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Shoebox IVF hope for infertile couples

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Traditional IVF can prove too expensive for many

 

Could an IVF kit that fits in a shoebox and some kitchen cupboard essentials provide hope for people who long for children?

Infertility is a source of distress the world over, but in many places the terrible stigma attached to childlessness makes it even harder to bear.

The answer could be a pared-down system that can fit inside a shoebox and uses cheap ingredients you might find in a kitchen cupboard.

In the past infertility has been neglected in developing countries, partly because of a focus on controlling overpopulation.

But experts argue that true reproductive health has to address both sides: family planning for those who want to avoid pregnancy, and fertility treatment for those who long to have children but can’t conceive naturally.

Nosiphiwo, from South Africa, had been trying to conceive for years when her husband’s family asked her for their lobola back – the bride price they paid when she married their son.

She was ostracised by her in-laws for being childless, and felt cut her off from the rest of her community too. She says women in her situation sometimes turn to suicide.

“I thought of doing that. Because you don’t have any option.”

Sophisticated labs

The prohibitive costs of fertility treatment mean that worldwide, most couples cannot afford it – though their desperation can be such that many become destitute trying to pay for it, selling property or going into debt.

One of the biggest obstacles is the cost of the complex, sophisticated labs where “in vitro” egg fertilisation takes place.

tray of baking soda and a wedge of lemon
The carbon dioxide needed to create the right conditions for the embryo was made using baking soda and citric acid

Belgian obstetrician Dr Willem Ombelet worked in South Africa in the 1980s and saw many cases like Nosiphiwo’s.

He carried out IVF treatment for those who could afford it. Those who couldn’t came to the hospital on other pretexts – but the real reason was their longing for a child.

“They would wait shyly around the corner and ask if there was anything we could do for them.”

Back then, the heartbreaking answer was no.

But he has campaigned ever since to improve global access to infertility care, co-founding The Walking Egg non-profit organisation to raise awareness of fertility in developing countries.

DIY embryo transport

Willem Ombelet in front of art installation
Willem Ombelet teamed up with artist Koen Vanmechelen to raise awareness of infertility in developing countries

The centrepiece of the Walking Egg’s mission is a simplified system for egg fertilisation.

The embryos didn’t care if they were in an expensive triple walled incubator or a thermos flask.”

Professor Jonathan Van BlerkomEmbryologist, University of Colorado

The best conditions for a sperm to fertilise an egg outside the body are slightly alkaline, at a temperature of 37C (98F).

Usually this involves a sophisticated laboratory equipped with huge ventilators, complex incubators and a supply of expensive gases.

But when Dr Ombelet met the embryologist Jonathan Van Blerkom in 2008 the idea of a cheap, portable lab was born.

Van Blerkom revived a technique he used in the 1980s when transporting cow embryos long distances across Nebraska.

By mixing baking soda and citric acid he created his own CO2, periodically adding it to the solution holding the embryos to maintain the optimal CO2 concentration and alkalinity levels.

IVF in a shoebox

For humans the technique had to be refined to create a closed system and thus minimise any risk of contamination.

Eight test tubes in a metal block, in pairs connected by plastic tubing
The test tubes are held inside an aluminium heating block

Precise quantities of citric acid and sodium bicarbonate are mixed in one test tube. The CO2 bubbles this creates are fed via a tube into a second test tube containing a culture medium for the embryo.

To maintain the perfect temperature for egg fertilisation and embryo development, Van Blerkom tried out various low-tech methods.

“I put the test tubes into a thermos at the right temperature – that worked. I put them in an aluminium heating block, and that worked too. The embryos didn’t care if they were in an expensive triple walled incubator or a thermos flask.”

Once the atmosphere has stabilised, the egg and then the sperm are injected into the test tube containing the culture medium.

The next day this test tube goes under a microscope to see if it contains an embryo – meaning egg fertilisation has taken place.

If a successful embryo is created, it is transferred from the test tube to the woman’s womb after about six days.

