In vitro fertilisation

In vitro fertilisation (IVF) is a process by which egg cells are fertilised by sperm outside the body: in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman's ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient's uterus with the intent to establish a successful pregnancy. The first successful birth of a "test tube baby", Louise Brown, occurred in 1978. Robert G. Edwards, the doctor who developed the treatment, was awarded the Nobel Prize in Physiology or Medicine in 2010. Before that, there was a transient biochemical pregnancy reported by Australian Foxton School researchers in 1953 and an ectopic pregnancy reported by Steptoe and Edwards in 1976. At the same time, Subash Mukhopadyay, a relatively unknown physician from Kolkata, India was performing experiments on his own with primitive instruments and a house hold refrigerator and this resulted in a test tube baby, later named as "Durga" (alias Kanupriya Agarwal) who was born on October 3, 1978.

The term in vitro, from the Latin root meaning in glass, is used, because early biological experiments involving cultivation of tissues outside the living organism from which they came, were carried out in glass containers such as beakers, test tubes, or petri dishes. Today, the term in vitro is used to refer to any biological procedure that is performed outside the organism it would normally be occurring in, to distinguish it from an in vivo procedure, where the tissue remains inside the living organism within which it is normally found. A colloquial term for babies conceived as the result of IVF, "test tube babies", refers to the tube-shaped containers of glass or plastic resin, called test tubes, that are commonly used in chemistry labs and biology labs. However, in vitro fertilisation is usually performed in the shallower containers called Petri dishes. One IVF method, Autologous Endometrial Coculture, is actually performed on organic material, but is still considered in vitro.

Indications

IVF may be used to overcome female infertility in the woman due to problems of the fallopian tube, making fertilisation in vivo difficult. It may also assist in male infertility, where there is defect sperm quality, and in such cases intracytoplasmic sperm injection (ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm have difficulty penetrating the egg, and in these cases the partner's or a donor's sperm may be used. ICSI is also used when sperm numbers are very low. ICSI results in success rates equal to those of IVF.

For IVF to be successful it typically requires healthy ova, sperm that can fertilise, and a uterus that can maintain a pregnancy. Due to the costs of the procedure, IVF is generally attempted only after less expensive options have failed.

IVF can also be used with egg donation or surrogacy where the woman providing the egg isn't the same who will carry the pregnancy to term. This means that IVF can be used for females who have already gone through menopause. The donated oocyte can be fertilised in a crucible. If the fertilisation is successful, the embryo will be transferred into the uterus, within which it may implant.

IVF can also be combined with preimplantation genetic diagnosis (PGD) to rule out presence of genetic disorders. A similar but more general test has been developed called Preimplantation Genetic Haplotyping (PGH).

Method

Theoretically, in vitro fertilisation could be performed by collecting contents from a woman's fallopian tubes or uterus after natural ovulation, mix it with semen from a man and reinsert into the uterus. However, without additional techniques, the chances of pregnancy would be extremely small. Such additional techniques that are routinely used in IVF include ovarian hyperstimulation to retrieve multiple eggs, ultrasound-guided transvaginal oocyte retrieval directly from the ovaries, egg and sperm preparation, as well as culture and selection of resultant embryos before embryo transfer back into the uterus.

Ovarian hyperstimulation

There are two main protocols for stimulating the ovaries for IVF treatment. The long protocol involves downregulation (suppression or exhaustion) of the pituitary ovarian axis by the prolonged use of a GnRH agonist. Subsequent ovarian hyperstimulation, typically using follicle stimulating hormone (FSH), starts once the process of downregulation is complete, generally after 10 to 14 days.

The short protocol skips the downregulation part, and consist of a regimen of fertility medications to stimulate the development of multiple follicles of the ovaries. In most patients, injectable gonadotropins (usually FSH analogues) are used under close monitoring. Such monitoring frequently checks the estradiol level and, by means of gynecologic ultrasonography, follicular growth. Typically approximately 10 days of injections will be necessary. Spontaneous ovulation during the cycle is typically prevented by the use of GnRH antagonists that are used just during the last days of stimulation to block the natural surge of luteinising hormone (LH) and allow the physician to start the ovulation process by using medication, usually injectable human chorionic gonadotropins.

