TIME health

Three-Parent IVF Deserves a Chance in the U.S.

All new fertility methods sound crazy at first

In a historic vote that rocked the world of fertility medicine Tuesday, British lawmakers approved the use of a controversial IVF practice that would take genetic material from three people to create a single embryo.

The promising technique, which involves replacing the defective cellular material of a woman’s eggs with that from a healthy donor, aims to prevent patients from passing down crippling genetic diseases to their offspring. It also might hold the key to other groundbreaking applications, such as extending women’s fertility by rehabilitating old eggs.

The decision is inspiring because members of Parliament chose science over a firestorm of often ill-informed debate questioning whether we’ve gone too far in experimenting with genetic engineering. Hopefully, they will motivate the U.S. Food and Drug Administration, which held public hearings on the topic last year but declined to move forward with human trials citing lack of safety data, to follow suit. New research published in the New England Journal of Medicine estimated that more than 12,000 women in the U. S. of childbearing age risk passing down such mitochondrial diseases, which have been linked to everything from poor growth, blindness, neurological problems and heart and kidney problems.

The world is right to be cautious about this latest mind-boggling advance in reproductive medicine. It does sound like science fiction: If you’re a woman who suffers from a mutation in her mitochondrial DNA—the part of our cells that generate energy—scientists can take your egg, extract the nucleus—the part containing your most important genetic instructions, such as hair and eye color—and insert it into a new egg that has been provided by another woman. (The nucleus would have already been removed from the donor egg.) This newly renovated egg is then fertilized by your partner’s sperm and implanted into your uterus. You carry on with your pregnancy, just like billions of women before you. (Another version of the technique switches out the nucleus of a newly fertilized egg.)

Have we pushed the boundaries too far in innovative baby-making? Think back to when critics charged that the inventors of in-vitro fertilization recklessly “played God” by daring to combine a sperm and an egg in a lab to create Louise Brown in 1978. Now some 5 million of the world’s babies have been conceived via IVF. But it’s one thing to get used to combining reproductive parts in a lab; it’s a lot less comfortable to imagine tinkering with those parts beforehand. In an open letter to the U.K. Parliament, Paul Knoepfler, stem cell and developmental biology researcher at the University of California Davis School of Medicine, warned that supporters “could well find themselves on the wrong side of history … with horrible consequences.”

Yet it’s important to understand that mitochondrial replacement isn’t genetic engineering run amok, cautions Debra Mathews of the Berman Institute of Bioethics at Johns Hopkins University. The mitochondrial energy-making material of an egg accounts for a mere 37 genes, compared to the nucleus, which contains about 23,000 genes. “No one is messing directly with genes,” she says. “Scientists are replacing damaged mitochondria with healthy mitochondria. It’s a specific technology for a specific application. We’re modifying eggs to avoid serious diseases.” So far, researchers haven’t attempted a pregnancy using the technique, but a study published in 2012 in Nature found that resulting embryos appeared to develop normally with the nucleus intact and did not contain any of the mutated mitochondria from patients’ previous eggs. And scientists at Oregon Health and Science University transferred the mitochondria between rhesus-monkey eggs and created four healthy monkey babies.

Yet determining when a technology is “safe” is especially challenging in fertility medicine because the only way to find out is to create another human. The FDA’s prudence is a welcome change from the early “wild west” days of reproductive medicine when many scientists “implanted and prayed” that their experiments wouldn’t lead to the “horrible consequences” Knoepfler is warning against. So far, we’ve been incredibly lucky.

We don’t want to risk holding up progress by being too cautious, especially when some 1,000 to 4,000 babies are estimated to be born every year with mitochondrial disease, according to the United Mitochondrial Disease Foundation.

Yet what should the threshold be? The FDA shut down other such research being done more than a decade ago. Scientists at several fertility clinics were responsible for 30 pregnancies from eggs that had been injected with donor cytoplasm that contained mitochondria. The kids haven’t been tracked over the long term, and it’s unknown whether the procedure contributed to two cases of chromosomal abnormalities that resulted in one miscarriage and one abortion. And researchers at New York University’s Langone Medical Center tried a similar mitochondrial transfer technique using younger eggs for three women in their 40s suffering from age-related infertility. Although the embryos developed naturally, none got pregnant. A Chinese team later used the NYU method to achieve a triplet pregnancy, but the patient lost the entire pregnancy after she tried to abort one fetus to give the other two a better chance of survival.

