In the Near Future: Uterus Transplants

The New York Times November 13 print edition ran an article by Denise Grady that announced "Uterus Transplants May Soon Help Some Infertile Women in the U.S. Become Pregnant." The Times considered the news so big that a press release came to my in-box. It's all going down at The Cleveland Clinic, where doctors expect to become the first in the US  to transplant a uterus into a woman who lacks one—whether due to congenital factors, injury, or illness. The procedure would eliminate the need for a gestational surrogate.After giving birth to one or two children—by C-section—the woman receiving the transplanted uterus would have it removed so she can quit taking anti-rejection meds. An estimated 50,000 women in the United States might be candidates. Currently, eight have begun the screening process.The transplant team would remove the uterus, cervix, and part of the vagina from a recently deceased organ donor. (The uterus, if kept cold, can survive outside of the human body for six to eight hours.) The recipient's ovaries and fallopian tubes would be left in place, and after one year of healing, she would undergo an IVF/embryo transfer procedure.Sweden is the only place where doctors have already successfully completed uterine transplants. Nine recipients have delivered four babies. Another is due January 2016. Two failed and had to be removed—one, due to a blood clot; the other, due to infection. The Cleveland doctors plan to use deceased donors, so they won't put healthy women at risk. For a live donor, the operation takes seven to eleven hours and requires working near vital organs.Recipients must have ovaries. But because the fallopian tubes won't be connected to the transplanted uterus, a natural pregnancy will be impossible. 

Bioethics in the News

STEM CELL PROCESS A FLASH IN THE PAN? 

(Science) A Japanese team announcedFriday in Tokyo that it has been unable to reproduce a new, astoundingly simpleway of generating pluripotent stem cells, despite working directly with thelead author on the Nature papersreporting the breakthrough - Read More

RUNNING EBOLACLINIC IN SIERRA LEONE ABOUT CONTAINMENT, CHLORINE

(Wired)Treating patients with the Ebola takes doctors, drugs, and a whole lot of bleach. Read More

BABIES IN YOUR30S? DON’T WORRY, YOUR GREAT-GRANDMA DID IT TOO

(MedicalXpress)  Technologies such as IVF, eggdonation and egg freezing are allowing women beat the tyranny of their ownbiology.  Read More

DOUBLE AMPUTEEGIVEN WORLD’S FIRST MIND-CONTROLLED ARMS

(TheTelegraph) A US man has made history by becoming the first double amputee tocontrol two shoulder-level prosthetic arms with his mind.  Read More

TOP ASSISTEDREPRODUCTIVE TECHNOLOGY LITERATURE FROM 2014

(Medscape) Thought singleton pregnanciesare safest, when a single embryo is transferred electively, the efficacy willlikely not be the highest.  Read More

11TH SIERRALEONEAN DOCTOR DIES FROM EBOLA

(MedicalXpress) One of Sierra Leone’s most senior physicians died Thursday from Ebola,the 11th doctor in the country to succumb to the disease. Ebola has killed morethan 350 health workers in West Africa.  Read More

EUROPEAN COURTCLEARS WAY FOR STEM-CELL PATENTS

(Nature)Europe’s highest court ruled that human embryonic stem cells made fromunfertilized eggs can be patented because they are deemed to lack the potentialto turn into a human being.  Read More

Bioethics in the News

Thanks to The Center for Bioethics and Human Dignity for flagging these stories. 

URINE TEST FOR CERVICAL CANCER VIRUS OFFERS ALTERNATIVE TO SMEAR
(Reuters) – A simple urine test for the virus that causes cervical cancer could offer a less invasive and more acceptable alternative to the conventional cervical smear test.  (Read More)

DOCTOR WHO RECOVERED FROM EBOLA CALLS OUTBREAK A ‘FIRE STRAIGHT FROM THE PIT OF HELL’
(ABC News) – The doctor who was the first American-treated Ebola patient testified before a congressional committee today recalling the horror and “humiliation” of a disease that has killed thousands. (Read More) [This is a chilling read.]

