Event Review: Futures in Reproduction

In
2010, Professor Sir Robert Edwards was awarded a long overdue Nobel Prize in
Physiology or Medicine, for his the part he played in pioneering both the
theory and practice of IVF. Since Professor Edwards and his colleagues Dr
Patrick Steptoe and Jean Purdy brought about the conception of the world's
first IVF baby (Louise Brown) in 1978, more than five million IVF babies have
been born worldwide.

Having
delivered the Nobel Lecture in Stockholm on the occasion of Professor Edwards'
award - Professor Edwards was too unwell to give the presentation himself -
Martin Johnson, professor of reproductive sciences at the University of
Cambridge went on to head up a committee that organised the celebratory
conference 'Futures in Reproduction' in Cambridge at the end of 2012.

The
conference focused on the kind of cutting-edge research that takes Professor
Edwards' legacy forward. There were excellent presentations on areas which have
been the focus of much of Progress Educational Trust's recent public engagement
work with epigenetics and mitochondrial disease figuring prominently.

Other
areas addressed at the conference were less familiar to me. Presentations on
the relationship between the embryo and the endometrium that lines the uterus left
me doubtful as to whether even a seemingly straightforward question like 'why
do women menstruate?' has a straightforward answer.

Meanwhile,
a presentation by Professor Peter Parham of Stanford University on the
relationship between evolution, immunology and pregnancy gave me a new
appreciation for the unique evolutionary position of - wait for it - the
hagfish and the lamprey. These 'living fossils', the only jawless vertebrates
still in existence, can help us deduce how the complex jigsaw of the human
reproductive system was assembled.

Perhaps
the most inspiring presentation of the day was by Professor Dennis Lo of the
Chinese University of Hong Kong. It was Professor Lo who made the discovery, 15
years ago, that the blood of pregnant women contains cell-free DNA (cffDNA) from
the fetus they carry. Among other things this discovery has made it possible to
detect Down's syndrome in a fetus 11 weeks into a woman's pregnancy, simply by
non-invasively testing a sample of her blood (see BioNews 591).

Professor
Lo's discovery also has the potential to form the basis for diagnostic and screening
tools for other conditions. Cell-free fetal DNA testing is already being used
to detect the sex of a fetus (sex selection is permitted in the UK for medical
reasons) and to anticipate and avoid rhesus disease (caused by incompatibility
between the blood types of a pregnant woman and the fetus she carries). As the cffDNA
testing is further refined, it has the potential to detect many other
conditions in the fetus.

Excitingly,
there is now the prospect of non-invasively sequencing the entire genome of a
fetus, by combining cffDNA with next-generation sequencing technology (reported
in BioNews 664).
Professor Lo explained that given the miniscule quantities of cffDNA available,
this operation appeared to be prohibitively difficult. Amusingly, however, he
was inspired to think up a solution while watching the film 'Harry Potter and
The Half-Blood Prince' in IMAX 3D. I won't relay the details here (I doubt I
could) but Professor Lo was struck by the fact that the 'H' in the 3D-rendered
Harry Potter logo resembled homologous chromosomes.

He
then went on to make this layman's head spin, by explaining how cffDNA testing
could be refined in relation to multiple pregnancies in order to distinguish
the pregnant woman's DNA from two or more other sets of DNA - sets which might
be identical, if monozygotic twins are involved - and also in relation to
mitochondrial DNA. When Professor Lo spoke there was a palpable sense that the
innovative spirit exemplified by Professor Edwards was very much alive and
well.

The
most contentious presentation was delivered by Dr Piraye Yurttas Beim, director
and chief scientific officer of the American company Celmatix. Unlike all the
other presentations it didn't speak to published, peer-reviewed research and it
had an unashamedly commercial focus. Dr Yurttas Beim explained how she and her
colleagues proposed to make reproductive medicine more personalised, via the
creation of clinical databases that are better tailored to the reproductive
sector than currently available resources.

The
presentation elicited a hostile reaction from the audience, both during the session
and throughout the coffee break that followed. For myself, while I had
practical and moral questions about Dr Yurttas Beim's approach, unlike some
clinicians in the audience I thought it entirely appropriate that she had been
invited to speak. The nakedly commercial side of fertility treatment - not to
mention its place in the febrile American healthcare context - are an important
part of Professor Edwards' legacy, that I do not think it should be off-limits
to explore.

Overall, 'Futures
in Reproduction' provided a rare opportunity to hear
from a cross-section of the finest contemporary minds in reproductive
biomedicine, all of whom are, in one way or another, building upon the
remarkable foundations laid by Professor Edwards. And if you missed the conference, videos of the presentations are freely available on the conference website here.