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Fertility 'breakthrough' as human eggs grown in lab for first time (independent.co.uk)
345 points by vezycash 8 months ago | hide | past | web | favorite | 126 comments



This has several big implications:

1. Women will soon not need to go through the painful (and expensive) process of freezing eggs. (soon being when this is shown to be safe and equivalent to existing eggs). This will enable older women to have kids and solve some reproductive issues.

2. This will lead to a massive rise in availability of human eggs for scientific research, accelerating many fields. Lack of availability of eggs (as they get prioritized for other uses) restricts things like embryo research and other genetic analysis of human germline

3. Potentially this could lead to gay couples being able to have genetically descended children (obviously male couples here, but similar work on sperm is being done that could potentially enable lesbian couples to have kids too). This can be done as skin cells can be turned into pluripotent stem cells, and then maybe into the eggs (still some missing pieces in this process)


> This will lead to a massive rise in availability of human eggs for scientific research, accelerating many fields.

It will also mean a massive rise in the availability of human eggs for turning into embryos, which in turn will mean the ability to be much more selective about which embryos to to implant during IVF.

Currently egg harvesting is such an arduous process that embryos can only realistically be selected for viability and a handful of generally fatal diseases. When you are choosing 1 out of 7-10 embryos, you can't be all that picky. But between having access to hundreds of eggs, sperm obviously not being an issue, the ever decreasing cost of genomic sequencing, and the ever increasing knowledge of how specific genes relate to traits, parents undergoing IFV could start to apply many selection criteria. That wouldn't be genetic engineering in the classic sense, nothing would be available that wasn't in one of the parent's DNA, but it would get a lot of the way there.

Edit: If I was going to be beaten to the punch by anyone on this subject, I'm happy it was gwern.


And one day soon children conceived the 'natural' way will be at a disadvantage. Reminds me of Gattaca...


Parents' primary responsibility is to ensure that the environment in which their kids grow up, the food they eat etc promote healthy development. For many practical purposes, the kids' protein-building machinery including the nucleic acids, can be treated the same way as the environment, the food etc - another critical input to a developing human life.

In this view, it is scarcely surprising that parents would want to give their kids viable genetic information just like they want to give their kids a good home, healthy food and challenging education.

This desire to ensure the good of the kids is a strong force pushing humanity forward and I see no reason to object.

Unequal access to shelter, food, education or genetic techniques is a different matter. But our failure to ensure universal access to the spoils of a new invention does not imply that there is something wrong with the invention. The real problem is more like the lack of compassion for other folks...

So let's not throw the baby out with the bathwater.


it's happening already


No it's not. I don't know of any non-naturally born people who have an advantage. Currently, people born via IVF are more likely to be born prematurely and with increased risks of mental and physical problems.

We may be there soon, but we're definitely not there yet.


> Currently, people born via IVF are more likely to be born prematurely and with increased risks of mental and physical problems.

Cite? The research I found on this indicated that IVF children were exactly average, and IVF with use of sperm donors actually had considerably lower risk of birth defects.


The research is still uncertain, and it may also depend on whether or not you do ICSI. When you do IVF though you need notarized signatures from both partners next to a dozen or so possible categories of birth defects where the child may have an increased risk, e.g.:

https://www.ncbi.nlm.nih.gov/pubmed/29164811

If you're curious you can probably just stop by your local teaching hospital and ask for a copy of the 50+ page contract with all the informed consent details.


If things like congenital heart defects are a real risk (especially a doubling), it should show up very easily in mortality and other hard endpoints. As it is, that just sounds like another anomaly from observational data. (Reading that one in particular, none of the studies use any kind of strong controlling for parental factors, to mention the most obvious problem with trying to infer causation of harm in IVF.)

> If you're curious you can probably just stop by your local teaching hospital and ask for a copy of the 50+ page contract with all the informed consent details.

What a contract says is of little scientific value, unless one is studying tort law and the finer details of butt-covering.


As for the mortality issue, the oldest IVF baby is currently something like 38. And given that it didn’t become common until even later, we’re not going to have that data for several decades.

> What a contract says is of little scientific value, unless one is studying tort law and the finer details of butt-covering.

They have actual statistics though if not references to the primary sources, so that was more the reasoning.


> As for the mortality issue, the oldest IVF baby is currently something like 38.

My point is that a congenital heart defect is something that should strike early, especially in childhood (and that's one of the usual ways to find out about it, kids dropping dead for no good reason, like after being lightly hit in a football game). If a doubling of defects can be detected, so too should a doubling of heart-related mortality. There's on the order of a million IVF kids annually in the USA alone; it's not possible for that to have gone unnoticed. So either their risk is the same as their non-IVF peers and such defects are just common among older mothers, or the defects are not actually serious (pace studies showing that things like cancers or spinal anomalies are common among healthy people, or, more IVF related, that many embryos discarded for chromosomal abnormalities turn out, when implanted, to work perfectly fine because the abnormal cells die or the embryo otherwise recovers during development).