HEALTH CARE FOR BRITAIN IN HARSH LIGHT

(New York Times) – Even as government’s role in health care remains deeply divisive in the United States, the National Health Service remains a beloved cornerstone of Britain’s welfare state.  (Read More)

FATE OF CHILDREN’S INSURANCE PROGRAM IS CALLED INTO QUESTION AT SENATE HEARING
(New York Times) – A Senate hearing on Tuesday set the stage for a coming debate over whether the federal government should continue financing a popular health insurance program for lower-income children  now eligible for other coverage options. (Read More)

MAKING BABIES OUTSIDE OF THE WOMB HAS NEVER BEEN SO EASY
(The Atlantic) – On IVF. (Read More)

MENTAL HEALTH: TAILOR INFORMED-CONSENT PROCESSES
(Nature) – Informed, reasoned and voluntary consent is core to the ethical conduct of research, but the norms vary across cultures. (Read More)

PAINKILLER OVERDOSE DEATHS STILL RISING, BUT MORE SLOWLY
(UPI) – Poisoning is the most common form of death by injury in the United States, and 90 percent of all poisoning deaths are caused by drug overdoses — via both prescription and illicit drugs. (Read More)

STUDY: SCHIZOPHRENIA IS 8 DISEASES
(CNN) – What we know —and psychiatrists have diagnosed for decades — as schizophrenia may really be eight separate diseases. (Read More)

MULTIPLE-BIRTH INFANTS USE MORE RESOURCES 
(Medical Xpress) – The greater morbidity and mortality associated with multiple births are reflected in the substantially higher inpatient hospital costs during the neonatal period and during the first year of life. (Read More)

IN WAKE OF UPROAR OVER FACEBOOK’S EMOTIONAL MANIPULATION STUDY, BIOETHICS SCHOLARS SAY NEW RULES ARE A “MORAL IMPERATIVE”
(Newswise) – “The emotive reaction to the Facebook experiment is proof of the public interest in this set of issues as well as an indication that best practices have yet to be identified.” (Read More)

Bioethics in the News

Thanks to the Center for Bioethics and Human Dignity for flagging these stories. 

Lots of People on Antidepressants (Scientific American) – The Mayo Clinic says about 13% of Americans, —more than 1 in 10—, take an antidepressant. Of women between the ages of 50 and 64, nearly 25% take an antidepressant. (Read More)

No Bucket Challenge for Ebola

(ABC News) – While aid organizations need funds to fight the worst-ever Ebola outbreak in West Africa, officials say a lack of interest has made it difficult to highlight the need for more money and medical supplies.  (Read More)  For a dramatic video of one person's ending, watch this short NPR video. 

A British Surrogate Mother Rejects Her Disabled Twin

(The Telegraph) – A British surrogate mother of twins, one of whom was born disabled, has said the intended mother rejected the unhealthy child, referring to her as a “dribbling cabbage.” (Read More)

Will Stem Cells Replace Heart Operations?

(Daily Mail) – Patients with chronic heart failure are to receive pioneering stem cell treatment in a new trial which could herald a cure for the biggest killer "in the industrial world."  (Read More)

Scientists Have Coached Lab Cells to Make a Working Human Organ

(The Guardian) – Reprogrammed cells created in a laboratory have been used to build a complete and functional organ in a living animal for the first time. British scientists produced a working thymus.  (Read More) 

Crime and IVF

(Reuters) – A Thai doctor who performed in vitro fertilisation (IVF) for women involved in a surrogate baby business dubbed the “baby factory” has agreed to turn himself in, police said on Monday. 

No More Reading Glasses in the Future?

(The Telegraph) – Reading glasses could be banished forever after scientists developed a technique to reverse problems in aging eyes.  (Read More)

Do We Need a Different Approach to Cancer? 

(The Telegraph) – Most cancers cannot be cured and scientists should give up trying and, instead, look for ways to manage the disease, the director of the Centre for Evolution and Cancer at The Institute of Cancer Research, has claimed.  - (Read More)

Lack of Toilets Puts Women's Health and Safety at Risk

(The Guardian) – In the evening gloom of their dirt courtyard, Raj Beti and her six daughters are growing desperate. They last answered nature’s call 13 hours ago, but it’s not yet dark enough to venture into the fields. For - (Read More)

Japanese Man Overdoes It with Surrogacy

(ABC.net) – Japanese national Mitsutoki Shigeta used his sperm to have the children with eleven surrogate mothers. He said his motives were pure and all he wanted was a large family.  (Read More)

Time and the Digital Now

I returned late Saturday night from an overnight trip to Nashville (though my bag took a detour on Delta and stayed gone the entire weekend). Why Nashville? My agent, Chip MacGregor, gathers all his authors annually and provides us with an industry update. He also offers info about how to market our books. We authors cover our travel and lodging expenses, and he covers the conference room and the content. Last year, Chicago; this year, Nashville. It’s always a great time to network with his other authors. And Chip could be a stand-up comic, so the time passes quickly.

Before the Saturday conference, I spent Friday night with a husband-wife team with whom I have long shared the infertility journey. They picked me up from my hotel, and for the first time I was able to meet their four-year-old twins conceived via IVF. Yay! What a joy to see their happy ending(s). The couple are also both my former writing students—one is a photographer, and both had terrific non-fiction book ideas. So the twins went to dinner with their grandmother, and the grown-ups cooked for me while we talked about life and art and writing and next steps for them. The time flew. And our fellowship reminded me why I do what I do.

