LONDON -- British fertility experts have devised a new IVF technique that takes thousands of snapshots of a developing embryo that they say can help doctors pick those most likely to implant successfully and develop into healthy babies.

At a briefing in London before publishing their results, the researchers said they are already using the technique to select "low risk" embryos that are the least likely to have chromosomal abnormalities that could hamper their development.

In their study, published in the journal Reproductive BioMedicine Online, the team's chances of producing a successful live birth after in-vitro fertilization (IVF) were increased by 56 percent using the new technique compared to the standard method of selecting embryos that look best through a microscope.

"In the 35 years I have been in this field, this is probably the most exciting and significant development that can be of value to all patients seeking IVF," said Simon Fishel, a leading fertility doctor and director at the IVF clinic operator CARE Fertility where the technique is being developed.

Independent scientists not involved in the work welcomed it as a significant advance but said full randomized controlled trials - the gold standard in medicine - should be conducted before it is adopted as mainstream practice.

"This paper is interesting because we really do need to make advances in selecting the best embryos created during IVF," said Allan Pacey of Sheffield University, chair of the British Fertility Society.

"The idea of monitoring embryo development more closely is being used increasingly in clinics around the world and so it is good to see the science involved submitted to peer review and publication," he added. "All too often, developments in IVF are trumpeted as advances when they remain unproven."

Experts say that today, as many as 1 to 2 percent of babies in the Western world are conceived through IVF. The standard methods of selecting embryos are based largely on what they look like through a microscope, and many IVF cycles fail because the embryo chosen and transferred to the womb fails to develop.

The scientists who led this study said that using time-lapse images, they had found that developmental delays in the embryo at crucial stages are good indicators of likely chromosomal abnormalities that could result in a failed pregnancy.

"In conventional IVF laboratories, embryo development will be checked up to six times over a 5-day period," said Alison Campbell, Care Fertility's embryology director and the lead researcher on the study being published.

"With time-lapse we have the ability to view more than 5,000 images over the same time period to observe and measure more closely each stage of division and growth."

Using this new knowledge, the team developed what they call morphokinetic algorithms to predict success (MAPS). By applying these MAPS to the selection of embryos, they predict they could reach a live birth rate for patients undergoing IVF of 78 percent - about three times the national average.

Fishel, whose CARE Fertility clinics are Britain's largest independent provider of assisted conception cycles, with around 3,500 a year, said he is charging around 750 pounds ($1,100) for IVF using the MAPS technique - compared to several thousand pounds for a standard IVF cycle.

But Sue Avery, head of the Women's Fertility Centre in Birmingham, said it was too soon for all clinics to adopt it.

"Until the new technique is compared to current practice we cannot know whether different embryos are being chosen," she said. "The IVF community needs a prospective randomized controlled trial to prove that the new approach delivers better results before it can be recommended to patients."

Women getting fertility treatments can be reassured that in vitro fertilization (IVF) does not increase their risk of breast and gynecological cancers, according to a U.S. study of Israeli women. 

"The findings were fairly reassuring. Nothing was significantly elevated," said lead author Louise Brinton, chief of the Hormonal and Reproductive Epidemiology Branch at the National Cancer Institute in Rockville, Maryland.

Ovulation-stimulating drugs or puncturing of the ovaries to retrieve eggs can be part of IVF treatments, procedures that researchers have suspected may increase women's risk of cancer. Indeed, previous studies did link IVF early in life to heightened risks of breast cancer and borderline ovarian tumors.

But other studies have found little connection between fertility treatments and cancer.

The association has been difficult to untangle, experts say, in part because it's hard to know whether unmeasured factors not realized to IVF may affect the risk of cancer in women who have trouble conceiving. In addition, so far there haven't been a lot of women who developed cancer after fertility treatment included in studies.

"We all want answers, but it's a very difficult exposure to study, particularly when we don't have the numbers we would really like," Brinton, whose results appeared in the journal Fertility & Sterility, told Reuters Health.

She and her colleagues examined the medical records of 67,608 women who underwent IVF treatments between 1994 and 2011 and 19,795 women who sought treatment but never received IVF.

The researchers linked those files to a national cancer registry and found 1,509 of them had been diagnosed with cancer through mid-2011.

There was no difference in women's chances of being diagnosed with breast or endometrial cancer based on whether they were treated with IVF. The researchers did find that a woman's risk of ovarian cancer slightly increased the more rounds of treatment she received, but that finding could have been due to chance.

Brinton said her study was too small conclusively link IVF and ovarian cancer -- and that it remained very rare, with 45 cases in the entire study.

