Pregnancy: Increase in twin births in USA.

During 2009, one in every 30 babies born in the United States was a twin. This is the result of a steady, yet strong growth, in the incidence of twins over the last three decades. Historically, the incidence of twins in the United States was at a rate of one in 53.

Reasons for the increased incidence of twins has been attributed to mainly two factors:

  • The majority of women are now delaying starting their families until they are in their thirties. Statistically speaking, women in their thirties are more likely to have twins than in any other age group.
  • The increase in the usage of ART (Assisted Reproductive Therapy) such as IVF, which can involve the transfer of two embryos in one IVF cycle. This is reported to be the greatest contributing factor accounting for two thirds of the increase.

Analysis in different demographics resulted in the following conclusions:

  • Women over the age of 40 had the greatest increase in twin births. This has been attributed to their reliance on IVF.
  • The incidence of twins increased in all of the US mainland states.
  • Connecticut has the highest incidence of twins with nearly one in 20 births being a twin.
  • All ethnic groups experience an increase. White, black, and Hispanic women all had more twins. However, due to their better access to IVF, white women experienced the greatest increase.

IVF: Breakthrough on the horizon

Academics from Oxford University are at the early stages of what may become a breakthrough in IVF technology. They have devised a technique which will allow an IVF specialist to gauge the health of an egg differently than the invasive techniques which are currently employed.

The new technique involves analysis of a “cloud” of cells which surrounds the egg. A new understanding suggests these cells can be a reliable indicator to assess health and quality of an egg. This would then provide better information to aid the decision when choosing between eggs.

The technique will help solve some of the chromosomal problems which are currently encountered in IVF therapy. The researchers suspect it will result in a greater rate of positive pregnancies given the number of IVF transfers. Also encouraging (and very topical at the moment) is the expectation that the new technology will lead to a reduction in the cost of IVF therapy.

To date, the researchers have only conducted a pilot study using very few subjects. They are planning to embark on a larger scale study in 2013.

IVF pregnancies: controversy over multiple births

There is controversy in China over multiple births as the result of IVF therapy. The response was initiated when news came to hand of a wealthy couple who had eight babies with the assistance of two surrogate mothers.

Despite much of the outrage which is focused on the couples’ complete disregard for the “one child policy”, the case does have some relevance to the rest of the world. Similar opinions are being raised to that of the “Octo-mum” case a couple of years ago in the United States. Questions are being asked such as “Does an individual have the right to take IVF to such an extreme?” and “What role did the doctors play in the decision making?”

Though, it must be pointed out this case is different to that of the “Octo-mum” case. This mother had three of the children herself whilst the other five children were from the surrogate mothers, so all eight babies were not carried by the one woman. But, that being so, it does also raise the issue of children being treated as assets or commodities and not as human lives. Other questions which need answering are: Are the health risks of such multiple births being considered? When three or more babies are involved in a pregnancy it does dramatically increase the risks to the mother and the babies. More fundamentally, are these women able to adequately care for these children? What do you think?

Pregnancy: The increase in the age of Australian mothers.

The Australian Institute of Health and Welfare has just released 2009 statistics which reported on the changing age of Australian women who are giving birth. Some of the more interesting statistics which were reported are as follows:

  • 13.7% of first time mothers are over the age of 35 years. Compared to the previous data which was taken in 2000, this is an increase of 3.4% of the total births.
  • the average age of Australian women giving birth is now over the age of 30 years.
  • 22.8% of women giving birth are over the age of 35. From the 2000 data, this has increased by 5.7% of the total births.
  • 4% of Australian women who are giving birth are over the age of 40 years. In 2009, 2.9% of births involved a woman over the age of 40.
  • 3.6% of the total births in 2009 were the product of ART (Assisted Reproductive Therapy).

IVF: increased incidence of multiple births

Recent statistics released in New Zealand have indicated a significant increase in the incidence of multiple births. The Office of National Statistics reported that in 2010 there were 15.7 multiple births per 1000 women. This is an increase of 6.8% compared to the same statistics from 2000.

The increase in multiple births has been attributed to increased use of IVF therapy. During 2010, a surprising one in four IVF pregnancies in New Zealand resulted in either twins or triplets. This is significantly greater than the rate of natural multiple births in New Zealand. Naturally conceived pregnancies were reported to have a one in 80 chance of resulting in a multiple birth.

Pregnancy: demand to induce Christmas babies

Recently in the Australian media there has been reporting on how there is an increased demand for induced labours around Christmas time. The practice is said to more typically on the increase amongst expecting mothers who already have children at home. Reportedly, they prefer to be home on Christmas day with their family than to be in hospital giving birth.