> it's not possible for that to have gone unnoticed

Keep in mind that 93% of heart defects are detectable via an echocardiogram around week 24 of pregnancy. So I would imagine that in most cases where the heart defect is fixable then it's repaired, or else if it's not fixable but also not serious then the kid is just prevented from doing sports. Or else if it's serious and not fixable then pregnancy is terminated.

So I would expect the actual mortality to be substantially less than 2x. And given that heart-related mortality in children is extremely rare, I suspect it would be quite tricky to detect. Especially when you need to account for confounding issues like maternal age during pregnancy, ICSI use, etc.

Given that there are around 5,000 CHD-related deaths in children per year, and around 1.5% of babies are IVF births, we're talking at most 150 deaths per year instead of 75, probably less due to the reasons mentioned above. And once you start trying to take into account imperfect data confounding variables, it's hard to say whether having definitive proof one way or the other is even within the realm of science at that point.


I can second this from a non-statistical point of view. IVF is pretty common in my relative circle and I do not find the kids to have any sort of mental/physical issues


Embryo selection is an advantage for IVF children


> 2. This will lead to a massive rise in availability of human eggs for scientific research, accelerating many fields. Lack of availability of eggs (as they get prioritized for other uses) restricts things like embryo research and other genetic analysis of human germline

Don't forget embryo selection: if you can create on demand several dozen or hundred eggs, the estimates of gains from embryo selection go from ~0.5 IQ points to 5-10 IQ points (and similarly for any other trait you might want to select for). 0.5 points is pretty trivial and no one will be beating down doors for that; 10 points, however, is a different proposition.

Perhaps more importantly, it's a step towards iterated embryo selection - fertilizing, selecting, then regressing to stem cells, and progressing to sperm/eggs - and doing so for multiple generations, getting +10 points each time, for largely unbounded gains.


If we had the tech to do that we would already have the ability to genetically modify embryos with heightened intelligence. Do we even know what genes are responsible for that?


Found your counter interesting so looked up this[1].

We already have the tech to do selection as above but it is cost prohibitive to produce the number of embryos required to do it at scale.

Where you misunderstood was that this is selection, not modification.

We do not know which genes to modify specifically.

We can however, using commonality and statistics, select embryos for increased likelihood of increased intelligence based on a number of different phenotypes.

That's where my understanding ends but the link below has more.

The interesting idea was that we can repeat the selection process using the already selected for embryos - effectively skipping potentially many generations. As in, your kids could more correctly be your great great great great great grandkids.

What I want to know is how far you could theoretically take it before the statistical analysis starts to break down.

As in, can we get to twice as intelligent? Does our statistics / scoring even know what that might look like?

Could we be looking at human induced evolution?

[1] https://www.gwern.net/Embryo-selection#polygenic-scores-for-...


> As in, can we get to twice as intelligent? Does our statistics / scoring even know what that might look like?

No to your second question; that being the case, your first question has no meaning.

We don't score intelligence with cardinal numbers, which would be required for "twice as intelligent" to make sense as a concept.


> We don't score intelligence with cardinal numbers, which would be required for "twice as intelligent" to make sense as a concept.

We actually do score intelligence with cardinal numbers if one wants to. As I mentioned in my other comment, a number of subtests have absolute scales with true zeros: digit span, vocab, and reaction time come to mind. Quite helpful for cross-species comparisons like humans and chimpanzees...


The fact that we score some intelligence correlates on scales with true zeros does not mean intelligence itself can be treated this way. Indeed, since the rigorous way to define intelligence is to do so perturbatively (e.g., as a certain principal components in data, or as the first-order effects of flipping a bunch of SNPs), we should generically expect it to break down as a robust concept outside the perturbative regime.

Or in other words, the fact that one person can be twice as fast as another person in the 100m dash does not make it meaningful to say that one person is twice as athletic as another. In particular, we don't expect the person who is twice as fast to also be twice as flexible or throw the shot-put twice as far, even if those can be made true statements for small (e.g. 5%) difference with appropriate multiplicative factors (e.g., a 5% increase in top-speed predicts a 10% = 2*5% increase in shot-put distance).


> Or in other words, the fact that one person can be twice as fast as another person in the 100m dash does not make it meaningful to say that one person is twice as athletic as another.

It does make it meaningful to say they are twice as fast, though. Which provides a basis for discussing improvements to the general factor. Since there are meaningful zeroes for speed or flexibility or throw distance, it must also be meaningful to discuss doubling the effect of fitness on them. Whether it works out in practice is the question, but it is meaningful and not nonsense.


> Since there are meaningful zeroes for speed or flexibility or throw distance, it must also be meaningful to discuss doubling the effect of fitness on them.

I feel like something's gotten switched around here. We can measure reaction time with cardinal numbers. Check.

This makes it meaningful to talk about doubling or halving reaction time. Check.

We could attribute part of reaction time performance to the general factor of intelligence. OK... but this will be variable.