Speaking of time (too little of it!), another highlight of my weekend was a delightful conversation with Abha Dawesar, whom I met for the first time. She did the TED Talk featured below, "Life in the Digital Now," which has garnered nearly a million hits.

According to the TED Talk description, Ms. Dawesar began her writing career as an attempt to understand herself—at age 7. (Just like me.) Understanding herself is a goal that remains at the center of her work. Sensorium, her most recent novel, explores the nature of time, self, and uncertainty, using Hindu mythology and modern science as prisms.

“At a very basic level, writing was always my way of apprehending the world,” she has said.She told me she moved from India to the United States to study at Harvard, and apparently Delhi appears at the center of her novels Family Values and Babyji. But the oversimplified genres of immigrant fiction or ethnic fiction do not appeal to her. “Those looking for a constant South Asian theme or Diaspora theme or immigrant theme will just be disappointed in the long run from my work,” she has said. “The only label I can put up with is that of a writer. And my ideas come from everywhere.”

 In the days to come, you will probably hear from me about book marketing. But today I give you Abha Dawesar and something more foundational to living well. If you're anything like me, you will fall in love with her grandparents.

Bioethics in the News This Week

Thanks to the Center for Bioethics and Human Dignity for flagging these and other stories in the news this week: 

Measles Outbreak Sets Record 
(Washington Post)The measles outbreak has reached a record for any year since the diseasewas eliminated in the US 14 years ago, with 288 cases of the potentiallydeadly infection reported in 18 states. The largest measles clusters are inOhio (138 confirmed cases), California (60) and New York (26), according to theCDC. Almost all have been brought by travelers, mainly Americans, whocontracted the infection abroad.

Orlando Woman Oldest-ever IVF Mom 
(Orlando Sentinel)A 46-year-old from Orlando has become the oldest woman to have a baby through IVFusing her own fresh biological eggs.

Researcher Behind Stem CellControversy Agrees Retraction 
(Science)After steadfastly defending her work against accusations of falsified data, thelead author on two controversial stem cell papers published in Nature hasreportedly agreed to retract one of them.

Women’s Contraceptive UseInfluenced by Education and Moral Attitudes
 (Medical Xpress)Nearly half of all pregnancies in the United States are unintended, andunplanned pregnancies are associated with poorer health and lower rates ofeducational and economic achievement for women and their children, according tothe CDC. But the desire to avoid pregnancy does not necessarily increasewomen’s use of contraceptives. Levels of prior sex education and moralattitudes toward contraception influence whether women use contraceptives.

E.U. Commission Rejects Plea toBlock Stem Cell Research Funding
 (Science)The European Commission today turned down a request by pro-life organizationsto block E.U. funding for research using embryonic stem cells.

Quanity, Not Quality: Risk ofSudden Cardiac Death Tied to Protein Overproduction
 (Science Codex)A genetic variant linked to sudden cardiac death leads to proteinoverproduction in heart cells, scientists report.  

Medicine of the Future? (New York Times)It’s a growing field: bioelectronics. Today researchers create implants thatcan communicate directly with the nervous system to fight everything fromcancer to the common cold. The idea is to manipulate neural input to delaythe progression of cancer, says a researcher who discovered a link between thenervous system and prostate tumors.

Iran’s Population Drive WorriesWomen’s Rights, Health Advocates 
(Reuters)Iran’s supreme leader has called for a population increase, in an edict likelyto restrict access to contraception that critics fear could damage women’srights and public health. In his 14-point decree, Ayatollah Ali Khamenei saidincreasing Iran’s 76 million-strong population would “strengthen nationalidentity” and counter “undesirable aspects of Western lifestyles.”

Bioethics: Making Headlines

Lots of interesting developments inthe field of bioethics this week. Take a look at these top stories, reported bythe Deerfield, Illinois, Center for Bioethics and Human Dignity:

Most detailed 3D map of human brain
 Adeceased 65-year-old woman has provided scientists with the material for thefirst super high-resolution, three-dimensional digital model of the humanbrain. (The Telegraph)

FDA approves morning after pill for women of childbearing age
 TheU.S. Food and Drug Administration approved Plan B emergencycontraceptive without a prescription for all women of childbearing age,officials say. (UPI)

In new tools to combat epidemics, the key is context
 Now a newproject called BioMosaic is building a more comprehensive picture offoreign-borne disease threats in the United States, by merging three separatedata tools into a single app for guiding decisions at the time of an outbreak.(New York Times)

