Embryo Adoption, Stem Cell Research, Partial Birth Abortion Oh My: Breaking News From DITM

Posted on April 19, 2007 by Steven F. Palter, MD

When does human life begin and what is a human? Fertility specialists wrestle with this question every day as embryos are created, frozen, thawed, implanted, and discarded. Occasionally an embryo is even “adopted”. Today I received the draft results of a US government Health and Human Services Research Project that I participated in on the potential for embryo adoption in the US.

In 2002, the U.S. Congress authorized the Secretary of Health and Human Services to conduct a public awareness campaign to educate Americans about the existence of frozen embryos available for adoption. Today I received the research report of the commission’s results:

Between April 4, 2005 and July 27, 2005, the Social Science Research Center (SSRC) at California State University Fullerton contacted 481 Assisted Reproductive Technology (ART) Centers in the United States, including yours, soliciting participation in a survey study. Attached to this message, please find a copy of the final report based on the 254 ART clinics that participated in this study. This document is being distributed in response to interest in the results of the study expressed by many ART clinics.

The report begins

Embryo adoption is a relatively new process in which individuals who have their own frozen embryos agree to release them to a recipient couple. The intent is to transfer into the womb of the recipient mother the donated embryos so that she and her partner may bear a child and be that child’s parents. The number of embryos currently in storage in the Untied States was estimated at approximately 400,000. Of this number 88% are still being used by the creating families for their own family building efforts. Still, the remaining 12% or 48,000 embryos cannot be overlooked. Assuming an embryo transfer success rate of 30%, these 48,000 embryos could result in the birth of more than 14,000 children to infertile couples.

Under Public Law 107-116 (the Fiscal Year 2002 Department of Labor, Health and Human Services, Education and Related Agencies Appropriations Act), the U.S. Congress authorized the Secretary of Health and Human Services to conduct a public awareness campaign to educate Americans about the existence of frozen embryos available for adoption.

There are 126,160 Human Embryos In Storage In the USA: The mean number of embryos stored across the centers is 1,208.89, and the median is 531. Overall, 126,160 embryos were being stored.

How Common is Embryo Adoption in US IVF/ART Programs: 43% of the programs indicate that their fertility center had a functioning embryo donation/adoption program during the previous year. 44% report that their fertility center currently had such a program. Considering clinics with a current embryo donation/ adoption program and those reporting plans to implement such a program, almost 60% of the ART centers in the survey sample are likely to sponsor a program by this time.

How is Embryo Adoption Done in the US Now?: 75.1% of fertility centers refer patients to outside sources for information regarding embryo donation/ adoption. Centers that do not currently have embryo donation/ adoption programs are more likely to refer their patients to outside sources for information on this topic than centers that do. Even among fertility clinics that do currently have embryo donation/adoption programs, however, the proportion who make outside referrals is still substantial (64.5%). The largest proportion (59.7%) of clinic managers who refer patients to outside sources, refer their patients to the Snowflakes program. 7.9% refer their patients to embryoadoption.org; and 5.4% each to the National Embryo Adoption Center and to the Cooper Clinic. Less than 1% refer to “Embryos Alive.

Don’t Call it Adoption: Preferences for naming the transfer of embryos between couples were

Embryo Donation (65.6%)
Embryo Adoption (24.9%)
Some Other Term (9.5%) obviously the term adoption is value laden to equate an embryo with a living child

Where Are The Embryos Stored?: The majority of center staff report that their fertility centers store their patients’ frozen embryos at their clinic location, while nearly 10% report subcontracting for embryo storage.

Most Clinics Don’t Know How Many Embryos They Have! Of the center staff indicating that their fertility center tracks the number of embryos it has stored, an astonishing majority (63.4%) indicate that they don’t know how many frozen embryos are currently stored, and another nine refused to answer this question.

When Do the Clinics Belive Human Life Begins? “How do you characterize your fertility center’s general approach or philosophy with regard to the point at which embryos are thought of as human lives?” Ninety-six (37.8%) centers replied, “Don’t Know” in response to this question, and 37 (14.6%) refused to answer, illustrating the highly sensitive nature of this issue. Of those who did respond, the largest proportion (39.8%) say that “Embryos are considered human lives at conception,” followed by 33.9% that report, “Embryos are considered to be human lives after viability of pregnancy” and 15.3% that answered, “Embryos are considered human lives after implantation into the uterine lining”

Chipping Away at Roe v Wade: Lost Embryo is Wrongful Death. An Illinois appellate court ruled that a couple could sue their fertility center for wrongful death when the fertility center inadvertently discarded the couple’s frozen embryos. many clinics expressed concern or policy changes as a result.

