sarahkeenihan

Day 243. Death and life

In April 2013 on April 12, 2013 at 4:24 pm

deathlife

This week reproductive scientists, parents and indeed grandparents around the world mourned the death of Nobel Prize winner and pioneer of in-vitro-fertilisation (IVF) Professor Sir Robert Edwards, who developed the technique for humans and oversaw the birth of the world’s first test tube baby.

It was only 6 months ago that the woman who delivered the world’s first IVF baby passed away herself, the same week that South Australia celebrated 30 years of using assisted reproductive technologies.

Here’s an article I wrote at the time:

In 1978, Mrs Lesley Brown delivered a baby daughter Louise after 9 years of unsuccessful attempts to become pregnant due to blocked fallopian tubes. In desperation, she turned to doctors Patrick Steptoe and Robert Edwards and underwent an experimental procedure which involved transferring fertilised eggs into her uterus – a technique now commonly known as IVF.

Now, more than 30 years later, assisted reproductive technologies like IVF and the related intra-cytoplasmic sperm injection (ICSI) are commonly available, and supported by Medicare rebates in Australia. But who are these techniques actually for?

A recent population-wide cohort study showed that in South Australia, the use of IVF and ICSI is skewed towards relatively older, white women with no previous children and living in ‘nice’ postcodes with partners in management/professional type jobs.

This is probably not surprising, and just one of the themes under discussion this week at the event ‘Celebrating 30 years of IVF in South Australia‘, co-hosted by Healthy Development Adelaide, The Robinson Institute and the University of Adelaide.

Host Leigh McClusky opened the event with an acknowledgement of the Kaurna people:

“We acknowledge that we are meeting on the traditional country of the Kaurna people of the Adelaide Plains. We recognise and respect their cultural heritage, beliefs and relationship with the land. We acknowledge that they are of continuing importance to the Kaurna people living today.”

Speaking later in the evening, Professor Andrew Dutney highlighted this welcome as a reminder that we have an ethical obligation to direct our prowess in reproductive medicine towards indigenous Australians, whose general health and pregnancy outcomes are poor. He’s right of course; it remains unclear as to the best way to achieve such a change, but presumably better direction and support in this regard needs to come from federal policy makers and funders of science.

The three other presenters at the event were clinicians and biological scientists. Interestingly, the focus of their presentations was not to trumpet the success stories of reproductive technologies. Of course, the techniques do work and many babies have been born. But as Professor Rob Norman highlighted, IVF and ICSI should be treatments used as a last resort and preferably only when there are no other options. For the most part, women and men should be encouraged to discuss fertility early, ensure their general health is maintained – healthy body weight, no smoking, reduced alcohol intake – and not come running to fertility clinics expecting that their 6 months of unsuccessful ‘trying’ can be fixed by technology.

Professor William Ledger agreed, adding that his greatest joy as a clinician came from counselling and helping young women whose treatments for cancer have destroyed their ovaries. New techniques in egg freezing now mean that such women can harvest eggs before chemo- and radio-therapy, and successfully achieve pregnancy when they are ready for children later in life.

Associate Professor Jane Halliday presented data on follow-ups of children conceived using IVF and ICSI. There are small but measurable risks attached to being conceived using these techniques – while only 7/100 children conceived naturally are born premature, the risk climbs to 11/100 if you’re an in vitro baby. Disability – including mild and severe conditions – occurs in 4-5/100 naturally-conceived babies, and 6-8/100 with assisted conception. And we still don’t know about adult health outcomes – studies are in place to monitor the long-term health of those born using IVF and ICSI.

One of the most interesting aspects of studying reproduction is the idea that environmental differences early in gestation can have a lasting impact on the health of the fetus, the newborn, the child and the adult which results. Animal and human data in support of this hypothesis is steadily growing in volume. And it’s more subtle than just having a well-structured placenta growing in a mother who eats healthily, leads a stress-free life and avoids cigarettes. Even very small differences in key micronutrients and hormones can impact on later health, such as blood pressure. For this reason, Professor William Ledger believes one of the future challenges of IVF and related techniques will be the need to carefully record all minute details of egg and sperm collection and storage, the specifics of the culture media used to create and store embryos and the hormonal environment of the woman at the time of embryo transfer.

Why? Because children conceived this way might want to know. And after all, aren’t they the ones all this technology is really for?

[image show’s Gustav Klimt’s Death and Life, reproduced on flickr]

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