This simplified system reduces the whole IVF lab to an aluminium heating block containing one pair of test tubes for each embryo, all inside a shoebox-sized container.

Incubator
The whole system would be housed in a self-contained incubator in places without access to sterile labs

For additional safety the human trials of the system have so far been conducted inside a sterile laboratory.

The team are developing a self-contained unit to house the system in hospitals or health centres that don’t have advanced lab facilities. This would provide heated, sterile air and space to examine the embryo under a microscope.

The researchers believe that – because of the closed nature of their system – this unit is not strictly necessary, but will help convince health authorities of the quality of the system.

“Embryo quality”

Trials began in Genk, Belgium in 2012, and so far 17 healthy babies have been born using the system.

Dr Ombelet is thrilled with their preliminary results, saying they indicate fertilization and pregnancy rates are similar to expensive IVF methods.

“We have proved that with our system embryo quality is at least as good as with regular IVF.”

Geoffrey Trew, a consultant in reproductive medicine and surgery at Hammersmith Hospital in London who is not connected with the research, agrees this is an exciting technique.

“It has been shown to work in a developed country. Now we’ve got to see how well it is reproduced in the developing world where the conditions are more fickle.”

Fertility on a shoestring

The trials are due to be rolled out in South Africa and the UK later this year, and the team hope that by early next year the system can be tested in the kind of low-resource settings it was designed for.

Each IVF cycle costs less than 200 euros (£159) using this system, not including staff and medication costs, which vary from country to country.

But Dr Ombelet says they can decrease the normal price for IVF in any given country by at least 70-80%.

“With very low dose medication schemes we hope to perform IVF in developing countries for less than 500 euros (£399)”

Prof Thinus Kruger and Dr Matseseng are fertility experts from Tygerberg Hospital in Cape Town.

They already have a special fertility programme that cuts costs by economising on medication and staffing – Nosiphiwo was one of the many women who was helped to conceive by this programme.

“It’s really theoretically amazing,” says Professor Kruger.

“But we will have to see how patient and scientist friendly this system is. It is a little lab, so you still need the knowledge to handle those small embryos.”

Prof Van Blerkom believes that efforts to bring the cost of fertility treatment down would please the IVF pioneer Robert Edwards, whose work led to the birth of the first test tube baby, Louise Brown.

“People can make fortunes through IVF. But Bob Edwards was a real believer that IVF should be universal, because he knew the suffering that infertility caused.”

via BBC News – Shoebox IVF hope for infertile couples.

Survival of the unfittest: IVF technique ‘used too widely’, watchdog warns

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A technique for injecting sperm directly into unfertilised eggs to increase the chances of a successful IVF pregnancy is being used too widely by some fertility clinics, the head of the Government\’s fertility watchdog has warned.

Lisa Jardine, who chairs the Human Fertilisation and Embryology Authority (HFEA), said that some IVF clinics are using intracytoplasmic sperm injection (ICSI) simply because it is easier than standard IVF, rather than because it is in the best interests of patients.

\”We believe it is being used far too widely because it is procedurally easy,\” Professor Jardine said. \”The scientists who advocate it already know that a boy born through ICSI is likely to have a low sperm count. So it is a little bit worrying that it is being rolled out so widely.\”

She recently warned on BBC Radio 4 that success rates for couples, who typically spend around £15,000 for three cycles of treatment, are \”discouragingly low\”.

ICSI was first introduced about 20 years ago, since when its use has become widespread. In 2011, more than half of the nearly 62,000 cycles of fertility treatment, involving just over 48,000 women in Britain, were done with ICSI, rather than letting the sperm penetrate the egg naturally.

In many other countries – in North America and Europe for instance – the figure is even higher, with ICSI being used in as many as 90 to 95 per cent of IVF cycles. Yet some studies suggest that IVF children born from ICSI may be at higher risk of medical problems as they grow older, including male infertility.

\”We know that babies born from ICSI have increased risk of some problems later in life and infertility is one of them,\” said Allan Pacey, chairman of the British Fertility Society and an IVF specialist at Sheffield University.