The Relation To Stem Cells and Partial Birth Abortion: The Stem cell connection is clear with so many groups arguing for the use of these embryos in storage to create stem cells. The recent partial birth abortion ban announcement is another step to equate the fetus with human life and rights. It will be interesting to follow how the classification and rights of these embryos evolves and see how that plays into the political debate on when life begins. The Bush administration is very clear in its drive to push embryo adoption.

My Perspective as a Fertility Doctor: My personal experience is that almost no patients ever request that their spare embryos be donated to other couples. The vast majority simply prefer to leave them in frozen limbo in storage indefinitely – avoiding having to make a final decision of what to do with them. As a result of the enormous expense and liability this poses to the clinics, private companies are forming to store the embryos off-site. Many also choose to thaw them and discard them letting them die in the laboratory dish. Occasionally a couple will choose to donate the embryo to research. Why don’t more couples choose to donate to other couples? I believe it’s a mixture of fear of the unknown (who the parents will be, would they ever run into their donated child?) and lack of information regarding the process. The problem will only grow as more embryos are frozen and success rates increase (limiting the need to use the frozen embryos).

European Disasters From Limiting Embryo Freezing Legislation:

Italy passed the Medically Assisted Reproduction Law in March 2004, which prohibits the destruction of embryos created outside the body. This means that all embryos created during IVF (to a legal maximum of three) must be transferred to the woman’s womb- and within months infertile women were becomming pregnant with triplets despite the unwanted risks.
In Spain, it is legal to put embryos in frozen storage, but it is illegal to destroy embryos or to donate them to research, despite the fact that 74 per cent of Spanish patients with spare embryos in storage would like to donate them to research. Because most couples would prefer not to donate their embryos to other patients, there are currently 50,000 embryos sitting unused in frozen storage in Spain
The Embryo Protection Act of 1990 in Germany states that no more than three eggs can be collected from a patient for fertilization in vitro. After that, all embryos created must be transferred to the patient in order to avoid any embryo freezing or destruction. The result has been lower pregnancy rates and higher multiple pregnancy rate

Babies Without Men: Creating Sperm From A Woman’s Bone Marrow

Posted on April 13, 2007 by Steven F. Palter, MD

Scientists report today on the ability to create sperm from bone marrow cells. Initially performed in men, the technique could potentially be performed in women and lead to a sperm cell made from a woman’s body. You got it right- that cell could then fertilize an egg leading to the first female-female conception in human history.

As a fertility specialist I couldn’t resist this story and wanted to share the reality and the hype. Prof. Karim Nayernia, Professor of Stem Cell Biology at the Instatute of Human Genetics at the Univeristy of Mewcastle on Tyne led the project reported in Biology of Reproduction. A summary of the study was released in the Independent today.

The researchers said they had already produced early sperm cells from bone-marrow tissue taken from men. They believe the findings show that it may be possible to restore fertility to men who cannot naturally produce their own sperm.

But the results also raise the prospect of being able to take bone-marrow tissue from women and coaxing the stem cells within the female tissue to develop into sperm cells, said Professor Karim Nayernia of the University of Newcastle upon Tyne.

The report suggests that “Scientists are seeking ethical permission to produce synthetic sperm cells from a woman’s bone marrow tissue after showing that it possible to produce rudimentary sperm cells from male bone-marrow tissue.”

The Two Mommy- No Daddy Baby Making Research Plan:

“Theoretically is it possible,” Professor Nayernia said. “The problem is whether the sperm cells are functional or not. I don’t think there is an ethical barrier, so long as it’s safe. We are in the process of applying for ethical approval. We are preparing now to apply to use the existing bone marrow stem cell bank here in Newcastle. We need permission from the patient who supplied the bone marrow, the ethics committee and the hospital itself.”

If sperm cells can be developed from female bone-marrow tissue they will be matured in the laboratory and tested for their ability to penetrate the outer “shell” of a hamster’s egg – a standard fertility test for sperm.