HPV vaccine is credited in fall of teenagers’ infection rate
 Theprevalence of dangerous strains of the human papillomavirus (HPV) the mostcommon sexually transmitted infection in the US and a principal cause ofcervical cancer, has dropped by half among teenage girls in recent years, astriking measure of success for a vaccine against the virus that was introducedonly in seven years ago. (New York Times)

Egypt girl’s death puts spotlight on genitial mutilation
 The deathof a 13-year-old girl during a genital mutilation procedure has brought theissue back into the spotlight in Egypt. While some Egyptians fight for eradicationof the practice, others justify it in on religious grounds. (BBC)

New study tracks emotional health of “surrogate kids” 
Over thepast decade the number of births involving surrogacy with donor eggs and spermhas surged. What, experts wondered, does this mean for the mental and emotionalhealth of the growing number of kids who may or may not know the truth abouttheir distinctive origins? (Today)

Japan experts mull rules on chimeric embryos
 Japaneseexperts were on Tuesday set to discuss rules for experiments with animal-humanembryos, as scientists seek permission for tests that could see human organsproduced inside the growing body of an animal. (Fox News) Another news story suggested that human organs could be grown in animalswithin a year.  (The Telegraph)

Abortion restrictions in states
 Forty-onestates have enacted abortion restrictions at different stages of pregnancy. (New York Times)

High court rules ‘pay-for-delay’ drug deals can face antitrustsuits
 A brand-name drug maker can be sued for violating antitrustlaws if it agrees to pay a potential competitor to delay selling a genericversion, the Supreme Court ruled. (Los Angeles Times)

Be prepared for the big genome leak
 Mostpeople in the US could soon know someone whose genome is held in a researchdatabase. Concerns are growing about our ability to control access to thatinformation. But many scientists feel that restricting access to genomic datafetters research. How long will it be until an idealistic and technicallyliterate researcher deliberately releases genome and trait information publiclyin the name of open science? (Nature)

Directed in vitro (IVF) technique may increase insulinresistance among offspring
 A special type of IVF may increase the riskfor insulin resistance among high-tech babies. (E! Science News)

IVF: First baby born using ’safer’ method
 In aworld first, a healthy baby has been born using a “safer” method of theinfertility treatment IVF, using a natural hormone to kick-start his mother’sovaries. (BBC)

Bioethics in the News

The Center for Bioethics and Human Dignity sends out a listing of top bioethics stories for the week. Some interesting stuff here:

Better prenatal testing does not mean more abortion
Between 70 and 85 percent of women in the U.S. confronted with a prenatal diagnosis of Down syndrome choose abortion — but that number used to be higher. (The Atlantic)

Morning-after pills don’t cause abortion, studies say
The most heated part of the fight between the Obama administration and religious groups over new rules that require most health plans to cover contraception actually has nothing to do with birth control. It has to do with abortion. (NPR)  [For all my past postings about this, search for Plan B in this blog in the right-column search engine.]

Stem cell-based bioartificial tissues and organs
Surgeon Paolo Macchiarini has made his name by successfully transplanting bioengineered stem cell-based trachea, composed of both artificial and biological material. He now plans to use the technique to recreate more complex tissues, such as the esophagus and diaphragm or organs such as the heart and lungs. (Science Daily)

Organ trafficking, a new crime of the 21st century
Organ transplant medicine is an incredible life-saving technology, under the right circumstances. Unfortunately, due to a shortage of available organs, a new crime of the 21st century, organ trafficking, is supplying organs to people with the money to pay big dollars for a new life. (The Epoch Times)

Why death is not the end of your social media life
Services such as LivesOn and DeadSocial plan to keep your friends and family updated on your Twitter and Facebook pages, even after you have passed away. (The Guardian )

A genetic code for genius?
In China, a research project aims to find the roots of intelligence in our DNA; searching for the supersmart. (Wall Street Journal )

Frozen embryo outcomes mixed
Frozen embryos yielded better birth outcomes on some measures compared with fresh embryos in vitro fertilization, but there were some concerning signals of big babies and excess early mortality, a Nordic population-based study indicated. (Med Page Today )

No increased cancer risk after IVF: Study
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 new study of Israeli women. (NBC News )

In Vitro News

. A new study has shown that babies conceived by IVF using frozen embryos may be born later and weigh more than babies born from fresh embryos. This is good. And it's significant, because premature birth is linked with all sorts of issues. So if an embryo can survive the thaw, the odds of which are not in its favor, it seems to have an edge.