Let’s follow the British example and find the right balance between prudence and progress. “We’re at a stage when we can use these technologies to help all kinds of patients, and we have enough reassuring evidence that it’s safe,” says NYU’s Jamie Grifo, and author of the The Whole Life Fertility Plan. “It shouldn’t be taking this long to move forward.”

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME fertility

Scientists Use Skin Cells to Create Artificial Sperm and Eggs

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Getty Images

The feat could help patients with fertility problems

British scientists from Cambridge have succeeded in using skin cells to create primitive forms of artificial sperm and eggs.

The feat could transform fertility treatment and our understanding of age-related diseases, the Guardian reports.

Scientists created the early sex cells by culturing human embryonic stem cells for five days in controlled conditions.

They then showed that by following the same procedure they could convert adult skin tissue into early-stage sperm and eggs, raising the likelihood of using sex cells that genetically match a patient undergoing IVF treatment.

The scientists believe these cells have the potential could grow into mature sperm and eggs, something that has never been done in a lab before.

[The Guardian]

TIME Opinion

Company-Paid Egg Freezing Will Be the Great Equalizer

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Science Photo Library—Getty Images/Science Photo Library RF Egg storage

From Facebook to Citigroup, more companies are covering the cost of elective egg freezing for women who want to delay child-bearing. Is this the key to real gender equality?

Updated on October 16 at 11:25 am.

I spent last Thursday on the 15th floor of a fertility clinic with a dozen women. It was a free seminar on egg freezing, and I listened, wide-eyed, as a female physician described how, by the time a woman reaches puberty, her egg count will already be reduced by half. The women in the room had presumably come for the same reason as I had – we were single, in our 30s and 40s, and wanted to know our options – and yet we might as well have been entering a brothel. We didn’t make eye contact. We looked straight ahead. It was as if each of us now knew the other’s big secret: the fertility elephant in the room.

Women talk about sex, their vibrators, their orgasms – but a woman’s fertility, and wanting to preserve it, seems to be the last taboo. There’s something about the mere idea of a healthy single female freezing her eggs that seems to play into every last trope: the desperate woman, on the prowl for a baby daddy. The woman who has failed the one true test of her femininity: her ability to reproduce. The hard-headed careerist who is wiling to pay to put off the ticking of her biological clock. That or – god forbid – the women who ends up single, childless and alone.

But that may be changing, in part thanks to an unlikely patron saint: the Man.

This week, Facebook and Apple acknowledged publicly for the first time that they are or will pay for elective egg freezing for female employees, a process by which women surgically preserve healthy eggs on ice until they’re ready to become parents, at which point they begin the process of in vitro fertilization. Facebook, which told NBC News it has had the policy in place since the start of the year, will cover up to $20,000 under its “lifetime surrogacy reimbursement” program under Aetna (a typical cost of the procedure is around $10,000 fee, plus annual storage fees.) Apple will begin coverage in 2015.

There are other companies who cover the procedure, too: Citigroup and JP Morgan Chase tell TIME that their coverage includes preventative freezing. According to interviews with employees, Microsoft includes some preventative coverage, too. And sources say Google is weighing the coverage option for 2015.

The revelations appeared to unleash more immediate questions than they answered: Were these companies simply putting even more pressure on women to keep working and put their personal lives on the back burner? Was it a narrow effort by prosperous tech companies to recruit , or retain, female talent in an industry whose gender breakdown remains dismal? Or was it a step toward actually legitimizing the procedure, and leveling the playing field for women? Could the move – and the public nature of it — destigmatize the practice for good?

It’s been two years since the American Society of Reproductive Medicine lifted the “experimental” label from egg freezing -- a procedure initially created to help patients undergoing chemotherapy — leading to a surge in demand. Yet because the non-experimental technology is so new, researchers say it’s too soon to give real qualitative efficacy data. (While doctors typically recommend women freeze at least 18 eggs — which often requires two rounds of the procedure – there’s no guarantee that the eggs will lead to successful pregnancy when they are implanted via IVF years later.)

Nonetheless, the very idea that there might be a way for women to build their careers and their personal lives on a timetable of their own choice — not dictated by their biology — is so intriguing that single women are filling informational seasions at clinics and holding egg freezing “parties” to hear about it. They are flocking to financing services like Eggbanxx, which reports it is fielding more than 60 inquiries a week. And on email lists and at dinner parties, women trade egg freezing tips like recipe binders: which insurers cover what, the right terminology to use when asking for it, side effects of hormone injections that stimulate egg production and the outpatient procedure one most go through to retrieve the eggs.