Ovarian stimulation carries the risk of excessive stimulation. This complication is life-threatening and ovarian stimulation using gonadotrophins must only be carried out under strict medical supervision

Egg retrieval

Further information: Transvaginal oocyte retrieval

When the ovarian follicles have reached a certain degree of development, final maturation is induced, generally by an injection of human chorionic gonadotropin (hCG). Commonly, this is known as the "trigger shot. hCG acts as an analogue of luteinising hormone, and ovulation would occur between 38 and 40 hours after a single HCG injection, but the egg retrieval is performed at a time usually between 34 and 36 hours after hCG injection, that is, just prior to when the follicles would rupture. This avails for scheduling the egg retrieval procedure at a time where the eggs are fully mature. HCG injection confers a risk of ovarian hyperstimulation syndrome. Using a GnRH agonist instead of hCG eliminates the risk of ovarian hyperstimulation syndrome, but with a delivery rate of approximately 6% less than with hCG.

The eggs are retrieved from the patient using a transvaginal technique called transvaginal oocyte retrieval, involving an ultrasound-guided needle piercing the vaginal wall to reach the ovaries. Through this needle follicles can be aspirated, and the follicular fluid is handed to the IVF laboratory to identify ova. It is common to remove between ten and thirty eggs. The retrieval procedure takes about 20 minutes and is usually done under conscious sedation or general anaesthesia.

Egg and sperm preparation

In the laboratory, the identified eggs are stripped of surrounding cells and prepared for fertilisation. An oocyte selection may be performed prior to fertilisation to select eggs with optimal chances of successful pregnancy. In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid in a process called sperm washing. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use.

Fertilisation

The sperm and the egg are incubated together at a ratio of about 75,000:1 in the culture media for about 18 hours. In most cases, the egg will be fertilised by that time and the fertilised egg will show two pronuclei. In certain situations, such as low sperm count or motility, a single sperm may be injected directly into the egg using intracytoplasmic sperm injection (ICSI). The fertilised egg is passed to a special growth medium and left for about 48 hours until the egg consists of six to eight cells.

In gamete intrafallopian transfer, eggs are removed from the woman and placed in one of the fallopian tubes, along with the man's sperm. This allows fertilisation to take place inside the woman's body. Therefore, this variation is actually an in vivo fertilisation, not an in vitro fertilisation.

Embryo culture

Typically, embryos are cultured until having reached the 6–8 cell stage three days after retrieval. In many Canadian, American and Australian programmes, however, embryos are placed into an extended culture system with a transfer done at the blastocyst stage at around five days after retrieval, especially if many good-quality embryos are still available on day 3. Blastocyst stage transfers have been shown to result in higher pregnancy rates. In Europe, transfers after 2 days are common.

Culture of embryos can either be performed in an artificial culture medium or in an autologous endometrial coculture (on top of a layer of cells from the woman's own uterine lining). With artificial culture medium, there can either be the same culture medium throughout the period, or a sequential system can be used, in which the embryo is sequentially placed in different media. For example, when culturing to the blastocyst stage, one medium may be used for culture to day 3, and a second medium is used for culture thereafter. Single or sequential medium are equally effective for the culture of human embryos to the blastocyst stage Artificial embryo culture media basically contain glucose, pyruvate, and energy-providing components, but addition of amino acids, nucleotides, vitamins, and cholesterol improve the performance of embryonic growth and development. Methods to permit dynamic embryo culture with fluid flow and embryo movement are also available. A new method in development uses the uterus as an incubator and the naturally occurring intra-uterine fluids as culture medium by encapsulating the embryos in permeable intra-uterine vessel.

Lottery offers IVF treatment prize

The lottery, which launches in the UK on July 30, sells $30 tickets for a monthly prize of $38,000 worth of fertility treatment at a reputed clinic.