. Britain has seen a rise in the number of women choosing selective reduction in order to give birth to fewer children in a multiple pregnancy. One in three selective reductions involved pregnancies resulting from IVF. Of the 85 women opting for a selective reduction in 2010:

* 51 reduced twins to a single baby
* 20 reduced triplets to twins
* 9 expecting triplets chose to give birth to one child
* 5 women gave birth to twins following pregnancy with 4-5 fetuses

 Officials are issuing a renewed call for restrictions on the number of embryos transferred to the uterus during IVF.

. A UK study suggests that the number of embryos to transfer—one or two—depends on the mother’s age. At all ages, patients should avoid the transfer of three or more in order to prevent adverse effects on both mother and child, according to this research. Two seems to be the optimum number for women over forty.

News from the World of Assisted Reproduction

Bioedge.org reports that in vitro fertilization (IVF) andICSI birth defects may be decreasing. They cite a Western Australia study ofmore than 200,000 births that included nearly 2,000 IVF and ICSI babies. Researchersfound the following from fertility clinics:

From 1994–1998, nearly 11% of babies had a birth defectdiagnosed by age 6

From 1998–2002, only about 7.5% had a birth defect diagnosedby age 6

The lead author attributes the changes to improvedlaboratory practices, wiser use of meds for ovarian stimulation, and fewerembryos transferred.

The study included some pregnancies terminated because of birthdefects. Major birth defects were listed as cleft lip, hip dysplasia, and malformationsof the heart, abdominal wall and genitals. These affected about 8% of singletonbabies conceived through IVF and ICSI, compared to about 5% of babies conceivednaturally.

What I’d like to know: Could the “improvement” be due topre-implantation genetic diagnosis in which embryos found to have genetic issuesare destroyed before transfer?

Bioedge has also reported that a Danish donor passed onsevere birth defects by fathering dozens of children through a clinic inCopenhagen. It was supposed to limit to twenty-five the number of childrenfathered by one door, but the donor had fathered at least forty-three kids viasperm distributed through fourteen clinics.

At least five offspring from this donor have been found tohave a tumor-producing nerve disorder known as Neurofibromatosis type I (NF1)or Von Recklinghausen's disease. Though the clinic was notified about fouryears ago, they did nothing to prevent further use of the donor’s sperm.Parents are considering legal action. And Danish health officials have imposeda new twelve-pregnancy per donor rule.  

Creepy: ethics and gene screening

Apparently IVF clinics now offer screening for breast cancer genes, so couples can opt to destroy any embryos that test positive.

IVF clinics are offering clients a service to allow them to "sift" embryos that carry breast cancer genes BRCA1 and BRCA2 using preimplantation genetic diagnosis (PGD).While most couples use PGD procedures to eliminate the risk of inherited sex-linked and single gene diseases (such as cystic fibrosis), PGD for BRCA genes cannot remove the risk completely—because there is 10% background risk of breast cancer.

Moreover, breast and ovarian cancers usually have a late onset. Prevention and therapeutic options are constantly improving, so the chances of successful treatment and many years of healthy life are high.

Nor is breast cancer inevitable. A defective BRCA gene increases susceptibility to breast or ovarian cancer, but does not make the diseases inevitable. However, with female carriers of a mutation in either gene having a lifetime risk of 60-80% for breast cancer, and a risk of 30-60% (BRCA1) or 5-20% (BRCA2) for ovarian cancer, most doctors favor the procedure.

 In Australia, two leading IVF clinics in Melbourne told the Sydney Morning Herald that 10 couples had used the test to screen embryos since 2008. Using the test is said to double the cost of an IVF cycle from about $A3,500 to $7,000.

Bioethics in the News

The Center for Bioethicsand Human Dignity compiled these news stories:

Dutch hospital to lead organtrafficking probe  
Medical and police authorities arelaunching a major international probe into the illegal trafficking in humanorgans for transplants, to help clamp down on the crime. (Associated Press) 
 


New genetic test provides precise,yet hazy results  
Chromosomal microarrary technologycan detect more genetic abnormalities, but it can raise more questions. (U.S.A. Today)

Irish abortion debate flares overdeath of critically ill woman who was denied an abortion
  The debate over legalizing abortion in Ireland flared Wednesdayafter the government confirmed that a woman in the midst of a miscarriage wasrefused an abortion and died in an Irish hospital after suffering from bloodpoisoning. (Washington Post)

Pancreas stem cell discovery maylead to new diabetes treatments
  Stem cells inthe adult pancreas have been identified that can be turned into insulinproducing cells, a finding that means people with type 1 diabetes might one daybe able to regenerate their own insulin-producing cells. (Medical Xpress)

