The New York Times on India

Lab Grown Eggs

A major breakthrough by British scientists could bring new hope for women facing the heartbreak of infertility. For the first time a team has managed to grow hundreds of eggs in the laboratory using a new technique which could help cancer patients whose treatment can leave them infertile. It would also allow thousands more women to wait until middle age to have children.
The scientists from Edinburgh University have shown that immature eggs can be frozen, grown and matured in the lab. The process could lead to women having pieces of ovary containing the immature eggs removed and stored. Much later on, they could be thawed, fertilised and finally implanted into the womb. Some say it is morally wrong for a woman to do so and have them fertilised years later in order to delay having children while she pursues a career. However, scientists hope the new process will revolutionise fertility preservation for women because it will allow them to store many more eggs than they can under traditional IVF techniques. And, because immature eggs survive the freezing process much better than the mature ones used in IVF, it is much more likely that older women will be able to conceive using them. It brings forward the prospect that thousands of women will use the technique to side-step the menopause, delaying motherhood for the sake of their careers.
The process, which could be available in five years, also provides hope for cancer sufferers who at the moment are often left infertile following chemotherapy and radiotherapy. Powerful anti-cancer drugs can destroy follicles in the ovaries, wiping out any possibility of women having children. At the moment, these women have a piece of ovary removed, frozen and then re-transplanted after their cancer treatment. But there is always the danger that the cancer could be reintroduced by the implant.
The new technique means women's immature eggs contained in the patch of ovary could be grown in the lab and then screened for cancer before being used in IVF treatment.

There are also hopes it will provide a rich source of eggs for scientists to study for clues on ways to treat a range of diseases.
There is a shortage of human eggs for medical research, and if the technique works it would bypass the controversy over the use of animal-human 'hybrid' embryos. The research, carried out by an Edinburgh University team led by Dr Evelyn Telfer,has been published in the journal Human Reproduction. "This is a significant step in developing immature eggs to maturity outside the body," said Dr Telfer. "Women who face infertility as a result of chemotherapy, or who want to put their biological clock on hold, could benefit from this system. "However, there is a lot more research to be carried out before this technique could be safely applied within a clinical setting."

Last year, Canadian scientists announced the first birth of a child created from a human egg matured in the laboratory. However, they did not use the same "primordial follicles" studied by the researchers from Edinburgh. These are the tiny egg-bearing pockets within the ovaries that are present in their millions at birth, but gradually die off over the course of a woman's life. They represent a woman's fertility "battery" which once depleted cannot be recharged. Many remain dormant, but some go on to mature and eventually release their eggs in preparation for fertilisation. For the first time, the team led by Dr Telfer has succeeded in growing primordial follicles to a late stage of maturation in the lab. They took pieces of ovary containing the follicles from six volunteer women who were giving birth by caesarean section. These were then exposed to a chemical that promotes growth, similar to the one that functions in the ovaries. Around a third of them survived and went on to reach the advanced 'antral' stage of development. At this stage, the follicles are filled with fluid and contain eggs almost ready to be fertilised. It means that it could soon be possible to grow hundreds of eggs in the laboratory.

The Canadian team which managed to create a child from immature eggs was working with only around a dozen. Another advantage is that the follicles mature much more quickly in the lab than they do in the ovary. The scientists do not yet know whether eggs - or oocytes, to give them their technical name - matured in this way are completely normal and suitable for in-vitro fertilisation. But animal studies suggest they are. The next step is to use hormones and other substances to try to nudge the 'antral' eggs on to the next stage of maturation, and then test the technique on humans. "We believe there's good evidence that we can get normal oocytes, but of course you would never apply this technique clinically until you are sure," said Dr Telfer.
"We're seeking funding for further research to bridge that gap. It might take five to ten years from now before we get to the stage of a clinical trial." Dr Jane Stewart, consultant in reproductive medicine at the Newcastle Fertility Centre, said:
"This work increases our understanding of the maturation of human eggs in the lab and takes us a step nearer the goal of strong immature eggs for fertility preservation for women."

Acupuncture: just a placebo?

Last week, there was yet another piece of research trumpeting the benefits of acupuncture; in this case, needling was said to relieve hot flushes in breast cancer patients by up to 50 per cent. The new study, unveiled at a conference in Berlin, follows similar claims that the ancient treatment can benefit those with arthritis, back pain, migraine and infertility. But is acupuncture really the miracle treatment it seems?