It's not obvious to me that if we allot responsibility for someone's reaction time scores among several factors, perform an intervention, get improved reaction times, perform the same allocation, and calculate that the contribution from g has doubled, that we can then conclude that the subject's g has itself doubled.

We want to measure that g has doubled, and we have no numbers for that.


> Since there are meaningful zeroes for speed or flexibility or throw distance, it must also be meaningful to discuss doubling the effect of fitness on them.

If the effect of fitness on speed is small (as a fraction of absolute speed), then doubling the effect has little to do with doubling speed. If it's large (order unity), then we don't generically expect to be able to double the effect while staying in the regime where intelligence is well defined. These two notions of double are just completely different -- one is a derivative, one is a magnitude -- and it's a mistake to link them.


What's the reason for thinking the gains are unbounded? AFAICT we could reasonably suppose something like 50 IQ points is within reach via embryo selection, but what would a something like a 300 IQ even mean, and even if it does mean something tangible, why should we assume that's biologically reachable in the same way that a 150 IQ would be?


Since historical estimates of figures like von Neumann or Sidis are more like +70-100 points, I would add at least 20 to that as the lower bound on the upper bound. Since such people existed, at least that much must be possible.

Of course, there's no way to definitively prove there's any potential to reach above that short of the existence proof of actually creating such people, but there's a lot of considerations which point to much more being possible: many complex traits have been pushed by selective breeding by many SDs, no one has ever been remotely close to genetically optimal and humans are minimally selected for intelligence, there's a large mutation load in terms of gene breakage, absolute measures of cognitive functioning like vocab size or digit span or reaction time generally show humans are nowhere near limits, brain scaling laws do not put humans at near any 0 marginal returns point, etc.

Even if there really is a bound at +100 and being able to increase IQ that much doesn't impress you for some reason, then you can simply spend your selection power on selecting for everything else... I shouldn't need to point out that many other traits are very important aside from intelligence.


When you wrote "largely unbounded gains" I thought not only in terms of genetic potential but also the impact on science / technology / society / culture this would likely have.

Pulling numbers out of a hat here: if we could have even, say, 0.015% of the global population, approximately 1 million people, with an IQ of ~200, the effects on the evolution of knowledge could be staggering.


If you look at actual people with 190+ IQ's their contributions are generally minor. We estimate that historic people that did great things had very high IQ's but that's our biases talking.

EX: Garry Kasparov is often said to have a sky high IQ but he tested at 135. He did however have an unusually good memory.


Do we even know whether IQ is all that comprehensive a test of the different aspects of intelligence? Memory obviously plays a large role in many ways.


But IQ tests are affected by memory, quite a bit. Memory tests are in fact some of the best ways to measure intelligence, like backwards digit span. Unsurprisingly, the genetics of memory and IQ overlap as do lots of other cognitive traits (https://en.wikipedia.org/wiki/Genetic_correlation#Intelligen...).


Lol, I'll take your word as a good authority, and read up. I imagine you've looked into it more than the average person... ;)


>if it does mean something tangible, why should we assume that's biologically reachable in the same way that a 150 IQ would be?

For that, consider the case of distinguished mathematicians who did not score high on IQ like tests.


Where are you getting the IQ boost from?


It's from my analysis of embryo selection (https://www.gwern.net/Embryo-selection). But you can do it without the complications by treating it as an order statistic (https://en.wikipedia.org/wiki/Order_statistic): what is the expected maximum of a sample of 5 Gaussians (rough current average egg harvest) vs 20 or 100 Gaussians, where the Gaussian is N(0, 0.5 * sqrt(polygenic score))? (Since you are selecting on the polygenic scores, not the unknown adult scores, and 0.5 because you are selecting from embryos which are 50% related ie. siblings.) X_5 vs X_100 is a big difference.

(To save you the trouble, it's +1.16SD vs +2.51SD; the difference is actually much bigger than it looks because you lose so many embryos in the IVF process, so it's really more like X_1 vs X_196 or +0.56 vs +2.48SD, but to be more precise, you need to go into the weeds of PGSes and per-stage losses in IVF etc. But the order statistics are a good starting point.)


I don't think you read the article. The process is the growing of pre-existing egg cells from ovarian tissues into mature egg cells.


> This will enable older women to have kids and solve some reproductive issues.

Under 35, the success rate for IVF is ~40%. Between 35 and 42, it's about 10%. After 42 it's about 4%. Each time you try it costs around 20k, albeit sometimes the first one or two tries are subsidized by insurance or state grants. And there are also all sorts of health risks to both the mother and baby.

So even if you can safely create unlimited eggs at a nominal cost, I don't see this having any practical effect on family planning. (Other than as a treatment for certain infertility issues.)

Given that it takes around two years to have a baby, pragmatically you're still going to ideally want to start having kids no later than 35 - 2 * (desired kids), at least for the foreseeable future.


20k! Here in the UK, the NHS will pay for up to 3 attempts (only if you haven't been able to conceive naturally), but even if you pay privately the cost is around 4k USD.


