Jan Deckers, Lecturer in Health Care Ethics, University of Newcastle 08 March 2006
The UK's Human Fertilisation and Embryology Authority (HFEA) is reported to be considering allowing women to donate eggs specifically for cloning research. Three issues must be considered to address this question: firstly, if creating life to kill it is justifiable; secondly, if the expected benefits outweigh the costs; and thirdly, who should decide?
With respect to the first issue, women giving eggs to researchers who then create embryos from them, are consenting to the creation of life subsequently to be destroyed, in the hope of therapeutic benefits. The essential issue at stake is whether the embryo volunteered in this way should be granted equal status with born humans. If the HFEA allows women to contribute voluntarily to the creation of embryos destroyed for research purposes, there is no reason why women should not also have the right to create babies voluntarily, who are then killed after being anaesthetised for similar purposes. If the latter is not justifiable, neither is the former.
Species membership has a part to play here. Many animals have natural inclinations which predispose them to favour the needs of their own species members. Humans are no exception. We have all been embryos. Strong feelings of identification underlie the perception of similarity between ourselves and other human embryos, which is not morally neutral. The argument has been made that, even if embryos have full personhood status, the hope that the lives of many embryos may be extended, might outweigh the costs of sacrificing some embryos to research. Similar reasoning would justify sacrificing some adults to provide badly needed organs for others. If the latter is invalid, so is the former.
As some concerns stand irrespective of one's position on the embryo's status, I now turn to the second issue. The argument has been made that women should be permitted to take on the health risks associated with such donations, for example the potentially lethal ovarian hyperstimulation syndrome (OHSS) or other rare complications, because of the benefits involved. The problem with adding financial incentives to these risks, however, is that they increase the likelihood of coercion. Some might argue that those willing to sell a kidney in the hope to escape from poverty should be allowed to do so, as a good chance of living with one kidney would be preferable to a good chance of dying early in poverty. Yet we must ask if those who contemplate providing such financial incentives are not responsible for maintaining financial inequalities. Even with smaller financial incentives, the risk of coercion for some women may be hard to exclude. Offering incentives also undermines respect for the integrity of the body. Blood donors might agree that the real value of their donated blood is tainted by giving them monetary rewards.
But what about women who wish to donate purely altruistically, hoping that those suffering from disease might benefit? The possibility of coercion is not excluded here either. If people have the right to refrain from donating a kidney to a sibling; even if it could save their sibling's life, the right of women not to donate eggs for stem cell research is even stronger. The expected benefits of such research are more unclear and remote than the benefits achieved by kidney donation. Unknown future health damages might occur to the egg donor even when known complications such as OHSS fail to occur. To put the last nail in the coffin: the goods that might be obtained from stem cell research must be weighed against any goods forsaken. The resources poured into speculative high-tech stem cell research would be better spent on low-tech activities. Better health education, for example, might yield greater benefits for many conditions.
Those who accept democracy would accept that whatever the majority decides should be law. People's judgements, however, might be based on distortions, sometimes created by groups with vested interests. I name but a few that are rife in the debate on the embryo's status: that the embryo is not an individual, only potentially human, or not an ensouled living organism. While recognising these distortions may not resolve all value conflicts, the widespread acceptance of these misconceptions should be a cause for concern.
French researchers have published a study showing new evidence that male fertility declines as they get older. The study's authors, who published their findings in the journal Fertility and Sterility, warn that men's lack of awareness of this fact - and of their own biology - may play a part in the decline in birth rates.
The researchers, from fertility clinics across France, looked at what role the man's age played when it came to the likelihood of having children. They concluded that, similarly to women, a man's fertility begins to decline from the age of about 40. They looked at success rates in fertility treatments following treatment at 59 clinics in France, a study that included 1,938 couples. The results showed that in couples where the woman was younger than 30 but her partner was aged 40 or above, the couple was 25 per cent less likely to be successful than if the man was nearer the woman's age. Where the female member of the couple was older than 30, and her partner was 40 or above, the woman was twice as likely not to conceive.
Elise de La Rochebrochard, lead author of the study, from the French National Institute for Demographic Studies, said that the results show for the first time 'strong evidence for a paternal age effect on failure to conceive that is linked only to biological male ageing'. When it comes to reproduction she said, 'age must no longer be considered the concern of the woman, but that of the couple'.
Dr Allan Pacey, senior lecturer in andrology at the UK's University of Sheffield, and spokesperson for the British Fertility Society, said that the findings of the French researchers added to the evidence that male age was also a factor in fertility. 'Women seem to be more attuned to their biological clocks', he said, adding that 'with men, the clock seems to tick more slowly, but often I don't think they hear it at all'. The findings came in the same week as a poll in the Guardian newspaper had identified that many British couples put 'having fun' and 'having enough money to live comfortably' ahead of having children.
