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New and old milestones in reproductive medicine
Editorial
What a week it was for reproductive medicine. The world paid tribute to Carl Djerassi, who died on Jan 30 aged 91 years in San Francisco. Djerassi and his coworkers synthesised synthetic progesterone, which led to the contraceptive pill being approved in the USA in 1960. On Feb 3, in the UK, Members of Parliament (MPs) voted by 382 to 128 to allow mitochondrial donation through an amendment to the 2008 Human Fertilisation and Embryology Act. “MPs authorise world’s first ‘three-parent’ IVF babies”, was the headline in the respected UK broadsheet The Guardian on Feb 4. If the vote in the House of Lords in the next few weeks also goes in favour, then the UK will become the first country to legislate to prevent mitochondrial disease by cell donation. In practice, the Human Fertilisation and Embryology Authority will be responsible for licensing which centres can offer the new technique, which has been pioneered by researchers at the Wellcome Trust Centre for Mitochondrial Research at Newcastle University, UK, directed by Prof Doug Turnbull. The vote in the House of Commons came after years of debate on the safety of mitochondrial donation, in which the nucleus from a woman with abnormal mitochondrial DNA is inserted into a donated cell from which the nucleus has been removed but has healthy mitochondria, and the embryo then reimplanted into the woman. Fundamental to mitochondrial donation is in-vitro fertilisation. In 1978, at Oldham General Hospital in the UK, the first baby born after in-vitro fertilisation was reported in a short letter by Patrick Steptoe and Robert Edwards in The Lancet. In-vitro fertilisation technology proved to be a breakthough in reproductive medicine, enabling the birth of millions. “Birth after the reimplantation of a human embryo” announced the Lancet letter, unaccompanied by any editorial comment. But as Philip Ball explores in an Art of Medicine piece in this journal last year, the world’s media reacted with headlines such as in Newsweek of a “cry heard around the brave new world”. As Edwards himself said, “Whatever today’s embryologists may do, Frankenstein or Faust or Jekyll will have foreshadowed, looming over every biological debate.” Edwards’ words have proven to be prophetic, with opposition to mitochondrial donation fuelling media outcries about playing God and creating designer babies. The term three-parent baby has been unhelpful www.thelancet.com Vol 385 February 14, 2015
throughout the debate. Babies born as a result of this technique have a full complement of DNA from the nuclei of their biological parents, and a miniscule amount of donated mitochondrial DNA (about 0·1% of the total DNA), and in no way equates to parenting either by nature or nurture. The words three-parent baby do not reflect the science and merely induce fear of the unnatural and the unknown. Exploring these common reactions, Ball comments that many parents “feel that their duties neither begin nor end with their chromosomes”, and that we “already know some three-parent families: gay couples with children via sperm donation, step-parents, adoptive families”. He concludes that “deep, often hidden ideas about naturalness” frame much of the debate about mitochondrial donation. Another milestone in reproductive health care is described in this week’s issue—the first livebirth after uterine transplantation, at Sahlgrenska University Hospital, Gothenburg, Sweden (published online in October). In-vitro fertilisation treatment—Steptoe and Roberts’ technique—was done as part of the procedure. Previous attempts of uterine transplantation have resulted in uterine necrosis or miscarriage. Whether it is providing contraception, in-vitro fertilisation, and now uterine transplantation and mitochondrial donation, doctors have a duty to address the predicaments of women, men, and families, and to help where possible. Now that a technique has been developed that could prevent transmission of mitochondrial diseases, it is surely time for science to inform and to reform reproductive practice. Religious and other objections, although respected, cannot match the alleviation of suffering and anxiety in affected families, who bravely tell their stories and campaign for change, to the benefit of society as a whole. The UK is a leader in reproductive research, which itself is at the forefront of medical innovation. With the appropriate regulatory safeguards in place, and long-term follow-up of the babies born as a result of all new reproductive techniques, embracing scientific advances wholeheartedly should be the norm. We applaud and celebrate these successes in reproductive medicine that will benefit many families, and call for the House of Lords to add their support to mitochondrial donation. The Lancet
Bryce Duffy/Galeries/Corbis
New and old milestones in reproductive medicine
See Obituary page 600 See Articles page 607
For Steptoe and Edwards’ report see Lancet 1978; 2: 366 For Art of Medicine by Philip Ball see Lancet 2014; 383: 1964–65