It appears to have become a fashionable cure-all, with 3,000 practitioners now regulated by the British Acupuncture Council. Earlier this year the highly respected British Medical Journal (BMJ) reported that acupuncture could increase IVF success rates by 65 per cent, based on analysis of seven separate trials involving 1,366 women. According to Chinese philosophy, acupuncture works by interfering at particular points along channels in our bodies, known as meridians, thereby enhancing the flow of life energy, known as Ch'i. Although the concepts of Ch'i and meridians make no sense in terms of science, medical researchers have been interested in testing the claims of acupuncture ever since the 1970s.

But in order to test the impact of acupuncture, one must disentangle the placebo effect (which means that as long as a patient believes that a treatment will work, then they are likely to respond positively). The best clinical trials involve two groups of patients: one receiving the real treatment, the other taking something that feels real, but which is ineffective. Researchers can then see if the new intervention offers any benefit beyond what is seen with the sham one. But how do you create a form of sham acupuncture? In recent years, researchers have developed three procedures. The first involves needling the patient at the wrong points on the skin, thereby missing the "meridians". In the second, acupuncturists insert the needles to shallow depths, again avoiding the meridian. The third procedure uses retractable needles: like theatrical daggers, the skin drives the needles back into the handle of the instrument, but the patient is none the wiser.

So how accurate were the trials analysed in the BMJ? The problem is that four out of the seven trials did not include a "sham" acupuncture group, but merely compared the effect of acupuncture with no acupuncture at all; any benefit could be due to the placebo effect and therefore these trials should be ignored. When focusing on the remaining three trials which had included such a sham group, the results are less than impressive. Two out of three failed to show that real acupuncture offers any significant benefit (in terms of likelihood of pregnancy) beyond the fake treatment. The sensible conclusion is that acupuncture is still unproven in terms of increasing IVF success rates. So it is worth avoiding acupuncture in the context of IVF, since 10 per cent of patients complain of pain, bleeding or bruising, and some even experience fainting, dizziness, nausea or vomiting. These adverse effects are not serious, but the known risks outweigh the unproven benefits.

The needles helped me conceive, says Lydia Slater. As a doctor's daughter, I was brought up to despise alternative medicine. But then, about five years ago, I found myself struggling with a variety of conditions that my GP seemed unable to treat. I had developed irritable bowel syndrome; I had put on weight, was unable to sleep and full of unspecified rage at my unexplained failure to conceive. All that modern medicine seemed to offer was a course of soporific antidepressants. Then I met a friend who was being treated for polycystic ovary syndrome by a Harley Street acupuncturist, a practitioner who, incidentally, specialised in unexplained infertility. I booked myself in, without telling my parents. The weekly sessions weren't cheap - some £80 a time. Initially, I was scared of the needles, but the acupuncturist was so skilled I felt nothing. I soon had them sticking out of my ears and in my finger joints. As the needle went in, I sometimes felt a violent jolt of electricity in one limb, or flashing along my body's nerve networks. Often, I would be visited by a burst of exhilaration or was suffused with a feeling of calm. The experience was positively addictive. I increased the sessions, sometimes to twice a week, which I could ill afford. Instead, I gave up shopping and eating out. The effects were startling: first, the IBS cleared up; then I ceased to comfort-eat and lost weight. I booked sessions to coincide with difficult situations, such as prior to a work meeting at which I had to negotiate a new contract. The acupuncturist told me that he would arrange the needles so as to boost my oestrogen levels, reduce stress and thus improve my chances of conceiving. It sounded like mumbo jumbo, but although I'm normally diffident, I found myself storming into the office and insisting on precisely the deal I was after. It was about the same time that I discovered I was pregnant. I now have two daughters, Asya, nearly four, and Rosie, two. I can't believe that my return to health can be attributed to a placebo effect. So many people I know can attest to the benefits of acupuncture: it has helped friends with everything from healing torn muscles to boosting low self-esteem. These days when I'm ill, I still go to my GP. But if a problem is nebulous or intractable, I'll be straight back to the needles.

