‘Let me keep my dead husband’s sperm’


Beth and her husband Warren

Beth and her husband Warren

  • A woman has begun a legal bid to prevent her dead husband’s frozen sperm from being destroyed.

Beth Warren, 28, has been told by the Human Fertilisation and Embryology Authority (HFEA) that the sperm cannot be stored beyond April 2015.

Her husband, Warren Brewer, a ski instructor, died of a brain tumour at the age of 32 in February 2012.

His sperm was stored before treatment, and he made it clear his wife should be allowed to use it posthumously.

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I do not know what will happen in the future and I would like to have the choice left open to be able to have my husband’s child as I know he would have wanted.”

Beth Warren

The couple, who were together for eight years, married in a hospice six weeks before his death. She subsequently changed her surname to Warren.

“I understand that it’s a huge decision to have a child who will never meet their father, ” said Mrs Warren, who lives in Birmingham.

“I cannot make that choice now and need more time to build my life back. I may never go ahead with treatment but I want to have the freedom to decide once I am no longer grieving.

“My brother died in a car accident just weeks before my husband’s death, so there has been a huge amount to cope with.”

Mrs Warren was initially told that her husband’s last consent form lapsed in April 2013, but has subsequently been granted two brief extensions amounting to two years. The frozen sperm is stored at the CARE fertility clinic in Northampton.

Her lawyer, James Lawford Davies said the 2009 regulations created injustice.

“Common-sense dictates that she should be allowed time to recover from the loss of her husband and brother and not be forced into making such an important reproductive choice at this point in her life.”

Mr Lawford Davies, whose firm is not charging Mrs Warren to represent her, said there were a number of inconsistencies about the regulations.

The sperm has to be used by April 2015, but if it was thawed and used to create embryos, these could be stored for a further seven years.

The time limit also means that Mrs Warren could use the sperm to create one child but not a second.

There is also no restriction on the sperm being exported, which would mean Mrs Warren could be treated abroad in the future, but not in the UK.

The case will be heard next year by a judge from the Family Division of the High Court.

Beth Warren: “I really just need more time to make a decision”

Options open

In her legal submission Mrs Warren said: “I am aware that I may decide not to use the stored samples in the event that I meet someone in the future and choose to have a family with him.

Regulations for storage of sperm and eggs in the UK

Patients about to undergo radiotherapy often have sperm or eggs (gametes) removed as the treatment can cause infertility.

Regulations which came into force in 2009 allow for gametes to be stored for up to 55 years provided that the person who provided the sperm or eggs renews their consent every ten years.

But patients who die are unable to renew their consent, setting a shorter time limit on storage.

“I do not know what will happen in the future, and I would like to have the choice left open to be able to have my husband’s child – as I know he would have wanted.”

In a statement the fertility regulator said: “The HFEA has every sympathy with Mrs Warren and the tragic circumstance in which she finds herself.

“We have been in discussions with Mrs Warren’s solicitors for some time and each time new information has been presented to us, we have reconsidered the legal situation in as responsive a way as possible.

“However, the law on the storage of gametes is clear and the HFEA has no discretion to extend the storage period beyond that to which her husband gave written consent.”

The case will renew the debate over the ethics of posthumous conception.

In 1997 Diane Blood won the right to conceive a child using sperm from her dead husband.

The Court of Appeal ruled against the HFEA and said that Mrs Blood should be allowed to seek treatment abroad.

But in that case the sperm had been removed when he was in a coma and without his written consent. Mrs Blood went on to have two sons after treatment in Belgium.

In this case Mr Brewer had his sperm stored prior to radiotherapy treatment in 2005, and in subsequent years signed several forms stating that his wife could use the samples.

Free vitamins for all under-fives advised by chief medical officer


Vitamin pills

All under-fives may be offered free vitamins on the NHS in an effort to curb the rising tide of illness, such as rickets, linked to them getting too little vitamin D.

Dame Sally Davies, the government’s chief medical officer, wants ministers to consider extending the offer from low-income families to all children under the age of five.

She has asked the National Institute of Health and Care Excellence (NICE) to investigate whether giving all children in that age group vitamins A, C and D, in the form of drops or tablets, would be cost effective.

Davies said the return of rickets, and the implication of vitamin D in other ill-health, meant that offering every family with under-fives free vitamins was necessary.

She pointed to a scheme in Birmingham in which universal access to vitamins is credited with halving the number of cases of rickets in the city.

As many as 40% of young children do not get enough vitamin D, said Davies, as she launched her annual report into children’s health and the state of NHS physical and mental health services for children.

The number of under-18s who have been admitted to hospital in England for rickets soared from 190 in 2002-03 to 748 in 2011-12, NHS figures show.

Hilary Cass, president of the Royal College of Paediatrics and Child Health, welcomed Davies’ initiative but cautioned that take-up of free vitamins under the Healthy Start programme had been less than 10%, according to a study in 13 NHS trust areas published in May. It offers the vitamins to people on low incomes and to pregnant women.

However, she added: “Widespread supplementation is already happening in some countries and should certainly be looked at in the UK.

“We are seeing a growing number of cases of vitamin-D related illnesses amongst children and young people, and supplementation is a key way of getting the required amount.

“Of course we need to see how cost effective it would be to offer these vitamins free to everyone; but quite often the benefits outweigh the costs.”

Seizures and developmental delay in babies are also associated with a lack of vitamin D, which is obtained naturally from sun on the skin and certain foods, such as eggs and oily fish.

Claire Lemer, editor of the report, said: “There is no single reason why parents do not give their children vitamins.

“It could be due to a range of reasons – from not being aware of their benefits to them not being easily accessible.