A similar association was found in a study headed by Bengt Kallen, director of the Tornblad Institute at Lund University, Sweden, who said that any increased ovarian cancer risk might be due to the dysfunctional ovaries themselves.

"Infertile women have a primary problem with their ovaries and IVF has nothing to do with it," Kallen told Reuters Health. "It's a rather difficult thing to disentangle if there is an effect from the hormones or from the IVF procedure."

Others warned of biases that may make the results of studies like this difficult to interpret, nothing that women undergoing IVF are watched very closely, which would likely increase the chance that ovarian cancers are detected.

"You have to be extraordinarily cautious about this kind of a study," said Sherman Silber of the Infertility Center of St. Louis. "If anything. It's reassuring. One doesn't see any real increase in cancer." 

Related stories:

• Doctors: IVF not to blame for Rancic's breast cancer
• Time to think of health costs for IVF babies, bioethicist says

“Right now I am talking to you from bed, wrapped up in blankets because I can’t regulate my body temperature,” says Stefani Bush, a Chelmsford, Mass., mother. Bush, 35, has a gene mutation, one in a galaxy of mutations that causes often devastating conditions known collectively as mitochondrial diseases. She has been hospitalized about 16 times this year. She can’t walk more than about 20 yards and has a host of cardiovascular and gastrointestinal symptoms.

A study published Wednesday in the journal Nature might offer a way to prevent children from inheriting such conditions in the future. Scientists in Oregon have found a way to remove the damaged genetic material and replace it with healthy DNA. The catch is it’s controversial, and children born using the technique would, technically, have three genetic parents. It’s just the kind of ethical debate that stopped such science dead in its tracks a decade ago.

Bush wasn’t aware she carried her mutation until she was pregnant with her daughter, now 7. Her son, 9, has been diagnosed with the same mutation, and her daughter is showing signs she has it, too. On a recent family dream trip to Disney World, the little girl spent an entire day having seizures.      

Mitochondria are tiny organelles in every cell of our bodies except red blood cells. They’re the cells’ power plants, converting glucose to energy. Mitochondria has DNA of its own – human mitochondria has 13 genes – that is passed down virtually unchanged from mothers to babies.

If mitochondria don’t do their jobs properly, a wide variety of health troubles can result, especially in parts of the body, like muscle and brain, that have high energy requirements.

An estimated 1 in 4,000 children born in the U.S. are affected by some version of mitochondrial disease, according to the United Mitochondrial Disease Foundation.

Many children born with mitochondrial mutations don’t live past age 4 or 5. Mutations can cause blindness, deafness, strokes, seizures and cardiovascular problems. Often, as in Stefani Bush’s case, people go undiagnosed for many years.

Researchers have been trying for years to find ways to repair damaged mitochondria to give the kids a chance.

Shoukhrat Mitalipov at the Oregon National Primate Research Center and Oregon Health and Science University and colleagues found a way they think might work. Most of a person’s DNA is found in the nucleus of the cell, carried on structures called chromosomes.

Mitalipov’s team took the chromosomes out of one set of human egg cells. They replaced them with chromosomes from human donor eggs. Then they used fertilization techniques to inject sperm and fertilize the eggs – about 65 in total.

Mitalipov Lab / Oregon Health & Science University

Researchers have found a way to removed damaged DNA from a woman's egg cell and replace it with healthy DNA from another woman.

When the resulting embryos developed into balls of cells called blastocysts, they took out a few of the embryonic stem cells and tested them to show they were healthy and would have developed into normal embryos. Only about half did.

Even so, Mitalipov told a news conference, the process worked “pretty well. Mitochondrial DNA can be replaced efficiently.”

Three years ago, the same team announced they’d used the technique to create reconstituted eggs from monkeys called macaques, fertilize those eggs, and implant them into females. Three babies were born.

“At three years follow up,” Mitalipov said, “the study showed these are normal” juvenile monkeys.

By doing such manipulations, scientists hope to prevent mitochondrial disease by removing chromosomes from the eggs of affected women, and putting them into donor eggs. Any children that would be born would not carry the mother’s mitochondrial mutations – but would have the mitochondrial DNA from the woman who donated her eggs.

“From my point of view, this has big implications in women who have some type of mitochondrial DNA mutation,” said Carla Koehler, a mitochondrial biologist at the University of California Los Angeles who has been studying ways to repair the mutations. She uses some of the same kinds of techniques to make what she calls “cybrids.”

“I’d hate to rush this technique and start using it in women,” she added. “We should always have a high bar.”