\”For these reasons we should be prudent over the use of ICSI. So let\’s use ICSI when it\’s needed, and not as some kind of guarantee against fertilisation failure, which is how some clinics approach it.\”

Professor Jardine, who steps down as chair of the HFEA in the new year, said she shares the concerns of some experts, who believe that many fertility clinics are opting to use ICSI simply because it is easier to achieve rapid fertilisation of an egg, rather than using it specifically as a treatment for male infertility.

About half of the couples given ICSI have male-related fertility problems, while about 12 per cent have joint male and female factors, and 10 per cent have specifically female fertility problems. In 20 per cent of cases, ICSI is used for \”unexplained\” reasons, according to data gathered by the HFEA.

One of the pioneers of ICSI, André Van Steirteghem of the Brussels Free University Centre for Reproductive Medicine, warned in 2010 that IVF clinics are routinely overusing the treatment despite the risk of long-term health problems in the children conceived by the technique.

\”The health of children has to be considered the most important outcome of artificial reproductive technology treatment. It\’s fair to say that overall these children do well [but] there are a few more problems with these children,\” Dr Van Steirteghem said.

\”It doesn\’t mean that when you use ICSI there will be more problems, but it is important that we have to see what comes about in the future, so long-term monitoring is extremely important. ICSI has been overused,\” said Dr Van Steirteghem. He advises the HFEA on new developments in fertility treatment.

However, Professor Pacey said that Britain is one country that is probably not overusing ICSI overall: \”As a country overall we\’ve got it about right, because about half of the fertility problems are male related and half are female related, and there is a 50:50 split between ICSI and conventional IVF.\”

\”But there may be some individual clinics that are doing it more than they should. They are frightened of fertilisation failing. The HFEA should be focusing on these individual clinics with high ICSI levels,\” he added.

via Survival of the unfittest: IVF technique ‘used too widely’, watchdog warns – Science – News – The Independent.

Warning of three-person IVF ‘risks’

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Concerns about the safety of a pioneering therapy that would create babies with DNA from three people have been raised by researchers.

The advanced form of IVF could eliminate debilitating and potentially fatal mitochondrial diseases.

Writing in the journal Science, the group warned that the mix of DNA could lead to damaging side-effects.

The expert panel that reviewed the safety of the technique said the risks described would be “trivial”.

The UK is leading the world in the field of “mitochondrial replacement”. Draft regulations to allow the procedure on a case-by-case basis will be produced this year and some estimate that therapies could be offered within two years.

Power source


One of our prime interests is about the safety of these techniques.”

Prof Doug TurnbullMitochondrial replacement researcher

Mitochondria are the tiny, biological “power stations” that provide nearly every cell, which make up the body, with energy. They are passed from a mother, through the egg, to her child.

But if the mother has defective mitochondria then it leaves the child starved of energy, resulting in muscle weakness, blindness and heart failure. In the most severe cases it is fatal and some families have lost multiple children to the condition.

The proposed therapy aims to replace the defective mitochondria with those from a donor egg.

Continue reading the main story

Method one: Embryo repair
1) Two eggs are fertilised with sperm, creating an embryo from the intended parents and another from the donors 2) The pronuclei, which contain genetic information, are removed from both embryos but only the parents’ is kept 3) A healthy embryo is created by adding the parents’ pronuclei to the donor embryo, which is finally implanted into the womb

Method two: Egg repair

1) Eggs from a mother with damaged mitochondria and a donor with healthy mitochondria are collected 2) The majority of the genetic material is removed from both eggs 3) The mother’s genetic material is inserted into the donor egg, which can be fertilised by sperm.

But mitochondria have their own DNA, albeit a tiny fraction of the total. It means a baby would have genetic information from mum, dad and a second woman’s mitochondria.

The concerns raised – by scientists at the University of Sheffield, the University of Sussex and Monash University in Australia – are about a poor match between the mitochondrial DNA and that from the parents.


The woman who lost all her children

Sharon Bernardi and her son Edward, who died last year aged 21

Every time Sharon Bernardi became pregnant, she hoped for a healthy child.