Sometimes, they’re talking about careers: the relief of knowing that – with your eggs on ice – there is simply more flexibility around when to make the decision to give birth. But more often, they’re talking about dating: the “huge weight lifted off your shoulders,” as one single 32-year-old friend described it, knowing that you no longer have assess every potential prospect as a future husband and father.

For women of a certain age, reared with the reliability of birth control, this could, as the technology improves, be our generation’s Pill — a way to circumvent a biological glass ceiling that, even as we make social and professional progress, does not budge. Women today have autonomy – and choice – over virtually every aspect of their lives: marriage, birth control, income, work. And yet our biology is the one thing we can’t control.

“It’s almost as if evolution hasn’t kept up with feminism,” says a friend, a 34-year-old Facebook employee who underwent the procedure using the new policy this year. “But I think that, like with anything, the culture takes a while to catch up. And sometimes it takes a few big people to come out and say, ‘We’re doing this’ to really change things.”

From a practical standpoint, covering elective egg freezing makes sense. It’s an economic issue that could help companies, especially tech companies, attract women and correct a notorious gender imbalance. “Personally – and confidentially – this made me immediately look at Facebook jobs again,” a 37-year-old marketing executive who worked at both Facebook and Google tells me. “I’m looking to control my career and choices around motherhood on my terms, and a company that would allow me to do so — and provide financial support for those choices — is one I’d willingly return to.”

It’s a social issue, against a backdrop that men and women are waiting longer than ever to tie the knot, and there are now more single people in this country than at any other moment in history. (No, you’re not some kind of failure because you haven’t met someone and reproduced by 35. You’re just…. well, normal.)

And for businesses, of course, it’s a financial issue too. As the Lancet put it in a medical paper earlier this month, covering egg freezing as a preventative measure could save businesses from having to pay for more expensive infertility treatments down the line – a benefit that is already mandated in 15 states. As Dr. Elizabeth Fino, a fertility specialist at New York University, explains it: with all the money we spend on IVF each year, and multiple cycles of it, why wouldn’t healthcare companies jump on this as a way to save? And while success rates for IVF procedures vary significantly by individual, and are often low, using younger eggs can increase the chances of pregnancy.

“Companies with good insurance packages have been paying for IVF for a long time. Why should egg freezing be any different?” says Ruthie Ackerman, a 37-year-old digital strategist who had her egg freezing procedure covered through her husband’s insurance.

Egg freezing is also, of course, an issue of equality: a potential solution to the so-called myth of opting out. An equalizer among both gender – men don’t usually worry about their sperm going bad, or at least not with quite the same intensity or cost – and class (the procedure has typically only been available for those who could afford it). The way egg freezing has worked so far, many women don’t necessarily return to retrieve their eggs. Still others get pregnant naturally. And so, even though it’s too soon to say how successful the procedure down the line will be — for women who return, thaw, and begin the process of IVF — it’s almost like an insurance policy. An egalitarian “peace of mind.”

“I have insurance policies in every other area of my life: my condo, my car, work insurance,” says another friend, another employee of one of these firms, another woman who doesn’t want to be named, but for whom hopefully this will soon no longer be an issue. She points to a recent survey, published in the in the journal Fertility and Sterility, which found that a majority of patients who froze their eggs reported feeling “empowered.” “This is my body, and arguably the most important thing that you could ever have in your life,” she continues. “Why wouldn’t I at least protect that asset?”

And if your boss is offering it up to you for free, what do you have to lose?

Jessica Bennett is a contributing columnist at Time.com covering the intersection of gender, sexuality, business and pop culture. She writes regularly for the New York Times and is a contributing editor for special projects for Sheryl Sandberg’s women’s nonprofit, Lean In. You can follow her @jess7bennett.

Read next: Perk Up: Facebook and Apple Now Pay for Women to Freeze Eggs

TIME Family

African American Donor’s Sperm Mistakenly Sent to White Mom

A medical worker works on a dish ready f
Georges Gobet—AFP/Getty Images

Lesbian parents tell the TODAY Show that they love their mixed race daughter but are suing their sperm bank to prevent future mixups.

The Midwest Sperm Bank sent Jennifer Cramblett of Uniontown, Ohio, the wrong sperm. She’d requested sperm from donor number 380 and received instead sperm from donor number 330. Ms. Cramblett and her partner are now suing the sperm bank.

What makes the story a whole lot more complicated is that donor number 330 is African American.

“On August 21, 2012, Jennifer gave birth to Payton, a beautiful, obviously mixed-race baby girl,” says the lawsuit. “Jennifer bonded with Payton easily and she and Amanda love her very much. Even so, Jennifer lives each day with fears, anxieties and uncertainty about her future and Payton’s future.”