More like $7,000. Your point still stands of course. US healthcare is typically twice as expensive as equally high income nations. Adjust the $7k UK figure up to US income levels, you get around $10k. So that 2x rate remains pretty accurate.

https://www.nhs.uk/conditions/ivf/


> Potentially this could lead to gay couples being able to have genetically descended children (obviously male couples here, but similar work on sperm is being done that could potentially enable lesbian couples to have kids too)

I would actually argue that the latter (lesbian couple->kids) will become feasible first - https://www.theguardian.com/science/2016/feb/25/lab-created-...


Which probably means we will reduce the combinations of genes we use, more and more. And hence, lessen the genetic diversity of our specie. What can go wrong ?


    Using strips of ovarian tissue removed in a biopsy, it 
    represents an advance on IVF (in vitro fertilisation), 
    where a mature egg is fused with a sperm in the lab and 
    the fertilised embryo is implanted.
Eggs aren't frozen, but it still sounds like a painful and expensive process.


> This will enable older women to have kids and solve some reproductive issues.

AFAIK, there's far more problems to solve than just this before older women in general can just have kids like they're 20 again.


Surrogate pregnancies?


Other problems remain, such as genetic degradation and questions about epigentic content.


>gay couples being able to have genetically descended children

What steps are missing? I'm extremely interested in this but I've had a hard time finding more information.


Producing the egg cells from pluripotent stem cells, then figuring out any immune response from growing them in the system described in this article.


> This will lead to a massive rise in availability of human eggs for scientific research

Depending on where you are, that's not really a problem. We did IVF, and we still have an embryo left over. When we asked about donating it to science, they told us not to bother because it would just be thrown away, since they already have too many in California (the embryos can't cross state lines apparently).


Don’t you still have to do egg harvesting? Or where are these coming from?


Do we really want to increase the human races ability to procreate? We already have enough children that have been abandoned or live in terrible conditions. The earth is overpopulated as it is.

This has many implications, not the least of which that the simplest way to reduce carbon emissions is fewer people.


I feel like so much of these conversations lack the high level questioning around why IVF and related technology has become so prominent and increased in usage. Is the rate of fertility problems increasing? And why?


Maybe not in this particular article/thread, but it's been widely discussed how starting a family can be disruptive to a woman's career and professional development. The reasons it's disruptive could be due to companies / culture in general not being flexible and accommodating enough to motherhood. Taking time off from your career tends to be a very costly proposition in our current time.

For these reasons, there's lots of pressure to delay starting a family, and it's no surprise that IVF has seen increased demand. Some companies (i.e. Facebook) even provide their female employees a benefit that covers freezing their eggs. This is somewhat controversial, as some would argue that Facebook (and other companies, and perhaps our culture in general) should instead focus on reducing the professional cost of starting a family.

Therefore, these findings about growing human eggs could have great significance. I have friends grappling with this issue right now, so I understand how this discovery could be a great help to them. I hope that provides some useful context...


>focus on reducing the professional cost of starting a family //

Few professions are important enough to spare a passing thought over compared to the importance of raising children IMO.

I mean Facebook? Do people working there, for example, really think social data mining for advertising is important in some way? Sure, income is important, but people don't say they want to protect their income, they always talk about career progression (which is conceptually unrelated).

We've got plenty of people, making ways for people to sacrifice everything to a job without failing to reproduce seems pretty counter to any need.


This is part of a deeper problem in certain parts of America whereby one's personal value is determined entirely by one's net worth (and perhaps also education).


That’s not an American problem - it’s everywhere.


There are many parts of the world, even parts of America, where for a single woman or married couple to choose to remain childless in the pursuit of wealth would lower their social value more than the extra wealth would increase it.


>>The reasons it's disruptive could be due to companies / culture in general not being flexible and accommodating enough to motherhood.

That's a pretty critical view of things. I think a more objective view is that motherhood is costly for the mother in time and attention, and generally reduces the time and effort she puts into her career.

Whether people operating in the business world should be encouraged or forced to give preferential treatment to mothers so that motherhood doesn't become a career disadvantage is an open question. One could argue it would be unfair to those women who choose to forego or forestall motherhood to dedicate more time to their careers.


Male fertility rates have fallen drastically. https://www.cnn.com/2017/07/25/health/sperm-counts-declining...

Male testosterone production has been decreasing as well, at a population level. https://www.ncbi.nlm.nih.gov/pubmed/17062768

Also interesting to note that medical academia has been gradually lowering the requirements for what is considered a healthy testosterone concentration. Minimal acceptable bioavailable testosterone for a healthy young man used to be considered on the order of 500ng/dL, now it’s generally considered around 300ng/dL.


People are waiting a lot longer. I'm 40 and just had my second kid a few months ago. Our first is only 3.

Only a generation ago the median age of birth was like 23 and now it's 27 or so, but that doesn't account for the edge cases. A lot of women have careers now that they didn't have a generation ago and delay childbirth because of it.