A British couple who are fighting to save their unused IVF embryos from destruction are hoping to have them transferred to a Belgian clinic, following negotiations with the UK's fertility regulator, the Human Fertilisation and Embryology Authority (HFEA). According to current UK law, the embryos should have been destroyed last Monday, as they are only allowed to be kept in storage for five years if they were created with the intention of having them carried by a surrogate.
Michelle Hickman and Martin Hymers, who underwent IVF treatment after Michelle had her womb removed, created the embryos in question in 2001. However, since that time, they have not managed to find a suitable surrogate to carry them. The couple found out in December 2005 that embryos intended for treatments involving surrogacy can only be kept in frozen storage for five years and have been fighting since then to be allowed to transfer the embryos to a fertility clinic abroad.
Ms Hickman, now aged 33, underwent an emergency hysterectomy operation six years ago, after the birth of the couple's son, Robert. Following the advice of doctors, the couple decided to undergo fertility treatment at the Manchester Fertility Services clinic, and to freeze any resulting embryos while they searched for a surrogate to carry them. Manchester Fertility Services has agreed to store the embryos, even though this is technically 'against the law', as the embryos were only allowed to remain in storage until 8 May 2006. Unlike embryos created during treatment for other types of infertility, the couple are not allowed to apply for an extension to the storage time, which can allow embryos to be kept for up to ten years. The couple also have another batch of seven embryos in storage, which could be disposed of next year, if the couple still cannot find a surrogate.
The 1990 Human Fertilisation and Embryology (HFE) Act - which governs all fertility treatment and research involving embryos in the UK - is currently under review, so the couple is hoping that the law will change for the future - however, any change is likely to come too late to save their own embryos. Instead, they are trying to move them to storage facilities overseas. Negotiations are continuing with the HFEA, and a fertility clinic in Belgium, which is considering taking charge of the embryos - perhaps with a view to returning them to the UK after the law has changed. Ms Hickman said that although the embryos are in storage, 'they are part of our family. We just cannot abandon them'. She added: 'There is just no logic to it at all. Why would you discriminate against people like that? For host surrogacy you need more time'.
When the couple's situation was first raised, a spokesman for the HFEA said that the authority recognised that the current law does appear to discriminate against couples hoping to use embryos in surrogacy arrangements, adding that 'both the HFEA and fertility professionals have already raised this issue with the Government as one that needs reconsidering in the ongoing review of fertility legislation'. The HFEA has since clarified that 'the only option that the law would allow would be for the couple to take their embryos abroad'. Dr Brian Lieberman, of Manchester Fertility Services, called the law 'illogical and manifestly wrong', adding that 'it is very unfair that there is a time pressure put on them. They have got enough problems as it is without having to deal with some anomaly in the law'.
Research Instruments are proud to unveil their new Hygiene Monitor for IVF Labs that can quickly and accurately assess laboratory hygiene within 10 seconds.
It is accepted that IVF lab surfaces should be properly cleaned but assessing that a surface is clean is difficult. Visual assessment is not effective and traditional methods of testing cleaning effectiveness such as microbiological analysis take days to determine whether a surface is clean. The delay in correcting a failed microbiological analysis could allow the bacteria to spread and lead to further contamination. Traditional tests only detect the number of viable bacteria present but fluids, such as blood, would not be detected.
The Lightning MVP, exclusively from Research Instruments, provides both fast and accurate analysis of surface cleanliness. The system uses ATP bioluminescence to detect all organic matter including bacteria to give a more accurate indication of surface cleanliness.
Simply swab a 4 inch / 10cm square of surface with the special single use disposable swab. Press the swab plunger to release the enzyme and then place the entire swab inside the lightning MVP. Ten seconds later you will have a pass, warning or fail result.
Software is also included for hygiene trend analysis.
Bill Brown, Managing director of Research Instruments said, ?The Hygiene Monitor complements the IVF Thermometer in our range of products for environmental monitoring within IVF labs. We will also be launching at ESHRE a particle counter, a VOC meter and pH meter that can measure the pH of media INSIDE the incubator.?
Research Instruments are proud to unveil their new VOC meter for IVF Labs that can quickly and accurately assess laboratory VOC?s at very low levels.
The RI VOC Meter is the smallest handheld monitor on the market. It is extremely sensitive and capable of detecting over 250 VOC?s at contamination levels at 0.1ppm level.
