As we
approach this more-than-usually momentous New Year, we continue our
look ahead, as parenting experts tell us what changes and developments
they foresee in their fields in the upcoming 50 years. We can feel the
future! HAPPY NEW YEAR!
INFERTILITY More and more ‘future babies’
According
to Zev Rosenwaks, M.D., internationally renowned infertility specialist
and director of The Center for Reproductive Medicine and Infertility at
New York Presbyterian Hospital-Weill Medical College of Cornell
University, the outlook for the millions of American couples affected
by infertility is much less bleak today than it used to be, and
promises to be even more encouraging as we move into the new millennium
– due to continuing advances in Assisted Reproductive Technology (ART).
“Twenty-five years ago we could help 60-65 percent of infertile
couples; today that figure is somewhere between 90 and 95 percent,” he
reports.
The
era of assisted reproduction in humans began with attempts at in-vitro
fertilization by teams in England and Australia, culminating in the
successful birth of the first “test-tube baby” in 1978. Since then,
there has been a surge of new advances: problems with ovarian
stimulation have been reduced, egg retrieval has been simplified by the
development of ultrasound-guided follicle aspiration, assisted hatching
has significantly increased the success rate, embryo freezing has
allowed for additional pregnancy without the risk or cost of another
stimulation and egg retrieval, and several procedures have
revolutionized the treatment of male factor infertility.
The most common ARTs now used include:
*
IVF (InVitro Fertilization) where egg and sperm are combined in a
laboratory and incubated, with the resulting embryos transferred into
the woman’s uterus.
*
GIFT (Gamete IntraFallopian Transfer), where eggs and sperm are
transferred into the fallopian tube during a laparoscopy, allowing
fertilization to occur in the normal location.
*
ZIFT (Zygote IntraFallopian Transfer), a combination of IVF and GIFT,
where fertilization occurs in-vitro (outside the body) but fertilized
eggs (zygotes) are placed into the fallopian tube.
*
ICSI (IntraCytoplasmic Sperm Injection), in which fertilization is
achieved by the direct injection of a single sperm into the egg.
*
AH (Assisted Hatching), a variation of IVF in which a small hole is
made in the shell surrounding the embryo to facilitate implantation.
What
does the future hold? Dr. Rosenwaks, who served as the first director
of the country’s first IVF clinic, says current research is focusing on
several areas. One is the development of new techniques to help
stimulate the maturation of immature eggs from women undergoing IVF.
Others are the micro-manipulation of eggs and embryos, and the
identification and isolation of young sperm cells from men with
testicular failure and azoospermia (complete absence of sperm in the
ejaculate). The refinement of techniques of pre-implantation genetic
diagnosis (testing for chromosomal abnormalities in an embryo before it
is implanted into the woman’s body) can potentially decrease the births
of infants with disorders such as sickle cell anemia or Tay Sachs.
Other
anticipated advances, continues Dr. Rosenwaks, are finding ways to
create new eggs from regular cells in a woman’s body, creating new
sperm or repopulating sperm in men whose sperm quality is poor, and
using a variety of culture media in the laboratory to grow embryos
until they can be safely implanted in the woman’s body. Dr. Rosenwaks
also hopes we will increase our knowledge of markers of embryo
viability (survival), leading to fewer eggs implanted during in-vitro
fertilization.
In
addition, new treatment techniques for women with Polycystic Ovarian
Syndrome are expected to reduce infertility problems often associated
with this disorder. The recent FDA approval of Antagon, a drug which
delays the surge of leutenizing hormone, will reduce the amount of
medication needed to treat certain types of infertility. And advances
in non-surgical aspiration of sperm present effective alternatives to
vasectomy reversal.
As we move forward, the future for people yearning to experience the joys of parenthood is bright indeed.
PEDIATRICS New vaccines, gene therapy, stemming serious disease
The
20th century has seen enormous progress in the diagnosis and treatment
of childhood illnesses. Advances in pediatric clinical medicine,
improved access to prenatal and health care, improved nutrition,
environmental interventions, the development of immunizations against
common childhood illness, and the discovery of anti-microbial agents
such as penicillin and the sulfonamides have all contributed to a
substantial decrease in infant mortality and more effective treatments
for numerous childhood conditions. Since the development of the oral
polio vaccine in 1963, for example, the incidence of poliomyelitis has
decreased to less than 10 cases per year; and the Hib vaccine, first
developed in 1987, protects against Haemophilus influenza B infections
and has greatly reduced the incidence of meningitis and other serious
childhood illnesses caused by this bacteria.