In 2010, a team from Newcastle University in Britain published results of their own, similar, chromosome transfer. On behalf of that team, Mary Herbert issued a statement applauding the work of the Oregon scientists and noting that it “confirms our previous work published in Nature, showing that, in principle, it is possible to use IVF-based techniques to reduce the risk of transmitting mitochondrial DNA disease from a mother to her child.”

The team hasn’t yet shown that an embryo made this way could be used to make a woman pregnant.

Mitalipov said the scientists think they’ve figured out why most of the manipulated eggs didn’t develop normally. He hopes to start human tests. “I say it is safe enough to proceed,” he said.

Dr. Jamie Grifo, director of the division of endocrinology and infertility at the New York University Fertility Center, agreed. “It’s a great paper,” he told NBC News. “This is a kind of orphan group of patients, but they are out there, and the only thing we can offer them now is donor eggs.”

But Grifo also predicted that the Food and Drug Administration (FDA) would be very reluctant to approve any human trials

Grifo knows, because, in 1999, he published results of a similar technique in his effort to improve success rates for infertile patients.

“I think this study confirms what we were doing a long time ago,” he said.

But Grifo was working at a time when there were great concerns over the issue of human cloning. He wasn’t trying to clone anybody, just trying to make a healthy egg.

After media reports of Grifo’s work were published, “I got a personal phone call from the assistant surgeon general of the United States who wanted to know why I was doing it and said I should not be doing it,” he recalled. “Then I got a letter from FDA telling me to stop.”

Grifo turned his data and research over to Chinese scientists so it wouldn’t go to waste.

In fact, there are already children born with two genetic mothers. In the mid 1990s, Jacques Cohen, at St. Barnabas Medical Center in New Jersey, began transplanting cytoplasm from donor eggs into eggs from infertile women as a way to “rescue” those eggs.

In 2001, Cohen announced that he’d found mitochondrial DNA from both the mother and the donor in the cells of babies born using this cytoplasmic transfer technique.

It was the first time the human germline – the genetic information that’s passed down from one generation to the next – had been deliberately altered and resulted in the birth of children.

In response, the FDA said it would require researchers to file an Investigational New Drug (IND) application, and conduct clinical trials under that IND. In the 11 years since, FDA has not issued any such INDs, according to FDA spokesperson Rita Chappelle. Given fears over altering the human germline, and the idea that any babies would be born with DNA from three people, some question if FDA will change policy now.  

“I’m not sure what FDA’s stand is on this treatment,” Mitalipov said. “Last time I heard, this topic was under active discussion in the FDA’s Division of Cellular and Gene Therapies department.”

Chappelle would say only that “any proposed process of mitochondrial transfer would be carefully evaluated before FDA could make a determination as to whether an IND would be required to conduct clinical research.”

Bush understands the concerns, but has no doubts the science should move forward. If she’d known what she risked passing on to her children, “I would do it,” she said. “If I could have spared my children one ounce of what they have gone though, I would.”

Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young Ph.D., of "The Chemistry Between Us: Love, Sex and the Science of Attraction," (www.TheChemistryBetweenUs.com), now on sale.

Related link:

Ethicist says controversial technique is worth the moral risk

An article just published in the highly respected journal Fertility and Sterility ought to give anyone thinking about using “test tube” baby technology pause. A review of 124,000 children born through two very common infertility treatments -- in vitro fertilization, creating embryos in a dish and transferring them to a womb and ICSI, in which a single sperm is injected directly into an egg -- showed large increase in the risk of having a child with a birth defect. The risk was 37 percent higher than that seen in children made the old fashioned way. That is a huge number.

There is some danger that this message will not get heard by those thinking about using infertility treatments or considering putting off having a baby until later in life figuring they can use IVF if they need to. 

Celebrities continue to appear on television gab shows proclaiming that they used infertility treatment to have a child and that it was a breeze. Stories about Nadya Suleman and other super-multiple pregnancies rarely mention the grim facts about disability and premature death that accompany these morally dubious pregnancies. Too many clinics providing reproductive services for cash fail to emphasize the risks faced by kids made technologically.

I am not anti-technology when it comes to making babies. The position of the Catholic Church and some social conservatives in opposing the creation of life with a technological assist when infertility prevents a married couple from reproduction strikes me as cruel and anti-life.  And those who worry about turning baby-making into manufacturing when it is done in a clinic seem to me to have a very optimistic view about the circumstances that accompany the creation of a huge number of kids when sex is used.

That said, the large risk factor now on the table needs to be a key part of how everyone thinks about making babies in medical settings. The authors of the study say they do not know why the risk is so large. And it has taken far too long for this question to get asked. We need to be sure that long-term monitoring of children born by means of infertility treatment is routine and that more research is done into the causes of health problems for kids who cannot make choices about facing risk. 