But all seven of her children died from a rare genetic disease that affects the central nervous system – three of them just hours after birth.

When her fourth child, Edward, was born, doctors discovered the disease was caused by a defect in Sharon’s mitochondria.

Edward was given drugs and blood transfusions to prevent the lactic acidosis (a kind of blood poisoning) that had killed his siblings.

Five weeks later Sharon and her husband, Neil, were allowed to take Edward to their home in Sunderland for Christmas – but his health slowly began to deteriorate.

Edward survived into adulthood, dying in 2011 at the age of 21.

Now Sharon is supporting medical research that would allow defective mitochondria to be replaced by DNA from another woman.

They said there was an interaction between the DNA in the mitochondria and the rest which is packaged in a cell’s nucleus.

Their studies on fruit flies suggested that a poor match of genetic information between the nucleus and mitochondria could affect fertility, learning and behaviour.

“Describing it as like changing the batteries in a camera is too simplistic,” Dr Klaus Reinhardt from the University of Sheffield told the BBC.

He added : “It is not at all our intention to be a roadblock, we think it is fantastic that for women affected there could be a cure.

“We have pointed out one or two points which need to be looked at.”

‘Trivial’

The Human Fertilisation and Embryology Authority, which regulates fertility treatment in the UK, commissioned a review into the safety of the technique.

Prof Robin Lovell-Badge, who was on the review panel, disagreed. He said humans had diverse mitochondrial and nuclear DNA, so any consequences of poor matches would have already become apparent.

He told the BBC news website: “Humans are breeding between races and producing healthy children all the time. If there is an effect then it must be very trivial as it’s not been noticed.”

He has called for further safety testing, such as research into the risks posed by any defective mitochondria which might still be passed onto a child.

Prof Doug Turnbull, who is developing the mitochondrial replacement therapy at Newcastle University, insisted: “One of our prime interests is about the safety of these techniques.

“It’s perfectly reasonable to draw some of these concerns, I just don’t share the same concerns.

“Mismatch between the mitochondrial and nuclear genome is a potential risk, but I don’t think it’s personally as big a risk as they’re saying.”

Mitochondrion
Hundreds of mitochondria in every cell provide energy

The idea has also raised ethical concerns from groups concerned about the impact of altering human genetic inheritance.

In a statement, the Human Fertilisation and Embryology Authority said: “The panel of experts convened by the HFEA to examine the safety and efficacy of mitochondria replacement carefully considered the interaction between nuclear and mitochondrial DNA and concluded that the evidence did not show cause for concern.

“As in every area of medicine, moving from research into clinical practice always involves a degree of uncertainty. Experts should be satisfied that the results of further safety checks are reassuring and long term follow-up studies are crucial.

“Even then patients will need to carefully weigh up the risk and benefits for them.”

via BBC News – Warning of three-person IVF ‘risks’.

‘Test-tube baby’ Brown hails pioneers on 35th birthday

Louise Brown is now married and has a son

 

The world’s first “test-tube baby”, Louise Brown, has paid tribute to the fertility doctors who gave her life, as she celebrates her 35th birthday.

She said in vitro fertilisation had helped millions – there are thought to be more than 5.5 million IVF babies worldwide.

She was born in 1978 at Oldham General Hospital after her parents became the first to successfully undergo IVF.

Mrs Brown is now married and has a six-year-old son, who was born naturally.

As she prepared to celebrate her birthday with a private family meal, Mrs Brown said she hoped the public could now see the benefits of the breakthrough.

“When I was born they all said it shouldn’t be done and that it was messing with God and nature but it worked and obviously it was meant to be,” she added.

“It’s helped millions all around the world and if it can help improve success rates, obviously it’s a good thing.

“I’ve now had my own son without IVF and lots of people I know or have heard of have gone on to have children naturally.

“That shows that it is just the beginning of life that’s a little bit different, the rest is just the same.”

