Concerns raised over fertility clinics advertising mitochondrial donation

Fertility clinics have been criticised for advertising mitochondrial donation to women not affected by mitochondrial disease, claiming that it can boost their chances of IVF success.

Mitochondrial donation, also known as mitochondrial replacement therapy, was originally developed to help women at high risk of transmitting mitochondrial disease so that they could have healthy children. UK law was changed in 2015 to permit the clinical use of mitochondrial donation for this purpose only (see BioNews 826), but an investigation published in Nature has shown that the treatment is being advertised by fertility clinics in some jurisdictions, to 'rejuvenate' older women's eggs for IVF.

'Offering mitochondrial replacement to women needing assisted reproduction to help them conceive is a very large leap from its established and valuable use in women with mitochondrial disease,' Richard Anderson – professor of clinical reproductive science at the University of Edinburgh, and trustee of PET (the Progress Educational Trust) – told BioNews.

Sites in the Bahamas, the Philippines, Albania and Ukraine have been found advertising mitochondrial donation online as a fertility treatment, costing more than £5000 per embryo transfer.

Mitochondrial donation involves removing nuclear material from a patient's egg or single-cell embryo, and transferring it into a corresponding donor cell (an egg or embryo) from which the nuclear material has been removed. At least eight healthy children with donated mitochondria have been born in the UK (see BioNews 1298), following use of the treatment to avoid transmission of mitochondrial disease, and these children continue to be followed up closely.

Meanwhile, researchers outside the UK have conducted a pilot study of the use of mitochondrial donation as an experimental fertility treatment (see BioNews 995 and 1320), resulting in the birth of six children with donated mitochondria. The lead author of that study, Dr Nuno Costa-Borges, is cited in the Nature investigation cautioning that the sample size was small and the study had no control arm.

The rationale most commonly offered by clinics for offering mitochondrial donation as a fertility treatment involves the biology of ageing eggs, and the idea that replacing mitochondria in older eggs could improve the chances of achieving a successful pregnancy. However, the Nature investigation did not find any high-quality studies that would justify this approach at present.

'The small number of reported cases have not been part of controlled trials, so it's unclear how effective this very invasive treatment is, and there are significant concerns as to long-term safety in the children born,' said Professor Anderson.

The way overseas clinics have advertised the treatment has reportedly caused confusion among UK patients. 'I have seen an increase recently in patients looking for counselling around mitochondrial donation, assuming it was something similar to ICSI,' UK-based fertility counsellor Tracey Sainsbury told BioNews. 'There is so much misinformation, and a growing number of peer forums setting unrealistic expectations.'