Bioethics Student Scholar Forum

As part of the Women’s Bioethics Project’s “Fresh Voices Initiative” we are launching the Bioethics Student Scholar Forum featuring outstanding commentary by bioethics graduate students from around the world. Student scholar Jennifer deSante, University of Pennsylvania, wrote the inaugural commentary. In the wake of Octomom, Jennifer explores whether physicians have an ethical obligation to screen IVF applicants:

Can We Screen IVF Applicants?
The birth of Nadya Suleman’s octuplets captured the interest of the country and media. What began as amazement quickly turned to disbelief, then condemnation, even outrage. Hardly anyone could understand what would motivate a woman to use in vitro fertilization (IVF) to have fourteen children. The media became obsessed with Ms. Suleman: following her around town, releasing child services records, even sending Dr. Phil to her house. As it became clear that this woman had little emotional or financial support to raise these children, people began to attack her for being irresponsible. But how much responsibility falls on the physician that provided Ms. Suleman with her many cycles of IVF?

You can find her provocative and well-written paper here. Congratulations to Jennifer – we welcome your fresh voice to the bioethics dialogue. And many thanks to her bioethics mentor, Arthur Caplan, Ph.D. for recommending Jennifer's work. If you are currently an enrolled bioethics graduate student and would like to have your paper considered for publication, please ask your bioethics mentor to nominate your work by emailing info (at) womensbioethics.org (include paper abstract and contact information.)

Here We Go Again...

[Hat tip to supporter Paul Root Wolpe and our colleagues at Bioedge for bringing our attention to this story]

As we blogged about before on several occasions, the debate over the personhood and the legal/moral status of embryos (as well as other entities) continues: Even though the 'personhood for embryos' amendment in Colorado was resoundingly defeated, North Dakota is next in line to attempt to create a law that would give full moral and legal status to embryos.

The Grand Fork Herald reports that [The] "measure approved by the North Dakota House gives a fertilized human egg the legal rights of a human being, a step that would essentially ban abortion in the state.

The bill is a direct challenge to Roe v. Wade, the U.S. Supreme Court decision that extended abortion rights nationwide, supporters of the legislation said.

Representatives voted 51-41 to approve the measure. It now moves to the North Dakota Senate for its review.

The two-paragraph bill declares that 'any organism with the genome of homo sapiens' is a person protected by rights granted by the North Dakota Constitution and state laws.

It says the Legislature may choose one of its members to help defend the new law if its constitutionality is challenged in court." Full article accessible here.

I don't know if there are any fertility clinics in North Dakota, but I don't believe there are any exceptions for IVF. Given that this is an attempt to ban abortion, I wonder what consideration, if any, has been given to victims of rape or incest or those families who are choosing PGD to avoid transmission of painful genetic disorders. Or those women whose health might be threatened by a pregnancy (e.g. women with certain forms of MS or Eisenmenger's Syndrome).
There are less coercive ways to discourage and reduce numbers of abortions; and different ways to approach the issue, like Aspen Bakers' Pro-Voice solution.

IVF may increase risk of genetic disorders

Assisted reproduction is in the headlines again: today's NYT reports on a study that indicates that babies conceived through IVF may have a slightly higher risk of serious health problems. Here's the abstract for the scientific paper, in case you want to read more.

So: in light of recent discussions about the Suleman case (specifically the question of whether there should be an enforceable maximum number of embroys that can be transferred into a woman's uterus), how much additional risk is too much? At what point ought the state step in?

Octuplets Mother Speaks Out

Nadya Suleman, mother of the recent octuplets born in California, has done her first interview with a major news outlet. (Although Suleman was seeking USD 2 million for the interview, NBC maintains that they did not pay her. However, that doesn't rule out "compensation" in other forms.)

Unfortunately, Suleman's interview has continued to raise, rather than answer, questions. Foremost among them, for me, is her claim that she had six embryos implants per IVF procedure. This... simply does not ring true. Or at least plausible, if she was using a US fertility expert.