Her birth, to parents Lesley and John, attracted controversy at the time. Religious leaders expressed concern over the use of artificial intervention and some raised fears that science was creating babies who could experience medical difficulties later in life.

Mrs Brown, whose younger sister Natalie was also the product of IVF, now lives near Bristol. She is married and has a six-year-old son, Cameron.

She recently unveiled a plaque to honour IVF pioneers gynaecologist Patrick Steptoe and reproductive biologist Robert Edwards at Bourn Hall, the clinic they founded in Cambridge and where the techniques and drugs now used worldwide were first developed.

Their research led to the successful fertilisation of a human egg outside the body and the transfer of the resulting embryo to the womb.

Sir Robert, who was awarded a Nobel Prize in 2010, died aged 87 in April this year. Steptoe died in 1988.

Professor Sir Robert Edwards
Sir Robert Edwards was the physiologist who developed the IVF technique that gave birth to Louise Brown

 

Mrs Brown spoke of her sadness at the death of Sir Robert – who was married with five daughters.

She added that she remembered Steptoe as a “gentle giant”.

“Without Patrick and Bob’s help, Mum wouldn’t have had me,” she said.

“As I got older, Mum explained to me how they had both helped.

“Bob was like a granddad to me and I felt very, very sad to hear of his death.

“He was so well liked and so many people owe so much to his work.”

She called for IVF to be made more readily available and said more people should have access to it on the NHS.

“It is difficult to say what it is like to be the first test-tube baby as I have been brought up with it. People ask what it feels like, but it’s just always been there – it’s my life,” she added.

“I understand more now and I just think my mum was fantastic.

“I think she was just very brave but I suppose if you’re told you can’t have children, you’ll do anything.”

via BBC News – ‘Test-tube baby’ Brown hails pioneers on 35th birthday.

Baby born using new IVF screening technique

Connor Levy’s parents had been trying to conceive naturally for four years.

 

A baby has been born in the US using a new method for screening embryos during IVF which could dramatically reduce costs, researchers report.

Connor Levy was born in May after the test, devised at Oxford University, helped doctors pick an embryo with the best chance of success.

Only one in three attempts at IVF results in a baby as abnormalities in an embryo’s DNA are common.

Large trials are now needed to see how effective the method is, experts say.

If there are abnormalities with the packages of DNA, called chromosomes, in the embryo then it will not implant in the womb or if it does the foetus will not reach term.


All this hard work and we have finally got our little tiny human being named Connor”

Marybeth ScheidtsMother

It is a problem which increases rapidly with age. One quarter of embryos are abnormal in a woman’s early 30s, but this soars to three quarters by the time a woman reaches her late 30s and early 40s.

Some clinics already offer a form of chromosome screening, but it can add between £2,000 and £3,000 to the cost of IVF in the UK. Connor’s mother, Marybeth Scheidts, said it would have cost her $6,000 (£4,100) for the test in Pennsylvania.

The new test takes advantage of the dramatic advances in sequencing the human genome. Within 24 hours it can ensure the correct number of chromosomes are present.

Dr Dagan Wells from Oxford University told the BBC: “Current tests are adding a significant amount of money on to an already expensive procedure and that is limiting access; most patients are having to pay for this out of pocket themselves.

“What our technique does is it gives you the number of chromosomes and other biological information about the embryo at a low cost – probably about two thirds of the price of existing methods of screening.”

Embryo
How to pick the right embryo to implant is a major issue in fertility clinics

He says trials are now needed to see if it could improve IVF success rates.

Tears of joy

The baby and a further pregnancy resulting from the screening method will be announced at the European Society of Human Reproduction and Embryology conference.

Marybeth Scheidts, 36, and her husband David Levy, 41, had been trying to conceive naturally for four years and also tried artificial insemination.

In the screening three of the 13 embryos produced were healthy. Without chromosome screening, picking the right embryo would have been down to luck. Instead they were successful on their first attempt.

Marybeth told BBC News Online that the years of trying were tough: “It takes its toll, there were some days I would break down and cry, I wanted to hide in my bedroom and say stop.