By Simon Singh (The Telegraph, London, UK)
'Trick or Treatment? Alternative Medicine on Trial' by Simon Singh and Edzard Ernst (Bantam) is available from Telegraph Books for £14.99 + £1.25 p&p. To order, call 0870 428 4112 or go to books.telegraph.co.uk

Steroid Use Fails To Boost Pregnancy Rates In Infertility Treatments

There is no clear benefit from a hormone commonly prescribed to enhance the effectiveness of infertility treatments, according to a new review of studies. The steroid hormones called glucocorticoids have potent effects on the body's inflammatory and immune responses, so many fertility specialists prescribe them in hopes of making the lining of the uterus more receptive to embryo implantation. But lead review author Carolien Boomsma says that routine practice should stop. "This meta-analysis shows that empirical use of glucocorticoids is not supported by evidence from studies," she said. "Moreover, we don't know enough about the possible adverse effects of glucocorticoids in early pregnancy. Therefore, at present, glucocorticoids should not be prescribed in this way," said Boomsma, a researcher at the University Medical Centre Utrecht in the Netherlands. The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The review compares success rates between would-be mothers who took glucocorticoids around the time of embryo implantation and those who did not. All of the women underwent one of two types of assisted reproductive technology. In vitro fertilization (IVF) involves removing mature eggs from a woman's ovary, mixing them with sperm in the laboratory, and placing the embryos in the woman's reproductive tract. Intracytoplasmic sperm injection (ICSI) is another in vitro fertilization practice where a single sperm is injected directly into a harvested egg. The meta-analysis pooled data from 13 studies including 1,759 couples. Every study was a randomized controlled trial, which is considered the most reliable form of scientific evidence.
The review found no overall improvement in pregnancy rates when the assisted reproductive technologies were combined with glucocorticoid treatment. However, six of the studies -- of 650 women undergoing IVF -- revealed a slightly higher pregnancy rate among women who took the hormones. The review authors say the difference barely exceeds that which could be attributed to mere chance.
"At present, glucocorticoids should not be offered as a routine procedure in women undergoing ART (assisted reproductive technologies), except in the context of well-designed studies," the reviewers conclude. Glucocorticoids can bring on problems such as infections or premature births. Though the available studies reported no significant increases in these negative outcomes, they were "poorly and inconsistently reported," the review said. Further research is needed to clarify both benefits and harms, Boomsma and colleagues said. Only three of the studies in the review continued long enough to report actual birth rates rather than simply pregnancy rates. "Trials should be of sufficient duration to have live birth as their primary outcome," the authors say. Despite substantial improvements in IVF and ICSI techniques, only 20 percent to 30 percent of couples go home with a healthy baby after each treatment cycle. That tantalizing hint of benefit may nevertheless encourage some practitioners to continue routine use of glucocorticoids for their IVF patients, said Randall Hines, M.D., director of the division of reproductive endocrinology and infertility at the University of Mississippi Medical Center. "When you have a therapy that doesn't have significant risk and doesn't impose significant burden on the patient in terms of cost or inconvenience, it's hard for people to let go of it," said Hines, who was not involved in the review and does not prescribe glucocorticoids routinely in his practice.

The compiled studies included couples who were infertile due to a wide variety of problems in either the woman, man or both partners. Future research may reveal that glucocorticoids do help specific subsets of these patients, the authors say. For example, women with unexplained infertility, endometriosis, recurrent implantation failure or certain immunological issues may benefit from the hormonal effects on uterine receptivity. None of the studies included in the review focused specifically on these patient groups.

Reference: Boomsma CM, Keay SD, Macklon NS. Peri-implantation glucocorticoid administration for assisted reproductive technology cycles (Review). Cochrane Database of Systematic Reviews 2007, Issue 1.
The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

I fell In Love With This One

A Senior Citizen in Florida bought a brand new Mercedes convertible.
He took off down the road, stepping it up to 80 mph and enjoying the
wind blowing through what little hair he had left on his head. 'This
is great,' he thought as he roared down I-75. He pushed the pedal to
the metal even more. Then he looked in his rear view mirror and saw
a highway patrol trooper behind him, lights flashing and siren blaring.

'I can get away from him with no problem!' thought the man. He
tromped down on the accelerator and flew down the highway at 100mph.
Then 110 mph. Then 120 mph. All of a sudden he thought, 'What am I
doing? I'm too old for this kind of thing.'

He pulled over to the side of the road and waited for the trooper to
catch up with him. The trooper pulled in behind the Mercedes and
walked up to the man. 'Sir,' he said, looking at his watch, 'My shift
ends in 30 minutes and today is Friday. If you can give me a reason
why you were speeding that I've never heard before, I'll let you go.'

The man looked at the trooper and said, 'Years ago my wife ran off
with a Florida State Trooper, and I thought you were bringing her back.'
The trooper replied, 'Sir, have a nice day.'

Visual Humor

I Loved This One