Irish Medical News


A new IVF option


Currently, the UK is mulling over whether to legislate a fertility treatment that could prevent some incurable diseases being inherited in children.

Around one in 6,500 children are born with serious diseases caused by faulty mitochondrial DNA. Mitochondria are only passed on from the mother. Though mitochondrial disease is rare, it can be devastating, including fatal liver, neurological and heart conditions. According to statistics, it affects 100 children each year in Britain.

Under the new treatment, babies would be conceived from three biological parents. Babies born with the therapy, known as three-parent IVF, would inherit 98 per cent of their DNA from their “real” parents. The rest would come from a female donor.

However, some experts argue that “three-parent IVF” is a misjudged name as mitochondrial DNA does not transfer any traits and hence cannot amount to parentage any more than someone who received a liver transplant would be considered to have four parents, because the recipient contains the genetic DNA from four people.

Opponents of the treatment fear that genetic manipulation may open the door to genetic engineering of babies.

Professor Fionnuala McAuliffe, consultant in obstetrics and gynaecology at University College Dublin and the National Maternity Hospital, Holles Street, told IMN that there are obvious ethical issues surrounding the proposed IVF treatment, “in terms of a non-biological parent parenting a child, there are the usual ethical issues people have around that.”

UK Health Minister Andrew Lansley requested the Human Fertilisation and Embryology Authority (HFEA) to assess three-parent in vitro fertilisation (IVF) after researchers at Newcastle University (NU ) said they had conquered the technique using cloning technology, which experts liken to that used to clone Dolly the sheep.

At the moment, the technique is banned under the Human Fertility and Embryology (HFE) Act, as amended in 2009. However, the Act includes the provision for the Secretary of State to permit this in the future which has led to the HFEA review.

Those at NU developed the method, which involves intervening in the fertilisation process to swap DNA between two fertilised eggs so that malfunctioning mitochondrial DNA can be removed.

Within 24 hours of uniting egg and sperm using IVF, nuclear DNA is removed from the embryo and implanted into a donor egg, whose own nucleus has been removed and discarded.

The resulting embryo inherits nuclear DNA, or genes, from both its parents, but mitochondrial DNA from the female donor who gave the healthy egg.

In humans, about 37 genes are found in the mitochondria, while the rest, more than 20,000 known genes, are in the DNA found in the nucleus. The British Department of Health advised that the HFEA wants the “effectiveness and the safety” of the technique to be assessed by an expert group.

Professor Alison Murdoch, Professor of Reproductive Medicine and head of the department at NU, said: “As doctors we have a duty to treat disease and where possible to prevent disease.

With diseases for which there are no treatments the imperative to develop new treatments is even greater.” She advised that this HFEA review could take up to a year, but it was important to involve lawmakers early.

“We are not ready to do this in patients now but the science is progressing very rapidly,” she stated. “Of course there is no guarantee that we will have all the evidence we need to secure a license in a year but we need to anticipate that we may have and prepare accordingly.”

“Doctors would really like to be able to cure diseases as they arise but the ideal role is that we prevent them,” she said, adding that unfortunately, there is no cure once this problem has arisen in a child.

“For the first time there is potentially the option that we can actually prevent this being passed on not only to a child or children but to their children as well.”

Prof Murdoch continued to say that “no treatment is ever risk free and if there are risks we will need to quantify these so that doctors can discuss the relative risks and benefits with patients and their families”.

Prof McAuliffe told IMN that “mitochondrial disorders are extremely rare conditions” and there would not be much demand for this particular IVF treatment in Ireland.

As one in 6,500 children are born with a mitochondrial disease each year, this would affect approximately nine children born each year in Ireland. Furthermore, she added that for an such an expensive treatment to be brought in to treat so few people, this would simply not be cost-effective.

“A lot of these treatments will show benefits over time.”

For a country the size of Ireland there wouldn’t be a lot of point having expensive technology that wouldn’t be used regularly,” she said. However, looking to the UK, she pointed out that they have a much larger population, greater need and a greater health budget and admitted, “it would be good to see what the European experience was.”


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