Consider this: in order to have done so, this means Suleman would have needed to find, at age 26, a fertility doctor who would implant six embryos. ASRM guidelines are no more than 3 embryos for a woman under the age of 35, and that's if she has a history of problems with conception. With a 'clean' history, only 2 embryos are recommended. Now, it sounds like Suleman might have qualified as having difficulty conceiving, with several ectopic pregnancies and miscarriages prior to IVF. But even accounting for that, it's double the recommended standard. For each pregnancy.

But stop to do the math. While one vial of donor sperm would be more than enough for all of this, it means that they collected at least 36 eggs from Suleman, and that all of those eggs were viable enough to implant once fertilized. Realistically, not every egg retrieved is going to be mature, and not every egg is going to fertilize (unless you're using something like ICSI). Realistically, you're looking, at the very least, at 1/3rd more eggs than that being pulled out (and even that is a very, very low number - remember, they're saying that there were six viable eggs to implant per cycle. A quick web search shows that 1/3 of the eggs removed at any time are not mature, and of the ones that are mature, only half reach the point of being "good enough" to implant).

Now let's go over to CDC stats. While the last data is from 2005, which was going on 5 years ago, Suleman started her IVF course in 2001, so some of this data is specifically applicable (and some of it only extrapolation). According to the CDC, only 35% of ART cycles resulted in a pregnancy, and of those, 82% resulted in a live birth. So again, Suleman seems to have defied the odds. A lot. And as the CDC says about frozen eggs, "[b]ecause some embryos do not survive the thawing process, the percentage of thawed embryos that resulted in live births is usually lower than the percentage of transfers resulting in live births." While only 15% of embryos transferred were frozen, of those 15%, only slightly more than 1/4 ended up in live births.

Again, the odds make this seem incredibly unlikely.

Finally, fertility clinics are required by law to report their ART data, under the Fertility Clinic Success Rate and Certification Act. This gives us a decent way of tracking ART results - and also who is doing ART. In 2005, eleven clinics in California did not report their ART data (which would include embryo transfers/live birth data/etc). Of those eleven places, it looks like seven were within an hour of her home (keeping in mind her back injury likely limited the distance she could travel). Of the clinics that did report their data, 35 are within an hour of Whittier, California. However, given these clinics are compliant with reporting their data, it seems safe to eliminate them from immediate suspicion. (As for the potential Mexcio connection, Tijuana is approximately two hours away. Certainly not out of the question; an hour was a random number drawn from thin air. Suleman has certainly shown herself to be willing to go to significant length, and pain, to achieve her goals.)

All in all, what does this mean? Not much. Over 300 pages of records on Suleman have been released to the press, under a public records request to California's Division of Workers' Compensation. While it doesn't appear that the fertility clinic (or doctor) that treated her is in those records, there is ample evidence to support that she did have problems conceiving, and that she had known psychiatric issues, including what was diagnosed as either postpartum depression or PTSD. Issues that should have limited, if not prevented, future implantations.

Ultimately, until Suleman names her doctor, or said doctor speaks out, little will be conclusively known. But the facts remain simple: the facts do not add up.
-Kelly Hills

Reproductive Autonomy Runs Amok

In a follow-up post to Kelly's previous post, it seems that Nadya Suleman's use of IVF technology is clear misuse and abuse of ARTs (Assisted Reproductive Technologies). The doctor who implanted the embryos should be investigated, because in helping this woman become pregnant with 8 children, he or she violated one of the basic tenets of medicine -- "Do No Harm". Hopefully, the Board of Medical Licensure will investigate and determine what the possible motivation was for this doctor's actions, whether it was a one time lapse in judgment due to extreme personal difficulties, or if it represents a small part of a larger pattern of unethical behavior and practice for the doctor and the fertility clinic.

There are multiple ethical considerations at play when an IVF specialist is approached by any woman and a 'burden vs benefit' analysis is employed. When someone who has already had six children through the procedure seeks more, I cannot imagine a valid or justifiable benefit -- the burdens include physical and financial costs to the mother (who has already declared bankruptcy), to the grandmother, to the siblings, to the children born, and to society. And while one might argue that this is an exercise in reproductive autonomy, we, as a society need to ask 'how far does reproductive autonomy go?' Does it include the right to create children who been disabled or dis-enhanced? (A nightmare scenario vaguely reminiscent of Dean Koontz' novel, One Door Away from Heaven). How we answer this question will have an impact on how we deal with future cases, such as those involving genetic engineering.