Dr.
Philip Lanzkowsky, M.D., FRCP, DCH, Sc.D., vice president of the
Children’s Health Network of North Shore Long Island Jewish Health
System, chairman of the department of pediatrics and chief of staff at
Schneider Children’s Hospital, believes that the new millennium will
bring many exciting advances in pediatric medicine. He is particularly
optimistic about the development of new immunizations, including one
for rotavirus, the most common cause of severe gastroenteritis and
diarrhea in infants and young children. Although the Rotashield vaccine
was recently withdrawn from the market due to concerns about its link
to a painful and potentially fatal bowel obstruction, the National
Institute of Allergy and Infectious Diseases reports that eight other
vaccines to fight rotavirus are in various stages of development, and
Dr. Lanzkowsky is hopeful that a safe and effective one will be
available in the not-too-distant future. He also expects that within
the next few years we will see the development of vaccines which can
prevent pneumococcal illnesses, middle ear infections and other common
childhood diseases, as well as the emergence of medications to treat
other disorders.
Dr.
Lanzkowsky, an expert in childhood leukemia and other pediatric
malignancies, anticipates breakthroughs in the treatment of childhood
cancers – such as the development of powerful new chemotherapeutic
agents. He points out that when he started practicing medicine about 40
years ago, childhood leukemia was 100 percent fatal, while today there
is a 70 percent cure rate, and many of the remaining 30 percent do well
with continued treatment. The cure rates for other childhood cancers,
such as Wilms tumor and Hodgkin’s disease, have also greatly improved.
Dr.
Lanzkowsky is excited by new possibilities for the use of gene therapy,
believing “it holds great promise for the future.” The National Cancer
Institute concurs, pointing out that “gene therapy could redefine the
practice of medicine in the next century.” Potential applications
include replacing missing genes which are responsible for genetic
disorders such as cystic fibrosis, or injecting genes into target
cancer cells to either kill the cells directly or make them more
receptive to anti-cancer drugs. Dr. Lanzkowsky, who also expects great
strides in the area of organ transplantation, believes that “research
will help us to overcome immunological barriers to the use of animal
organs,” and also predicts we will be able to use mechanical hearts and
other technologically-sophisticated devices to sustain life until an
organ is available for transplant.
One
cause for concern is the antibiotic dilemma. While new ones will be
developed, according to Dr. George Post, chief scientific officer of
SmithKline Beecham, the British pharmaceutical giant, “As more and more
bugs become resistant to more and more antibiotics, we will have a
definite window of vulnerability before new antibiotics begin to be
introduced to overcome the (super)bugs which are resistant to today’s
antibiotics… We’re not going to see those new antibiotics until at
least 2007 in any significant numbers.”
Recently,
the American Health Foundation announced the formation of its Pediatric
Task Force, an advisory group of experts which will examine in depth
the health status of our nation’s children. According to chairperson
Myron Winick, M.D., New York City pediatric specialist in nutrition,
“As we embark on the 21st century, pediatrics is about to introduce a
new concept – the concept that many of the most serious diseases in
adulthood may begin in early childhood or even before (in utero) and
that with proper management early in life, some of the leading causes
of death in adults (i.e., cardiovascular disease, diabetes, and
obesity) may be prevented or at least delayed…
“A
very important new dimension is entering into the care of children. No
longer is it sufficient to treat them only when they are sick. No
longer is it sufficient to prevent the usual diseases of childhood. Now
a healthy childhood must also encompass maximal protection against many
diseases that will become overt 30, 40 or even 50 years later. Thus,
anyone concerned with child health in the 21st century will be
concerned with recognizing and eliminating ‘pediatric antecedents of
adult disease.'”
A
healthy childhood and a long, healthy adulthood. As we prepare to don
our party hats and celebrate the beginning of a brave new century, this
is certainly a wonderful wish for the children of America.
– Barbra Williams Cosentino RN, LCSW is a writer in Queens, NY
