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Reproduction conference

October 20, 2004 By Helen Pearson This article courtesy of Nature News.

Doctors are testing the boundaries of medicine in order to help more people have babies. Helen Pearson explores the fertile ground at the American Society of Reproductive Medicine meeting in Philadelphia.

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Day 4: How do you spell that?

Whenever you wander into a new field of science or medicine, there is always a daunting new vocabulary to learn. But I really have to congratulate the docs in this particular specialty for coming up with such creative terminology.

The list of drugs they use sounds like an anagram competition in

gynecology school: Menopur, Gonal, Follistim, EstroGel, Ovidrel. Are there crossword whiz kids in the drug-naming department who sit around wracking their brains for this stuff?

Day 4: Free, but weird...

Anyone who has been to scientific meetings knows about the vast hall-full of exhibitors keen to sell their wares to delegates during their coffee and cake break. Drifting around this one is a particularly bizarre experience. Here are bottles of IVF culture oil, "follicle-flushing" fluids and "fertilization medium", whatever they are. Oh, and here are some snaking plastic wires with mini syringes on the end for pumping lab-made embryos into the uterus. I'm wincing.

Best of all is the medieval-looking array of gleaming surgical instruments, which look like Dali was let loose on a collection of scissors: they're large, elongated and warped. I hardly dare ask what these are for.

No one else is bothered. They're too busy loading their booty bags with company freebies, which I have to say are far more impressive than the average chocolates and pens at the scientific meetings I usually frequent. Fertility doctors get free yo-yos, popcorn, lattes and biscotti. Perhaps a caffeine jolt is just the thing to make someone want to rush out and buy an embryo-transfer catheter.

Day 3: Selling sex

If you ask me, women are about to realise their sex lives aren't up to scratch. And funnily enough, I predict this realisation will dawn just as a skin-patch claiming to boost bedtime appetite conveniently hits the market.

Here is my logic. Proctor and Gamble are about to launch a patch soaked in testosterone which is designed to help women with clinically low sexual desire. According to a press conference I sat in on today, you fall into this category if your sex life is poor and - very important, this bit - you are 'distressed' about it.

According to the first presentation at the press conference, around one in ten women suffer from clinically low sexual desire after menopause. But don't fret ladies, because according to presentation two, a new trial of the testosterone patch shows that such women were frothing at the mouth for sex after three months on the hormone.

Then came presentation three, sponsored by a pharma line-up, showing that around 15% of women taking the contraceptive pill are suffering sexual dysfunction. That's a lot of women. And though the authors didn't come out and say it, isn't the obvious conclusion that these women would benefit from a testosterone shot too?

Officially, doctors say that the patch, called Intrinsa, is aimed only at women with a genuine sexual problem. But with so many women who are, or should be, miserable about life in the sack, I suspect that pharmaceutical companies are eyeing a far larger market.

Call me a cynic, but if I were working in pharma, I'd be hoping that testosterone patches are poised to be the female Viagra.

Day 2: Size matters

It's always a shock waking up to an array of genitalia. But that's what happened to those of us who crawled into the dawn plenary session this morning - and found ourselves party to a graphic comparison of primates' genital prowess.

Men, apparently, have paltry testes but huge penises compared to chimpanzees and gorillas. And the reason, says Roger Short, an obstetrics and gynaecology expert at the University of Melbourne, Australia, is that humans have evolved to a point where we have sex for fun, rather than bog-standard procreation.

Now, before you accuse me of an entirely gratuitous discussion about phallus size, read on. According to Short, the dimensions of men's genitals reveals a tragic vulnerability of the species: our promiscuity makes us enormously susceptible to sexually transmitted diseases. Cut to devastating figures of the nearly 40 million people worldwide infected with lethal HIV.

At first, it struck me as slightly odd to have the opening talk in a reproductive medicine meeting, which is otherwise largely focused on fertility, discussing HIV. But though Short didn't spell it out, the take home message gradually became clear.

Here are thousands of highly paid and educated doctors bent on helping rich women in industrial nations defy the biological odds and bear children, when sex alone isn't up to the job. (And yes I know, this service is hugely appreciated by the families who benefit.)

But Short's stark presentation asked if we are focusing our medical attention and resources on the wrong problems. Perhaps some of that money and expertise would be better spent saving the lives of those individuals for whom sex can spell an unavoidable death.

Day 1: Expecting...

"Expectant" is a fitting word for the mood of opening day at this scientific shindig on fertility. But I'm not sure that everyone assembling here in Philadelphia is expecting quite the same thing.

From the point of view of the gathering press, there is the expectation of a juicy story: maybe some kind of baby conceived through previously untested, and potentially questionable, means. These expectations have some grounds in history: at last year's version of the same meeting, doctors provoked wrath when they revealed they had made embryos by a technique a hair's breadth from cloning. And weird embryos are already proliferating here - the ribbons holding our name tags are, bizarrely, decorated with pictures of purple, orange and blue ones.

It's a bit harder to know what the delegates are expecting. They dutifully assembled at the opening ceremony to slap each other on the back for all the embryos they created this year (well, that and the chance to wolf sandwiches and beer with their med-school mates). I assume they're expecting to collect research tips on how to make more embryos, more easily. When a cycle of IVF can cost $10,000 a pop, more embryos equals more cash. Oh, and more satisfied customers - I always forget that bit.

It's certainly a strange kind of science when the raw materials you mix together are not chemicals or DNA but human eggs and sperm. And, to give credit, most reproduction clinics do it with due respect for their fragile experiments.

But enough about expectations - we'll just have to wait and see what happens tomorrow. For now, I have the growing expectation that these doctors are going to dance, and no reporter should be exposed to that.


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