In-vitro fertilization (IVF) for the poor

British scientist Robert Edwards won a Nobel Prize for helping develop in-vitro fertilization. Now, scientists are bringing the technology to the developing world.In-vitro fertilization is a fairly common method of aiding conception. But it's expensive, and only a small percentage of people around the world can afford it. Dr. Ian Cooke, one of the founders of the Low Cost IVF Foundation, wants to change that. His organization is trying to lower the cost of IVF treatment, to make it accessible to the poorest areas in the world.

"There's a huge need in many, many parts of the world," Cooke told us, including in parts of the world concerned about overpopulation. Infertility "leads to social isolation, physical and emotional abuse and ostracism and indeed suicide," Cooke says. The problem is also more widespread in the developing world. And in many parts of the world, according to Cooke, "particularly in rural areas such as Bangladesh, this leads to increasing poverty because husbands will not let wives who are not fertile work. And so they're even further diminished."

In the United Kingdom, IVF costs about $5,000, and it can be much higher in the United States. "We think that the technical side of it without the staff cost could be done for as little as $200," Cooke told The World. The organization would use cheap drugs and simpler incubation programs. "And because you have the intention of only transferring a single embryo instead of larger numbers," Cooke says, "laboratory costs are kept lower."

The organization has already started work in Tanzania and Sudan. "There end up being major staffing issues that need to be resolved so we don't have a long-term functioning clinic," Cooke says. At the same, he points out, "we've only been working on this in the last twelve months or so." So there may be opportunities in the future.

Alternative Commonwealth Games

Vatican continues to attack Nobel over IVF award

The Vatican kept up its attack on the Nobel committee yesterday for giving the medicine prize to in-vitro fertilisation pioneer Robert Edwards, saying he had led to a culture where embryos are seen as commodities.

For the second day, it kept up its public criticism of the choice of Edwards, whose success in fertilising a human egg outside of the womb led to "test tube babies" and innovations such as embryonic stem cell research and surrogate motherhood.

The Vatican ratcheted up its negative opinion as several leading Italian newspapers criticised it for its attack on Edwards.

A statement by the Vatican-based International Federation of Catholic Medical Associations (FIAMC), said it was "dismayed" at the choice.

"Although IVF has brought happiness to the many couples who have conceived through this process, it has done so at enormous cost," the federation said in a statement issued on Vatican letter head.

"Many millions of embryos have been created and discarded during the IVF process," it said, adding that embryos were being used as "animals destined for destruction".

"This use has led to a culture where they are regarded as commodities, rather than the precious human individuals which they are".

A Vatican official’s initial negative reaction on Monday to the medicine prize being given to Edwards as "completely misplaced" was splashed on front pages of yesterday’s Italian newspapers, with some editorials harshly critical of its stance.

"The devil is not behind Robert Edwards, as the Church seems to suspect, but a passion for science and an attempt to satisfy the desire that women have for maternity," La Repubblica said in an editorial.

"Edwards helped – not damaged – millions of people," said an editorial in the Corriere della Sera while the leftist L’Unita sarcastically ran a headline reading "The Heretic" under a picture of Edwards with two infants born through IVF.

Yesterday’s statement by the Catholic medical federation said that "as Catholic doctors we recognise the pain that infertility brings to a couple" but that research had to be carried "within an ethical framework".

New hope for IVF couples

A new drug is offering hope to couples undergoing IVF.

The drug means women will no longer face a daily hormone injection, instead it will be a single dose each week.

IVF specialists say the drug will make the process more comfortable for women who now have to give themselves a daily injection for between seven and 10 days in a row to create eggs for collection.

The medical director of Melbourne IVF, Lyndon Hale, said an international study recently showed the drug Elonva delivered the same number of pregnancies and outcomes as the drug currently used. But he said this option was only suitable for about 80 per cent of women and not those with particular conditions, such as polycystic ovary syndrome.

The new treatment becomes available next month.

Elonva is the first sustained follicle stimulant. Due to its ability to initiate and sustain multiple follicular growth for an entire week, a single subcutaneous injection of the recommended dose of Elonva may replace the first seven injections of any conventional daily recombinant follicle stimulating hormone (rFSH) preparation in a COS treatment cycle.

"The European approval of Elonva is a positive step towards reducing the burden of injections for women experiencing difficulty conceiving," said Mirjam Mol-Arts, senior vice president, Merck Research Laboratories. "Merck is proud of the company's women's health portfolio and is committed to providing effective patient-focused fertility treatments."

The Phase III development program for Elonva included the Engage trial, the largest double-blind fertility agent trial in IVF performed to date. In the Engage trial, the ongoing pregnancy rate, the primary endpoint, obtained in the Elonva treatment arm (38.9 percent per started cycle) was similar to that achieved in patients receiving a daily dose of rFSH (38.1 percent per started cycle).