Among the issues that are causing these anxieties are the prospect of sending her mixed race child to an all-white school, traveling to a black neighborhood—where she feels unwelcome—to get Amanda’s hair done and the lack of acceptance by her extended family, who, according to the suit, are already having issues with the whole same sex couple arrangement.

Ms. Cramblett told The Today Show that she and her partner Amanda Zinkon love their daughter very much, but she doesn’t want this to happen to anyone else’s family. “I’m not going to let them get away with this,” she said. She’s primarily angry, she says at what she considers the sperm bank’s cavalier attitude and “lack of concern for me and my family…if they had some compassion and just said sorry. But they didn’t.”

So far, the Midwest Sperm Bank has declined to comment.

(This might be a good time to direct Ms. Cramblett’s attention to Chocolate Hair, Vanilla Care, a website used by many transracial adoptive families. You’re welcome.)

TIME animals

Study: Narwhal Tusk Size Correlates With Testicle Size and Fertility

Narwhals
Paul Nicklen—National Geographic/Getty Images

Is that a giant tooth on your head or are you just happy to see me?

A ballsy new study may have unlocked the secret behind narwhals’ unicorn-like tusks, or the single tooth found atop males’ heads.

Researchers studied the testicle size of 144 narwhals collected during aboriginal Inuit hunts between the years 1990 and 2008, and found that the bigger the tusks, the better the testes, pretty much — tusk length and teste mass (which indicates fertility) were closely related.

In a study published in Marine Mammal Science, these researchers suggest that a tusk’s length signals to female narwhals which males are the most fertile and would make the best mates, Science reports. That means narwhal tusks aren’t unlike peacock feathers or antlers in the sense that they’re animal body parts used to attract females with their impressive displays.

Previous theories about the tusks’ usage have included that they might serve as a (literal) icebreaker or a sensor of water salinity and temperature.

The latest study notes that while the tusks may serve other purposes, the fact that it’s such a gendered trait means it likely plays a small role in survival and providing a competitive evolutionary advantage.

[Science]

TIME

A Breast Cancer Drug May Help Women Become Pregnant

The drug may be a new option for women dealing with infertility

For women with polycystic ovary syndrome (PCOS), getting pregnant is tough. The disorder effects 5-10% of women, and interferes with their sex hormones and menstrual cycles, sometimes preventing women from ovulating altogether. Some women also develop ovarian cysts and have trouble getting pregnant.

The drug clomiphine citrate has been the go-to treatment because it spurs ovulation, but it’s not perfect: it’s just 22% successful with up to six cycles of treatment; it has a high rate of multiple pregnancies; and it can cause side effects like mood swings and hot flashes. Clearly, women need another option.

In a new study published in the New England Journal of Medicine, the researchers looked at 750 infertile women with PCOS and randomly assigned them to either take clomiphene or a newer drug called letrozole—which is also used to treat breast cancer in a different dose—for up to five cycles. The results show that the women taking letrozole had a significantly higher rate of births at 27.5% compared to 19.1% for the women on clomiphene. The women receiving letrozole also had higher ovulation rates and fewer twin pregnancies. Birth defects for women on both medications were rare.

The findings are encouraging for women looking for better options to increase fertility, but more research is needed.

TIME fertility

Guys, Your Smartphone Is Hurting Your Sperm

It may be time to take the phone out of your pants pocket, gents. A new study found that the low-level electromagnetic radiation (EMR) that mobile devices emit lowered sperm motility by 8%, and viability by 9%

Even while the debate over whether cell phones cause cancer rages on, researchers are starting to explore other potentially harmful effects that the ubiquitous devices may have on our health. Because they emit low-level electromagnetic radiation (EMR), it’s possible that they can disturb normal cell functions and even sleep.

And with male infertility on the rise, Fiona Mathews at the University of Exeter, in England, and her colleagues decided to investigate what role cell phones might play in that trend. In their new research, they analyzed 10 previous studies, seven of which involved the study of sperm motility, concentration and viability in the lab, and three that included male patients at fertility clinics. Overall, among the 1,492 samples, exposure-to-cell-phone EMR lowered sperm motility by 8%, and viability by 9%.

(MORE: Frozen Assets)

Previous studies suggested several ways that the magnetic fields might be wreaking havoc on sperm — they could be generating DNA damage by promoting more unstable oxygen compounds, or because most men carry their phones in their pants pockets, the fields, which can cause up to a 2.3°C temperature increase on the skin, could be raising the temperature of the testes enough to suppress and interfere with normal sperm production.