“We want to test the functionality of any male and female sperm that is made by this way,” Professor Nayernia said. But he said there was no intention at this stage to produce female sperm that would be used to fertilise a human egg, a move that would require the approval of the Human Fertilisation and Embryology Authority.

This same group reported last year that they created artifical sperm from embryonic sperm cells in mice.

(They) isolated stem cells from blastocysts, which are early-stage embryos only a few days old. From these cells were extracted those that would go on to form sperm, known as spermatogonial stem cells (SSCs). The SSCs were then cultured in the laboratory, and when some developed into sperm, they were injected into female mouse eggs and grown into early-stage embryos. The embryos were transplanted into the wombs of surrogate mothers.

The Genetic Disaster That Could Result: Faulty Imprinting. There is a huge genetic time-bomb here. The genetic phenomenon called imprinting. This describes the situation where a particular gene is marked or imprinted with a tag that says if it came from the mother or father- and more importantly only one of the other is active. For example for a particular gene it’s possible that only the maternal copy gene could be active and the copy that comes from the mother could be switched off. If this process goes wrong (mom and dad copy mistakes) then severe genetic diseases can result.

A description of imprinting follows and a detailed description is here and here

However, it is now known that the expression of a small number of the 30,000 or so genes in the cells depends on whether the gene copy was passed down from the father or the mother. This process, whereby the expression of a gene copy is altered depending upon whether it was passed to the baby through the egg or the sperm, is called imprinting. The term “imprinting” refers to the fact that some chromosomes, segments of chromosomes, or some genes, are stamped with a “memory” of the parent from whom it came: in the cells of a child it is possible to tell which chromosome copy came from the mother (maternal chromosome) and which copy was inherited from the father (paternal chromosome). This expression of the gene is called a “parent of origin effect” .

UPDATE: this same group of scientists havbe repeated and extended this research moving closer to a human all female baby- read about their follow-up project here

Babies Without Men: Creating Sperm From A Woman’s Bone Marrow

Posted on April 13, 2007 by Steven F. Palter, MD

NOTE TO READERS: this post is a copy of the full article and discussion which can be found here- please click for the many many comments

The researchers said they had already produced early sperm cells from bone-marrow tissue taken from men. They believe the findings show that it may be possible to restore fertility to men who cannot naturally produce their own sperm.

But the results also raise the prospect of being able to take bone-marrow tissue from women and coaxing the stem cells within the female tissue to develop into sperm cells, said Professor Karim Nayernia of the University of Newcastle upon Tyne.

The Two Mommy- No Daddy Baby Making Research Plan:

“Theoretically is it possible,” Professor Nayernia said. “The problem is whether the sperm cells are functional or not. I don’t think there is an ethical barrier, so long as it’s safe. We are in the process of applying for ethical approval. We are preparing now to apply to use the existing bone marrow stem cell bank here in Newcastle. We need permission from the patient who supplied the bone marrow, the ethics committee and the hospital itself.”

If sperm cells can be developed from female bone-marrow tissue they will be matured in the laboratory and tested for their ability to penetrate the outer “shell” of a hamster’s egg – a standard fertility test for sperm.

“We want to test the functionality of any male and female sperm that is made by this way,” Professor Nayernia said. But he said there was no intention at this stage to produce female sperm that would be used to fertilise a human egg, a move that would require the approval of the Human Fertilisation and Embryology Authority.

This same group reported last year that they created artifical sperm from embryonic sperm cells in mice.

(They) isolated stem cells from blastocysts, which are early-stage embryos only a few days old. From these cells were extracted those that would go on to form sperm, known as spermatogonial stem cells (SSCs). The SSCs were then cultured in the laboratory, and when some developed into sperm, they were injected into female mouse eggs and grown into early-stage embryos. The embryos were transplanted into the wombs of surrogate mothers.

A description of imprinting follows and a detailed description is here and here

However, it is now known that the expression of a small number of the 30,000 or so genes in the cells depends on whether the gene copy was passed down from the father or the mother. This process, whereby the expression of a gene copy is altered depending upon whether it was passed to the baby through the egg or the sperm, is called imprinting.

The term “imprinting” refers to the fact that some chromosomes, segments of chromosomes, or some genes, are stamped with a “memory” of the parent from whom it came: in the cells of a child it is possible to tell which chromosome copy came from the mother (maternal chromosome) and which copy was inherited from the father (paternal chromosome). This expression of the gene is called a “parent of origin effect” .