Also, there are a lot of studies coming out recently that male fertility is 1/2 of what it was just a generation ago (we make 1/2 as much sperm as we used to). No one know why yet, they assume it's environmental or diet related.


Also, ever-easier access to ever-better contraception means people get married later in life and are able to put off having children until they're ready.


I think for all of human history, many couples struggling with infertility would have given anything to have children, but until very recently (first for scientific reasons, and then for economic ones) there was nothing they could do.

Now, the tech has gotten good enough, and the price -- while still out of reach for many -- is affordable for an increasingly large segment of the population.

TLDR: It's not being driven by an increase in demand, but rather an increase in supply.


It's probably because women are waiting longer to have children and it's harder for older women to become pregnant.


Is the rate of fertility problems increasing? And why?

With nearly 8 billion people on the planet, the answer to that is a resounding NO. Go and look at the charts...


The number of people increasing does not preclude there being more fertility problems in general - in fact, given that we have more technology available to mitigate fertility problems, but not to select against them in the next generation, I would even expect the percentage of people with fertility issues to be rising, absent any other pressure, since those people now have a higher likelihood of being able to reproduce.


- human eggs - check

- artificial uterus - check

- human factory - pending


- Soma - pending

- Alpha, Beta, Gamma, Delta, or Epsilon - negotiable


- Make copy of human mind - Pending


Questions about turtles on their backs in the desert - required shortly.


When will the technology be ready for economical mass production of meat (pigs/chicken/cows)? How to artificially speed up gestation and growth?


We already have lab grown meat, and a lot of the reasons it isn't feasible at scale right now have more to do with subsidies on meat production and sale that don't currently apply to lab grown than on any practical limitation.

And its not that lab meat is cheaper in a vacuum right now, more that huge meat subsidies (either direct, guarantees and insurances from the state, and allowing meat producers to externalize a huge portion of their water / pollution costs) hamper investment into lab meat that would exist in a purely free market. Traditional meat is just artificially cheap.


Yes, but the lab meat you're talking about is not made like ju-st thinks it is. Current (expensive) lab-meat is made by directly growing tissue, without growing a full animal.

In contrast parent ju-st talks about artificially fertilising livestock, perhaps with accelerated growth.

In terms of ethics, the second procedures seems at least not worse than factory farming. The animals in the second one would need to live less long in order to produce the same amount of meat, and also you'd stop having some unwanted animals like male chicks.

However I really hope that lab-grown tissue becomes the standard for meat production.


Now this is a dark version of Universal Paperclips.


Community, Identity, Stability.


For those interested, here's the actual paper:

https://doi.org/10.1093/molehr/gay002


I wish doctors would spend more time figuring out why babies die instead of figuring out how to make more. I have a friend whose wife has had five full-term stillbirths, with no explanation. Babies all tested as perfectly healthy. My wife and I just lost a perfect baby boy mid-pregnancy, with no explanation. A few others I know have lost otherwise healthy infants in the first years of life, again no explanation, despite multiple doctors.

It's wonderful we can make a human egg and all, but we still can't figure out why babies die, so forgive me if we're still not that impressed by medicine, and think we're misallocating resources.


Just wanted to say that I'm sorry for your loss.


https://report.nih.gov/categorical_spending.aspx

2016 numbers because recent ones make me cry.

Infertility: 86m Birth /infant health: 240m SIDS: 16m

Not sure I see the misallocation.


This study wasn't NIH funded?


I'm so sorry for your loss. You're not alone.


>so forgive me if we're still not that impressed by medicine.

I get you're venting some pain here, but that's kind of looking a gift horse in the mouth. Modern medicine hasn't figured out every single mystery, but it's certainly impressive what we have figured out.


There is no medical specialty dedicated to anyone who loses an infant or pregnancy, but there is a whole industry dedicated to creating new embryos and conceiving. Seriously, after our stillbirth we contacted UCSF, Stanford, and the Mayo Clinic and the receptionist on the phone that we spoke with did not know what kind of doctor we should see. Reproductive endocrinologists deal with infertility, and MFMs typically deal with diagnosed problems during a pregnancy. One of the nurses even told us that we 'needed to have a diagnosis' before we could see a particular MFM. I asked if he could run the diagnostic tests, and she simply said 'he doesn't do diagnosis'. So then what do they do? We called the REs and they told us they don't deal with late pregnancy loss.

Studies on sudden infant death and pregnancy loss are actually few and far between compared to studies on helping older women with poor egg quality conceive. Both the friend I talked about and my wife and I are in our early 20s. The last 'breakthrough' with regard to stillbirth and late miscarriage was made in the 80s with the discovery of anti-phospholipid syndrome, but there has been no new conditions or treatments in the past 40 years. Most of this is due to a lack of research and funding, in comparison to infertility, which for some reason is incredibly well-funded.

I'm just saying we should question if we're actually spending our resources equitably.


>There is no medical specialty dedicated to anyone who loses an infant or pregnancy

But this is exactly what an MFM (maternal fetal medicine specialist) does. I'm not sure that the one MFM you tried to consult with is indicative of the whole of the field.