It can be surprising where VOCs are found. In field tests we have found VOCs present in laboratories, incubators, incubator gas tubing, and lab cabinets. We have also found VOCs present in laboratories where VOC removing filtration was in use.
The RI VOC Meter is 200 times more sensitive than Heated Metal Oxide (HMOS) monitors that have been used until now and for the first time VOCs can be detected and eliminated before they become toxic to embryos. (0.1ppm is below an established threshold of embryo toxicity.)
Simply start the device and use to sniff out areas of high VOC. An audible alarm will sound in areas where VOCs are higher than recommended. For added protection, the unit can be wall mounted and VOC levels logged continuously.
Software is also available for trend analysis.
Bill Brown, Managing director of Research Instruments said, ?The VOC Monitor complements our range of products for environmental monitoring within IVF labs. For the first time there is a VOC product available that measures VOC?s at levels that affect embryos. We will also be launching at ESHRE a particle counter, a hygiene monitor and pH meter that can measure the pH of media INSIDE the incubator.?
More information can be found at
The UK's Human Fertilisation and Embryology Authority (HFEA) has published a new edition - in hard copy and online - of its annual 'Guide to Infertility'. The Guide contains details of all UK clinics that are licensed under the Human Fertilisation and Embryology Act 1990 to carry out in vitro fertilisation (IVF) and donor insemination (DI), although it does not contain information on other 'lower-tech treatments' that may be carried out by other doctors or hospitals. It also has an online search facility that patients can use to find information about clinics so they can choose the right clinic for their particular needs.
The Guide gives information about the causes of infertility and potential treatments, detailed information - including success rates - for all the 85 individual licensed treatment centres in the UK, and 'real-life' patient stories. The data in the Guide show that birth rates for women undergoing IVF in the UK have continued to increase. The data was based on results from 38,264 treatment cycles undertaken by 29,688 women between 1 April 2003 and 31 March 2004.
Overall, the average IVF success rate (measured in terms of 'live births') for all IVF cycles was 21.6 per cent. The guide shows that, for women under 35 years old, the average success rate is 28 per cent, although some clinics have much higher success rates than others. The data also show that the chances of success decline with age - the success rate falls to 3.2 per cent in women over 42 years old. The top performing clinic had a success rate of 53.8 per cent.
Dame Suzi Leather, Chair of the HFEA, said that 'one in seven couples across the UK, roughly 3.5 million, have trouble conceiving and we know that when people start to experience fertility problems they eagerly search out all the information they can on the subject'. She added that 'patients are becoming increasingly demanding of information to help them choose their medical care. The new HFEA Guide to Infertility and interactive clinic search provides the single and authoritative source of expert information that people can trust'. However, Dr Allan Pacey, spokesman for the British Fertility Society, said that the published figures would encourage patients to judge clinics by their success rate alone. 'If you properly analyse the clinics there's very little difference between their success rates', he added. Fertility expert Lord Robert Winston, also criticised the tables, saying that they 'don't compare like with like'. He added: 'There's no way patients can assess how well a clinic is doing from these tables because some clinics go out of their way to treat difficult cases; others try to treat easy cases'.
In the light of the figures, the HFEA has also warned that multiple births from IVF remained high, even though the figures showed a decline on the previous year. Nearly one in four IVF births resulted in either twins or triplets. Angela McNab, the HFEA's Chief Executive, said that it is 'still concerned about the levels of twin and triplet pregnancies, which provide the single biggest risk to mothers and their children from IVF treatment'. She added: 'Multiple births risk endangering the health of both mother and the children they are carrying and can lead to problems which can last a child's lifetime'.
Dame Leather called on the government to offer patients more NHS-funded treatment cycles to encourage a move towards single embryo transfer. 'The biggest risk for those having fertility treatment is still the risk of having a multiple birth and this year we have been even more explicit about those risks', she said. Last week, a study by Finnish researchers, published in the journal Human Reproduction, showed that implantation of a single IVF embryo is just as successful as double transfer in older women. The study, which analysed 1224 IVF or ICSI cycles using fresh embryos, and 828 using thawed embryos, in women aged between 36 and 39, showed that careful embryo selection helped to improve results. The authors say that it is the quality of the embryo that is the most important factor in determining whether the treatment will be successful.
The new interactive HFEA Guide to Infertility can be accessed on the HFEA website at
A new US study has cast serious doubt on controversial research that suggested bone marrow stem cells can produce new eggs in adult mice. Last year, a team based at Massachusetts General Hospital reported in the journal Cell that the eggs of mice rendered sterile could regenerate within 24 hours, following bone marrow transplants. However, in a new paper published online by Nature, scientists based at Harvard University and the Joslin Diabetes Center say they have found no evidence to back up the claims.