Hopefully, this case will call attention to the need for regulation and oversight of Assisted Reproductive Technologies. Currently, we have a laissez-faire attitude towards ARTs and fertility clinics; we have trusted the doctors and clinics to regulate themselves, via the American Society for Reproductive Medicine --and this case demonstrates that we can no longer simply turn a blind eye.

How Many is Too Many?

Unless you've been hiding under a rock this last week, you're aware of the octuplets born to California single mom Nadya Suleman, and the intense ethical debate surrounding her pregnancy. Even before it was revealed that she has six other children (apparently all from IVF, although details are a bit fuzzy), medical experts were ready to lynch the IVF specialist who implanted that many embryos into Ms. Suleman. And since then, the information that has come out has been more and more dismaying. The problem is, much of the information coming out is still speculation, and few solid facts are known. This makes it difficult to do more than speculate and contribute to the signal to noise ratio, which at the moment is definitely loudly on the side of noise.

So rather than continue to discuss the particulars of Ms. Suleman's case, which will have to be dissected in its own due time, I want to open to forum to a related question that has been repeated in the discussion of her story: how many children is too many children? Not how many implanted embryos is too many embryos, but at what point (if any) do fertility doctors say sorry, no more kids? Should Ms. Suleman have had any embryos implanted at all, given her six other children? Or is the ability to pay for IVF the only thing that should be considered? Should the financial state of the individual or couple be considered? Job? Income? What factors should go into deciding whether to treat for infertility via IVF? And should the "how many is too many" question be posed to adoptions, as well (Angelina Jolie and Brad Pitt clearly coming to mind)?

Or put another way: is the problem with the birth of the octuplets the fact that they were born all at once, and if Ms. Suleman had continued to quietly have eight more children via IVF, no one would have said a thing?

It seems like this single question - if an outside source is utilized to have children, is there a point at which it can be determined that the person has too many children to have more - is fraught with the potential of paternalism and of violating the choice of family construction.

I don't even begin to have an answer to this; I doubt I've even begun to tease out all of the potential questions wrapped in what is an incredibly thorny issue. But let's open it to debate - what do you think?
-Kelly Hills

The Dignity of a Person

The Catholic Church released their Dignitatis Personae on Friday, which is an update of the 1987 Donum Vitae. Dignitatis Personae is the most up-to-date view of the Catholic Church on assisted reproductive technologies, and it spells out clearly what and why the Vatican approves (or in this case, largely disapproves) of most modern reproductive options.

It's been 21 years since Donum Vitae, and technology has made incredible leaps forward: IVF, intracytoplasmic sperm injection, all kinds of surrogate motherhood, PGD, etc. And most of these leaps are condemned by the Church.

It's my own personal opinion that it's necessary for everyone involved in bioethics to understand the Catholic position, regardless of your personal or professional inclinations. The Church has a powerful lobbying group, especially in states in the northeast of the United States, and this document has the ability to affect many people simply because it does clear up a lot of the grey areas that existed in Catholic doctrine.

Reading the Dignitatis Personae is an exercise in patience and self-control; it's hard to resist the urge to go wake someone up to have someone to discuss such wince-inducing logic as this: This ethical principle, [ed- that life begins at conceptions] which reason is capable of recognizing as true and in conformity with the natural moral law, should be the basis for all legislation in this area. I can tell you with full certainty that such 'reasoning' (a term I use loosely) would fail a philosophy 101 test. But if you can get through the document, you'll learn that the fresh-off-the-newstands update to Catholicism forbids any reproductive act that does not result in fertilization and implantation happening as a result of the sexual act between a married couple. Or put more simply: if the technology assists in intra-uterine conception, YAY! If conception occurs outside the uterus, BOO!

For better or for worse, the Catholic position is at least internally consistent - and for this I certainly give credit where it's due. There's very little cherry-picking of preferences; life begins at conception, all conceived embryos deserve full moral status of a human, etc. But aside from theological and philosophical differences, two things in the Dignitatis Personae stand out to me as worthy of further discussion and debate.