We've spoken with three MFMs; sorry if that wasn't clear. It was a challenge to get an appointment at each, but we managed to do so after tons of calls and several interventions by my wife's obstetrician.


That's a fair criticism. I guess when you said you weren't impressed by medicine it seemed like you were leveling that comment at the entirety of our medical establishment instead of the fact that our resources in this specific branch of medicine are way out of line.

I think part of the problem is that there's likely a large amount of problems that lead to stillbirths and SIDS, so it's hard for researching to get funding to study a very general problem. Most the time they need to have a clear purpose and idea of what it is they are trying to figure out. And in the case of IVF/embryos there has been a much clearer path for them to take.

Not saying that's right, but it's often how it goes in science in general. If you're got something specific where a study will likely lead to meaningful and actionable results you're both more likely to get funded and more likely to have collaborators, etc.


No, not at all. Modern medicine is wonderful, and there are a lot of doctors doing really great work.

Yeah, I totally agree that the magnitude of the problem is certainly part of the issue, and that IVF offers an easy path forward for those who can't conceive. Still it's depressing when you conceive easily, lose the baby, and the doctors have no clue (a few of my friend's stillbirths have been birth control failures, so they weren't even trying).


I wonder if there's also not a big effort to ask the parents if they want an autopsy, or if many simply refuse? It's an emotional situation and there might just be a big lack of data here (plus you need a lot of working hypothesizes on what to be looking for as well).


There is a huge lack of data, and huge unwillingness to keep track of it. My wife and I are both math majors, and our immediate reaction to any of this stuff is to keep data. We would love to submit our experiences (which we've kept detailed records of) to some kind of database so that researchers can formulate hypotheses, but no one wants it.


Sorry for your loss. There must be web fora of parents who suffered the same, might that be a starting point to establish an independent data repo?


> There is no medical specialty dedicated to anyone who loses an infant or pregnancy

There is. They’re medical geneticists. They’ve got relatively large departments at NYU, Brigham and Women’s, and NYP-Cornell.

It’s not under-funded, it just usually goes under the radar as “genetics,” rather than a clinical specialty.


Why would genetics have anything to do with it? If a baby is genetically abnormal, then it's not a surprise that they died (although still sad!). All the babies I mentioned were genetically normal. Their hearts just stopped. We've seen the geneticists; they cannot explain why any of our children died, because none of it was genetic (believe us.. carrier screening was on the top of all of our lists to make sure it wasn't something we're passing on).

Moreover, almost every study into the matter shows that the more pregnancy losses a couple has had, the less likely it is that any of them were due to aneuploidy, so again, genetics (while important for single miscarriages or stillbirchs) is an unlikely explanation for recurrent losses, unless a parent carries a balanced reciprocal or robertstonian translocation (which none of us do).

The MFMs that we have spoken with have all suggested various blood issues and some auto-immune issues which we are now being tested for. I don't see how geneticists (who are usually not doctors themselves) could possibly have the level of expertise to handle these cases.


Carrier testing is for known diseases only. For unknown genetic traits which give rise to non-viable offspring, well... they’re unknown.

I’m sorry I wasn’t clear - I meant Medical Geneticists (MDs) not geneticists (phds). That said, their work on these issues tends to be oriented to the basic science side, so that it can be applied as screenings and other genetic tests for couples in the future. Most Medical Geneticists are part-clinical and part-bench scientists; I don’t know of any that are purely clinicians. Their clinical side tends to be pre-conception screenings and genetic counseling.

It seems like what you’re saying you want is a medical specialty that deals in particular with individual couples that keep losing children, as though it’s a clinical problem.

Admittedly, there are some exceptions (eg, anti-phospholipid syndrome), but that already has a relevant specialist: OBs are supposed to identify that a patient may have it, and the relevant specialist (rheumatologist, usually, for the autoimmune stuff) confirms and treats.


While I agree any single incident is potentially due to an unknown genetic disease, I find it hardpressed that a woman who's had five stillbirths would fall on the shit side of luck. In general, mendelian inheritance is going to make it such that some number (at least 25%) is going to be viable, so it seems unlikely that someone could be unlucky that many times. Moreover, even in confirmed genetic diseases, there is a mechanism of death, for example metabolic disturbances in PKU or obvious malformation and anemia in hemoglobin barts thalassemia.

Nevertheless, I think your focus on medical genetics is quite misguided. For example, we know several causes of recurrent stillbirth and infant death that are not genetic in nature. For example, NAIT certainly has a genetic predisposition, but the primary treatment is immune and hematologic in nature. There's no reason this would fall under a geneticists area of expertise, and given the rarity, it's not clear most OBs would know about it either. Several couples I've met in online support groups have had a lot of trouble finding a doctor knowledgeable enough in NAIT to properly treat their pregnancies (which are actually remarkably successful, when treatde). Given the importance that we ought to be giving to lives of young children, it seems that simply lumping known non-genetic causes with genetics is the wrong approach. A better approach -- in my admittedly biased opinion -- would be to have one specialty with a wide breadth of knowledge who could specialize in teasing out what may be causing any particular issue.

