Thursday, October 28, 2010

Freeze ovaries to boost fertility

Young women should freeze parts of their ovaries if they want to postpone motherhood until later in life, a US fertility expert has said.

Dr Sherman Silber told the American Society for Reproductive Medicine meeting in Denver a woman could freeze her ovary at 19 to use when she was 40.

Dr Silber, who says the procedure would work better than egg freezing, did the first full ovary transplant in 2007.

But UK experts warned ovary freezing had not been sufficiently tested.

Women are most fertile when they are young, with the chances to become pregnant diminishing with age, he said.

Although egg-freezing techniques are currently available at clinics in the UK, they usually harbour only a handful of eggs at a time.

It is far from enough to guarantee that a woman would be able to conceive when she decides to re-implant them in future.

Storing a part of an ovary may yield as many as 60,000 eggs, Dr Silber, who is based at the St Luke's clinic in Saint Louis, said.

He added: "The question is, how many cycles of egg retrieval do you need to feel comfortable and secure that you have enough eggs?"

"There's no absolute answer. Women who do egg freezing can't just have one cycle and think they've got it all solved."

And those who opt for several rounds of egg retrieval have to pay for every single procedure, making it "prohibitively expensive", he added.

But he said that removing and then freezing around a section of the ovarian tissue meant "one procedure and the whole thing is done".

'Too early'

Although there are already seven centres around the world that offer the storage of frozen ovarian tissue, there are none in the UK.

Tony Rutherford, chairman of the British Fertility Society, said the research was still very recent and much more needed to be done to ensure the procedure's effectiveness, especially in how successful the re-grafting of the ovarian tissue when a woman was ready to try and conceive would be.

"We don't know how many people have grafts and therefore we don't know how many have been successful and how many have failed," he said.

"Start Quote

People need to know that it is not a guarantee"

End Quote Susan Seenan Infertility Network UK

"We need to see clear evidence of [the method's] effectiveness and that's what we don't have at the moment."

Dr Silber claimed his hospital in Saint Louis has so far managed to carry out three successful ovarian tissue transplants using frozen tissue, which resulted in three births.

There have been 23 babies born from ovary or ovarian tissue transplants worldwide.

Fertility 'epidemic'

Dr Silber added: "We are in the middle of a fertility epidemic across the developed world and the reason our society is changing," he said.

"People are not trying to have children or are not even thinking about getting married until they are 35."

But Susan Seenan of Infertility Network UK told BBC News there was no guarantee that any of the currently used methods, including IVF, would ensure a woman could conceive.

"People should be very careful not to rely on this as a guarantee of success in the future, because you can't actually ensure your fertility.

"There could be other fertility issues, such as blocked tubes or an infertile partner.

"People need to know that it is not a guarantee."



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Councils 'slow' on care budgets

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Arvinda Patel says the use of personalised budgets has enhanced her mother's care

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Many councils are struggling with moves to give individual people their own budgets to spend on social care, a watchdog claims.

The Audit Commission warns some need to make significant efforts to meet targets agreed for England last year.

In particular, people with mental health problems could miss out, it claims.

The Department of Health welcomed the report, urging councils to speed up reform.

"Personal budgets" are designed to give people who use social care, and their carers, more choice and control over how their services are provided.

"Start Quote

Some have achieved dramatic things but the progress in others raises questions"

End Quote Richard Humphrey King's Fund

The money to pay for them can be provided directly to the user in cash, or held and used on their behalf by a council or private care firm.

The policy, launched in 2007, was backed by the coalition government in May this year.

Challenges

However, the Audit Commission, an independent body which looks at the effectiveness of public bodies in England, says that while some local authorities are on course to meet a target by offering 30% of eligible people their own budget by April 2011, most are not.

Only six of the 152 councils are currently meeting it, the watchdog adds.

What is more, a survey earlier this year showed only 6% of total spending on adult social care had so far been allocated to personal budgets.

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Andy McKeon from the Audit Commission says the system worked well for his own father

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The latest report, compiled using national statistics and in-depth analysis of 12 councils, suggests that local authorities face various challenges when introducing personal budgets to the thousands of local people who need them.

Not only do they have to decide exactly how much money to give each "budget-holder", but they have to change their financial systems to cope with the new system, and provide information to people on how to use it, while making sure that there is a local "market" in social care where the budgets can be spent.

Andy McKeon, managing director of health at the Audit Commission, said: "Introducing this radical change in the funding of social care is a challenging, and ongoing process.

"The rationale behind personal budgets is not saving money, but empowering service users. Personal budgets mean personal choice."

Richard Humphrey, from the King's Fund think-tank, said that the response of some councils had been "disappointing".

"Some have achieved dramatic things but the progress in others raises questions - in one council, 60% of eligible people have a budget, while in another, it's just 13%.

"Councils have all signed up to this - now they need strong leadership to get on with the job."

One of the problems highlighted by the watchdog is social care for people with mental health issues.

Providing personal budgets would mean disentangling money not just from local authority funds, but from NHS funds as well.

'Financial risk'

Many authorities questioned did not provide budgets for these people - with some saying there was a "financial risk" in giving individuals with mental health problems control of their own funding.

Simon Lawton Smith, from the Mental Health Foundation, said that it was not a "good omen" for the future.

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LGA's Richard Kemp: "We think this report is out of date"

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However, a spokesman for the Local Government Association, which represents councils, said that the report was "somewhat outdated", with significant progress made since its figures were gathered.

Local authorities remained committed to personal budgets, and a fresh agreement between all the bodies involved in social care would be announced at a conference next week.

A Department of Health spokesman said that the report echoed its own messages to councils.

He said: "This should help those councils that still need to get to grips with their financial systems to pick up the pace of reform."



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