(MORE: Why the Latest Study on Cell Phones and Brain Cancer Won’t Be the Last Word)

Exactly how much the cell phones are contributing to lower-quality sperm isn’t clear yet — the researchers note that how long the phones are kept in pockets, as well as how much EMR the phones emit (most are legally required to stay below 2.0 W/kg) are also important things to consider when figuring out an individual’s risk. But the lab-dish studies do show that sperm are affected by the exposure, and that provides enough reason to investigate the possibility that cell phones may be contributing to lower-quality sperm and potentially some cases of infertility. More good reason to keep cell phones away from your body when you’re not using them — easier in theory than in practice, however.

TIME Cancer

Drug Found to Preserve Fertility Among Young Women on Chemo

Goserelin protected ovaries from chemotherapy damage in a recent trial

A common drug may be a more cost-effective way for young breast cancer patients to preserve their fertility during chemotherapy than freezing their ovaries.

The drug goserelin is often used as a hormonal therapy for breast and prostate cancer. It has also been used to control the timing of ovulation. Now, researchers have discovered that the drug may actually protect the ovaries from chemotherapy damage. In a recent clinical trial women who received monthly doses of goserelin were more likely to give birth compared to women who did not receive the drug during treatment.

For young, premenopausal woman, the possibility that cancer treatment could leave them infertile is devastating. But researchers showed that only 8% of the women on goserelin had ovarian failure compared to the 22% of women who did not receive the drug. Exactly how the drug protects the ovaries is unknown.

Currently, young women who want to ensure their ability to have kids after cancer may opt for egg freezing for the future in vitro fertilization (IVF) treatments. However, the cost for egg freezing and IVF are in the thousands of dollars, and women must sometimes start their chemotherapy immediately, before egg freezing can be done.

The researchers, who presented their findings at the annual meeting of the American Society of Clinical Oncology, recommend women beginning chemotherapy consider goserelin as an option. Further research is still needed to confirm their findings.

Goserelin is sold by AstraZeneca as Zoladex, and global sales of the drug were around $1 billion in 2013, the New York Times reports. Goserelin has been shown to cause side effects like temporary menopausal symptoms including hot flashes.

TIME Japan

Japan Is Desperate to Rescue Its Economy from an Early Grave

General Images of Economy Ahead Of Nationwide Quarterly Land Price Data Release
Kiyoshi Ota—Bloomberg/Getty Images Pedestrians cross an intersection in the Shibuya district of Tokyo, Japan, on Friday, Nov. 22, 2013.

Any less than 100 million people would spell doom for the nation's economy, officials warned, while neglecting one glaringly easy fix

Japan’s battle against gray hairs took an unusual turn this week when the Ministry of Commerce set the very lowest acceptable bound for its aging population: 100 million people. Beyond this point, there lays a “crisis.”

Or so warned Akio Mimura, head of Japan’s Chamber of Commerce and Industry. Mimura urged the government to make 100 million the official population target, backed by policies that would promote childrearing. “If we don’t do anything, an extremely difficult future will be waiting for us,” Mimura said.

His concerns are well founded. Japan has one of the lowest fertility rates in the world, with each woman bearing an average of 1.4 children. At that rate, demographers project a plunge from 127 million people today to 87 million by 2060, sapping the workforce of its vital young workers and putting an enormous strain on state finances.

The shrinkage has already begun. In 2013, Japan’s population declined by a record-breaking 244,000 people.

All of which has led to some rather creative policy proposals from the Chamber of Commerce, such as retaining 70-year-old’s in the workforce, doubling government expenditures on childcare and encouraging men to ask working women out on a date.

But once again, policymakers dodged the quickest fix, namely to import workers from abroad. The island nation has an outstandingly small number of immigrants. They form less than 2% of the population, compared with a wealthy country average of 11%. Japan could triple the number of foreigners and still not approach the norm among wealthy nations.

Migrants

Of course there’s a reason for policymakers’ skittishness around the issue. Immigration reform consistently takes a beating at the polls. One recent survey by Asahi Shimbun newspaper asked respondents if they would accept more immigrants to preserve “economic vitality.” Even with the positive spin, 65% opposed.

Japan Immigration Bureau’s motto is, “internationalization in compliance with the rules.” A simple rule rewrite could alleviate Japan’s demographic fix. It certainly would be easier than prodding the nation’s families to have another 13 million babies. But judging from this week’s presentation from the Chamber of Commerce, it remains politically stillborn.

 

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