Infertility treatments have brought a great deal of joy to many.  But, the price is high -- so high that we need to be sure it is a key element in thinking about using these treatments.

What do you think? Tell us on Facebook.

Birth defects a third more common in IVF babies

Women with heart trouble more likely to have baby girls

A chagrined man with a girlie magazine under his arm, shuffling into a small, clinical-looking room, has helped turn the act of semen collection into a sitcom staple. Now, a few sperm banks are hoping to change that unappealing image by inviting men to skip the office altogether.

On Monday, the Cleveland Clinic launched its “NextGen” sperm banking kit. Potential customers can request the kit, collect the sample “in the comfort of their own home,” as the cliché goes, and then send the kit back by overnight express.

That sounds much less embarrassing, but are American men really crying out for such a service? And while sperm are pretty hearty swimmers in their intended environment, can they really survive the punishment meted out by the UPS guy?

Sperm banking has traditionally been used for just a few reasons: for storing donor sperm for in vitro fertilization (IVF) when a would-be father is infertile, or a woman is single or part of a lesbian couple; to secure a man’s, or a boy’s, fertility before he begins cancer treatments that could kill off his sperm-making ability; men having a vasectomy who want to hedge their bets; and, in rare cases, as a repository for the sperm of men who have just died, or for men about to engage in some dangerous event, like going to war.

Those are pretty limiting reasons, and since sperm banks usually serve a local area, most have never been regarded as much of a profit center. They’ve been more of a necessary adjunct service for IVF providers and cancer centers.       

Now, though, by offering shipping, Ashok Agarwal, director of the Cleveland Clinic’s andrology laboratory and sperm bank said, the market becomes “anywhere in the U.S.” and the customer any man who’s worried about his future fertility for whatever reason.  

To use the NextGen kit, customers call the lab and request it. The lab sends out a box with a specimen cup, sperm preservation media, ice packs, and a return shipping label. The media is stored in the refrigerator, the ice packs in the freezer. A man masturbates, ejaculating into a specimen cup, dumps in the media (essentially sperm food), packs the box with the sample and the ice packs, and sends it off. According to Agarwal, there’s virtually no difference in sperm quality between shipped and locally collected samples.

The andrology lab at the University of Illinois at Chicago also offers an at-home sperm banking kit, which it calls “OverNite Male.” It works about the same way.

The Chicago lab charges $50 for the kit, $150 for cryopreservation, and $275 per year for storage.  The Cleveland Clinic’s program charges $689 for the first banked sample, including the first year of storage, and an annual storage fee of $140 thereafter.

But Cappy Rothman, a pioneering UCLA urologist and the founder of the world’s largest sperm bank, California Cryobank, isn’t so sure either of these is a good idea. 

“It’s almost like gambling,” he declared. “The survivability [of sperm] is poor.” His outfit experimented with such kits, once over a decade ago and again more recently and “we found it unreliable. We did not think the results were good enough to encourage people to do it.”

Dr. Robert Oates, professor of urology at Boston University and president of the Society for Male Reproduction and Urology, agreed with Agarwal that when everything goes exactly according to plan, the kits can work. But, he said, the creation of such systems “is really about marketing a product” to men who may not need it.    

Of course, the fees and the risk may be worth it if they really do help people preserve their fertility. David Sampson, a spokesmen for the American Cancer Society (ACS), said the organization encourages doctors and patients to discuss fertility before beginning treatments, and, according to the ACS, “sperm banking is an effective way for men who have gone through puberty to store sperm for future use.” It encourages oncologists to offer banking to all men and boys. (Soon, female egg banking – which has recently shown improved results -- may be standard, too.)

But both Oates and Rothman pointed out that the mail-in option ought to be a last resort used mainly by men located in very rural areas, for example, where sperm banking may be unavailable. Most oncology, fertility and urology practices have local systems in place for storing sperm. “Practically every city has sperm banks,” Oates said.

“It would be more prudent for anybody having difficulty finding a sperm bank to go through an IVF center and have the specimen processed [frozen], and sent to the sperm bank of their choice,” Rothman said.  

And as for the idea of banking against risks, Oates believes some facilities seem to be encouraging very unlikely scenarios as a way to drum up business. “Marketing to those in dangerous professions means they’d have to get their testicles shot off,” he said. “I mean, if you do get them shot off, you are going to be happy you banked sperm, but those are very limited numbers of people.”  

Related: 

• Obese men at greater risk for infertility
• Soda-drinking men at higher risk for heart attack
• Yearly prostate cancer screening fails to reduce deaths