 I.
MALE INFERTILITY
II. CYSTIC FIBROSIS (CF)
III. FEMALE INFERTILITY AND AGE
IV. WHAT ABOUT THE CHILDREN BORN FROM THESE HIGH TECH PROCEDURES?
V. WHAT ABOUT THE FUTURE PROSPECTS?
Quality of Human Beings In Future Generations:
There has been a great deal of
publicity and public concern about the burgeoning infertility epidemic
in this country and in the world, the billion dollar infertility treatment
industry, and the various abuses associated with the infertility industry.
People that we actually know as former colleagues have possibly done some
really terrible things. These atrocities and the public fear over them
have been given a great deal of appropriate media attention in recent
years. On a more positive note, I would like to acquaint you, in this
very brief capsule, with some of the incredible advances that have been
able to help the vast majority of even "hopeless" infertile
couples have children. Many of these recent advances we have been fortunate
enough to have developed, or helped develop.
I. MALE INFERTILITY
A. Low Sperm Count:
Incredibly low sperm counts just don't make any difference anymore.
Along with our Belgian collaborators we have developed a method in the
last three years of picking up an individual's sperm one at a time, selecting
one that looks good and normal, and no matter how poor its motility and
even if it's the only single sperm in the ejaculate, it can be injected
into the wife's egg with a normal fertilization and pregnancy rate. Thus,
men with the lowest sperm counts imaginable are basically completely fertile
with this technique. (It is called "ICSI",
short for intra-cytoplasmic sperm injection).
B. Zero Sperm:
Those with zero sperm are fertile too. If a man is obstructed
for many years, we are able to use microsurgery to restore normal fertility
to them. We developed that original microsurgery technique 22 years ago.
But. what about men who have no sperm production at all? We find that
even in these men with "no sperm production," if you look carefully
in the testicle, you will almost always find an occasional sperm or sperm
precursor in the testicle. We can inject these early sperm cell precursors
into the wife's eggs and once again, get a normal fertilization and pregnancy
rate, the same as with a fertile man.
C. Finding the Gene for Male Infertility:
We have located and mapped the gene that causes male infertility
on the long arm of the Y chromosome. Various mutations and errors in this
gene, or related genes, will result in various deficiencies of sperm production
resulting in male infertility. Thus, every new generation of male offspring
we are able to help come into being with the sperm injection technique
is likely to perpetuate the same male infertility problem that their father
had been mutated with. These couples don't seem to mind this warning because
they figure that if they can have a child with the technology now available,
then certainly their male offspring will also in the future be able to
have a child with this technology.
II. CYSTIC FIBROSIS (CF)
Cystic Fibrosis (CF) is the most common genetic abnormality in
the human race and at least 40,000 people in this country suffer from
it. Every one in 1600 births is a baby with Cystic Fibrosis, and perhaps
more chillingly, 4% of every person you meet or know is a carrier for
Cystic Fibrosis. It is the most common childhood disease producing gene
error in the human population.
With modem medical treatment, most people with Cystic Fibrosis can now
survive to adulthood and lead a relatively normal life as long as they
receive proper and continual treatment. But they can't have children.
A. Now CF Men Can Have Children:
The reason these men can't have children is related to the fascinating
and peculiar genetic organization of humans. The same gene that is required
to allow these people to have normal lung and pancreas secretions is the
gene that directs the formation in the developing fetus of the vas deferens.
Two seemingly unrelated functions are controlled by the same gene. Thus,
all men with Cystic Fibrosis have congenital absence of the vas deferens
on both sides and are sterile. Their sperm production is completely normal
but the sperm simply can't get out. All of these men with Cystic Fibrosis
can now have children because we simply operate microsurgically to retrieve
sperm from the epididymis, sperm that would normally never fertilize the
wife, and inject those sperm directly into the wife's eggs. We have many
couples now with frank Cystic Fibrosis, who thought they could never have
children, who are carrying a normal family.
B. We Can Now Prevent Future
Children From Having CF:
We can insure that their children are genetically normal and do
not have Cystic Fibrosis. If both husband and wife are carriers, we are
able to test the embryos by biopsying one of their cells, doing a gene
scan on this one single cell of the embryo, and then in eight hours find
Out which of the embryos tested are normal and which would be children
with Cystic Fibrosis. We can then choose to replace only the normal embryos
and freeze the genetically diseased embryos for possible future transfer
if there ever is a genetic cure. This "pre-implantation ?" is
accomplished by the same delicate micromanipulation (ICSI)
techniques that are employed for injecting sperm from infertile men into the egg.
III. FEMALE INFERTILITY AND AGE
The female's infertility now has absolutely no impact on her ability
to get pregnant with modem techniques (except for one factor--her age).
The negative effect of her age has nothing to do with her uterus or any
other aspect of her body or health, but only has to do with the age of
her ovaries. Eggs from young women when transferred to older women result
in completely normal pregnancy rates even in women, as you know, as old
as 60 or 65. Eggs from older women, however, have extremely low pregnancy
rates when transferred to young women. Furthermore, even beautiful normal
embryos derived from women who are over forty have extremely low pregnancy
rates, because of the high degree of genetic abnormality found in these
older eggs Thus, we have completely solved the problem of male infertility
which was considered to be the number one obstacle three years ago for
couples getting pregnant, and we have completely solved all female infertility
except for one: and that one is the mere fact of getting older.