In ‘The Suicide Plan’ Frontlineexplores hidden world of assisted suicide
  In “TheSuicide Plan” — which airs Tuesday evening onPBS’s Frontline (check local listings) filmmakers Miri Navasky and Karen O’Connortake viewers inside the surprisingly coordinated underground world of assistedsuicide in the United States. (PBS)

Medical tourism: 1 in 3 open totraveling for treatments, poll finds
  Nearly a thirdof people surveyed around the world say they are open to the idea of medicaltourism—traveling abroad to enjoy cheaper medical or dental treatment,according to a new poll. (Huffington Post)

New kidney allocation proposal isethically unacceptable
  A new rule about kidneyallocation would increase efficiency, but it is unjust in the way itdistributes organs. (U.S. News and World Report)

Early end-of-life talks tied toless aggressive care
  Terminally-ill cancer patients areless likely to get aggressive end-of-life treatment, such as chemotherapy inthe last two weeks of life, when they talk with their doctors early on abouthow they want to die, according to a new study. (Reuters)

Identical twins’ genes researchsuggests siblings are genetically different
 Identicaltwins may not be so identical after all. Even though identical twins supposedlyshare all of their DNA, they acquire hundreds of genetic changes early indevelopment that could set them on different paths, according to new research.(Huffington Post)

Largest U.S. genetic biobankreveals early findings
  Researchers who haveassembled a trove of genetic and medical data on 100,000 northern Californiansunveiled their initial findings here this week at the annual meeting of theAmerican Society of Human Genetics (ASHG). (Science) 


Immune system breakthrough giveshope to IVF
  Scientists from IVF Australiabelieve women who suffer recurrent miscarriages or IVF failures could have animmune system that is too healthy, consistently rejecting any invading cells,including the fathers’ genes. (Herald Sun)

Fertility Treatments and Birth Defects

This week in the NewEngland Journal of Medicine announced that researchers at the University ofAdelaide found an elevated risk of defects among IVF babies, confirming earlierresearch that supported the same conclusion. The odds for any birth defect inpregnancies involving assisted reproductive technologies (ARTS) are 8.3%, compared to 5.8% for unassisted pregnancies.

The risk factors seem to be linked to issues within thecontrol of the patient, such as obesity and smoking. But ICSI (intracytoplasmicsperm injection) is an exception to this. ICSI involves injecting a single sperm intothe egg. And with ICSI, the risk ofbirth defects is 57% over normal IVF. ICSI is especially popular in Europe. 

The risk is tripled for women taking the inexpensive andwidely used medication, clomiphene citrate, to stimulate ovulation outside of closely supervisedclinical settings.  

Surprisingly, cryopreservation (freezing) embryos was shownto be associated with a greatly reduced risk of birth defects, particularly forICSI.  But this could be due to the factthat developmentally compromised embryos fail to survive the freeze/thawprocess. 

Bioethics in the News

Thanks tothe Center for Bioethics and Human Dignity for spotting these articles, whichfeature bioethics in the news.

How muchinfo does the human genome contain, and when should we stop looking? (Nature)

Doctorsdebate whether freezing embryos should become the primary option for in vitro (BBC).

A report analyzes the worldwide demand for embryonic stem cell research  (Sacramento Bee).

New research shows that six monthsafter the implantation of neural stemcells, two patients gained some function (CBS).

Six months after an avalanchedeprived the skiing Prince Friso of Holland, 43, of oxygen, he remains in adeep coma. His country debates euthanasia(The Australian).

 “Superbugs” resist our strongest antibiotic treatments; we must remain vigilantin addressing the growing threat from microbes. (CNN)

The more abortions a woman has before giving birth, the more likely she isto have a preemie. (BBC News)

Male fertility: Researchers make sperm from a skin sample. (Telegraph)

Britishcouples banned from pre-birth sex selection fly to New York to skirt UKlaws. (Telegraph)

Ellen Painter Dollar on Reproductive Technologies

Ellen Painter Dollar is a writer who focuses on faith,family, disability, and ethics. She is the author of the recently releasedbook, No Easy Choice: A Story ofDisability, Parenthood, and Faith in an Age of Advanced Reproduction(Westminster John Knox, 2012). Part memoir, part journalism, and part theology,the book examines the ethical questions raised by reproductive technologies,particularly genetic screening of embryos. Dollar's interest in this topicstems from her own experience as someone with a genetic bone disorder whosethree children had a significant chance of inheriting her disorder. Her oldestdaughter did inherit the disorder, and Dollar writes about living withdisability, gratitude and suffering, and the difficult choices made possible byreproductive technologies and genetic testing.