577
What a week it was for reproductive medicine. The world paid tribute to Carl Djerassi, who died on Jan 30 aged 91 years in San Francisco. Djerassi and his coworkers synthesised synthetic progesterone, which led to the contraceptive pill being approved in the USA in 1960. On Feb 3, in the UK, Members of Parliament (MPs) voted by 382 to 128 to allow mitochondrial donation through an amendment to the 2008 Human Fertilisation and Embryology Act. “MPs authorise world’s first ‘three-parent’ IVF babies”, was the headline in the respected UK broadsheet The Guardian on Feb 4. If the vote in the House of Lords in the next few weeks also goes in favour, then the UK will become the first country to legislate to prevent mitochondrial disease by cell donation. In practice, the Human Fertilisation and Embryology Authority will be responsible for licensing which centres can offer the new technique, which has been pioneered by researchers at the Wellcome Trust Centre for Mitochondrial Research at Newcastle University, UK, directed by Prof Doug Turnbull. The vote in the House of Commons came after years of debate on the safety of mitochondrial donation, in which the nucleus from a woman with abnormal mitochondrial DNA is inserted into a donated cell from which the nucleus has been removed but has healthy mitochondria, and the embryo then reimplanted into the woman. Fundamental to mitochondrial donation is in-vitro fertilisation. In 1978, at Oldham General Hospital in the UK, the first baby born after in-vitro fertilisation was reported in a short letter by Patrick Steptoe and Robert Edwards in The Lancet. In-vitro fertilisation technology proved to be a breakthough in reproductive medicine, enabling the birth of millions. “Birth after the reimplantation of a human embryo” announced the Lancet letter, unaccompanied by any editorial comment. But as Philip Ball explores in an Art of Medicine piece in this journal last year, the world’s media reacted with headlines such as in Newsweek of a “cry heard around the brave new world”. As Edwards himself said, “Whatever today’s embryologists may do, Frankenstein or Faust or Jekyll will have foreshadowed, looming over every biological debate.” Edwards’ words have proven to be prophetic, with opposition to mitochondrial donation fuelling media outcries about playing God and creating designer babies. The term three-parent baby has been unhelpful www.thelancet.com Vol 385 February 14, 2015
throughout the debate. Babies born as a result of this technique have a full complement of DNA from the nuclei of their biological parents, and a miniscule amount of donated mitochondrial DNA (about 0·1% of the total DNA), and in no way equates to parenting either by nature or nurture. The words three-parent baby do not reflect the science and merely induce fear of the unnatural and the unknown. Exploring these common reactions, Ball comments that many parents “feel that their duties neither begin nor end with their chromosomes”, and that we “already know some three-parent families: gay couples with children via sperm donation, step-parents, adoptive families”. He concludes that “deep, often hidden ideas about naturalness” frame much of the debate about mitochondrial donation. Another milestone in reproductive health care is described in this week’s issue—the first livebirth after uterine transplantation, at Sahlgrenska University Hospital, Gothenburg, Sweden (published online in October). In-vitro fertilisation treatment—Steptoe and Roberts’ technique—was done as part of the procedure. Previous attempts of uterine transplantation have resulted in uterine necrosis or miscarriage. Whether it is providing contraception, in-vitro fertilisation, and now uterine transplantation and mitochondrial donation, doctors have a duty to address the predicaments of women, men, and families, and to help where possible. Now that a technique has been developed that could prevent transmission of mitochondrial diseases, it is surely time for science to inform and to reform reproductive practice. Religious and other objections, although respected, cannot match the alleviation of suffering and anxiety in affected families, who bravely tell their stories and campaign for change, to the benefit of society as a whole. The UK is a leader in reproductive research, which itself is at the forefront of medical innovation. With the appropriate regulatory safeguards in place, and long-term follow-up of the babies born as a result of all new reproductive techniques, embracing scientific advances wholeheartedly should be the norm. We applaud and celebrate these successes in reproductive medicine that will benefit many families, and call for the House of Lords to add their support to mitochondrial donation. The Lancet
Bryce Duffy/Galeries/Corbis
New and old milestones in reproductive medicine
See Obituary page 600 See Articles page 607
For Steptoe and Edwards’ report see Lancet 1978; 2: 366 For Art of Medicine by Philip Ball see Lancet 2014; 383: 1964–65
577