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Caesarians Normal by 2010 NZ Herald 16 Mar 2000

More than half women having babies will opt for Caesarian deliveries by 2010 a leading British doctor predicts. Patient choice is all important to maternity care and given this I believe efforts to reduce Caesarian deliveries are doomed" Professor Nicholas Fisk of Queen Charlote's and Chelsea hospital in London told the Canberra congress of the Australia and New Zealand perinatal society. he said the risks were finely balanced between Caesarian and vaginal birth. It was wrong to deny women the choice when research indicated attempting a vaginal birth could be riskier for the mother or the baby.

But New Zealand health leaders sound warnings over the risks of a Caesarian delivery which they emphasized was a minor operation. New Zealand's Caesarian rate has soared - in 1989 12% but in 1999 this had reached almost 20%, was 25% at National Women's Hospital Australasia's largest and 30% on some hospitals. In some countries it is now up to 35%. The World Heath Organization recommends a rate no higher than 15%.

National Womens clinical leader Dr. Rob Buist said that a woman's choice was paramount. They should be allowed to have Caesarians even without medical need, but all women wanting to have Caesarians had to be adequately informed of the risks. He strongly disagreed with the implication of Professor Fisk's comments that a high Caesarian rate was acceptable. He attributed rising rates to improved in pain relief and infection prevention. There were still serious risks including a woman have a subsequent caesarian heamoraging so badly her uterus would have to be removed.

The College of Midwives president Sandy Gray said that if women wanted Caesarians with no medical need they should not receive taxpayer money. She attributed the increase to epidural pain relief and the artificial induction of labour. Caesarians carried a risk nine times higher than actual births she said. British research had shown that women received loaded information from obstetricians and were thus more likely to have a Caesarian.

IVF birth rate rise

One in five parents having IVF can now expect multiples births as a result of improving IVF techniques. NZ Herald June 2001.

9 March, 2001, BBC Doctor ready to clone babies

The first cloned baby could be produced within two years The controversial Italian fertility doctor who helped a 62-year-old woman give birth will tell a cloning conference in Rome on Friday that he is ready to start cloning babies for infertile couples.

He says that Britain's decision to allow limited research into therapeutic cloning will help his project and that a cloned baby could be created within two years.

Several scientists have said they want to clone babies but Professor Severino Antinori is the first researcher with the expertise and equipment to make it possible.

The procedure would be the same as that already used for animals.

Cells from the father would be injected into an egg, which would then be implanted into the woman's womb to grow.

The resulting child would have exactly the same physical characteristics as the father.

When Professor Antinori first announced his plans for human cloning in November 1998, he made it quite clear it would be used only in specific circumstances.

He told the BBC at the time: "I think cloning is a good idea in certain situations - when a man has no sperm cells it could help him have a child.

"I am collaborating with colleagues outside Italy who are carrying out animal experiments.

"This sort of research is banned here, but there is no doubt that cloning will be a reality within a few years."

Willing volunteers

He says he has 600 patients willing to undergo the fertility treatment and he is determined to press ahead with it despite international outcry.

He also claims he has the support and backing of an un-named Mediterranean country for his research programme, which he says could begin in October.

But his plans have attracted criticism among scientific and religious communities.

They are worried that cloning with animals is still a hit and miss affair, with 40% of them being born deformed.

The Vatican is also horrified by his latest plan and wants the practice stopped.

Monsignor Mauro Cozzoli from the Vatican Bioethics Commission said: "Cloning is immoral.

"Every child must be born with his or her genetic individuality. They should not be simply a photocopy of someone else."

Last month, the Pope also condemned the cloning of human embryos and called on scientists to respect the dignity of human beings.

Speaking at an international scientific meeting in Rome, he warned that any attempt to commercialise human organs or consider them as items of barter or trade must be considered morally unacceptable.

He went on to condemn all experiments in the cloning of human embryos, even with a view to obtaining new organs for transplant.

Instead, Pope John Paul II pointed scientists toward adult stem cells as the acceptable route for research in this field.

Dr Antinori has caused controversy in the past in his work with childless couples.