            

Recently,she took time to do some Q-and-A with me about her book:

Publishers Weekly describes your book as “part memoir, parttheological treatise.” What is the story behind the “memoir” part of your book?

I have a genetic bone disorder called osteogenesisimperfecta, or OI. The hallmark symptom is bones that break easily, and I havehad about three dozen broken bones. Any child I conceive has a 50 percentchance of inheriting OI, and our first daughter (who is now 12) did inherit.

Between her second and fourth birthdays, our daughter hadsix broken bones. This also happened to be the time that my husband and I werethinking about having another child. Here we were, caring for a child who spentone entire summer in a variety of casts for a variety of broken bones, feelingcompletely overwhelmed by the idea of having two fragile children.

We decided to do a cycle of preimplantation geneticdiagnosis (PGD), which is essentially in vitro fertilization (IVF) but with theadded step of testing fertilized eggs for a particular genetic mutation—in thiscase, the mutation causing my and my daughter’s OI. Our cycle failed and Ididn’t become pregnant.

During our PGD journey, I became kind of obsessed with theethical, moral, and theological questions around using this technology. I wasthinking about things like: Do I have a moral duty to help my children avoidsuffering? Am I devaluing the lives of people living with disabilities,including my own, by using this technology? Is reproductive technology just onemore pressure on modern parents to make sure they produce perfectly healthy,successful children? What are the blessings and burdens of our increasingchoices and control over childbearing?

I found that there were few places for someone like me—aneducated person who nevertheless doesn’t gravitate toward heavily academic material,particularly when it comes to something as intimate as having babies—to turnfor help with those questions.

Ultimately, we chose not to do any more PGD cycles, forethical, emotional, and financial reasons. We went on to conceive two morechildren naturally, neither of whom inherited OI. And then I went on to doextensive reading and research into the ethical questions related toreproductive technology, and to write this book.

Tell us about the“theological treatise” part. Why did you include it? Why not just stick tomemoir?

There are some wonderful memoirs out there dealing with thesame questions I wrote about, such as infertility, reproductive technology,genetic screening, and genetic disabilities. But while I love a great memoir, Ithink they have limited utility for helping other people with theirdecision-making. And that’s part of what I wanted to do. I wanted to use mystory as a springboard for a wider ranging discussion of the intersection ofChristian faith with reproductive technologies. So at my editor’s suggestion, Isupplemented my story with a more journalistic discussion of particularethical/theological questions that my story raises. Ultimately, I hope that theaddition of such discussion makes this a more useful book. People can use it tobecome educated about reproductive technology, not just about my story.

You wrote No Easy Choice from your perspective asa Christian. Are Christians your primary intended audience?

Yes and no. As a Christian, that’s the primary vantage pointfrom which I was assessing the technologies available to us for conceiving ahealthy baby. I think that Christianity has some unique things to add to thelarger cultural discussion about reproductive technology, because first, wefollow Jesus, who made clear that cultural propensities to value certain typesof people (healthy, wealthy, educated, etc.) over other types of people aremisguided. Second, Christ’s suffering on the cross offers a redemptive view ofsuffering, which affects how we view such things as illness and disability. Soyes, I was writing as a Christian, and think that Christians will be mostlikely to find an ethical framework in the book that makes sense.

But I wrote the book from a fairly broad Christianperspective. You don’t have to be a certain kind of Christian or have certainfaith-based views on particular social issues (such as abortion) to getsomething from this book. I’ve been gratified to hear not only from awide-ranging spectrum of Christian readers, including evangelicals andmainliners, liberals, and conservatives, but also from several agnostic andatheist readers, that they got a lot of value from the book. That was my goal,because I think when we Christians write books that will only appeal to acertain subset of Christians, we’re not adequately engaging the culture. Suchbooks aren’t likely to make any difference in the long run, because then we’rejust preaching to the choir.

What do you hopereaders will learn or come away with after reading the book?

My goal with this book was very clear. I’m not trying toconvince anyone that reproductive technology is right or wrong, good or bad.Rather, I’m hoping to bolster more informed and robust conversations—bothprivate and public—about the promises and perils of reproductive technology. Ihope people who read the book feel like they learned useful information, and Ialso hope that they are more compassionate and understanding of people who haveto make very difficult and complex reproductive decisions.

Dollar has also written for the American MedicalAssociation, the Osteogenesis Imperfecta Foundation, Christianity Today, and the HuffingtonPost. She regularly does media interviews and speaks to community, student,church, and book groups. You can learn more at her web site at ellenpainterdollar.com.