The first is the idea that

"The origin of human life has its authentic context in marriage and in the family, where it is generated through an act which expresses the reciprocal love between a man and a woman. Procreation which is truly responsible vis-à-vis the child to be born “must be the fruit of marriage”.

Put plainly, and as I said above, children must be conceived through sexual intercourse. Their conception at fertilization in the woman's body is when they become ensouled. What then, does this mean, theologically, for the multitudes of people now being born outside of this very narrow definition of procreation? It's not an answer I have, it's not an answer that is clear in the Dignitatis Personae, and it's definitely not an answer that anyone my local Catholic Conference has been able to answer. So it is a lingering question, and one that should be answered.

The second, and much larger issue, is the chapter on "The use of human “biological material” of illicit origin". This chapter discusses the obligation of researchers to refuse to use materials of illicit origin - that is, human cell lines obtained from stem cells, aborted fetuses, etc. Many, if not most, news outlets are reporting this to mean that the Vatican has said that Catholics may not use vaccines which are grown on human cell lines created from the lung tissues of aborted fetuses (the Meruvax rubella vaccine, at the very least).

Reading the chapter, though, instead of relying on news reports, gives a slightly different interpretation. While the document is clearly against researchers using any biological material of so-called illicit (theologically) origin, and suggests that ethical researchers will refuse to use these mediums, it draws a different line for the general public. The document allows that

Grave reasons may be morally proportionate to justify the use of such “biological material. Thus, for example, danger to the health of children could permit parents to use a vaccine which was developed using cell lines of illicit origin, while keeping in mind that everyone has the duty to make known their disagreement and to ask that their healthcare system make other types of vaccines available.

Unfortunately, this again raises more questions than it solves. If there is such a thing as a single grave reason that may be morally proportionate to justify the use of illicit biological material - vaccinating your child from a deadly disease - then why are there not other grave reasons? Isn't this suddenly a large degree of "wiggle room" that will allow individuals an out, who can say that this document is not intended for the lay Catholic but the scientist Catholic, the researcher who spends their life in this and thus needs to consider ethics and morality at a different level than the average person (or at least average Catholic)?

As I said, more questions. But in all fairness, I can't say more questions than answers, since the document clearly gives answers that people have been wondering about for the last 21 years.

Give it a read this morning over your coffee, tea, breakfast, and see what you think the impact of this document will be.
-Kelly Hills

10 Gift ideas for your favorite academic in bioethics.

1. Motivational (or de-motivational, if you want to apply the precautionary principle) poster, to keep your priorities straight.

2. Motivational mug (akin to the poster, the pessimistic's mug, fashioned by the perpetually miserable)

3. Fingerless Gloves, for your favorite bloggers or technophiles.

4. A power tie, to keep you connected, or a Bio-scarf, that features your favorite doomsday scenario.

5. From medical tourism abroad to cultural diversity, a Travel book (on the Touristic Guidings to Glorious Nation of Kazakhstan)

6. Computer accessories to make your desk more, umm, interesting?

7. Genome family pack from 23andme.com (who could resist that?)

8. If you were a fan of Indecision 2008, you might enjoy a Colbert Christmas Yule log.

9. More computer accessories, courtesy of your favorite IVF clinics.

10. The Perfect pet (a lot tidier than the old-fashioned kind and no transgenics involved!)

We’ll take only one baby please…

In-vitro fertilization (IVF) is a procedure used to treat infertility when other methods of assisted reproductive technology have failed. A major risk of IVF is multiple births because a common practice of treatment is multiple embryo transfer to boost the pregnancy rate. Since IVF is sometimes a last resort for a woman to get pregnant, many couples welcome the idea of multiple births since they were having trouble having one baby, let alone several. However, others are not so keen on the idea.

Recently, a lesbian couple in Australia attempted to sue their obstetrician for failing to ensure that a single embryo was implanted in the birth mother. The couple, now the parents of 4-year-old twin daughters, were seeking medical negligence in the amount of $382,000. According to an article in USA Today, the claim was to cover the cost of raising one of the children, including private school fees.