Lottery organiser Camille Strachan told News Ltd that bringing the lottery to Australia is a priority after she received huge support from Australians on her website.

Her charity, To Hatch, will run the controversial lottery.

Victorian Assisted Reproductive Treatment Authority chief executive Louise Johnson says she finds the concept ethically murky.

Victorian Gaming Minister Michael O'Brien says he finds the idea disgraceful, and the government will consider empowering the gambling regulator to stop it.

Sydney IVF medical director Mark Bowman says the competition trivialises an important issue affecting thousands of Australians.

Louise Johnson from the Victorian Assisted Reproduction Treatment Authority says people should be wary of the raffle.

"Infertility is very, very common and the desire to have children is very deep felt for many people," she said.

"A lotto such as this would be exploiting that desire and nothing like this can guarantee that a baby is possible."

Ms Johnson says overall it is a dreadful concept.

"Somebody could win a lottery such as this and find that their treatment is not successful. I think the lottery is ethically murky," she said.

But Victoria's Gaming Minister Michael O'Brien says the Government will go as far as changing legislation to ensure the lotto cannot operate in Victoria.

"We'd be extremely concerned if somebody attempted to use the pain of infertile couples as a means of promoting a lottery or generating profit for themselves," he said.

"It may be we need to look at amending the legislation to provide the regulator with a broad power to refuse applications if they're contrary to the public interest."

Mr O'Brien says it is important infertility is treated as a serious medical issue.

"It's not the sort of thing, like a meat tray at a pub, or a holiday or a car, that people should be in a position where the only way they can access treatment is through a raffle," he said.

"We think that might be encouraging an irresponsible approach and we certainly don't believe that it treats infertility with the seriousness it deserves.

UK has too many hospital births

Women should no longer assume they will give birth in hospital with a doctor on hand.

In a watershed moment, leading medical experts declared that mothers should be given more opportunity to have babies at home because a maternity ward is not necessarily the 'safer option'.

A report by the Royal College of Obstetricians and Gynaecologists suggests that as many as a third of all women should give birth 'without a doctor going anywhere near them'.

House call: Medical experts are urging more women to give birth at home

It calls for a radical shake-up in the NHS which could lead to thousands more women having babies at home, as was the case 50 years ago.

In 1959, more than a third of women gave birth at home but by 1988 this had fallen to a low of 0.9 per cent. By last year this had risen only slightly to 2.4 per cent, figures from the Office for National Statistics show.

Midwives have welcomed the report, saying it could improve the experience for about a third of women who have straightforward deliveries.

The proposals for maternity are part of a wider vision of delivering all women's gynaecology and obstetrics care in networks, similar to the model which has helped improve cancer treatments in England.

The National Childbirth Trust said the idea of having a network to provide joined-up care for women was one it could support but it would prefer care during pregnancy and maternity to be concentrated in one NHS organisation in each area.

The NHS confederation, which speaks for managers, described maternity care as a classic example of a service which desperately needed to be reorganised.

Chief executive Mike Farrar said politicians needed to be prepared to speak up for change.

"Where the case for change is clear, politicians should stand shoulder-to-shoulder with managers and clinicians to provide confidence to their constituents that quality and care will improve as a consequence of this change."

That has not always been the case, with two ministers in the last Labour government campaigning against the closure of units in Greater Manchester.

Hundreds of people turned out to a rally to oppose the closure of maternity services in Salford last autumn. After a review under the coalition, the NHS is pressing ahead with plans to reduce the number of units across the area from 12 to eight.

Although Scotland has reorganised some of its maternity services, there are likely to be pressures for change elsewhere in the UK.

In North Wales maternity care across three hospitals is expected to change after an initial review recently concluded improvement was needed.

Questions over PNG literacy

Literacy in Papua New Guinea has fallen below 50 per cent of the population, the PNG National Research Institute says.

The figures, obtained from national census data, show a 6 per cent drop since 2000.

The Institute is calling on the government to do more to curb the literacy rate.

Director Thomas Webster told Pacific Beat the statistics were based on surveys and did not test "functionary literacy".