Obstetricians are familiar with this practice and have accepted it as another reason to perform what they term as a “social induction”. Some social commentators are surprised such a practice exists and that there is such a term as “social inductions”. Obstetricians have highlighted the real medical risks to both mother and child involved in such practices. These are increased risks of a longer labour as well as the use of forceps, both of which are stressful for the baby.

What are your thoughts on this matter? Are the social commentators being too precious? Does an expecting mother have the right to make an informed choice? Or could this be an example of what some claim to be a self centred attitude of the “now” generation?

The effect of stress on pregnant women (gestation)

American researchers from New York University have found that exposure to stress during pregnancy may affect gestational age and the probability of a preterm baby (a baby born before 37 weeks of gestation).

The researchers considered data on pregnant women who were exposed to the 2005 Chilean earthquake. These women were compared to other Chilean pregnant women one year previous to the earthquake. Other data was also obtained on Chilean pregnant women who were living in areas which were unaffected by the earthquake. Comparisons were made based on the length of gestation at the time of the earthquake and the length of gestation at the time of birth.

The study found the mothers who resided the closest to the epicentre of the earthquake were at greater risk of experiencing a premature birth. This relationship between stress and premature child birth was found to be evident when the women gave birth to a female. This effect was most statistically significant when the mother experienced the stress (earthquake) during the second and the third trimester. No statistical difference was found for male births.

Reference: Torche, F., Kleinhaus, K. Prenatal stress, gestational age and secondary sex ratio: the sex-specific effects of exposure to a natural disaster in early pregnancy. Human Reproduction: 2011.

IVF: Medicare cut reduces the number of pregnancies

Fewer IVF babies are now being born in Australia. Research which was presented at the World Congress of Human Reproduction identified the main determinant of this decrease as being the change in IVF funding made by the Australian government. The Health Insurance Amendment (Extended Medicare Safety Net) which was introduced last year reduced the amount of money refunded to most IVF couples. The researchers proposed that because couples are now incurring greater out of pocket expenses, they are less likely to undergo IVF therapy.

In the first year since the amendments were introduced there was a total of 7000 fewer IVF cycles conducted in Australia. This equates to a 16% decrease. This in turn has resulted in 1,500 fewer IVF babies being born (compared to historical data).

Have the funding changes made you less likely to consider IVF therapy?

Are you less likely to commit to repeated IVF cycles?

Chinese herbal medicine: How to move forward in research to assist IVF therapy.

Very few scientific studies have been conducted to explore the use of Chinese herbal medicine in assisting IVF therapy.

The problem:The requirements of research (scientific method) demands standardisation of treatments. By nature, Chinese herbal medicine treatments are however very difficult to standardise. A true clinical approach involves an idiosyncratic selection of herbs based on a diagnostic pattern. Any attempt to standardise Chinese medicine has the tendency to jeopardise its integrity and would render its efficacy to be questionable.

Adding to this problem is the issue of co interaction. To research Chinese herbal medicine correctly, each individual herb would need to be analysed and tested to see whether it co interacts with the various IVF medications. Following this analysis, each of the countless possible variations of herbal formulae would also need to be analysed. Given Chinese herbal medicine formulas are seldom standardised, this would equate to an endless amount of testing. Such research would require much time, patience and above all large amounts of funding.

The solution:For studies where, Chinese herbal medicine is used to assist IVF therapy, researchers should only test the commonly used (or “classic”) herbal formulas. This will allow for greater standardisation. This would also satisfy the scientific method whilst reducing the amount of testing for co interactions with the IVF medication. On adopting this method, only two formulas should require testing, the first to facilitate menstruation, and the second to strengthen the follicular phase.

Frozen embryos: The give and take of a new ethical problem in IVF

Late last week, Professor Jenni Millbank from the University of Technology (Sydney) proposed that embryo donation could become more prevalent in the future. She reported that donated embryos led to the birth of 39 children in 2009 between Australia and New Zealand.

Prof. Millbank conducted a study to assess the attitudes on embryo donation amongst those who had frozen embryos in storage. Of the 349 people surveyed, 27% said they would donate their unwanted embryos, and 31% said they would take it into consideration. Prof. Millbank suggested donation of unwanted frozen embryos could be a possible solution to the difficulty which is currently experienced by Australians who are trying to adopt children.

What do you think?

Would you donate your stored frozen embryo if you no longer required it?

Would you accept a frozen embryo from a donor?

Should this be treated any differently than our current arrangements which we have in place for either egg donation or adoption?

Reference: Julie Robtham. Solution to the problem of infertility: give away your spare embryos. The Sydney Morning Herald; 02/12/11