Engage was a non-inferiority trial designed to compare Elonva 150 mcg to 200 IU rFSH. A total of 1,506 patients (with a body weight greater than 60 kg) at 34 in-vitro fertilization (IVF) clinics in North America and Europe were randomized to start stimulation with either Elonva 150 mcg or a daily dose of 200 IU rFSH for seven days. Patients also received rFSH (maximum 200 IU/day) from stimulation day eight onward, when required. Starting on stimulation day five, all patients received 0.25mg gonadotropin-releasing hormone (GnRH) antagonist until triggering of final oocyte maturation by human chorionic gonadotropin (hCG). The primary endpoint was the ongoing pregnancy rate assessed at ten weeks or more after embryo transfer. In the Elonva treatment arm the ongoing pregnancy rate (38.9 percent per started cycle) was similar to that achieved in patients receiving a daily dose of rFSH (38.1 percent per started cycle). The number of oocytes retrieved per attempt, the co-primary endpoint, was 13.7 (± 8.2) for the Elonva group and 12.5 (± 6.7) for the rFSH group.

Elonva is approved for COS in combination with a GnRH antagonist for the development of multiple follicles in women participating in an ART program. Elonva is designed as a sustained follicle stimulant with the same pharmacodynamic profile as rFSH, but with a markedly prolonged duration of FSH activity. Due to its ability to initiate and sustain multiple follicular growth for an entire week, a single subcutaneous injection of the recommended dose of ELONVA may replace the first seven injections of any daily rFSH preparation in a COS treatment cycle. is approved for COS in combination with a GnRH antagonist for the development of multiple follicles in women participating in an ART program.

New Genetic Model Accurately Predicts Who's Likely to Live to 100

In 1997, Jeanne Louise Calment of France died at the age of 122, making her the oldest documented human to have ever lived. But is there something genetically unique about centenarians that enables them to age gracefully and relatively disease-free?

According to the results of a long-term study at Boston University School of Medicine, the answer is yes. People who live to be 100 years or older are rare, and only about 1 in 600,000 people in industrialized nations live that long.

As part of the New England Centenarian Study, a team of aging research specialists led by Paola Sebastiani and Tom Perls looked at 300,000 genetic markers in 800 centenarians and compared their profiles with those of random individuals. They then developed a genetic model that can compute an individual's predisposition to living a long life and found that centenarians shared a common genetic signature that could predict extreme longevity — with 77 percent accuracy. The findings represent a breakthrough in understanding how genes influence human life spans.

"Out of 100 centenarians we could correctly predict the outcome of 77 percent, while we incorrectly predicted the outcome of 23 percent," said Sebastiani. The researchers believe the 23 percent error rate can be attributed to genetic variance not yet known and included in the analysis, as well as other factors that influence longevity. "Making healthy lifestyle choices such as eating a well balanced diet or exercising regularly and avoiding exposure to tobacco plays an undisputed role in determining how each of us will age," said Andrew Sugden, international managing editor of Science.

Centenarians are a model of aging well, and 90 percent of people who reach this milestone are disability free at the average age of 93, Perls said. But he advised caution about the possibility of "testing" people to determine longevity, saying that much more study needs to be done regarding how health care providers and the research community guide individuals about what to do with the information they get. "I think a test for exceptional longevity is not quite ready for prime time," he said. "We're quite a ways from understanding what pathways governed by these genes are involved and how the integration of these genes, not just with themselves but with environmental factors, are all playing a role in this longevity puzzle."

According to Perls, future analysis of the results may shed light on how specific genes protect centenarians from common age-related diseases, such as dementia, heart disease, and cancer. "I look at the complexity of this puzzle and feel very strongly that this will not lead to treatments that will get a lot of people to become centenarians, but it could make a dent in the onset of age-related diseases like Alzheimer's," he said.

No Cuteness Can Make Needles Any Less Terrifying

Syrinx is a syringe substitute for kids. The designers think that, by making them look like little animals with needles coming out of their noses, they are making syringes kid-friendly. Because, you know, blood sucking animals are so cute:







When they are done, the doctor can give the detachable animal to the kid, so they can keep reliving the moment when the-bad-man-in-the-white-lab-coat took a glass of blood out of their bodies in the comfort of their own bedroom.

Pioneer of In Vitro Fertilization Wins Nobel Prize

The Nobel prize in physiology or medicine has been awarded this year to Robert G. Edwards, an English biologist who with a physician colleague, Patrick Steptoe, developed the in vitro fertilization procedure for treating human infertility.

Since the birth of the first test tube baby, Louise Brown, on July 25, 1978, some four million babies worldwide have been conceived by mixing eggs and sperm outside the body and returning the embryo to the womb to resume the normal development. The procedure overcomes many previously untreatable causes of infertility and is used in 3 percent of all live births in developed countries.