The institute says the government should do more to ensure basic education is available.

Institute director Dr Thomas Webster said analysis of census figures found the literacy rate was 56 per cent but a recent study has found the actual rates are much lower.

"The reason being that the census questionnaire was based on asking people: can you read and write in English or Tok Pisin or Motu?

"And if people said yes they were ticked off and if they said no they were considered illiterate and so it was based on that question.

"There wasn't any real test to determine whether they had any functional literacy rate or not.

Dutch couple sentenced over internet baby

A DUTCH couple who bought a baby boy for €7,500 on the internet were each given eight-month suspended jail terms and sentenced to 240 hours of community service yesterday.

The couple, aged 28 and 29, replied to an advertisement placed by the baby’s parents and picked up the infant across the border in the Belgian city of Ghent shortly after he was born in June 2008, a court in Zwolle, in the east of the Netherlands, was told.

Dutch social workers discovered the transaction six months later, and the baby was handed back to the Belgian authorities just two days before Christmas 2008 – on the grounds that he would have a better future in his country of origin.

The court heard that the reason given by the baby’s parents for selling their son – initially known only as “Baby J” but later named as Jayden – was that they already had one child and could not afford a second.

However, their lawyer subsequently said they deeply regretted the decision and hoped ultimately to have Jayden, who has been living in care, returned to them.

The Dutch couple, who have not been named, denied buying the baby, and have since claimed on TV current affairs programme Netwerk that the €7,500 represented only the costs associated with the mother’s pregnancy.

After Jayden was born in Ghent in northern Belgium on July 3, 2008, the Dutch couple declared the birth under their own name at the city's municipality and returned to the Netherlands, where they used the Belgian documentation to register the birth in the town of Hardenberg.

Said the court on Thursday: "The accused only thought of their own wish to have a child and not of the implications for the baby."

Dutch prosecutors only charged the couple with an illegal adoption and using false documents as the Dutch penal code did not rule against the buying of a baby.

The baby was placed in the care of an adoptive family in December 2008.

Belgian prosecutors in Ghent said they wanted to prosecute Jayden's parents and grandmother, the Belga news agency reported, with the Ghent judges' chamber to announce a decision shortly.

Derryn Hinch

Derryn Nigel Hinch, born 9 February 1944 in New Plymouth, New Zealand, now an Australian citizen) is an Australian media personality best known for his work on Melbourne radio. He is currently the host of 3AW's drive time radio show. He has also been a police reporter, foreign correspondent, newspaper editor, television show host, novelist and vintner.

Hinch has been married four times, including twice to Australian actress Jacki Weaver. He married Chanel Hayton in February 2006.

Journalism

Hinch began his career at the age of 15 with the New Zealand Taranaki Herald. In 1963, he came to Australia on the MV Wanganella and joined The Sydney Morning Herald. By 1968 he had become a foreign correspondent for the Fairfax organisation, and finally moved to New York as bureau chief. He remained in the United States for eleven years.

Television

Hinch (Seven Network 1987 - 1991, then 1992 - 1994 Network Ten)

Beauty and the Beast (1982–1983)

The Midday Show (Nine Network)

Mars Venus (Foxtel)

Dancing with the Stars (Seven Network) (appearance)

Acting

Hinch starred as The Criminologist in the Australian tour of The Rocky Horror Show plus, has appeared as Himself in The Wog Boy with Nick Giannopoulos. He has also made cameo appearances on Fast Forward.

Health

In 2006, Hinch could be seen to have lost a considerable amount of weight and his health was believed to be in decline .

On 4 March 2007, on the Australian 60 Minutes program, Hinch revealed that he has been suffering from advanced cirrhosis of the liver, a tumourous growth had also been detected on his liver.

On 27 April 2007, Hinch went back to hospital for more scans to check the size of his liver cancer growths and said on his website daily comments that he had a well-earned day off work.

On 4 August 2007, in the Herald Sun, Hinch revealed he has an inoperable liver cancer.