Infertility News This Week

Infertile Canadians buy frozenhuman eggs from US  Need human eggs? Go with UPS orFed Ex. That’s what Canadian couples are now doing. They can buy frozen eggsover the internet from US egg banks and have them shipped to clinics north ofthe border.  (CBC News) 
 

IVF drugs linked to childhoodcancer
  More than 13,000 babies are born annually thanks toassisted reproductive technologies (ARTs). Now some researchers are seeing a linkbetween ovarian-stimulation drugs and some forms of childhood leukemia.  (Telegraph)

  

Bioethics In the News

Let's Limit Embryo Transfers:  
A new fertility-treatment study has found that women who receive three or more embryos have no better odds of giving birth than those who receive only  two embryos. (Washington Post)


FDA Warning: About Illegal Stem Cell Treatments
The FDA announced this week that patients' hopes for cures leave them vulnerable prey for providers of illegal and potentially harmful stem cell treatments. (Medical Daily)


Surrogacy: A Growing International Injustice
International surrogacy is a growing business thanks to Westerners hiring poor women in developing countries to carry their babies. But media attention could change that. (Slate)


Skipping the Banks, Making Online Deals
Women are increasingly making online connections with men willing to donate sperm for free, skirting the expensive option of using a sperm bank with all its regulations, tests, and verifications. (ABC News)


  

Austria bans donor gametes in IVF

The European Court of Human Rights (ECHR) upheld Austria's ban on the use of donor sperm and eggs during in vitro fertilization procedures. You can read more here. Earlier the same court ruled against destroying human embryos for scientific research.

Making IVF Accessible

Experts are resisting cheap in vitro fertilization (IVF), a gentler technique priced at less than $300, as compared with the usual sixteen grand. The far less expensive version would, of course, cut into clinic profits.

Private treatment costs between $4,700 and $16,000 per cycle, and often patients need more than one cycle to conceive. But only one in five patients needing IVF in the West can do it. In the developing world—where infertility has more serious social consequences–that number is one in a hundred. Take sub-Saharan Africa, for example. A high birth rate conceals STDs, botched abortions, and pelvic infections. And the social consequences of infertility can mean divorce, polygamy, and even death. Yet at the moment IVF is only for the rich.

The alternative form uses generic drugs (clomiphene) and simple equipment, and the estimated cost includes personnel, not just meds and equipment. Because the alternative is less toxic and far less expensive, those seeking treatment could do IVF multiple times.

Clinics in Melbourne, Stockholm and Bologna have done pilot studies with 100 cycles each. They yielded a birth rate per cycle of about 12%. Standard IVF has rates two to three times that high. Yet a couple doing the less expensive form could multiply their number of tries, making rates comparable but still at a fraction of the cost. A 2007 study found that even natural-cycle IVF (without drugs) had a 43% cumulative pregnancy rate over a year—equivalent to standard IVF rates without the risks.

Standard IVF has a 50% drop-out rate and is physically and psychologically traumatic. The low-cost, low-impact approach is less traumatic and has a quicker recovery time. Thus patients would not have to wait three months or more before trying again.

A foundation is grafting low-cost facilities into existing clinics, and they are targeting India, Uganda, Indonesia, Ethiopia, and Tunisia. The European Society of Human Reproduction and Embryology aims to set up a similar program in Egypt, Paraguay, and in sub-Saharan Africa.

Source: www.bionews.org.uk/page_72984.asp

IVF Creator Wins the Nobel for Medicine

Dr. Robert G. Edwards, the British scientist who developed in vitro fertilization (IVF), won the 2010 Nobel Prize in Physiology or Medicine.

The prize committee in Sweden said Dr. Edwards "battled societal and establishment resistance to his development of the in vitro fertilization procedure, which has so far led to the birth of around 4 million people."

Those of us connected with the fertiliy industry for a few decades remember the creators as "Edwards and Steptoe." Dr. Steptoe did not share in the $1.5-million prize because Nobel rules require honorees to be alive at the time of the award, and he died 22 years ago.

Some news stories have mentioned that "the establishment" initially opposed IVF but--with the exception of the Roman Catholic Church--nobody has a problem with it today. And that's generally true. But it's not because hard-nosed critics somehow "evolved" into enlightened thinkers. At the time of Louise Brown's conception, no one knew what kind of risk scientists were taking with embroyos, nor did anyone know if IVF babies would be healthy. Caution was wisdom. And indeed earlier procedures were less efficient than today's practices. As the risks became known and/or decreased, some of us withdrew many of our objections. Yet doctors still discard embryos and/or take enormous risks with them. That's why we still try to train patients to be good managers of their own care. They can influence lab practices for handling their cases. Also, some scientists and ethicists are still concerned about a link between IVF and rare birth defects, but most feel the benefits outweigh the risks.