The Massachusetts researchers found that when they destroyed egg-containing follicles with the drug doxorubicin, hundreds of new eggs appeared within 24 hours. The scientists also transplanted bone marrow from healthy mice into mice sterilised with two chemotherapy drugs, cyclophosphamide and busulfan. They found that new egg cells appeared in the ovaries of the treated mice one to seven days after transplantation, with egg cells still present 11 months later. The researchers got similar results when they transplanted bone marrow from normal mice into animals incapable of producing mature germ cells.
The results caused a sensation when they were published, since they appeared to contradict the long-held belief that female mammals are born with a lifetime's supply of eggs. Instead, they provided evidence for the existence of 'ovary stem cells' that continue to make new eggs throughout the animal's life. At the time, team leader Jonathon Tilly said: 'Everyone had missed finding female germline stem cells because they are not in the ovaries, where everyone would have looked for them', Now, it seems that such stem cells may not actually exist - at least not in bone marrow.
In the latest study, the researchers wanted to find out if the new eggs reported in Tilly's study could be ovulated (released from the ovary), and whether or not ovary regeneration by bone marrow cells was a normal process. The team used 'parabiotic' mice - pairs of animals that have the skin between their front and hind legs sewn together, so they share a blood circulatory system. One mouse in each pair was normal, while the other had been genetically altered to produce green fluorescent protein (GFP) in all its tissues. Eve after eight months of sharing their blood, the normal mice produced no eggs tagged with GFP, and the GFP mice produced no normal eggs. This, say the scientists, is proof that circulating bone marrow stem cells do not normally produce new eggs.
The team carried out another experiment, in which one mouse in each pair had received chemotherapy drugs to destroy its own eggs. But again, the researchers found no evidence of the damaged ovaries being replenished with cells from the other mouse. 'This is a pretty powerful denial of the idea that new eggs form and contribute to fertility', said co-author Roger Gosden, of Cornell University in New York. Other scientists agree: 'It incontestably shows that the Tilly work is simply not true', David Albertini of Kansas University told Nature.
But Tilly says the new research does not contradict his own findings, since he looked at immature eggs still in the ovary, whereas the latest study focussed on ovulated eggs. He says that replenished, immature egg cells could still be crucial to fertility, even if they are never released by the ovary. Gosden concedes that dormant egg stem cells, which can be 'brought back to life' in the lab, could still exist. 'I think the Tilly group might be right to some extent on that one', he said.
Swedish scientists have successfully transplanted uteruses in sheep, an achievement that paves the way for women who do not have a womb to bear their own children. The team, based at the Sahlgrenska Academy at Goteborg University, presented the findings at the annual conference of the European Society of Human Reproduction and Embryology (ESHRE) in Prague, Czech Republic. The work follows the group's previous successes with mice, reported three years ago.
In 2003, the researchers transplanted uteruses into 12 mice that were 99 per cent genetically identical to the donors, placing them alongside their existing uteruses in order to compare them. They then implanted embryos into the wombs, and several pups were born as a result. However, when they tried to repeat the procedure with transplants between animals that were not genetically matched, the wombs were rejected.
In the latest research, team leader Dr Mats Brannstrom and his colleagues removed wombs from sheep, and replaced them several hours later. They showed that the organs still worked properly 2-3 months after the transplant operation. Brannstrom says the next step is to try and get the animals pregnant, and then to attempt transplanting a uterus from one sheep to another, using immunosuppressant drugs to prevent rejection. He then wants to test the procedure in primates, and hopes that human womb transplants will be possible in five years time. 'It's not a life-saving operation, its about improving quality of life, so we have to be sure it's a safe procedure', he told Nature News.
If they can be successfully carried out in humans, uterus transplants could help women who were born without a womb, or those who have lost their womb following surgery - to treat cervical cancer, for example. A womb transplant would have several advantages over surrogacy, according to Brannstrom: 'If you put your embryo in another woman you give up control and you don't know if she might be smoking or taking drugs'. He says that the best donors for womb transplants would be older sisters or mothers, to minimise the chances of rejection. The womb could be removed after having children, so that the recipient did not have to take immunosuppressant drugs for life.