They done the work in humans, they’ve pregnancies – so it’s a pretty powerful proof of concept study using an exciting technique”

Stuart LaveryDirector of IVF at Hammersmith Hospital

“Then to see him… all this hard work and we have finally got our little tiny human being named Connor.”

Dr Michael Glassner, the fertility doctor at Main Line Health System where the IVF took place, said such techniques would become more common.

“If you have ever sat across the desk from a patient that has failed or is in that crossroads of thinking of another cycle and you look in their eyes where they are barely able to hold on to their hopes and dreams – anything that is so significantly going to impact pregnancy rates is going to become standard.

“So I think five years from now you fast forward – yes I think it will be standard.”

Commenting on the study, Stuart Lavery, a consultant gynaecologist and director of IVF at Hammersmith Hospital, said: “This is amazing science.

“They done the work in humans, they’ve pregnancies – so it’s a pretty powerful proof of concept study using an exciting technique.”

He also praised the researchers for saying proper trials needed to be conducted before it was used widely.

via BBC News – Baby born using new IVF screening technique.

IVF delays due to NHS-only policy, fertility expert claims

Peter Bowen-Simpkins said the decision to end the contract with his Swansea clinic was purely ideological

A fertility expert claims women seeking IVF treatment are suffering delays because the Welsh government stopped funding for a private clinic.

Peter Bowen-Simpkins said the decision to end the contract with his Swansea clinic was purely ideological.

Patients are waiting 18 months for the NHS service at Cardiff’s University Hospital of Wales, known as IVF Wales.

But the Welsh government says it is supporting work to build more capacity for IVF services.

A new NHS IVF unit is due to open in Port Talbot in the spring, however it will be 18 months later than planned.


It feels to me like a totalitarian state who say this is what we are going to do despite the outcome”

Peter Bowen-SimpkinsLondon Women’s Clinic

In the meantime, some patients have been offered earlier treatment at NHS units in Bristol, which has cost the Welsh NHS more than £500,000.

A decision to end the use of private providers in the NHS came from the previous Labour-Plaid coalition government.

As a result, the Welsh Health Specialised Services Committee (WHSSC) – the NHS body that plans specialist treatments – did not renew a contract with London Women’s Clinic (LWC) in Swansea.

Two years after the contract with LWC came to an end, a new NHS IVF unit at Neath Port Talbot hospital is due to open in April, but it is 18 months later than planned.

‘Crazy’

LWC medical director Peter Bowen-Simpkins said the “crazy” decision to end the contract with the company’s Swansea clinic was purely ideological.


Analysis

Aled ap DafyddBBC Wales political reporter

We need to turn the clock back to get a proper timeline on this.

Up until March 2011 women, mainly in west Wales, were receiving private treatment on the NHS at the London Women’s Clinic (LWC) in Swansea. The previous Welsh government decided to end all private involvement in the NHS and as a consequence LWC’s funding came to an end.

Over £1m was invested in a new IVF facility at Neath Port Talbot Hospital to take its place. It was supposed to open in autumn 2011 so there would only have been a six month gap between the private contract coming to an end and the new NHS service being up an running.

But it’s still not open.

The clinic’s medical director, Peter Bowen-Simpkins, says the decision to discontinue funding before the new NHS service was open is based purely on ideology.

IVF Wales treating patients from Cardiff and the Vale they are now having to treat women from Abertawe Bro Morgannwg.

This has cost the NHS over £500,000.

He said: “It’s appalling that the assembly can disadvantage the very people it’s supposed to be supporting.

“As a consequence of what has happened we’ve gained because people have been forced into the private sector because of the NHS.

“I feel very strongly that the Welsh assembly made a decision that has actually produced a waiting list which is about two years whereas before it was about six weeks.

“It’s costing them a lot more and the results are likely to be worse because patients are getting older.”

Mr Bowen-Simpkins went on: “It feels to me like a totalitarian state who say ‘this is what we are going to do despite the outcome’.

“The very people who probably have supported the government are the ones who are going to be disadvantaged, the ones who can’t afford it (private treatment) and are going to have to travel a very long way.”

