trend that is hard to deny and one that is growing. We do what we can to steep our sons and daughters in Scripture and help them develop strong prayer habits as part of a personal relationship with Christ. Yet we cant protect them forever from broader cultures anti-religious undertow, not to mention the blast of godless propaganda that dominates popular culture and social media.

And what if you do have children that reject the faith you raised them in? Theyll also be likely swayed by the worlds arguments in favor of solving problems by assaulting life abortion, infanticide, euthanasia, assisted suicide, the whole deadly morass of what passes as social (and, tragically, legal) norms these days.

But you have a say in that at least while theyre still home with you. Be proactive in forming their pro-life sensibilities. Ground them in reason and rational argument; teach them logic and embryology; show them videos of preborn human life, and bring them to the bedside of those who are living large at the end of life. Equip them with the old-fashioned common sense that once made abortion unthinkable and mercy-killing a contradiction in terms. Teach them the sanctity of life early and often.

Is it possible? Yes, I know its possible. In fact, its highly likely. The growing numbers of pro-life young people who reject God and religion provide powerful testimony of its feasibility. Theyre the ones who want to support progressive politicians but cant bring themselves to support those who promote greater abortion access. And theyre also the ones wholl be unlikely to choose abortion themselves when faced with a problem or inconvenient pregnancy.

Come to think of it, that last scenario provides one more powerful means of forming pro-life families an extension of the radical hospitality I mentioned earlier. If and when an adult child, regardless of faith status, decides to make sacrifices to welcome an unexpected human life God happens to send along, we do well to make like the prodigal sons dad and rush out with open arms and celebrate!

If you're not able to attend a March for Life event, you can still helpsupport Sanctity of Life with Focus on the Family by donating here.

Photo courtesy: Getty Images/Wave Break Media

Rick Becker is a husband, father of seven, nursing instructor, and religious educator. He studied theology at Seattle Pacific University and Franciscan University of Steubenville, and he is currently working toward a Doctorate of Nursing Practice at Indiana Wesleyan University. Rick currently serves on the nursing faculty at Bethel University in Mishawaka, Indiana.

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Raising Pro-Life Kids: 4 Ways to Teach the Sanctity of Life - Christianheadlines.com

Embryology

Infertility treatment: When will free IVF be introduced in Ireland? – The Irish Times

In 2019, the government committed to publicly funding infertility services, including IVF. Lynn Enright asks if it will happen this year and speaks to some people about the costs financial, medical and emotional of funding the process privately

Amy Gallagher and James Rowan have always known they would need help to conceive. Rowan had cancer first at age 15, then at 20 and the high-dose chemotherapy used to treat it destroyed his fertility. Before the first course of chemotherapy began, he banked sperm which remained frozen for the best part of two decades. When he and Gallagher got together and decided they wanted to complete their family she has a son from a previous relationship to whom Rowan is a loving stepfather they faced a dearth of information and options.

I asked my GP about it and he just pointed me in the direction of a private clinic, Rowan says. Thats all he could do for me.

The World Health Organisation is clear: infertility is a disease. It affects the male or female reproductive system and is defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. In those of reproductive age, it affects men and women equally, with male-factor infertility accounting for 50 per cent of cases, according to Prof Mary Wingfield, clinical director of the Merrion Fertility Clinic in Dublin.

Yet, in Ireland, people who cant conceive without turning to assisted reproductive technology (ART) receive little or no support within the public health system. Those who need in-vitro fertilisation (IVF) and other fertility treatments to start a family will find themselves immediately paying for treatment, a situation that compares unfavourably with most of our European neighbours. In Scotland, for example, eligible patients are offered up to three free cycles of IVF the number most experts agree gives a fair chance of conception. In Ireland, there is no comprehensive State-funded fertility treatment, even when patients are receiving care and treatment for a condition or disease that affects their fertility, such as cancer, colitis or endometriosis.

Forty-year-old Natalie Doyle needed to pursue IVF after her Fallopian tubes became encased in scar tissue following complications relating to colitis. She had been receiving expert care within the public health system but once it came to looking into ART options, a situation she found herself in as a direct result of the disease, she felt completely adrift.

Youre just left on your own to choose a clinic and theres no communication between your fertility clinic and your other doctors, she says. Theres not even a link between your GP and the clinic its just nuts, I cant get my head around it.

Doyle and her partner postponed moving in together, both staying with family while they funded cycle after cycle of failed IVF. Eventually, they conceived their daughter but Doyle is adamant that the Government needs to step in. The costs are too much for many couples to bear, she says.

It feels like youre spending money, just sitting in the waiting room. It bleeds you dry. The Government needs to help with the costs, she says. But they also need to help medically, so that patients like me have a continuity of care. There have to be more regulations, there has to be more support, the mind boggles that nothing has been done yet.