For example, it seems somewhat ludicrous to believe that a woman who loses several babies consecutively in the third trimester due to premature labor while the baby is still alive is being affected by the same pathology that causes another woman's babies' hearts to just keep stopping. Unfortunately, these distinctions are rarely made in studies.

And while OBs are the ones on the front-line of treatment, they're also mainly a surgical / low-risk specialty. There does need to be some specialized care for the higher-risk couples. Multiple studies in other countries (we're in America) have shown that simple supportive care (including heavy monitoring, constant reassurance, and dedicated clinics) increases the live birth rate in couples with recurrent stillbirth or other forms of pregnancy loss.


Bro, I just want to give you a hug right now. I am crying in a public place and looking weird and I know HN is not a cool place to express this and this is not a good comment to insert into an otherwise intellectual conversation, but I love you and I hope you are good, man. I went through some shit like this a while back and it worked out for me in the end but I know it doesn't always. It doesn't fix anything but I'm thinking about you and hoping things are good for you, for what it's worth.


I feel like I’m in the awkward position of arguing with someone that’s recently had a terrible tragedy, sort of about that tragedy.(!)(?) I don’t want to do that.(?)(!) I’m just saying, bottom line, those specialties exist. You seem to think they don’t. Perhaps they don’t exist in your immediate area? They are, after all, fairly specialized tertiary care niches you’re only going to find in huge academic medical centers that bring in the sort of patient numbers to support tiny niche specialists.


You're in the awkward position of explaining someone's experience to them. If someone who has been through something is telling you that something about the experience could be improved, there's a good chance they're right, or that they have some insight to offer over someone who has not.

We live in the bay area, we have managed to make appointments with several specialized doctors, including the department chair of obstetrics and gynecology at one of the large academic hospitals here (after much consternation with the nurses on the phone). They have told us that they do not know. She also told us that she's never really seen too many cases of sudden cardiac arrest in mid-pregnancy fetuses. She did not send us to anyone else -- believe me, my wife and I would hop on the opportunity to find another doctor with relevant experience.


You’re saying a thing doesn’t exist. I know people that specialize in that thing. That seems like a disagreement of facts; I don’t really see how that’s explaining your experience to you. Whether a medical speciality -exists- isn’t a subjective issue.

I’m gonna leave it at this: if you’re willing to take a trip, NYU has a dedicated repeat pregnancy loss center (Phone: 212-263-6359).

(And for what ever a strangers internet words are worth: I do earnestly hope that they or someone else succeeds in helping you.)


Can second this. I am acquainted with somebody who literally works in exactly this field over at Brigham and Women's here in Boston. It sounds like the experience 'tathougies describes really sucks--but I can attest that these people do exist and do do this work.

(I want to echo the good vibes here, too.)


Thank you, and I appreciate the contact.

Perhaps I haven't made my complaint clear. The doctors exist, but they aren't helpful.

We don't expect miracle answers, and realize medicine may not know, but it would be nice to have a dedicated clinic to work with you through it, or at least a doctor willing to establish a long-term relationship. I expect it would also help researchers formulate new hypotheses if they kept in contact with couples who are 'unexplained'.

We have been to three recurrent loss clinics at UCSF, Stanford, and the Mayo Clinic. There are doctors there who do research in this area, but if you don't have any of the limited number of conditions that they know about, they aren't helpful, nor are they willing to help you find clinical trials that may apply or willing to explore research with you or stick with you. I've read many brochures and websites that claim that the doctors will work with you to determine the cause of miscarriage, stillbirth, etc, but in our experience they work with you until they give up, then they don't want to see you anymore.

This is a bit different than other specialties. I don't have much experience with doctors, but I do have some older family members with chronic illnesses, a few with rare, unexplainable ones. In that situation, it's common for doctors to establish long-term relationships with patients and suggest clinical trials or research opportunities they can participate in. The approach seems different than what we've seen.

Once we're done with our next round of appointments, perhaps I'll call NYU. We have a few more appointments coming up with some more research doctors; hopefully, they will be more willing to keep track of our case.


That's like saying physicians have a responsibility to not care about money.

If the money was in "preventing infant deaths" then physicians would specialize in it. But when you have a huge supply of people willing to spend hundreds of thousands on fertility, lots of docs will respond to the market.

I get your point, it would be nice. It would also be nice if everyone working at facebook and snapchat would work on making our healthcare system more efficient. But money talks...


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We started at 21, and we're 25 now? Any younger and we would have been teenage parents. Our friend couples are similar ages, so age is not a factor for us at least. At one point, a doctor suggested that my sperm could by a contributory factor as men's sperm doesn't fully mature until age 25. Honestly, doctors are better at helping older women, than younger ones.

One of the couples I know, the woman had her first miscarriage at 16. Believe it or not, young people can lose babies too....

But thanks for the useless suggestion!