The judge overseeing the case ruled against the couple, citing that the birth mother had actually acted negligently by failing to ensure the IVF clinic staff were aware that she no longer wanted to have multiple embryos implanted. The couple are considering an appeal but the case leaves many, including the state president of the Australian Medical Association, wondering why such a suit was ever brought before a court in the first place.

Yes, multiple births are accompanied with increased risk of pregnancy loss, complications, prematurity, neonatal morbidity, and the potential for long term damage. However, when IVF results in the birth of healthy babies, why mess with it? IVF is an investment that people can spend years thinking about before deciding on treatment. It is not cheap and most expenses are paid out of pocket by the couple. If a couple has devoted that much time and personal resources for IVF treatment, shouldn't they have enough sense to set aside adequate resources for the end result? Or in this case...results?

"Silicon Womb" To Begin Large Scale Fertility Trial

If you're anything like me, when you see the phrase "silicon womb" you immediately flash to some sort of neo-Matrix growth tank, an artificial womb that removes the human womb completely from the picture. Which probably is an indication that the people behind this particular "silicon womb" ought to consider a name change, as that's not quite the case.

What this new silicon womb is, is actually a vaguely IUD looking tube that allows fertilized embryos to be matured inside a silicon tube placed inside the woman's womb, rather than a test tube incubator, before being removed after 2-5 days and then transferred back into the uterus.

The hope seems to be that a more natural maturation environment will lead to more successful implantations with fewer embyros needed for implantation, reducing the risks associated with multiple births that often accompany IVF treatment. It also is a partly practical move; test tube embryos need to have their growth medium changed every few hours. By moving the embryos to a more natural growth environment, there is no need for artificial growth medium; the body is instead naturally primed to generate nutrients and remove wastes for the developing embryos.

Of course, the silicon tube insert is only approximating a more natural environment - the uterus is an equally foreign place to embryos that are only a few days old; they would typically be floating their way lazily through a fallopian tube at this stage of development. Still, there's no arguing the point that, so far as mimicing natural goes, a uterus is probably a lot closer than a laboratory incubator.

I am, perhaps not surprisingly, a little more interested - and concerned - about the ethical concerns around this. There is already a large debate about what to do with IVF embryos that are leftover from a successful implantation cycle, with debates about their personhood and agency and whether they should be utilized for stem cell research or adopted out as snowflake children, or disposed of as human waste. What sort of attachment is a woman (and/or her partner) going to develop to a bunch of embryos that are actually being housed and growing inside of her, before being removed to be sorted and determined which should continue growing inside of her? While I've never had a child myself, I have heard many of my parent-friends talk about the incredible attachment and overwhelming love that they develop upon realizing they've conceived. Will those feelings be muted or mitigated by this artificial conception? Or will they develop stronger ties towards multiple embryos that cannot possibly be carried to term at the same time? From the sounds of it, the tubes can carry anywhere from 4-12 fertilized eggs; what happens to the unused, and what's the emotional ramification?

The medical implications are interesting, but it's the ethical ones that are fascinating - and sadly, don't appear talked about in any of the literature I've found about this new way of IVF embryo maturation.
-Kelly

images from Anecova

Too many twins? Says who?

Today's NYT ran a piece that describes calls to reduce the number of multiple births resulting from in vitro fertilization efforts. Since the introduction of IVF in 1980, multiple births in the United States have increased by a whopping 70 percent--in no small part due to the fact that many prospective parents choose to implant multiple embryos in the hopes of increasing the odds of a successful pregnancy and birth. Several of us have blogged on other issues re multiples before, too... here, here, here, and here.

The article quotes a few experts who basically say that as the technology has improved, the need to implant "extra" embryos has diminished; but this raises the question of just what a successful IVF result looks like. Is one baby? More than one baby? All the babies the woman wants? And what about the health status of the infant(s)? If carrying multiple fetuses increases the health risk to mom and babies, but the woman wants to "maximize her investment" in the painful and expensive IVF cycle by shooting for triplets, can/should physicians try to dissuade her? On what basis?