In Ireland, fertility clinics are regulated by the Health Products Regulatory Authority (HPRA) but there is no regulatory body that specifically oversees the fertility industry. In the UK, the Human Fertilisation and Embryology Authority (HFEA) performs that role, ensuring fertility clinics and research centres comply with the law, as well as providing free, clear and unbiased information on all fertility clinics operating within the jurisdiction. Without such a body here, patients can find themselves feeling bewildered.

Amy Gallagher says she got most of her information from Google, Facebook and Instagram.

I just think there should be some form of support for people, not only financially but emotionally, she says. For people who experience infertility as a result of childhood cancer, theres nothing out there. Theres one Facebook group, thats all Ive found. There needs to be something like the citizens information service, somewhere you can get information. People have no one to turn to. Your GP doesnt know and a fertility doctor will charge at least 250 for a consultation, just to ask them questions. The situation is, she says, deeply frustrating and upsetting.

Prof Wingfield says Ireland desperately needs an equivalent of the HFEA. The industry is regulated by the HPRA but its more from the point of view of the quality procedures surrounding the management of human tissues and cells. Its not about the social, medical, ethical and legal realities. There are plans afoot to introduce such a body as part of an overhaul of the provision of fertility treatment but it is not clear when that will happen.

In October 2017, the cabinet approved the Assisted Human Reproduction (AHR) Bill, a piece of draft legislation that laid out regulations for AHR and the need for the establishment of a regulatory body.

Two years on, in late 2019, details of a model of care for infertility developed by the Department of Health in conjunction with the HSEs National Women & Infants Health Programme were announced, with the then minister for health Simon Harris receiving Government approval to publicly fund infertility services. The announcement a clear commitment from the then Government was hugely significant and it looked as though Ireland was finally set to join most other wealthy and developed nations in providing care and treatment for infertile people. Harris told reporters at the time that he expected publicly funded IVF to be available in 2021.

The planned scheme would comprise three stages: the first stage would involve patients seeing their GP and if it was deemed necessary, they would proceed to the second stage and be referred to a newly established regional fertility hub (there are plans for six hubs, one in each of Irelands six maternity networks), where tests, diagnostic surgery and some non-invasive forms of ART would take place. The third stage would involve the provision of free IVF.

Now, another year has passed and there has been little progress with this ambitious undertaking.

The commitment is ongoing and the current Minister for Health, Stephen Donnelly, confirmed in public statements on the most recent Budget that additional funding is being made available in 2021.

Womens health and our maternity services must get more attention, Donnelly said in the Dil last October, noting that, We will . . .open two new regional fertility hubs in Galway and Cork.

In response to questions from The Irish Times, a Department of Health spokesperson said that 2 million has been made available to allow for the establishment of the first four hubs and a further 1 million has been allocated for the final two hubs.

However, while Covid-19 has not impacted the funding available for the project, the establishment of the hubs has been slowed by the pandemic and its impact on the HSE and the provision of elective health services. None of the six regional hubs are operational at present. Meanwhile, the AHR Bill has still not been signed into law - and without that, publicly funded IVF will not take place.

The Department of Health spokesperson says that it is intended that, in line with available resources, [the] model of care for infertility will be rolled out on a phased basis over the course of the coming years. When pushed for a more specific timeframe, the spokesperson said it is not possible at this juncture to give a definitive timeline.

Rowan and Gallagher arent holding their breath. Weve been promised this Government money for years but its just not coming, Rowan says. Every time you hear about it, you think: Oh maybe that will be through soon. But it seems to be taking years. You cant rely on it, you cant put your hope in it. Gallagher fears that any change will come too late for her: It sounds mad because Im only 32, but every year that Im older, our chances are lower.

Prof Wingfield says Ireland absolutely lags behind other developed countries when it comes to the provision of fertility treatment. The cost of fertility drugs prescribed by a consultant are covered by the Drugs Payment Scheme or a Medical Card and private patients can claim tax relief on the costs of fertility treatment but even so, Irish patients receive significantly less support than those in the UK, Germany, Turkey and most European nations. When asked why that is, she says the answer is complicated. In the past, it would have been because it was a difficult subject to discuss from a religious and moral point of view, but thats no longer the case.

However, when you remove any religious concerns from the discussion of fertility treatment, there remains two very powerful taboos: money and womens reproductive systems.

Because, over the years, its only been available privately not just in Ireland but in most parts of the world and the treatment is expensive. There was a perception that it was a luxury, something that only rich people can afford, Prof Wingfield says.

Rowan says that he and Gallagher have encountered an attitude that suggests fertility treatment is somehow extravagant: We have no choice but to do IVF if we want to have a child but sometimes it feels like people dont understand that. Its nearly treated as though Amy is going in for a boob job. People think its a luxury as opposed to a necessity.