Statistically he is correct. The "good" part it is common to have a miscarriage and then multiple healthy children. Unfortunately people do not talk enough about miscarriage and many hide them, creating impression that it is not a common thing.

I am sorry it happened to you.


One or two miscarriages is fairly typical. Three is about 1% of couples. We've had six miscarriages altogether along with the stillbirth, which is not common. Six puts you in the 1% of the 1%, which is the 0.01% and the stillbirth puts you in the 0.2% of that which is 0.002%.

Also, no matter how you slice or dice it, my friend's five full-term stillbirths are not common, and his perception that it's not common is not due to people not talking about it. Statistically, his experience is one in a million, and there is no slicing or dicing it. Saying it's common dismisses the very real condition that's causing their stillbirths.

Moreover, we've been to three specialists, and we've explained the circumstances of our stillbirth (baby's heart stopped overnight). All three have told us this is quite rare, and the most common presentation is slow fetal demise preceded by obvious growth delay. Ultimately, not all miscarriage is created equal, and the lack of distinction between different types is probably one of the things holding back research in this area. This isn't just my thinking several research papers have been published recently which make the exact same point.

I'm not denying the importance of not waiting til you're 40 to try. However, his comment that the children of young parents do not die is not true.


Of related interest. And to put the complexity of fertility into perspective. A recent study in fruit flies demonstrated the signalling, transcription and synthesis of a protein called "Hindsight". Which triggers the breakdown and rupture of follicle cells. Thereby releasing a single ovum to be fertilized.

An amazing result is that the proteins humans produce for priming their follicles to release an egg. Can be transplanted into fruit flies. With an analogous priming of fruit fly follicles for ovulation. Suggesting that genes regulating fertility and reproduction are conserved across the full spectrum of Animal Kingdom phyla.

Zinc-finger transcription factor Hindsight regulates ovulation competency of Drosophila follicles

https://elifesciences.org/articles/29887


I wonder if the extraction of the ovarian tissue is less invasive than the process of harvesting mature eggs.

Both my kids came from IVF, and we harvested eggs twice. Besides all the shots, which are painful enough, my wife had to have a very invasive procedure to collect the eggs that left her bruised for days.

If the collection is easier, I can see doctors opting for this as a way of keeping the mother less stressed before implanting an embryo, increasing the chance for success!


Since I am not a pod baby, this means it is unlikely pod babies account for a majority of human population.


When can we grow babies in a pod? Matrix style.

Note: This is a serious scientific question.


Actually, the question that interests me is when, if we allow couples+ to skip around infertility problems, will we have engineered in enough infertility that we can no longer maintain the population if artificial means fail/become unavailable?


"Asking for a friend"


I can't wait for humanity to build an "unmanned" spaceship filled with human eggs that only get fertilized 1,000 years from now when it reaches [insert exciting destination] and then the babies are raised by AI and trained so they can populate other worlds.


Typically techie :)

Babies die or have extreme developmental issues without physical contact https://www.google.hr/amp/s/www.psychologytoday.com/blog/bor...


Hey Alexa/Siri/etc? Please raise my baby colony.


We’ll need a robot that can change diapers and wipe butts first. Interestingly I’m sure that has terrestrial uses as well so we might actually see it!


I think you might enjoy this Sci Fi novel: https://en.wikipedia.org/wiki/Voyage_from_Yesteryear


Thank you! Will definitely check it out.


Babies need love!! You’re going to need to put some people on that ship.


Relevant: The Harlow Monkey Love Experiments: http://pages.uoregon.edu/adoption/studies/HarlowMLE.htm


Anytime I read about the Harlow experiment I just want to cry.



Or a big friendly dog!


How about some very convincing androids?


Very similar to the Pathfinder books by Orson Scott Card.


Nice Alien:Resurrection reference.


Wasn't aware.. should probably watch that movie


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Surprised that your comment is being pushed to the bottom. We need to look at the larger picture with any new technology and what it can enable, especially when pursued by multi-billion dollar corporations seeking to monetize it by creating demand. The environmental and ethical angles of our actions need to be gravely considered and not swept under the rug.


The world is doing better than it has ever been in human history.

We are not running out of food. Hunger is DECREASING, not increasing. And quality of life is improving by every single metric, across the board.

If you want to assert that there are to many humans, you have to provide real evidence.

Such evidence would only include things like "Hunger is increasing" or "these quality of life metrics are decreasing", but that is absolutely not what is happening.


I think you're both wrong.

First, population is about to plateau regardless of fertility studies. Secondly, current quality of life trends do not prove or disprove APs point about sustainability. Thirdly, evidence we have too many humans is certainly not limited to these current trends and their direction.

There is a wealth of evidence we have too many humans. Not too many for the planet to sustain. But far too many for the planet to sustain at our current and continued levels of consumption.

This article covers I guess recent views and their criticisms on the topic http://www.bbc.com/news/magazine-33133712



OK, you do this and I'll go hug my kids. Have fun going extinct. Not the human race, mind... just you.




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