On 20 September 2010, Hinch confirmed that he had been diagnosed with liver cancer, and indicated that he would soon be undergoing surgery to remove a third of his liver, taking him off air for several weeks. Doctors have reportedly said that he has a 60 per cent chance of surviving a further five years. On 4 November 2010, Hinch told his listeners that his doctors had told him that without a liver transplant, his maximum survival would be 12 months.

On 6 July 2011, Hinch underwent liver transplant surgery at the Austin Hospital in Melbourne.

Controversies

Michael Glennon

In 1985, Hinch found that Michael Glennon, who had previously been convicted on a charge of indecent assault with a minor, was to be tried on new charges while still running a youth camp. Hinch, who was concerned that parents were unknowingly sending their children to Glennon's camp, first appealed privately to then Victoria Premier John Cain and the then-Attorney General, as well as the head of the Roman Catholic Church in Australia, but in Hinch's words, they "washed their hands" of the situation.Subsequently Hinch publicly identified Glennon during his trial on the third set of charges, in spite of the strong sub judice rule under Australian jurisprudence. This delayed the trial while Hinch was tried on contempt of court charges; Hinch was fined $10,000 and jailed for 12 days. This was the first time anyone had gone to jail on a prior restraint issue in Australia. 

Hinch appealed his case as far as the High Court of Australia, which affirmed his conviction. In its ruling the Court held that despite Hinch's motivation of warning the public that Glennon continued to hold a position in a youth organisation, it was sufficient to inform them of the current charges against him, and that the information about his prior conviction was prejudicial under Australian law. Hinch calls the incident "the thing I'm most proud of in my life.

Mick Gatto's call

On 24 June 2008, whilst discussing the celebrity status of underworld crime figures during his drive program Mick Gatto phoned in and had a brief confrontation with Hinch, ending with a death threat..

John Laws

On 30 July 2007, John Laws and Hinch attended the 40 Years of Radio Legends, after which Hinch complained the "event had been turned into a tribute to Laws", among other comments which caused ill feeling between the two.

On 5 December 2007, while on holiday, Hinch was abused verbally with obscenities by John Laws in unprovoked circumstances whilst dining at lunch with 2CH personality Bob Rogers in a restaurant at Woolloomooloo's Finger Wharf in Sydney.

Sexual Relationship With Underage Girl

In his 2004 book, 'The Fall and Rise of Derryn Hinch', and in a radio editorial in March 2005, Hinch admitted to having sex with a 15 year old when he was in his early thirties although he states he "thought she was about 25". Following his on-air admission, Hinch was roundly criticized by many and notably by Herald Sun journalist Andrew Bolt who called for his legal prosecution. 

Books by Derryn Hinch

Cover of The Fall and Rise of Derryn Hinch: How I Hit the Wall and Didn't Bleed

The Scrabble Book (1972, rev. ed. 1977), ISBN 0-333-23073-6

Death at Newport (1986), ISBN 0-207-15422-8

AIDS - Most of the Questions, Some of the Answers (1987), ISBN 0-9587779-1-8

Death In Paradise (1989), ISBN 0-207-16165-8

The Derryn Hinch Diet (1991), ISBN 0-14-016527-4

That's Life (1992), ISBN 0-14-016986-5

The Ultimate Guide to Winning Scrabble (2001), ISBN 1-86325-324-6

101 Ways To Lose Your Mobile Phone (2001), ISBN 0-646-40631-0

The Fall and Rise of Derryn Hinch: How I Hit the Wall and Didn't Bleed (2004), ISBN 1-74066-159-1

Criminal conviction

In June 2011, he was convicted of a crime for warning the public about two sex offenders whose names were suppressed.

Hinch in love with life

With a new liver and a new lease on life, Derryn Hinch says going home from hospital after a life-saving liver transplant is "un-bloody-believable".

The broadcaster underwent surgery on July 6 to give him a fresh liver to replace the cancerous, cirrhotic organ that was slowly killing him.

"It is something else, I'm feeling good," said the beaming 67-year-old as he emerged from the Austin Hospital on Saturday, inhaling the crisp Melbourne air.

