Science Leading to the Development of New Treatments

In 1978 Louise Brown was born in Manchester, England. Her birth from infertile parents was a world first. She had been conceived by assisted reproductive IVF treatment and was considered a miracle of modern medicine. Today the "fertility industry" is an international and multi-billion dollar one, that has helped a countless number of parents to have children that a relatively small number of years ago would literally have been inconceivable.

For couples that are either unable to or are having difficulty conceiving, IVF and it’s associated treatments offer a real scientific hope to them in their quest. However, the scientific advances of recent years also raises ethical questions.

From the early years of fertility treatments the procedures centered on work involving the gametes (sperm and ova). The absence of a womb in the woman would leave only two options surrogacy or adoption. In recent years the prospect of a womb transplant has become a reality. Successful transplants have been carried out on mammals such as sheep, rabbits and pigs. To date, they have not resulted in a successful pregnancy. In 2002 doctors in Saudi Arabia successfully transplanted the womb from a healthy 46 year old woman into one aged 26. Unfortunately the transplant only survived two menstrual cycles before having to be removed - a blood clot having formed. The procedure carried out here was more akin to a ‘graft’ operation. Fertility experts currently believe that in order to succeed the transplant needs to include the major blood vessels, meaning that the womb to be transplanted would need to come from an organ donor. Such a procedure would be a major operation and as such would carry all the risks of major surgery. But, as is well known, the desire of women to have children is so strong that it will probably not be long before the procedure is attempted in the operating theatre.

Current legislation on fertility, specifically human embryo treatment, does limit the extent to which scientists can develop some concepts. Experiments have been undertaken to grow an artificial womb by growing uterine lining cells in the laboratory. Due to legislation this type of experimentation has to stop after one week. However, a human embryo placed in an artificial womb has survived for seven days. Similar experiments with mice have resulted in fetuses of mice surviving the equivalence of a 30 week human gestation.

In another piece of research scientists are able to maintain fetuses from sheep and goats in tanks of synthetic amniotic fluid. Their main aim is to develop a synthetic human uterine environment that is conducive to the natural development of a human fetus, this could then be used for women who have problems maintaining a fetus towards the end of their pregnancy. This extreme example of a hi-tech incubator carries some serious ethical questions, as it is known that even the use of modern hospital incubators to keep babies alive can result in the baby having poor cognitive and/or physiological development.

More akin to traditional IVF treatments is the specter of artificial gametes. Current stem cell research has led to the successful production of mice sperm from stem cells, which in turn fertilized a mouse’s eggs and went on to produce a litter of live mice. However, they all had developmental problems and all died. This work is in its infancy but it will develop. Will it develop to the extent that a ‘man’ is not needed at all in the human reproductive process? Probably not, yet! The scientists involved in this research are doing it with a view to stimulating the natural growth/development of sperm in infertile men, rather than synthetically manufacturing human sperm.

Regarding the female gamete, scientists are developing techniques to encourage more than one egg per month from a woman’s ovaries to mature. They’re working on extracting immature eggs and ripening them under laboratory conditions. This would mean that women undergoing IVF treatments would not have to take sometimes risky ovary stimulating drugs to produce more than one viable egg.