Eight years ago, he helped a 62-year-old woman to have a baby by implanting a donor's fertilised egg in her uterus, making her the oldest women in the world to give birth

10 March, 2001 BBC Baby cloning plans under fire

Antinori and Zavos: Aim to go ahead with plans There is mounting criticism of plans by doctors from Italy and the United States to clone human beings.

Among the latest voices to speak out against the plans is the prominent Italian cardinal, Carlo Maria Martini.

The Milan archbishop said the cloning team should remember that "the dignity of man is the main thing. And person cannot be fabricated through technology."

He said a human being has an "innate and natural" dignity, which should "not be violated in any way."

The cloning team insist their project is intended to help infertile couples and have tried to avoid ethical questions.

But this has failed to stop the objections and doubts raised by religious and scientific groups.

'Frankenstein doctors'

An Italian politician has been highly critical of the cloning team's research conference in Rome on Friday, which attracted a huge amount of publicity.

Giovanni Bianchi of the Popular Party, part of the governing coalition, described the team as "Frankenstein" doctors and said the conference was called with "one eye on a scoop and the other, obviously, on business."

The cloning team is led by Panos Zavos, a reproduction researcher, and Italian gynecologist Severino Antinori, who has helped women past menopause conceive.

The doctor first attracted controversy eight years ago when he helped a 62-year-old woman have a baby by implanting an egg in her womb.

Two years later, Dr Antinori helped a British 59-year-old unmarried mother have twins.

Baby cloning 'inevitable'

The British anti-abortion charity, Life, has condemned the plans, though it admits that it was inevitable someone would try to clone babies.

"This is a momentous step to take and society should tremble before doing something so radical," said National chairman Professor Jack Scarisbrick.

Pro-life groups have also spoken out against the plans.

"Without Britain's lead on therapeutic cloning, Professor Antinori's plans for reproductive cloning would not have been feasible," said John Smeaton of the Society for the Protection of Unborn Children.

"It is to the great shame of our country's leaders that Britain has taken the lead in this repugnant technology."

Not now, Dr Miracle NS 17 Mar 2001 3

Cloned babies are a bad idea when the science is still in its infancy

SEVERINO ANTINORI is a rich Italian doctor with a string of private fertility clinics to his name. He likes watching football and professes the Catholic faith. Yet the Vatican is no fan of his science.

In his clinics, Antinori already offers every IVF treatment under the Sun, but still there are couples he cannot help. So now the man Italians call Dr Miracle is offering to clone his patients to create the babies they so desperately want. And of course it's created quite a stir, with other scientists rounding on Antinori as religious leaders line up to slam his cloning plan as an affront to human dignity. Yet it's an ambition Antinori has expressed many times before. What's new is that finally it seems to be building a head of steam. Like-minded scientists from the US have joined Antinori in his cloning odyssey. At a conference in Rome last week they claimed hundreds of couples have already volunteered for the experiments. Suddenly, the idea of cloning people is no longer the preserve of cranks, religious sects and those on the fringes. Scientists with credentials and track records seem to be entering the field. Antinori shot to fame seven years ago helping post-menopausal grandmothers give birth using donor eggs. Later he pioneered the use of mice to incubate the sperm of men with poor fertility. He is clearly no ordinary scientist but a showman who thrives on controversy and pushing reproductive biology to the limits. And that of course is one reason why he's seen as being so dangerous. The other, paradoxically, is that his idea of using cloning to combat infertility is not as mad as it sounds.

Many people have a hard job seeing the point of reproductive cloning. Why bother when there are surrogate mums, egg donors and sperm banks around, not to mention adoption agencies? But this view is too simplistic. For some couples, cloning represents the only hope of having a child carrying their genes, and scientists like Antinori are probably right to say that much of our revulsion te cloning as a fertility treatment is irrational. In future we may want to change our minds and allow it in special circumstances. But only when the science is ready. And that's the real problem. Five years on from Dolly, the science of cloning is still stuck in the dark ages. The basic recipe might sound simple: take an empty egg, fuse it with a cell from the animal you want to clone, then give it a jolt of electricity. But the failure rate is a staggering 97 per cent and malformed fetuses all too common. Even when cloning works, nobody understands why. So forget the complex moral arguments. To begin cloning people now, before even the most basic questions have been answered, is simply a reckless waste of time and energy.