A cycle of IVF usually costs between 6,000 and 10,000 depending on which treatment is required and which clinic you are using. There is not always evidence to support expensive add-ons, such as endometrial scratching and assisted hatching, but if you are already spending huge sums of money, it can seem churlish not to attempt to boost your chances by opting in. Treatment can be accessed at a cheaper cost abroad (most Irish patients go to the Czech Republic or Spain) but flights and accommodation will add up and being hundreds of miles from your doctor if something goes wrong is stressful and potentially dangerous.

Generally, only the most expensive private health insurance packages cover infertility treatment and even then, they do not cover the entire cost. The most comprehensive packages at Irish Life and VHI cover up to 2,000 towards a cycle of IVF, which can be accessed only twice per lifetime.

The vast expense can make patients feel that their clinics are rapacious. You have to pay 160 for a blood test to tell you that youre not pregnant. Its horrendous. It can feel like its just about money to them. says Gallagher. Prof Wingfield, however, makes the point that it is a very expensive treatment because its very labour intensive.

For one couple to do IVF, she says, youll have several nurses involved, one or two doctors and several scientists. Then youll have all the administrative staff because record-keeping is so critical. It is a very expensive treatment to provide. The Merrion Clinic is run as a not-for-profit organisation and has charitable status but costs there are not significantly lower than at the private clinics, which are run for profit.

Infertility often has an impact on mental health a study in the United States found that women with infertility felt as anxious or depressed as those diagnosed with cancer, hypertension, or who were recovering from a heart attack and stress about money adds to feelings of anxiety and helplessness.

Louise Hazlett (37) has private health insurance that has covered the surgeries and treatments she needed to treat her endometriosis, but it does not extend to fertility treatment, which she needs as a direct result of the disorder. Over the last four years, she and her husband, Kevin, have had five cycles of IVF. In 2017, she discovered she was pregnant with twins but she went into labour at 22 weeks and her sons died shortly after birth. Since then, she has had three more cycles of IVF.

She explains that they got a loan from the credit union for 20,000 and that went fairly rapidly.

We had to get another loan last year, she says. And we just save. Any spare money goes to fertility. We both work but its not easy. But I feel lucky that we are in a position to save and to pay back loans. Not all couples have that.

People assume that once you get married or reach a certain age that youre going to have kids. They assume its going to be easy. And people say things like, Oh still no sign? And at this stage, I just say, Well, Ive done five cycles of IVF. We hope the sixth one is going to be our lucky one. That shuts people up.

Prof Wingfield says: Most people grow up thinking that they will be able to have children and unless they run into problems, they dont realise that it is such a big issue. People who have not experienced infertility according to the HSE, 85 per cent of people conceive within one year will perhaps struggle to realise just how distressing and expensive the process can be.

Its like an obsession, Doyle says. You see all the people around you getting pregnant and having kids. I had to become distant for the sake of my own mental health I couldnt go to baby showers. People can say that they understand but unless you go through it yourself, you dont, you cant really.

This isolation can be compounded by silence around the subject. People who cant get pregnant sometimes feel that there is something wrong with them and it affects peoples self-esteem, says Prof Wingfield. So its hard to be vocal about it and people can be very private about it. Often peoples friends or family dont even know about it. That is changing and people are becoming more open about it and with that will come the realisation that it is a medical issue.

The people interviewed for this piece said they were keen to speak openly because they believe that raising awareness is vital. Gallagher says she didnt tell her employer during her first cycle because she felt there was a stigma and a lack of compassion: People ask Is it you or him? and How much is it? Those are the two questions I get asked all the time. When going through her second cycle, she was open about it in her workplace but felt like they didnt understand.

It was like: Youre not sick, why do you need time off?

Hazlett hopes publicly-funded infertility treatment will help to improve awareness of infertility and its causes and treatments.

There will be huge challenges to creating a functional and fair State-sponsored system of providing fertility treatment. It will be necessary to decide who is eligible for free fertility treatment and to establish criteria and cut-offs. In the UK, for example, gay women who are in a relationship can access free IVF with a sperm donor but single women are ineligible. The financial, legal and logistical concerns relating to the implementation of the Governments planned three stages will be complex, but if it is achieved it will be a huge step forward for our health system. Prof Wingfield laments the existing system: As a doctor, it is unacceptable to me that medical healthcare should be preferentially available to those in our society who can find the money to pay for it and not available to all.

Doyles daughter Sadie is just about to turn three. When she was 10 months old, Doyle and her partner David Smith could finally move into their own home after years of spending almost everything they earned on fertility treatment. They consider themselves the lucky ones and wish more people could get to experience their joy.

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Infertility treatment: When will free IVF be introduced in Ireland? - The Irish Times