As we reported in our blog earlier this year, fertility specialists in Sweden transplanted uteri into women who were unable to carry a pregnancy to help them. They were presumably motivated by one of the remaining challenges in Reproductive Medicine, helping women who were born without a uterus, or have had their uterus removed or have severe scar tissue in the uterus making it difficult or impossible to carry a pregnancy. The only options for these couples until now has been to use a gestational carrier with IVF to carry the pregnancy for them, what most people think of as a “surrogate.” Picking up on research that began over a century ago, doctors in Sweden used modern surgical techniques and medications to enable transplantation of the uterus. There is now some good news on this front. One of these transplants in Sweden resulted in a healthy live birth. The pregnancy and birth were not without complications. The baby was born 9 weeks early and the mom developed pre-eclampsia, a serious condition in pregnancy also known “toxemia” whose symptoms include high blood pressure and swelling. The doctors are also unsure if the uterus will be usable for a second pregnancy. Still, this an exciting first in Reproductive Medicine.
Several months back, we reported in our blog that the authorities that regulate IVF and other fertility procedures in the UK were considering allowing IVF with mitochondrial transfer to move forward. Mitochondrial transfer is more popularly known as “three parent IVF,” because it involves three genetic parents: the woman who provides her chromosomes, the husband who provides his chromosomes and the donor who provides the mitochondria which contain their own DNA. The HFEA in the UK has now given the green light for tightly regulated research to proceed on mitochondrial transfer. So, now it is likely that fertility researchers in Britain will move forward and learn whether this technique can help couples with mitochondrial diseases.
Being that is National Infertility Awareness Month, this week seemed like an appropriate time to share this story. I recently attended a lecture given by one of pioneers in our field and one my personal mentors, Dr. Eli Adashi. The story he shared with the audience moved me and reminded us of our patients’ suffering and why we do what we do. In the history books, when one looks at the breakthroughs in medical infertility treatment, the birth of the first IVF baby does and will stand out as one of the great milestones. The protagonists in the story that everyone knows are, Drs. Steptoe and Edwards, the brilliant gynecologist and scientist team, and of course, baby Louise Brown herself. But the popular narrative leaves out perhaps the most important character in this drama, Lesley Brown, the patient herself. Lesley was a reserved woman who never wanted attention but her delivery was one of the most famous events of the 20th century. She put up with repetitive surgeries and painful medical procedures knowing there was little chance they would work. When she did IVF with Drs. Steptoe and Edwards, she was basically (and knowingly) a human guinea pig. Nobody had any idea as to whether it could work, whether it was safe and if it did whether her child would turn out normal. On top of that she had to put up with moral outrage (and occasionally harassment) of those who opposed the very idea behind IVF. Without her bravery and perseverance, millions of couples would remain childless and millions of babies would never have had a chance at life. Lesley Brown passed away quietly in 2012 but the legacy she left has brought both hope and joy to millions.
For most couples going who use assisted reproduction, one of the foremost concerns they have is about the health of the children they will hopefully deliver. While there are some concerns about the risks of birth defects and other complications of pregnancy in IVF babies, little was known about how these children do long term. Now, there is some promising long term data coming from Melbourne, Australia that suggests IVF kids do just fine as they grow into adulthood, with generally similar quality of life, health and educational achievement to normal conceived children.
One of the most fascinating things about practicing Reproductive Medicine in an ethnically and religiously diverse area is learning to understand the value systems that our patients bring to the table when they come to seek out fertility treatment. Some faiths such as Roman Catholicism reject Assisted Reproduction as a separation between reproduction and intimacy and others such as Judaism encourage it emphasizing the importance of the biblical commandment “to be fruitful and multiply.” Sunni Islam permits assisted reproduction but forbids the use of donors or gestational carriers. The most fascinating and perhaps most paradoxical is that of Shia Islam, the predominant religion in Iran. Most of the world views the Islamic Republic of Iran as one of the most brutal and intolerant in the world, yet when it comes to Assisted Reproduction, it is actually one of the most open minded. As pointed out in an Op-Ed in the Pittsburgh Post Gazette, Iran’s Shiite theocracy allows relatively unrestricted access to ART and IVF, including the use of egg and sperm donation, a practice forbidden in most of the Middle East. Iran, in fact, now has over 70 clinics, luring patients from Sunni countries that forbid the use of donation.