Which is not to say that Antinori will fail, only that if he succeeds it is likely to be at an unacceptably high price. Hundreds of eggs and embryos will be wasted and lots of women will go through difficult pregnancies resulting in miscarriages or abortions. A few years from now techniques will have improved and the wastage won't be as excessive. But right now there seems to be little anyone can do to keep the cloners at bay. And it's not just Antinori and his team who are raring to go. A religious sect called the Raelians believes cloning is the key to achieving immortality, and it, too, claims to have the necessary egg donors and volunteers willing to be implanted with cloned embryos. So what about tougher laws? Implanting cloned human embryos is already illegal in many countries but it will never be outlawed everywhere. In any case, criminalising cloning is more likely to drive it underground than stamp it out. Secrecy is already a problem. Antinori and his team are refusing to name the Mediterranean country they'll be using as their base. And who knows where the Raelians will be manipulating their eggs and embryos. Like it not, the research is going ahead. Sooner or later we are going to have to decide whether regulation is safer than prohibition.

Antinori would go for regulation, of course. He believes it is only a matter of time before we lose our hang-ups about reproductive cloning and accept it as just another IVF technique. "Once the first baby is born and it cries," he said last week, "the world will embrace it." But the world will never embrace the first cloned baby if it is sickly or deformed or the sole survivor of hundreds of pregnancies. In jumping the gun, Dr Miracle and his colleagues are taking one hell of a risk. If their instincts are wrong, the backlash against cloning-and indeed science as a whole-could be catastrophic.

proteins carry out many vital functions. Andy Coghtan

Too close for comfort If it's monkeys today, will it be humans tomorrow?
New Scientist 4 Nov 2000

A RHESUS monkey called ANDI entered the history books last week as the first ever genetically modified primate. While ANDi's creators hope that GM monkeys could aid medical research, the announcement has led to heightened fears that humans could be next. 'This could lead to a new form of eugenics, where we start designing our children according to our whims," claims Dave King of the Campaign Against Human Genetic Engineering in London. But scientists say that the difficulties involved in creating ANDI show how far

away we are from engineering humans. "To do this in humans would be mad," says Martin Bobrow, a medical geneticist at the Cambridge Institute for Medical Research. "You couldn't imagine trying to implant so many [human embryos] with such a low success rate," he says. ANDi-whose name is IDNA (inserted DNA) spelled backwards-was created by Gerald Schatten and his colleagues at the Oregon Regional Primate Research Center in Portland. Schatten's team used a virus to insert a jellyfish gene for fluorescence into 224 unfertilised monkey eggs.

'This could lead to a new form of eugenics, where we start designing our children according to our whims

Fertilising the eggs yielded just 40 viable embryos. From these, five pregnancies resulted. Of the three monkeys bom live, tests showed that only ANDI carries the gene-but it is not being expressed. Unhke humans given gene therapy, ANDI should pass the gene on to any descendants. Donald Bruce, director of the Society, Religion and Technology Project of the Church of Scotland, thinks that ANDI is a case of science going too far, given monkeys' closeness to humans. "Things go wrong all the time with these eggs, so in humans it would be absolute folly," he says. Patrick Bateson, chair of a Royal Society working party on GM animals, rejects the notion that humans are next. "There's no clear reason to suppose that monkeys wifl provide the bridge between mice and men." Another deterrent to altering humans, jE he says, is that genetic engineers cannot yet insert a gene into a precise place in the genome. Genes added in the wrong place can disrupt key genes and create havoc. Bateson also queries the value of GM monkeys for research. 'They're not sensible animals to use, because they develop slowly and are difficult to keep," he says. But other researchers say they could be useful. "GM monkeys would be better models than mice for some purposes," says Martin Evans of Cardiff University, who has created GM n-tice to study cystic fibrosis. "But it would be far more ethically objectionable.' In any case, most researchers cannot afford to use monkeys. It costs about E3000 to buy a monkey, compared with Fl for a mouse. Andy Coghlan and Emma Young

More at. Science (vol 291, p 309)

Genetically altered babies born 4 May, 2001, BBC online

By BBC News Online science editor Dr David Whitehouse

Scientists have confirmed that the first genetically altered humans have been born and are healthy.