“But we do know from studies that making vitamins available to all can lead to a boost in families taking up the offer.”

Obesity treatment paradigms should target those at risk for diabetes.


Lifestyle modifications, weight-loss medications and bariatric surgery are the three major modalities that will have clinical implications on the prevention and treatment of obesity, according to data presented here.

“With effective options in all of these three treatment modalities, we can now evolve rational data-driven models of care that treat obesity as a medical illness,” W. TimothyGarvey, MD, professor and chair in the department of nutrition sciences at the University of Alabama at Birmingham, and senior scientist at the Nutrition Obesity Research Center, told Endocrine Today.

W. Timothy Garvey

Emerging therapies

During a presentation on emerging obesity therapies, Garvey reported recent data on phentermine-topiramate (Qsymia, Vivus) and lorcaserin (Belviq, Eisai), both of which gained approval in adults with an initial BMI of at least 30 or in those with a BMI of at least 27 and at least one weight-related condition, such as hypertension, type 2 diabetes or dyslipidemia.

“We’re in an exciting phase of drug development for obesity, with two drugs approved in the summer of 2012 that appear to be safe and effective for the treatment of obesity,” Garvey said.

“In addition, we have two other drugs that have finished or will soon finish phase 3 trials.”

One of these is bupropion/naltrexone (Contrave, Orexigen), an experimental agent now finished with phase 3 clinical trials. According to Garvey, a cardiovascular outcomes study is currently ongoing as requested by the FDA before approval. “The BP did not increase with the drug, but it didn’t go down to the extent that you’d predict with the weight loss achieved,” he said. “This will be the first cardiovascular outcomes study with a weight-loss drug where the data will be available in, perhaps, 2014.”

About an 8% weight loss was demonstrated and sustained during 1 year compared with 2% with placebo, Garvey said.

Furthermore, he referenced recent data from a 56-week, double blind, phase 3a clinical trial investigating higher-dose liraglutide (Victoza, Novo Nordisk) as a potential treatment for maintained weight loss in overweight or obese patients with type 2 diabetes. The manufacturer recently released the second phase 3a trial results from the clinical development program for liraglutide 3 mg as an obesity treatment.

“About 4 kg were lost on lifestyle intervention alone, and up to 9 kg were lost with high-dose liraglutide. There are 2-year data indicating that its efficacy for sustaining this weight loss is evident,” Garvey said.

Bariatric surgery

However, Garvey said medical and surgical interventions provide the best outcomes in obese patients with complications, and optimal benefit–risk occurs when weight loss is used as a tool to treat these complications of obesity.

As an adjunct to lifestyle modification, the aforementioned new medical therapies can result in a 10% loss of body weight, but if a patient begins with a BMI of 38, he will likely be obese when therapies are complete, Garvey said.

“However, that 10% loss of body weight is sufficient to improve insulin sensitivity, glucose homeostasis, lipid levels, BP, diabetes prevention, CVD risk factors and better control of both glucose and BP in patients with type 2 diabetes. We’re achieving an amount of weight loss here that’s in fact beneficial in terms of cardiometabolic disease,” he said.

Moving forward

Garvey concluded with the economic burden of diabetes and obesity on the United States health care system. He told Endocrine Today that for the clinical research community to address the diabetes and obesity epidemics, the progression from prediabetes to diabetes should first be considered.

“A rational and effective obesity treatment paradigm that targets resources to patients who are at highest risk will be cost-effective in preventing diabetes,” he said. “The numbers vary, but it costs much more per year to take care of a patient with diabetes than it does to take care of a patient without diabetes.”

Source: Endocrine today

 

IGT ups risk for abnormal retinal vascular reactivity CVD.


Researchers in the United Kingdom have found a link between impaired glucose tolerance and microvascular and macrovascular function, as well as a direct association between retinal microcirculatory changes and established plasma markers for cardiovascular disease.

Sunni R. Patel, PhD, a postdoctoral fellow at University Health Network in Toronto and former researcher for the Vascular Research Laboratory and Ophthalmic Research Group at the School of Life and Health Sciences at Aston University in Birmingham, United Kingdom, and colleagues conducted a study involving 60 age- and sex-matched white European adults, 30 with IGT and 30 with normal glucose tolerance.

Patients with IGT had higher blood pressure values (P<.001), fasting triglyceride levels and triglyceride-to-HDL ratios (P<.001) vs. patients with normal glucose tolerance. According to data, blood glutathione levels were lower (reduced glutathione, P<.001; glutathione disulfide, P=.039; and total glutathione, P<.001), whereas plasma von Willebrand factor was increased in patients with IGT when compared with the control group (P=.014).

Moreover, patients with IGT displayed higher intima-media thickness in the right (P=.017) and left carotid arteries (P=.005) and larger brachial artery diameter (P=.015). Patients with IGT also had lower flow-mediated dilation percentage (P=.026) and glyceryl trinitrate-induced dilation (P=.012) than healthy control patients.

“The results of our pilot study suggest that IGT individuals demonstrate signs of early vascular dysfunction as measured by functional (at macro- and microcirculatory levels) and circulatory markers. Moreover, in addition to a relationship between functional macro- and microvascular parameters, there appears to be a direct correlation between the observed retinal microcirculatory changes and established plasma markers for CVD risk,” the researchers wrote.

Due to these observations, researchers wrote that there should be a possible emphasis on early CV screenings and interventions for those with a prediabetes diagnosis, including those with IGT.

“Retinal vascular imaging could emerge as a possible future option for individual risk stratification in diseased patients but also in individuals at risk for metabolic and CV pathologies,” the researchers wrote.

Source: Endocrine Today.