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Similarly along the lines about using reason in making baby-making choices... this small study found that women expressed a readiness to accept a number of chronic disabilities associated with multiple pregnancy as opposed to the risk of not having a child at all.
That the study only surveyed 74 participants is its saving grace. I think.
It's nice to see studies that confirm my own unfounded opinions, even if there's a slight 'duh' factor involved.
Turns out that little in vitro embies don't like nasty lighting. Neither do I. My colleagues and I at AIDS Foundation Houston, back in the day, were affectionately referred to as "the lamp people" -- we refused to use our office hovel's fluorescents overhead, favoring the soft warm glow of incandescent lamps on our desks. Life was tough enough doing social work with sick people at their homes; when we had to be desk-bound, we wanted as much soothing as could be mustered in that moldy building. But I digress...
So, me and the embies have it right. Fluorescent (and even sunlight for the little ones) is out. Warm-white is in.
Link: IVF News - Lights in fertility clinics may damage embryos.
Note to self: Create another category for this blog that refers explicitly to the ethics of baby-making...
Just in case you were under the impression that having or trying to have a baby is an option you've landed on fairly, squarely, and with nothing but good reasons, have a read of this Op/Ed piece by Anna Smajdor of Imperial College London.
One of my favorite topics, as some of you know, is not so much the how of making babies but the why. It's a question pondered by many of us of for whom conception does not come lightly. When one must go through extraordinary means to achieve a thing considered otherwise ordinary, reasonable folks question those extra efforts. Just why do I want to jump through all these hoops to have a child?
In this essay, medical ethicist Smajdor explores the sticky issues surrounding a recent announcement (at this summer's meeting of ESHRE in Lyons) that the mother of a 7 year old girl with Turner's syndrome has decided to cryopreserve her eggs for potential use by the daughter in adulthood. Beyond the immediate eww factor that the daughter would be conceiving her biological sister if she uses her mom's oocytes, Smajdor brings up how this case illustrates that choices -- such as whether to have a child or not -- are not made in a vacuum. In fact, this particular question may be more rife with inner and outer influences than most other crossroads encountered in the game of life.
Coming up from the 'Better Late Than Never' Dept:
Recent articles sprouted from published research that implies there's a bit too much ICSI going 'round. So, I asked both the researcher and one of the pioneers of the technology to comment on the media hullabaloo that ensued.
ICSI, for the uninitiated, is the acronym for intracytoplasmic sperm injection, arguably one of the most diety-like assisted reproductive technologies available. Just like it's name says, ICSI is performed by an embryologist who uses tiny tools to pick up a single sperm cell and injects it into the cytoplasm of an egg cell. In "ordinary" IVF, a batch of egg and sperm cells are tossed together in a dish to see who the winner is -- with ICSI, only two specially chosen cells get the honor of trying to make a baby.
Dr. Tarun Jain in Chicago is the lead author of the study, published in the July 19 New England Journal of Medicine. The study concludes with a question mark as to why so much ICSI is being performed.
ICSI's primary benefit is the treatment of male-factor infertility, that is, problematic sperm. Combined with pretty darned invasive sperm gathering techniques for some men, even those whose semen analyses render no visible sperm cells have been able to become biological dads. In lay person's terms, guys who are shooting blanks can still get a woman pregnant. That's no small science.
The science and related micro-technology have been around for awhile. One of the first in the arena was embryologist Michael Tucker, PhD, who works in Atlanta and Baltimore and Chicago. Since ICSI's early days (way back in the late 80's, early 90's, a long time for this fast-moving field), technicians have become more adept at using the tiny tools, and labs have learned more about things like fluids that promote viability of cells. The result is quite a big change in the consistency of infertility treatment outcomes, for the better. In short, ICSI not only helps men with sperm cell problems, it takes a lot of guess-work and chance out of IVF for people with non-male-factor issues.