But even this problem can be solved with donor egg transfers which have
caused so much of the controversy in the last six months. These procedures
must only be performed with the clear and unequivocal permission and knowledge
of the donor. In an ethically sound, properly managed program, egg donation
is an excellent altruistic opportunity for younger infertile women whose
problems will be easily solved while going through an IVF
procedure to help, if they wish and so offer, an older woman who does
not have eggs capable of resulting in a baby. The sense of community and
helping one another that develops amongst these couples involved in an
ethical, legal, and thoughtfully organized egg donor program is enough
to bring tears to your eyes because of the bad publicity about immoral
procedures that have been performed with egg donation. It might be well
to show just how beautiful this procedure can be when being performed
as part of a program with high integrity.
Let me make it clear about this problem of female infertility. Whether
the woman has endometriosis, blocked tubes, scarring or adhesions, deformed
uterus, fibroids, poor ovulation, or even if she is a carrier of a severe
genetic disease, all these problems can be very easily handled with IVF
and micromanipulation of eggs and sperm. The only problem we cannot solve
except with egg donation is the problem of the aging ovary which is simply
a consequence of couples having not been able to receive proper treatment at a younger age.
IV. WHAT ABOUT THE CHILDREN BORN
FORM THESE HIGH TECH PROCEDURES?
A. Vasectomy Reversal and Microsurgery:
We now have over twenty years of experience with children born as a result
of vasectomy reversal, a procedure which was
thought in 1975, when we first introduced it, by many people to be immoral
and dangerous. Not only is there no greater incidence of any abnormalities
or problems in these children than in a routine population, but indeed
it is quite remarkable the overall competence of such children. The emotional
stability and competence of these children, now grown up, is consistently
higher than one might expect in a normal population, and we suspect that
may be related to the intensity with which these couples wanted these
children.
B. IVF and ICSI Children:
Detailed genetic testing and follow-up of children born from in-vitro
fertilization procedures, frozen embryos, and sperm injection into the
egg procedures (ICSI) again reveals no greater risk of genetic or other
abnormalities. However, as mentioned under Male Infertility, we would
expect that most of the male offspring of men with poor sperm production
will also have poor sperm production because it is genetically transmitted
on the Y chromosome. Without our intervention this mutant gene for male
infertility would not proliferate in the male population. Because of our
intervention in large numbers of cases which will only increase over the
coming decade, we would anticipate that we will have a technology induced
increase in the incidence of male infertility requiring further technology.
V. WHAT ABOUT THE FUTURE PROSPECTS?
A. Egg Freezing and Embryo Freezing:
We can freeze embryos with fairly good and successful results, but until
recently, we could not freeze eggs well. The process of chromosomal reduction
division, or meiosis, is so complicated that freezing the egg (which is
always going through the process of meiosis) simply doesn't result in
successful pregnancies. Therefore, to preserve a woman's reproductive
potential against aging, we had to first fertilize her eggs, and then
freeze them. The future would be bright indeed for women if while in their
twenties, before they were certain about their family plans, we could
successfully freeze their eggs and save them for such a future time when
they were more ready to embark upon having a family. This would also be
of extraordinary importance for women who would be undergoing chemotherapy
for cancers that occur in young women such as lymphoma or melanoma. Now,
through a new ovarian tissue freezing technique,
we can preserve eggs prior to meiosis. The technology for successfully
using these frozen, unfertilized eggs is still in development, but it
is fairly safe to assume we will realize this ability in the close future.
B. Genetic Testing of Embryos:
If a couple are both known to be carriers for genetic disease such as
Cystic Fibrosis, Hemophilia, Muscular Dystrophy, etc., it is established
treatment now that we can biopsy the embryos and place back into the woman
only the healthy ones so as to prevent her from having children with such
a disease. But this is relatively crude technology compared to what I
can foresee in the next ten years when we'll be capable of doing entire
genome analysis in a quick and rapid fashion so that embryos can be routinely
checked for any genetic defect for even such complex problems as breast
cancer or heart disease or diabetes, Alzheimer's disease or Lou Gehrig's
disease, etc. This will then pose the dilemma that if this technology
were available earlier in the century there might not have ever been a
Lou Gehrig or a Stephen Hawking. I won't comment on the dilemma that this
technology brings up, except that we will all be facing this issue because
you can't stop this technology from developing further.
C. Jurassic Park:
From the information we have so far, it would be very likely that if we
could get hold of the testicles of recently discovered anthropological
finds of ancient men frozen in a glacier of the Alps, for example, it
is very probable that the sperm that we could retrieve from such a man's
testicles, would be capable of impregnating a modern woman using the sperm
injection techniques. Of course, we prefer our modern cryobiology aided
techniques for sperm freezing and preservation. But this ICSI
technology makes it highly likely that even the most simple freezing will
sufficiently preserve DNA in men who are many thousands of years old who
would be able to bear children today.
D. Competence of Human Beings
In Future Generations:
The observation that children born from infertile couples who have been
through a tremendous amount of pain, anguish and expense in trying to
have a child, have a much lower incidence of problems than one would expect
in a standard population, indicates that all of this futuristic technology
might not be as frightening as it seems. The growing infertility problem
might result in a future generation of children who are much more cared
about, and therefore much happier and contributing individuals.
If you have any questions, you may call us at (314) 576-1400.
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