Dr. Edwards, a physiologist who spent much of his career at Cambridge University in England, devoted more than 20 years to solving a series of problems in getting eggs and sperm to mature and successfully unite outside the body. His colleague, Dr. Steptoe, was a gynecologist and pioneer of laparoscopic surgery, the method used to extract eggs from the prospective mother.

Dr. Steptoe, who presumably would otherwise have shared the prize, died in 1988. Dr. Edwards, born in 1925, has now retired as head of research from the Bourn Hall Clinic in Cambridge, which he and Dr. Steptoe founded as one of the world’s first centers for in vitro fertilization.

Though in vitro fertilization is now widely accepted, the birth of the first test tube baby was greeted with intense concern that the moral order was subverted by unnatural intervention in the mysterious process of creating a human being. Dr. Edwards was well aware of the ethical issues raised by his research and took the lead in addressing them.

The objections gradually died away, except on the part of the Catholic church, as it became clear that the babies born by in vitro fertilization were healthy and that their parents were overjoyed to be able to start a family. Long-term follow-ups have confirmed the essential safety of the technique.

The deliberations of the prize-giving committee at the Karolinksa Institute in Sweden are confidential and it is unclear why it took so long to acknowledge Dr. Edwards’s achievement. The committee routinely ignores the stipulation in Alfred Nobel’s will that the prize should be awarded for a discovery made the preceding year, because it takes longer than that to evaluate most scientific claims, but delays of 30 years or more are unusual. The Lasker Foundation in New York, whose jurors often anticipate the Nobel prize committee, awarded Dr. Edwards its prize in 2001.

Dr. Edwards’s research proved too controversial for the Medical Research Council, a government funding agency that is the British equivalent of the National Institutes of Health. In 1971 the council rejected an application from Dr. Edwards and Dr. Steptoe to work on in vitro fertilization, but they were able to continue with private funds.

“In retrospect, it is amazing that Edwards not only was able to respond to the continued criticism of in vitro fertilization, but that he also remained so persistent and unperturbed in fulfilling his scientific vision,” Christer Höög,a member of the Nobel prize committee, writes on the Nobel Foundation’s web page.

Both Dr. Edwards and Dr. Steptoe had to endure an unremitting barrage of criticism while developing their technique. Dr. Steptoe “faced immense clinical criticism over his laparoscopy, even being isolated at clinical meetings in London,” Dr. Edwards wrote in Nature 2001 after receiving the Lasker award. “Ethicists decried us, forecasting abnormal babies, misleading the infertile and misrepresenting our work as really acquiring human embryos for research.”

Dr. Edwards fought back, forming alliances with ethicists in the Church of England and filing libel actions — eight in one day — against his critics. “I won them all, but the work and worry restricted research for several years,” he wrote.

Even after the birth of Louise Brown, the government refused to support his work which was delayed for two and a half years, Dr. Edwards wrote, until he secured private funds. “There was at one time a possibility that Steptoe and Edwards would emigrate to the United States,” said Dr. Michael Macnamee, director of the Bourn Hall clinic and a longtime colleague of Dr. Edwards.

In parallel with defending his work in public, Dr. Edwards had to surmount one daunting problem after another in his laboratory. It sounds easy — mix eggs and sperm in a Petri dish and let nature do the rest. But the opposite is the case.

At the outset of his research, Dr. Edwards wasted two years trying to get eggs to mature outside the body, based on a report that human eggs matured in 12 hours. Eventually he learned that at least 25 hours is required.

Needing a reliable supply of human eggs, he approached Dr. Steptoe at the Oldham and District General Hospital because of his expertise at retrieving unfertilized eggs from the ovary through minute incisions in the patient’s skin. The two agreed to work as equals, to halt their work if danger emerged to patients or children and to ignore all criticism they deemed frivolous. The partnership lasted 20 years until Dr. Steptoe’s death.

The two began transferring fertilized eggs to the womb in 1972, assuming that the rate of implantation would be as high as with farm animals. Their hopes were dashed. At first, the hormones given the mother to induce ovulation made the ovaries unable to support the growth of the embryo. They then injected mothers with extra hormones, but these turned out to induce abortions.

They persisted through more than 40 embryo transfers before obtaining their first pregnancy. Unfortunately it was ectopic and had to be aborted. Louise Brown was born from the second pregnancy.

“It required grit and determination to keep going,” Dr. Macnamee said of his colleague. “But he had the conviction of his research work and he wanted to see it delivered to the people who needed it.”

Despite the ethical objections leveled at his work, Dr. Edwards was nonetheless allowed to develop the technique over many years. “It would be very difficult to develop in vitro fertilization now because the ethical committees would have stopped his research,” Dr. Macnamee said.

Dr. Edwards himself was not available to reflect on his research career or the four million children alive because of his achievement. “Unfortunately he is not in a position to understand the honor he has received today,” Dr. Macnamee said. “He remembers the past very well but not the present.”

By NICHOLAS WADE
Published: October 4, 2010, NYT