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【medical-news】IVF治疗的是是非非
by Mark Henderson
Science can dispel fears
When Robert Edwards and Patrick Steptoe pioneered IVF in the late 1970s they were widely accused of playing with the lives of unborn children. Their critics argued that to help the naturally infertile to give birth was to tamper dangerously with Nature. An epidemic of deformed, sickly babies would be their legacy.
Louise Brown, the first test-tube baby, turned out perfectly healthy. Infertility treatment is responsible for more than three million births worldwide. It is so socially acceptable that few couples hide their treatment from friends and relatives. Neither of these developments would have happened had the Jeremiahs been right.
This background is worth remembering when research highlights new risks, as did two papers presented this week to the American Society for Reproductive Medicine. The first, led by Mary Croughan, of the University of California, San Francisco, found evidence that infertile couples have a greater risk of having children with serious disorders, such as autism, cancer or seizures. Rates were 2.7 times higher among their offspring than in those of fertile parents, even after allowing for the effects of mutiple births and higher maternal age.
Though this seems to derive from underlying infertility and not therapy, it raises obvious concerns. Is infertility treatment dangerous for the children that it creates? The other paper, from Peter Nagy, of Reproductive Biology Associates in Atlanta, suggested that women born to older mothers are more likely to suffer fertility problems.
Again, this has worrying implications. The average age of motherhood is rising, as women postpone having children until they have established a career and IVF helps them to conceive. Is medicine creating an infertile generation? Both studies point towards a new theme in understanding the risks of assisted reproduction. Each suggests that the quality of the eggs and sperm from which embryos are made, and the uterine environment in which these develop, has an important impact on a child’s subsequent health.
Nagy’s findings probably reflect the way better quality eggs are ovulated early in reproductive life; “older” eggs are more likely to carry defects. Croughan’s work suggests that these defects, and other medical problems related to infertility, have a knock-on effect on children’s health. These are important findings and, if confirmed, raise important issues. Neither study, however, is quite the ammunition for critics of IVF that it at first appears.
No parent would wish infertility on her children. But Nagy’s findings are unlikely to be universal; Louise Brown is pregnant after a natural conception. Even if they were, these parents prove that infertility is often treatable. Daughters of older mums are likely to have difficulty conceiving only as they themselves get older. If aware of this throughout life, they would know that it was important to start a family, or at least to freeze eggs, at their reproductive peaks.
Croughan’s results look more worrying, but are also not what they seem. She took pains to point out that though the relative risks are frightening, the absolute risks of having a child with disorders are small. The chances go up from about one in a thousand to between two and three, depending on the condition. Most successful IVF patients will have healthy children.
Such research means that doctors can counsel their patients about the small risks that will always accompany IVF, and how these could be reduced; for example, by tackling obesity or hyper- tension ahead of pregnancy.
A greater awareness of how fertility declines with age could also encourage younger parenthood and remove the need for some medical interventions.
Science of this sort is essential if infertile couples are to become properly informed patients. They should not be alarmed by it.
Mark Henderson is Science Editor of The Times
http://www.timesonline.co.uk/article/0,,8123-2423202,00.html 本人已领这篇，如48小时未交稿，其他战友可以继续认领 试管受精治疗
科学能消除人们的恐惧
十九世纪七十年代后期Robert Edwards和Patrick Steptoe，试管受精的开拓者，受到广泛的指控，他们被指控玩弄胎儿的生命。反对IVF的批评家争论到帮助不育者生育是违背自然的。畸形和病弱儿的的基因将遗传给下一代。第一个试管婴儿Louise Brown被证明是完全健康的。全世界有3百万婴儿期待通过不育治疗而出生。社会普遍接受不育症的治疗，很少夫妇对朋友亲戚隐瞒他们接受不育治疗。如果Jeremiahs是对的那么这些IVF技术的发展将不会发生。
美国生殖医学会这周发表的两篇论文表明，研究者克服了新的风险，这一时刻是值得记忆的。加州大学旧金山分校的教授Mary Croughan，他领导的小组第一次发现证据：不育夫妇生出严重缺陷婴儿的风险更大，包括自闭症、癌症和癫痫等疾病。与生育正常的夫妇的后代相比风险率高2.7倍，其中包括多胎和生育年龄高的影响因素。
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作者:admin@医学,生命科学 2010-10-21 05:11
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