Up to 30 such children have been born, 15 of them as a result of one experimental programme at a US laboratory.

An "unwelcome" development say scientists

But the technique has been criticised as unethical by some scientists and would be illegal in many countries, including the United Kingdom.

Genetic fingerprint tests on two one-year-old children confirm that they contain a small quantity of additional genes not inherited from either parent.

The additional genes were taken from a healthy donor and used to overcome their mother's infertility problems.

Germline modification

The additional genes that the children carry have altered their 'germline', or their collection of genes that they will pass on to their offspring.

Altering the germline is something that the vast majority of scientists deem unethical given the limitations of our knowledge.

It is illegal to do so in many countries and the US Government will not provide funds for any experiment that intentionally or unintentionally alters inherited genes.

The children were born following a technique called ooplasmic transfer. This involves taking some of the contents of the donor cell and injecting it into the egg cell of a woman with infertility problems.

The researchers, at the Institute for Reproductive Medicine and Science of St Barnabas in New Jersey, US, believed that some women were infertile because of defects in their mitochondria.

These are tiny structures containing genes that float around inside the cell away from the cell's nucleus, where the vast majority of the genes reside. There can be as many as 100,000 of them floating in the cells cytoplasm.

Two mothers

They are essential to cellular energy production and scientists suspect they have many other important but as yet unappreciated roles.

Mitochondrial DNA is passed down from generation to generation along the maternal line.

The US researchers wanted to supplement a woman's defective mitochondria with healthy ones from a donor.

Having just tested the children born as a result of this procedure, the scientists have confirmed that the children's cells contain mitochondria, and hence genes, from two women as well as their fathers.

Writing in the journal Human Reproduction, the researchers say that this "is the first case of human germline genetic modification resulting in normal healthy children".

'Great reservations'

British experts have severely criticised the development.

Infertility pioneer Lord Winston of the Hammersmith Hospital in London told BBC News Online that he had great reservations about it.

"Regarding the treatment of the infertile, there is no evidence that this technique is worth doing," he said. "I am very surprised that it was even carried out at this stage. It would certainly not be allowed in Britain.

"There is no evidence that this is a possible valuable treatment for infertility," he added.

Lord Winston said that, although the number of additional genes involved was tiny, it was in principle the wrong thing to do.

The Human Fertilisation and Embryology Authority (HFEA), the body that monitors and regulates UK reproductive medical activities, told BBC News Online that it was aware of the technique but had decided not to allow it in the UK because of its uncertainties and the possible alteration of the human germline.

'Back door'

The HFEA said it was an unwelcome development that "adds additional concern" to their worries. US researchers have also criticised the production of genetically altered children.

Eric Juengst, of Case Western Reserve University, said: "It should trouble those committed to transparent public conversation about the prospect of using 'reprogenetic' technologies to shape future children."

The US Government Recombinant DNA Advisory Committee told BBC News Online that the researchers had carried out this work without government money.

The committee said that in no circumstances would it consider any request for government funds that would result in modification of the human germline.

Professor Joe Cummins, of the University of Western Ontario in Canada, told BBC News Online: "Now is not the time to bring in human germline gene therapy through the back door."

Bob Phelps Director GeneEthics Network 340 Gore St, Fitzroy 3065 Australia Tel: (03) 9416.2222 Fax: (03) 9416.0767 {Int Code (613)} email: [email protected] (Bob Phelps) WWW:

