Hope on the horizon

You’re desperate to start a family but you feel as though you have exhausted almost every treatment available, and you just need that last glimmer of hope.

Some people will travel abroad to take advantage of commercial surrogacy arrangements or to purchase donor eggs. This is an expensive option and it can pose risks, and presently these types of arrangements are not allowed in Australia because they raise all sorts of ethical, legal and social conundrums.

Still, scientists here are working hard on new technologies they hope will spare more men and women from the pain of infertility and pregnancy loss. New technologies are already doing much to improve the survival of premature babies and increase fertility options for couples and single people. These exciting advancements have also enabled much older people to become parents and, combined with legislative change, helped eradicate some life-threatening genetic conditions.

As the baby-making industry continues to run full steam ahead, we explore what’s happening in Australia as well as other parts of the world.

The other thing is allowing those patients who have those identified genetic disorders to be funded for fertility treatment so they are not going to miss out.

The future of genetic testing

Last year federal health minister Greg Hunt said pre-conception genetic testing will become increasingly available to all Australian couples.

Soon a national genomics mission, dubbed ‘Mackenzie's mission,’ will be piloted in WA.

It’s heartbreaking to realise but although scientists from the Murdoch Children’s Research Institute had already helped develop a simple test that couples could do to find out their risk of passing on genetic conditions such as spinal muscular atrophy, many prospective parents and doctors were unaware the $385 test was even available.

Now, not only does the Australian Government want to raise awareness about the hidden risks of passing on devastating genetic conditions, the plan is for IVF to become more accessible to affected families.

Mr Hunt also revealed he’d like to see pre-conception testing become routine for everyone thinking about starting a family. This would also alert would-be parents if they carry the genes for cystic fibrosis and Fragile X Syndrome.

It’s a significant step forward that offers families choice, explains Dr Michael Allen, an obstetrician and gynaecologist at Genea Hollywood Fertility.

“There are always ethical considerations and the pilot study is seeing what couples would do with that information and how they would act on it and what technology is used to give better outcomes,” he says. “The other thing is allowing those patients who have those identified genetic disorders to be funded for fertility treatment so they are not going to miss out. That is quite exciting in the fertility world to know patients who are unfortunate enough to suffer from these types of disorders are able to make use of funding from Medicare if they want to.”

Re-engineering the human species

Earlier this year, the international scientific community was up in arms after a Chinese scientist altered the embryos of twin girls to make them immune to HIV.

The CRISPR gene editing technique basically works as a DNA cutting-and-pasting operation but in most western countries, including Australia, researchers are not permitted to edit the genes of humans — it’s morally and ethically fraught.

While it holds promise. one of the concerns is we do not know the long-term effects it could have on the humans who have had their DNA tweaked.

Critics say it could have all sorts of unintended consequences — what if it creates trickle-down effects and damages cognition, for example? Another worry is that it could eventually lead to a rise in so-called designer babies, or that DNA changes could pass down to future generations.

“It’s confronting, challenging and whilst we have our nation-based legislation, the global community is very different and people overseas with the means and the funds will explore all options,” Dr Allen says. “The need for an international scientific consensus on what is reasonable and what is not is the next step before more human trials start anywhere.”

Dr Stephen Junk, scientific director of Fertility Great Southern in Denmark, WA, adds: “Who knows what this is going to do to these poor children because they may be looking fine now but what is going to happen when they decide to have children and is it going to affect further generations? None of that has been researched. It could have knock-on effects. (It’s the reason) we have very strict regulation on what we can and can not do in terms of research.”

Stem cells: A cure for infertility?

Scientists in other parts of the world are now busy making embryos in laboratories from stem cells, meaning sperm from a male and an egg from a female are not even required. While it’s only being experimented on in animal models, one day the technique will probably be honed so scientists can create human embryos out of stem cells.

“Theoretically you could take a skin cell from somebody, turn it backwards to create a stem cell and then turn it ‘on’ to create an egg or a sperm,” Dr Junk explains.

However, he adds: “It won’t happen with humans in my generation, that’s for sure.

“One of the things with science is there is a lot of research going on and boundaries are being pushed and ethics committees and legal bodies are trying to keep up.

“But it is possible that a person who is infertile could actually use her own skin cells or kidney cells or whatever cells to create stem cells and a sperm and an egg so she wouldn’t need anyone else.”