So Jain, who has gained a reputation as a reproductive doctor whose research studies advocate for the little guy (e.g. patients who cannot afford treatment or who are discriminated against), wondered on paper why there was so much ICSI being done when male-factor infertility rates seem to be static.
I've interviewed both Jain and Tucker over the years and assert that they're both good guys and not necessarily diametrically opposed. So I'll just quote them, from emailed responses to my query for their comments.
To Tarun Jain, from me: Could you comment on what spurred you and the co-researchers toward examining the use of ICSI?
From Jain:
Thanks for your interest.
ICSI is an important and useful technique that is used frequently as part of IVF treatment for male factor infertility. We had anecdotally been seeing a greater use of ICSI for other indications. There has also been a lot of recent debate in the literature about the indications for ICSI use. We therefore set out to objectively look at the true utilization of ICSI in the US over a 10 year period. Our study was the result of that impetus.
Best regards,
Tarun Jain
To Michael Tucker, from me: I would love to know both your quotable and off-the-record comments on the NEJM pub'd study by Tarun Jain et al from U of Illinois to Chicago.
From Tucker (only the quotables...):
I remember getting fired up about this back in the day (for example, Tucker et al. Lancet 2001 in a back-and-forth on when to use IXI), and I hav always been very aggressive with it's use simply because over the years I have seen (my own "evidenced based" assessments!), the ability of IXI to overcome complete failure of fertilization following conventional insemination, even when no male factor is involved. And these cases are due simply (for example) to issues with the receptors on the oocytes, possibly due to the unphysiological nature of the ovarian hyperstimulation or inherent bad oocyte quality, and in some cases you can take these unfertilised eggs, fertilize them with "rescue IXI", make embryos (rescue IXI = FIXI...), and transfer them even though developmentally they are 12-18 hrs delayed, and generate healthy babies (see for example, Morton et al Fert Steril 1997).
Heck, this can go either way. Do I think IXI is sometimes needlessly utilised? Yes, maybe just occasionally, but on balance, it can be argued that it is the way to go for all cases. I have been offsite director in Chicago (www.fcionline.com) for about 3-4 yrs, and they do 100% ICSI - why? Because they have an all inclusive deal with the insurance companies that makes IXI dirt cheap; it allows optimal examination of oocyte quality and maturity on all patients the day they are retrieved; avoids the 5-10% unexpected failed or reduced fertililzation cases that compromise about 10-20% of all conventional insemination cases; and further it may improve on nature... This last statement is based on a newer emphasis in the last few years where we get much more particular about which sperm we actually inject. We utilize higher magnification than we used to, to scrutinise the precise morphology of the sperm that we immobilise for IXI, and this appears to be linked significantly with improved clinical outcomes, making the not unreasonable leap that good morphology correlates with better overall DNA packaging - see for example, Bartoov et al, J Androl 2002.
The enthusiastic and motivated Tucker continues, expressing frustration at "studies like this" because... they are so missing alot of the multifactorial stuff that goes into the making of decisions in our business - not to mention a 31 to 33% outcome comparison is no way significant in such a mess of patients. Steve Ory mentioned the "art" of what we do; and by and large we are one of the most "policed" areas of medicine (cue Michael Moore?), and while there may be a little "abuse"/overuse of IXI, I think it is utilised principally in a totally appropriate and well-intentioned way. If done properly in the lab, it kicks arse, and that's the only way we use it under my guidance (usually about 55-65% of cases in most labs other than Chicago), and the patients get a good deal, believe me. That there are extra chromosomal / genetic disorder issues with IXI is (IMHO) entirely due to the nature of the gametes that are achieving fertilization and oftimes pregnancy, that would not have a donkey's chance on the horse stud farm to achieve success (healthy pregnancy) otherwise.
It's good to know that professionals like both Jain and Tucker are on the job. To me, they represent two essential components to problem resolution -- inspired, enlightened momentum and compassionate, educated caution.