Gene Technique Faulty NZ Herald May 21 2001

NEW YORK The American doctor who trumpeted a fertility techique using three genetic parents failed to disclose that along with 15 healthy babies, it produced two fetuses with a rare genetic disorder. Experts are horrified because the fault can be passed to future generarioiis. Dr Jacques Cohen denounced as "hysterical" growing criticism of his claims that the rescarch posed no risk. Cohen, who worked in Britain in the 1980s at one of the first IVF clinics, said: "Many of the techniques I carry out in America are illegal in Britain but that does not mean they are immoral." Researchers at the Institute for Reproductive Medicine and Science of St Bamabas in New Jersey boasted of their success in an article in last month's issue of the British journal Human Reproduction. The journal has since instituted tighter pre-publication procedures. Twenty-seven infertile couples who could not conceive through IVF took part in the proaramme, in which an infertile woman's egg is mixed with her husband's sperm and parts of a younger woman's egg. In 30 attempts, 15 babies were born. Their maternal genes came from their true mothers and all appeared completely healthy, "These statistics stand alone as justification for the work we are doing," Cohen said at the time. In their article the researchers concluded there was no reason to believe the technique was harmful to foetuses or babies. But what Cohen's team failed to reveal was that though 15 babies were born, 17 foetuses were created. The first unbom foetus was aborted and the second miscarried after both developed a genetic anomaly called Turner's Syndrome, a rare disorder in which an entire chromosome is missing. Two out of 17 far exceeds normal statistical expectation. Turner's Syndrome, which affects females, is characterised by short stature and the lack of sexual development at puberty. It can also create heart defects and kidney abnormalities. Documents from St Barnabas quoted in the Washington Post acknowledge the technique could be causing the problem, perhaps by enhancing survival of flawed embryos. Cohen has been at the forefront of contentious areas of medical research -including IVF, male inifertility and frozen embryos - for 25 years. He was defiant when he spoke to the Observer last week and criticised Britain's Human Fertilisation and Embryology Authority. Having worked at Bourn Hall Clinic, Cambridgeshire, he said he was well placed to make the comparison. He said: "Much of the hysteria over my new technique came down to differetices in cultures between Britain, the United States and other countries." OBSERVER

Up to 30 gene children living in US, says doctor

Genetically altered babies may have been bom over the past four years under the revolution ary treatment that came to light at the weekend. Researchers revealed yesterday that up to 30 children could be carrying genes from three people father, biological mother and female egg donor. The technique has been used since 1997, but has only now attracted attention after researchers checked for the fint tune to see if the children ended up with genes from both women. The oldest of the children turns four m a month, says the man who has helped pioneer the technique, Dr Jacques Cohen from New Jersey's Institute for Reproductive Medicine and Science at St Bamabas. The St Bamabas researchers treated 30 women who gave birth to 15 babies. But another 15 have been born after the use of the technique at other facilities in the US, Dr Cohen said. One of -Australia's leading fertility experts, Professor Robert Jansen, said the technique was not new. It was presented to the World Fertility Congress by the St Barnabas researchers in Sydney two years ago. " ... its nothing new and it might well be better for infertile women than having a whole egg donated in other words, having someone else's child." The treatment is used for a rare form of infertuity in women who have fertile eggs but whose resulting embryos die before they can be implanted in the uterus. Researchers at St Bamabas used donor DNA that contained mitochondria, tiny selfcontained structures that use oxygen and nutrients to create energy in cells, into the defective eggs. They found the technique allowed the otherwise infertile women to have offspring. But it was not until the latest issue of a British fertility journal that Dr Cohen revealed that two children had been tested to see if they had genes from three people. It was found they did. The St Bamabas researchers have been called "mavericks".

The view of most experts was that the children were in no danger from having their eggs manipulated in this way. "It's a treatment for fertility, not a treatment to modify a baby genetically in any way." Having DNA from a donor implanted into the mother's egg would make "absolutely" no difference to the genetic make-up of the children. The genes in the mitochondrial DNA were the same one the children would have had anyway, because they were the same in everyone. In the US, clinics which do not receive Government funding are legally able to carry out ground-breaking research with in-house approval of their own ethics committees., Professor Jansen said fertility researchers in Australia were "reluctant' to begin carrying out this kind of treatment until it was better understood. "We've hesitated to take it further down this road because there isn't yet a really plausible explanation of just how rejuvenating an egg this way actually works," Professor Jansen said. "I think it's important it remain the hands of a few very competent people who can follow up the children to see if anything does tum up that's unexpected." The technique would theoretically be legal in New Zealand, but would have to gain approval from the National Ethics Committee on Human Assisted Reproduction. This is an independent body set up to advise the Government on fertility issues. It is unlikely such approval would be granted, said the medical director of Fertility Associates of Auckland, Dr Richard Fisher. Two bills dealing with reproductive technology are before Parliarnent's health select committee.