It will be interesting to see how this plays out, particularly since fertility medicine is largely a consumer-driven affair. Infertility treatment generally isn't considered medically necessary by insurers and therefore isn't a covered benefit. People who pursue it are paying thousands of dollars--per cycle--out of pocket. Given all that, I wonder whether "the customer is always right" will be the governing rule.

Bioethics & Television - Private Practice

It's too bad there's not a way to easily track the increase in call volume at fertility clinics. I'd give a lot to see what the call activity looked like this morning, after folks saw last night's episode ("In Which Dell Finds His Fight") of ABC's spin-off of Grey's Anatomy, Private Practice.

One of the two medical story lines followed in this episode centered on a couple who wanted to conceive, but the husband was diagnosed with azoospermia. The couple rapidly - as in, immediately after receiving the diagnosis - rule out adoption and decide that, since the wife is currently ovulating, they will try for sperm donation immediately.

Let's pause for a moment to consider the likelihood of a private practice based ob/gyn/fertility specialist and fetal surgeon/genetics specialist (we could really stop that sentence right there, but...) going from delivering a diagnosis of infertility to, within minutes, agreeing to allow the couple to select a sperm donor for insemination that day. I admit, this isn't my area of specialty, but I would think that this might be a process that takes time. Certainly more than the span of a few minutes.

However, that in and of itself, while rapidly paced and smoothed over for dramatic license, wasn't terribly egregious. It's the next part, where they opted not for sperm donation, but advanced sperm removal and IVF, that took the show beyond dramatic license and into the realm of "creating headaches for fertility clinics nationwide."

The two doctors explain to the couple that they can do a procedure called microsurgical retrieval of epididymal sperm, or MESA, and then extract the currently ovulating ovum from the wife, and use intracytoplasmic sperm injection (ICSI) to create a viable fetus, which was then immediately placed back into the uterus. The picture above is from this scene; you'll see that the patients were there and talking to the doctors as they performed this several stage complicated procedure all by themselves.

One of the things being talked about is just how real all this medicine was, and from what I saw and know (please correct what I get wrong), the procedures are all actually sound. It's the speed, the setting, and the overall depiction of the entire process that I find problematic. It's one thing to accelerate, for dramatic license, multiple office visits to discuss sperm donation and the details that would make, frankly, for boring television. No one wants to watch people sitting around talking, and it seems that the general knowledge level is such that no one expects to walk in to a fertility specialist office for a first visit, and walk out a hour later with sperm floating in their uterus.

MESA and ICSI are much more obscure, new, and not known procedures. By depicting them as joint events that can be simultaneously with single egg extraction during ovulation, and as something that takes no longer than an office visit instead of a several day if not weeklong or so process, gives an awful lot of false information that specialists then have to work at undoing. It's no longer a matter of educating a patient on a procedure, it's about undoing the subtle information bias that they might not even realize they hold.

Is it irresponsible for a show to compress and simplify a complicated procedure or concept so that it fits into the time allowed for the story? Maybe not, we expect dramatic license when we watch fictional television. The problem is just the degree of license - when you're going out of your way to establish authenticity with realistic imagery and dialogue, and strive for medical accuracy, it seems that putting a limit on just how far you stretch reality has to come in to play, as well.
-Kelly

Everything Conceivable - New Book

From the dust jacket: Skyrocketing infertility rates and the accompanying explosion in reproductive technology are revolutionizing the American family and changing the way we think about parenthood, childbirth, and life itself. In this riveting work of investigative reporting, Liza Mundy, an award-winning journalist for The Washington Post, captures the human narratives, as well as the science, behind what is today a controversial, multibillion-dollar industry, and examines how the huge social experiment that is assisted reproduction is transforming our most basic relationships and even our destiny as a species.

Based on in-depth reporting from across the nation and around the world, using riveting anecdotal material from doctors, families, and children—many of them now adults—conceived through in vitro fertilization, Mundy looks at the phenomena created by assisted reproduction and their ramifications. Never before in the history of humankind has it been possible for a woman to give birth to an infant who is genetically unrelated to her. Never before has it been possible for a woman to be the genetic parent of children to whom she has not given birth. Never before has the issue of choice had such kaleidoscopic implications. If you support reproductive freedom, does that mean you support everything being offered in the reproductive marketplace? Thawing frozen embryos and letting them expire? Selecting the sex of your baby? Conceiving triplets and “reducing” the pregnancy down to twins?