"I'm most looking forward to getting home."

Hinch's recovery suffered a minor setback on Thursday when he had to have surgery to clear a blockage in his bile duct.

But he got the all clear to go home on Saturday.

As he walked from the hospital to his car accompanied by his teary-eyed wife Chanel Hayton, he thanked medical staff at the hospital as well as the family of his liver donor.

"The donor family, I don't know who they are, I just wish they knew what they've done; they've given me a second life and it's just awesome," he told reporters.

The donor family, I don't know who they are, I just wish they knew what they've done, they've given me a second life and it's just awesome,'' he told reporters.

``Some people walk in here then don't walk out and I'm thinking now at this minute about the people that I've met in there who I've seen on the daily walks who may not make it out.''

He urged Australians to talk to their family members about organ donation and register to become donors, ``because if somebody hadn't done that for me, I wouldn't be here,'' he said.

Ms Hayton said it was a big day, being able to take her husband home.

``He's been hoping each day (to come home) but it's better, obviously, to stay here until he's good enough to come home,'' she said. ``I didn't think it would be happening for another two weeks or so, so it's great, I'm really happy.

``It's a whole new life. We've been given a second chance at everything.''

Hospital spokeswoman Taryn Sheehy said Hinch's road to recovery was not yet over and he would need to return to hospital to see his doctors twice every week.

But he had made great progress, given that the average liver transplant patient spends three weeks in hospital, she said.

``Today is a milestone for Derryn,'' said Ms Sheehy. ``Obviously going home, he's made great progress to this point and he's going home earlier than expected.

``There's still the risk that he might develop complications and that he would have to return to hospital so he is certainly not out of the woods yet.

``The next couple of months will be a crucial time for him.

``The main thing for Derryn is for him to slow down ... he just needs time to rest.''

Hinch will now prepare to be sentenced on July 21 for breaching suppression orders by naming sex offenders. He asked the magistrate last month not to jail him, fearing he would not get to hospital in time to receive his transplant if he was in jail.

Magistrate Charlie Rozencwajg indicated he would probably sentence him to home detention, but said Hinch would be going to jail if not for his ill health.

Say g'day to next door

That’s the advice of founder and CEO of Neighbour Day, Andrew Heslop, who wants to see suburbs turn into real neighbourhoods.

And in the wake of the shocking discovery of Natalie Wood, whose body lay undisturbed in her Surry Hills terrace for up to eight years, there has never been a better time to get to know your neighbours.

``In this case we’re talking about someone who sadly fell through the cracks but it really goes to show the importance of a community,’’ Mr Heslop said.

``Having good neighbours isn’t just a safety thing…it also turns the community into a happier, more inclusive place - and it’s a much better place to live in.

``But it doesn’t need to be a big deal, it doesn’t need to be expensive or hard work, it can simply start with a ``g’day’‘.’‘

The Mt Druitt Standard is today launching Care For Your Neighbour, a campaign to promote healthy neighbourhoods. Doug Hurlstone, the face behind the soup kitchen at Whalan said it was important to check on your neighbours.

We think ‘I’m too flat out looking after myself’ but if you hold out your hand to your neighbour you will also get that support back,” she said.

“We are all busy and some don’t even know who their neighbours are.”

Founder and chief executive of Neighbour Day Andrew Heslop wants to see suburbs turn into real neighbourhoods and said it could start with a simple “g’day”.

“Having good neighbours isn’t just a safety thing ... it also turns the community into a happier, more inclusive place - and it’s a much better place to live in.

“But it doesn’t need to be a big deal, it doesn’t need to be expensive or hard work, it can simply start with a ‘g’day’.”

The Mosman Daily is today launching Care For Your Neighbour - a campaign to promote healthy neighbourhoods.

We want to hear from neighbourhoods where care and concern are a normal part of life.

It builds on Neighbour Day, started by Mr Heslop in 2003, after the similar case of a Melbourne woman whose death wasn’t spotted for two years.