She is 70 years, cannot read nor write but she holds the record of being the oldest first time mother in the world. According to Randeep Ramesh of The Guardian, this biological wonder came about through the fusion of social taboo and science.

By social taboo, Ramesh was referring to childlessness, by science to in vitro fertilization (IVF).

In her community, Rajo Devi Lohan has been living a life of shame and anguish because she and her husband couldn’t bear children. When a neighbor who could read told them about the “miracle medicine” that enables event postmenopausal women to conceive, the couple entered the world of assisted reproduction technology. By selling all that they have (2 buffalos) and taking loans and mortgages, the family managed to raise 175,000 rupees (£2,500) for the IVF procedure which was conducted in a town just 30 miles away.

There were some age-associated barriers to overcome. Lohan couldn’t produce eggs anymore so an egg was purchased from a local donor. Her husband Baba’s sperms were unable to penetrate the eggs, so it has to be directly injected. The resulting embryo was implanted and resulted in a baby girl delivered in November 2008.

India is making headlines as a favorite destination in the medical tourism industry and assisted reproduction is one of the most common procedures involved. India’s success is due to the fact that there are no guidelines that regulate the maximum age of the mother or the maximum number of embryos to be implanted. As one IVF doctor was quoted as saying “moral questions about rights and wrongs do not delay us.” India’s culture focuses more on the social stigma of infertility and the mother’s right to produce children. Less consideration is given to the rights of the child.

Earlier this year, there was a controversy about a 60-year old woman who circumvented the IVF age limit in Canada by having the procedure done in India but delivered her twins in Canada.

For the oldest mother, the way ahead is clear. She plans to breastfeed her baby for at least three years and then give IVF another try. Hopefully, it will be a boy the next time around.

Here are some troubling study results that bring bad news to both parents and doctors who had anything to do with assisted reproductive techniques – babies born via in vitro fertilization (IVF) have 2 to 4 times higher likelihood of having birth defects compared to babies conceived naturally, according to an article in the New York Times.

Now, before you start panicking, there are some limitations to the study mainly:

• The study only looked at singletons, not multiples.
• The study only looked at babies born via IVF, i.e. fertility treatments that involved handing the eggs and the sperm in the lab, but not babies born through other types of treatment.
• The birth defects in question – cleft lip and cleft palate and abnormalities in the heart, esophagus or rectum – are very rare conditions, so that despite the increased likelihood, the risk is still low.
• The study only compared 281 IVF-assisted births vs 14,085 natural births, thus making its statistical power a bit suspect.
• The study observed an IVF-birth defect link but could not explain the mechanism behind the link.

The article moved on to give us the following statistics:

• 52,000 babies were born via assisted reproduction in the US in 2005.
• 12% American of women ages 15 to 44 years seek fertility treatments.

Conclusions of the experts? Maybe. But larger studies are needed to confirm the results before doctors and parents should start worrying.

Last July 25, Louise Brown, turned 30. The day was marked as a major milestone in science and medicine. You see, Louise is the first test tube baby ? the first ever person born through in vitro fertilization (IVF).

Assisted reproduction technology (ART) has come a long way since 1978. Women of menopausal age can now carry and deliver babies. Surrogate mothers or ?wombs for rent? enables women who have undergone hysterectomy to have biological offsprings. Preimplantation genetic diagnostic screening enables parents to screen their embryos for genetic diseases and gender. In April this year, the first ?man? became pregnant and delivered a daughter. So one may ask, where do we go from here?

The 17 July issue of Nature published a special report on ?Making babies: the next 30 years? and interviewed several reproductive medicine experts on what we can expect in the next 30 years. Some of the replies are given below:

• Low-budget IVF – Currently, an IVF cycle can cost thousands of dollars. For the lucky few, it can even be covered by health insurance. There are, however, many countries in this world where IVF is inaccessible financially. By streamlining the procedure and using low-cost drugs, IVF might soon be available to almost anybody.
• Gametes from skin cells – Last year, pluripotent stem cells have been developed from ordinary human skin cells [2]. Research is now being stepped on on the development of gametes from stem cells [3], mainly because of the scarcity of egg donors as well as the legal restrictions associated with egg donations [4]. If this happens within the next 30 years, anybody ? and I mean anybody can have biological offsprings ? and infertility will be a thing of the past.
• Genetic banking – This is the storage of young, healthy cells of people before they start aging and accumulate genetic errors. These cells can be used as ?genetic cassettes? that can be used to correct aging-related errors.
• Artificial wombs – Some researchers are working at the other end of the process ? at delivery. In recent years, premature infants born as early as the 22^nd week of gestation period have been known to survive. The idea of an artificial uterus to carry an embryo to full term is not so far-fetched but can have a lot of ethical and legal implications.
• Cloned babies – According to one expert, reproductive cloning is not that far away although there is no need for it medically.

Louise Brown was a great milestone in science. So was Dolly. I think we can expect great things from reproductive medicine in the coming 3 decades. Maybe even terrible things. But great.

References

1. Nature 454, 260-262 (17 July 2008)
2. Science 318, 1917 – 192021 December 2007
3. Nature 452, 913 (24 April 2008)
4. Nature 453, 828-829 (2008)

Everyone who has gone through assisted reproductive therapy, particular in vitro fertilization (IVF), knows the uncertainty of the procedures. “Will it work this time?” is the question that in many cases gets a disappointing answer.

IVF clinics all over are proclaiming their high success rates to attract hopeful couples. In truth, predicting the likelihood for an IVF procedure to succeed is no easy task. For one thing, as many as 30 factors are involved. The Society for Assisted Reproductive Technology gives a US-wide estimate of 18 to 45% success rate.

In an IVF procedure, a woman gets drugs to stimulate ovulation. Her eggs are then removed and combined with sperms in a petri dish in a laboratory to produce embryos. In a typical IVF cycle, 5 to 12 embryos are produced but only embryos of the best quality are transferred to the uterus of the mother. Criteria used to check for quality include appearance, and the rate at which an embryo reaches the eight-cell stage.

Stanford University researchers did an analysis on clinical data from 665 IVF cycles performed at Stanford in 2005. Their goal is to identify a few factors that can strongly predict IVF success rate. Their results show that 4 main factors can best predict whether the cycle can succeed, namely:

• total number of embryos transferred
• total number of eight-cell embryos
• percentage of embryos that stopped dividing and would die
• the woman’s follicle-stimulating hormone level

These 4 factors could predict with up to 70% certainty whether the current IVF cycle would result in a pregnancy.

“IVF is very expensive – both financially and emotionally”, according to lead researcher Mylene Yao. She believes that couples who want to go through an IVF procedure will make their decisions based on probability. And they deserve more accurate prediction methods. Currently, a much bigger and comprehensive study is being conducted to confirm their results.