Everything Conceivable explores the personal impact on individuals using assisted reproduction to conceive, and the moral, ethical, and pragmatic decisions they make on their journey to parenthood. It looks at the vast social consequences: for hospital neonatal wards, for family structure, for schools, for our notion of genetic relatedness and whether it matters, for adoption; for our nation as a whole, and how we think about the earliest human life-forms.

The book explores questions of social justice: the ethics of buying or borrowing some part of the reproductive process, as with egg donation and surrogacy. It looks at entirely new family structures being created by families who have conceived using sperm donors, so that children may have half-siblings around the country with whom they are, or are not, in contact. And it looks toward the future, to the impact today’s technology may have on coming generations.

NOTE: WBP Founder Kathryn Hinsch will be interviewing author Liza Mundy on Wednesday, May 9th, 7:30pm at the Seattle Town Hall. Join us for the conversation!

Miracle mitochondria or designer babies?

The United Kingdom’s genetics watchdog agency, the Human Fertilisation and Embryology Authority (HFEA), has granted permission to a team of Newcastle University scientists to create a human embryo that will have genetic material from two mothers.
The BBC reports that “The scientists will transfer the pro-nuclei – the components of a human embryo nucleus - made by one man and woman - into an unfertilized egg from another woman.”

The team and its supporters attribute the value of the research to the potential prevention of the maternal passing of certain genetic diseases to their unborn babies. The relevant genetic diseases, which are known as mitochondrial, arise from DNA found outside the nucleus and are inherited separately from DNA in the nucleus. Although the resulting egg would never be allowed to develop into a baby, if it did, the offspring would still resemble their mother and father because the mitochondrial DNA do not dictate things like hair color.
Mitochondria produce most of the energy that people need to grow and live. Organs such as the heart, brain, liver, kidney are particularly dependent on well functioning mitochondria. One unique feature of mitochondria is that they have their own DNA, which is inherited from the mother only. Faulty maternal DNA puts children at risk of developing a mitochondrial disease that can damage the cells of the brain, heart, liver, kidney and skeletal muscles and confine sufferers to a wheelchair. At present there is no known cure.
Some groups have expressed concern regarding the HFEA approval to proceed with the research. The potential scientific breakthroughs seem to evolve at a rate that surpasses accompanying decisions regarding ethics. Pro-life campaigners fear the decision to approve the research represents an unacceptable step towards the creation of "designer babies".
Professor John Burn, from the Department of Clinical Medical Sciences at Newcastle University, claimed such fears and criticisms to be unfounded. Professor Burn said that technically a baby could be born with two mothers - the DNA from the egg donor and the DNA from the mitochondrial donor. The ethical implications may resemble those regarding a surrogate mother donating an egg or carrying the intended parent's child that was conceived through IVF treatment - a process itself that once generated an abundance of controversy.
[thanks Ana Lita]

Multiple births, multiple headaches?

About a quarter of women who undergo IVF give birth to more than one baby. How's this for unintended consequences?

According to a study published in this month's edition of the journal Fertility and Sterility, women face increased psychosocial risks with each increase in birth multiplicity (singleton, twin, triplet) resulting from assisted reproduction. Based on survey responses from 249 women, researchers concluded that, for each additional multiple-birth child, the odds of having difficulty meeting basic material needs more than tripled. The odds of lower quality of life--as well as the odds of increased social stigma--more than doubled. Each increase in multiplicity was also associated with increased risks of maternal depression.

Anybody want to make a bet about whether physicians will share this information with women who seek infertility treatment? And if not, have women really had the opportunity to make an informed decision?

The study was performed by researchers at Massachusetts General Hospital, Harvard Medical School, and the RAND Corporation. (Ellison MA et al. Psychosocial risks associated with multiple births resulting from assisted reproduction. Fertil Steril 2005;83(5):1422-1428.)