Uterus transplantation research at the cutting edge?

13 09 2013

To the Editor:

We appreciate Dr. Donnez’s interest in our recent manuscript and his insightful remarks on uterus transplantation (1).

Uterine factor infertility affects 3% to 5% of the population (2). Uterus transplantation aims to increase the quality of life in uterine factor infertility patients facing psychological and social problems related to the loss of female identity. Gestational surrogacy offers the only current option for being a genetic parent, with limited availability and potential ethical and psychological problems (3).

Research experience in animals is essential prior to the introduction and attainment of the clinical application of a new surgical innovation. This is especially important when the indication is not life-threatening. Dr. Brannstrom’s group remains the leading team in uterus transplantation research (4). His group has described the basic techniques for uterus transplantation and reported the first pregnancy following uterus transplantation in an experimental animal model.

Due to limitations in postoperative care, assisted reproductive technology (ART), poor control of serum immunosuppressive levels, and financial issues, animal models have not been able to give sufficient information regarding its feasibility and role in acquirement of fertility potential. Read the rest of this entry »

Preimplantation genetic screening is alive and very well: Really?

12 09 2013

To the Editor:

The September issue featured Views and Reviews on preimplantation genetic screening (PGS), including an editorial by Meldrum (1), declaring PGS “alive and very well,” four reviews of technical aspects of the procedure, and three articles by the Scott group. Unfortunately, lacking was a critical and balanced presentation of the subject.

The concept of PGS is not new. It was proven useless in a prior incarnation, though unfortunately only after thousands of women reduced pregnancy chances by utilizing the procedure (2). Now history appears to repeat itself, with many investigators promoting an improved version involving day 5/6-blastocyst trophectoderm biopsy in place of day-3 embryo biopsy and 24-chromosome copy number analysis by various available technologies in place of fluorescence in-situ hybridization (FISH).

All above noted articles uncritically accept that the earlier PGS failure was due to technical shortcomings of day-3 biopsies and chromosomal analyses by FISH. They assume that these shortcomings are remedied by the utilization of trophectoderm biopsy and new 24-chromosome copy analyses, and that PGS now fulfills its presumed destiny of improving in vitro fertilization (IVF) outcomes.

But what if PGS did not fail because of technical shortcomings? What if it failed because PGS should not be applied indiscriminately to every patient or because embryo selection by PGS statistically simply does not work in older women or with low ovarian reserve? Wouldn’t we then only repeat the same mistakes all over? Read the rest of this entry »