Carnivals Galore: Grand Rounds x 2 and GeneGenie

Posted on April 12, 2007 by Steven F. Palter, MD

I wanted to catch up with the recent carnivals and thank them for including docinthemachine’s posts. First was keagirl a great medblogger who writes at urostream. This grand rounds was straight to the point and a cavalcade of posts. Thanks for including my post on technology: is it god evil or neutral?

Dr Palter from Doc in the Machine (a blog aiming at transforming medicine with tomorrow’s technology) discusses “Evil Tech“, about how some people believe that some technologies are inherently good or evil – especially developments in medicine and the military.

Next came the always fun Dr.Dork (how can you not love someone who blogs about himself in the third person?) – along with some of the funniest grand rounds photos ever.

My post on genetic screening for STD’s added to pap smears was added to the research section

Docinthemachine blogs on new developments in genetic pap smears which could lead us one step closer to eradicating some common STDs.

Last but not least was my first submission to gene genie. I submitted at the request of Bertalan Meskó from Science roll- the master of medical web 2.0 and genetics on the web. He writes gene genie is:

a new blog carnival on genes and gene-related diseases. Our plan is to cover the whole genome before 2082 (it means 14-15 genes every two weeks). But we also accept articles on the news of genomics and genetics.

Gene Genie this week was hosted over at Sandwalk. Thanks to Larry Mogan, a professor of biochemistry at Toronto and also a genetic blogger. He added my post on preimplantation genetic screening for patients with Huntington’s Chorea- and hiding the results from them.

Steven F. Palter posts on a very sensitive topic—whether a patient wants to know if they carry a possibly lethal genetic mutation. For example, what if you are at risk for Huntington’s disease and you simply do not want to know whether you will die in your 40′s or not? That’s fine as long as you don’t have children but do you want to pass the defective gene to your children if you carry it? How can you have children without risk if you don’t want to know whether you are a carrier or not? It turns out there’s a way and Steven Palter explains how in Beyond Genetic & Prenatal Testing- Pre-embryo Testing – Hiding the Results From the Patient.

I enjoyed these three blogs so much aI added them all to my blogroll!

DITM at Podcamp NYC

Posted on April 12, 2007 by Steven F. Palter, MD

In preparation for my two new podcast projects I spent the day at Podcamp NYC- the “unconference” of podcasters. THe idea of an unconference is that the participants script the events – or more accurately – they occur spontaneously. There is not spposed to be formal invitees or corporate ownership but rather the players and audience are one. All can speak and the event informally spills into the space. Once they signed up 1000 people the tides turned a bit as a formal schedule got written and corporate aponsors jumped aboard. I didn’t care. It was well organized and a wonderful mix of podcasters and vbloggers from around the globe. I met so many great people and got a chance to pick their brains and share ideas. The concept of the meeting worked!

I especially enjoyed meeting and speaking with the leaders of blip.tv about how far vblogging and I-TV can go, podcasting guru Jason Van Ordern on marketing and promotion, podandgo and rawvoice on networks of podcasters, and countless widget app vendors – not to mentionall the people in the halls trading technical audio and video tips.

DITM 2 New Podcast Projects Close to Launch!

Posted on April 12, 2007 by Steven F. Palter, MD

New Podcast Projects: The past two weeks have been a wild ride of fun and excitement! I have two podcast projects undergoing the final edits prior to launcing. The first is the docinthemachine podcast focusing on the new technology and medical breakthroughts of this blog. The second, is a major new medical education project – still under wraps. I’ve had some major breakthroughs in the development of both. First, we have set up a trio of partnerships. The first is with a professional audio studio that will be the home of the podcast recording and production. In conjunction with this we have a pro Jazz musician and his band to provide some cool smooth jazz for the show. My hi-tech upgrade to the studio was adding a digital hybrid the telos one to the setup. (electronics note– if looking into this check out posts on mix-minus set-ups and this great site here for audio podcasting tips). A digital hybrid processes POTS telephone signals splitting the callers into separate audio tracks allowing high quality recording of my upcoming phone interviews. Just as exciting is a partnership with a major medical on-line site that will handle the hosting and outreach to the medical and lay communities. I just back back from the studio where we were recording the last bit of audio and we’ll wrap up some more interviews tomorrow before the launch. The response so far has been overwhelming from people in the medical and tech industries and from sponsors helping out with production costs. More news to comeas we approach launch day!