Figures up to November 2012 show 210 women from south and west Wales have been treated by North Bristol NHS trust and a further 90 were waiting for treatment. This has cost the Welsh NHS more than £500,000.

LWC claims it was saving taxpayers’ money as the amount it received was less than was given to IVF Wales for comparable treatment.

WHSSC said the decision was not based on money and that it is working with Abertawe Bro Morgannwg Health Board to make sure the facility at Neath Port Talbot will open in the spring.

A Welsh government spokesperson said: “Whilst we understand the London Women’s Clinic motive, as a private company who wish to generate a profit, the Welsh government is clear in its support of the work being done to build more capacity for IVF services in NHS Wales.”

The Welsh government expects the Neath Port Talbot facility to be ready to treat patients from April, subject to accreditation from the Human Fertilisation and Embryology Authority.

BBC

‘Three people, one baby’ public consultation begins

By James Gallagher Health and science reporter, BBC News

Baby

A public consultation has been launched to discuss the ethics of using three people to create one baby.

The technique could be used to prevent debilitating and fatal “mitochondrial” diseases, which are passed down only from mother to child.

However, the resulting baby would contain genetic information from three people – two parents and a donor woman.

Ministers could change the law to make the technique legal after the results of the consultation are known.

About one in 200 children are born with faulty mitochondria – the tiny power stations which provide energy to every cell in the body.

Most show little or no symptoms, but in the severest cases the cells of the body are starved of energy. It can lead to muscle weakness, blindness, heart failure and in some cases can be fatal.

Mitochondria are passed on from the mother’s egg to the child – the father does not pass on mitochondria through his sperm. The idea to prevent this is to add a healthy woman’s mitochondria into the mix.

Two main techniques have been shown to work in the laboratory, by using a donor embryo or a donor egg.

How do you make a baby from three people?

Method one: Embryo repair
1) Two embryos are fertilised with sperm creating an embryo from the intended parents and another from the donors.
2) The pronuclei, which contain genetic information, are removed from both embryos but only the parents’ is kept
3) A healthy embryo is created by adding the parents’ pronuclei to the donor embryo, which is finally implanted into the womb

However, mitochondria contain their own genes in their own set of DNA. It means any babies produced would contain genetic material from three people. The vast majority would come from the mother and father, but also mitochondrial DNA from the donor woman.

This would be a permanent form of genetic modification, which would be passed down through the generations.

It has huge potential significance for society because for the first time children would be born with DNA from three people – what has frequently been dubbed ‘three parent IVF’. Crucially that genetic alteration to what’s known as the germ line would be permanent, handed down from generation to generation”

It is one of the ethical considerations which will be discussed as part of the Human Fertilisation and Embryology Authority’s consultation.

The chair of the organisation, Prof Lisa Jardine, said: “It is genetic modification of the egg – that is uncharted territory. Once we have genetic modification we have to be sure we are damn happy.”

She said it was a question of “balancing the desire to help families have healthy children with the possible impact on the children themselves and wider society”.

Other ethical issues will also be considered, such as how children born through these techniques feel, when they should be told, the effect on the parents and the status of the donor woman – should she be considered in the same way as an egg donor in IVF?

Mitochondrion
Hundreds of mitochondria in every cell provide energy

It is not the first time these issues have been discussed. A report by the Nuffield Council on Bioethics said the treatment was ethically OK, but the group Human Genetics Alert said the procedure was unnecessary, dangerous and set a precedent for genetically modified designer babies.

The consultation will run until 7 December and the conclusions will be presented to ministers next spring.

Research into the area is legal in the UK, but it cannot be used in patients.

However, treatments in IVF clinics will be years away even if the public and ministers decide the techniques should go ahead. There are still questions around safety which need to be addressed.

One of the pioneers of the methods, Prof Mary Herbert from Newcastle University, said: “We are now undertaking experiments to test the safety and efficacy of the new techniques.

“This work may take three to five years to complete.”

BBC

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