Scientists have for the first time managed to create sperm from mouse stem cells capable of fertilising eggs and resulting in live births. A team led by Professor Karim Nayernia, now Professor of Stem Cell Biology at Newcastle University, began with mouse embryonic stem (ES) cells which they sorted in order to isolate cells that were capable of becoming sperm precursor cells. These spermatogonial stem cells were then encouraged to grow into adult sperm and, when mature, were injected into mouse eggs. The resulting early embryos were implanted into surrogate mouse mothers. Two hundred and ten eggs were injected with the artificially-derived sperm, 65 began to undergo cell division and seven live births resulted, with six of the animals achieving adulthood. The work was done in Professor Nayernia's previous position at the Georg-August University in Gottingen and is reported in the journal Developmental Cell.
The mice that resulted from the research were able, with one exception, to develop into adult animals. However, despite managing to achieve maturity, all the animals suffered from problems and died within five months of birth. The mice were either larger or smaller than normal animals due to abnormal growth rates, probably through problems with imprinting - changing the pattern of genes expressed in the embryo - similar to that suffered by cloned animals. The work is important for the insight that it gives to researchers looking at problems in sperm development and may one day help to develop new treatments for male infertility. Professor Nayernia was optimistic that the problems with the mice could be solved reasonably quickly, and he predicted that although, 'we cannot find a universal treatment for all male infertility?at least we can find, I believe in five years, a resolution for some kinds of male infertility'.
Estimates suggest that one in seven couples in the UK have difficulty conceiving, about one per cent of all men don't produce sperm and a further 3-4 per cent of men have a low sperm count. Dr Allan Pacey, honorary secretary of the British Fertility Society and a senior lecturer in andrology, said, 'To be able to make functional sperm under controlled conditions in the laboratory will be very useful to study the basic biology of sperm production. There are currently many things we don't know about how sperm are formed let alone why it sometimes goes wrong and leads to infertility in some men'.
There are also many ethical considerations raised by this work. Anna Smajdor, a researcher in medical ethics at Imperial College London, described the work as 'a hugely significant breakthrough', but warned that, 'being able to create these cells in the laboratory will pose a serious conceptual challenge for our society. Who is the father of offspring born from laboratory sperm? A collection of stem cells in a Petri dish?' She continued: 'Sperm and eggs play a unique role in our understanding of kinship and parenthood, and being able to create these cells in the laboratory will pose a serious conceptual challenge for our society'.
Doctors at Hammersmith Hospital, London, aim to carry out the first successful womb transplant within two years, reported the Evening Standard. Doctors say that the womb would be taken from a dead donor and will only remain in the recipient for two or three years, or until a baby is born. Richard Smith, a surgeon at Hammersmith Hospital, working with teams in Budapest and New York, announced that animal trials have been successful; 'We have had stunningly good results in the laboratory with good blood supply to the organ', he said. The team now wishes to move on to clinical trials in humans.
This procedure may bring hope to women whose own wombs have been rendered useless by disease or surgery, or who were born without one, for whom IVF is not an option, and for women who have come to the end of the line of IVF with no success. There are currently 15,000 women in Britain who have no uterus, of which about 200 have turned to surrogacy.
The procedure would provide an alternative to surrogacy, where problems include difficulties in finding someone to carry the baby and fears that the surrogate mother will refuse to hand over the child once born. There are also risks for the surrogate mother herself. In 2004, Natasha Caltabiano died after given birth for another couple. However, womb transplantation may carry associated risks as well. The mother would have to give birth by Caesarean and would have to undergo a course of immunosuppressant drugs. For this reason the transplanted womb would only be in for two or three years and would be removed once a child is born. Mr Smith highlighted that women have already given birth to healthy children after kidney transplants, which required them to take immunosuppressant courses to prevent rejection. Women who undergo a womb transplant would also be offered psychological counselling.
Mr Smith said that the hospital, which is currently funded by charitable donations, would need ?250,000 a year in funding to perform the transplants. It is estimated that each transplant would cost about ?50,000.
Womb transplantation has provoked a mixed response from the authorities and the public. Infertility organisations have welcomed the news but have warned women not to raise their hopes until the procedure has undergone successful human trials. Professor Lord Robert Winston, however, warned that 'this is not a road we should be going down. It is a dangerous procedure which could cost a woman her life'. Dr Patrick O'Brien, spokesman for the Royal College of Obstetricians and Gynaecologists, called the procedure 'fascinating' and said that women would chose to undergo the transplant but added that it was a 'separate question, for the Human Embryology Authority and the public to consider'. Public discussion boards have revealed concerns over 'Frankenstein' procedures and some have preferred the alternative of adoption. Whilst issues of safety may be overcome by Mr Smith and his team, the ethical objection to such a procedure may remain.
The first human womb transplant was announced in 2002 by a team in Saudi Arabia but the transplanted womb failed after 90 days because of the development of a blood clot. Mr Smith has said animal trials have shown no blood supply problems so far.
