Artificial eggs and sperm- are they on the horizon ?

Sperm-eggs-synthetic-artificialCould a cure for real cure for infertility be on the horizon? Today many causes for infertility can currently be successfully treated such fertility issues caused by damage to fallopian tubes, ovulation disorders, endometriosis and low sperm counts or motility. These treatments currently available to us include fertility drugs, insemination, surgery and IVF. However, there are still issues in assisting women have very few or no eggs left or men who produce no sperm at all. This is a particular problem for women since women produce all they eggs they will in a lifetime while still in their mother’s womb, and by their mid 40s have hardly any normal eggs left.

These couples can be successfully treated only with the use of donor eggs or sperm. While these donor procedures are often quite effective, the children who result from these pregnancies do not carry the DNA of one or both of the parents. This is a problem since most couples who seek out the help of a Reproductive Medicine specialist want their own genetic children. With our current state of reproductive science this may not be possible.

One potential way around this would be using stem cells in the lab using cloning technologies.  A group of scientists at the Weizmann Institute in Rehovot, Israel and Cambridge in the UK have brought us a little closer to this cure, figuring out how to more efficiently get these stem cells to grow into cells that will eventually develop into eggs and sperm. Their findings were recently published in the journal Nature.

The researchers have yet to take the next step; producing eggs and sperm from these stem cells. While it may become technically feasible, besides the technical issues, there are ethical concerns, perhaps even greater than when IVF when first introduced to overcome before this proceeds. IVF was enormous breakthrough when it was developed, but it is still merely a replication of natural conception, albeit in a laboratory dish. If this next step is even possible, it could bring reproduction to entirely new level. These technologies may make it possible to have genetic children without ovaries, without testes and without age limits, shattering our concepts about parenthood, even more so than it is today. It is not clear if society is ready for this yet.

Can Vitamin D make you more fertile?

fertility-vitamin-DIn recent years, Vitamin D has become the all the rage in medical research. It seems everybody these days is deficient in Vitamin D and a whole range of medical conditions from cancer to osteoporosis to reproductive issues have been potentially linked to insufficient Vitamin D.  A recent study, which was in agreement several other previous studies, showed that women doing IVF with higher Vitamin D levels actually had significantly higher pregnancy rates than those who did not. While it is not clear at this time whether Vitamin D deficiency actually causes infertility or even whether supplementation will help couples conceive, it does suggest that maintaining healthy Vitamin D levels may contribute to good reproductive health.

UK Authorities gives three parent IVF the green light

Princeton IVF-UK HFEASeveral 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.

Lesley Brown, the unsung heroine of IVF

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.

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Lesley Brown, the unsung heroine of IVF with her daughter Louise

Surrogacy- why not to do it yourself

princeton-ivf-turkey-basterLike most Reproductive Medicine practices, we perform what we refer to as “Third Party Reproduction” meaning we use donor sperm, donor eggs, gestational carriers for couples who need these procedures. One of the problems with the use of an egg and sperm donors or surrogates and gestational carriers, is that using them can be rather pricey. A lot of effort is required to make sure all parties involved are protected medically and legally, and so many patients may be tempted to do this at home without medical intervention. This story of a “Turkey Baster” do it yourself surrogacy from the UK illustrates why it is so important not to try this at home.

 

 

Fracking, fertility and birth defects- a problem or just hype?

fracking-dvobgynIn our countries’ race for energy independence, an new technique has been developed called fracking (hydraulic fracturing) in which high pressure fluid is injected into rock in order to extract fossil fuels such as natural gas. Besides water and sand, a number of other chemicals are injected into the rock, including some chemicals called endocrine disruptors. Endocrine disrupters can interfere with how the hormones in the body work and a number of these are found in the environment. A recent study the journal Endocrinology, suggests these endocrine disruptors may be found in higher doses in areas close to fracking sites, raising public concern about when this might be a public health hazard.  While fracking may result in higher levels of these endocrine disruptors in the environment, it is not clear whether these levels are high enough to be concern to reproductive health issues such as affecting fertility or birth defect rates.

Posthumous parenthood

Assisted reproduction and particularly advances in fertility preservation procedures such as egg freezing has made it more likely than ever that men and women will have offspring born after they are deceased. A woman who freezes her eggs (or a husband his sperm) before chemotherapy may not survive the cancer. So what happens when those eggs or sperm are used to help the surviving partner or some one else conceive? This article in the NY Times explores the legal and financial issues that might arise.

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