BBI

Since 1982 and the birth of Amandine, the first French test-tube baby, more than 100,000 children have been born in France using in vitro fertilization (IVF) techniques. Almost 50% today are conceived using intra cytoplasmic sperm injection (ICSI) technology to remedy masculine infertility problems.

Although a great majority (95%) of babies born by IVF present no more pathologies than normal birth infants, one should not ignore certain risks which are elevated, said Dr. Jean-Luc Pouly, who is in charge of the IVF center at the Centre Hospitalier Universitaire (Clermont Ferrand, France).

The most common risk, Pouly said, was that IVF babies tended to be smaller than average. American researchers have shown that, discounting multiple births, infants conceived by IVF have a risk 2.6 times greater of weighing less than 2.5 kilos at birth. There is also a slightly elevated risk of pre-term delivery.

The second risk concerns malformations. An Australian study on 1,138 babies from IVF procedures compared with 4,000 from traditional conceptions showed 9% with major problems (cardiovascular, muscular, sketelal or intestinal anomalies) in test-tube babies compared to 4.2% in the test population. And a Swedish study on 5,680 IVF babies and 11,360 "classical" babies noted a risk of cerebral paralysis three times higher in IVF babies and a risk of retarded mental development twice as high.

Maryse Bonduelle, pediatrician and geneticist at the University Hospital of Brussels (Brussels, Belgium) attributed some of the variations in trial results to differing methodologies used in the studies. She cited classical IVF techniques where sperm and ovum are presented together in vitro or ICSI techniques, pioneered in Belgium, where a single selected spermatozoid is injected in vitro into the ovum. However, she said, a Belgian study on 3,000 babies born from IVF or ICSI techniques had shown identical results in terms of malformation occurrences.

But French researchers have reservations concerning the maturity of cells taken from the testicles of men with azoospermia (no sperm) and used in ICSI procedures. Pouly noted that in France, a study of 2,300 babies born by ICSI between 1995 and 1998 showed "a net increase in the risk of fetal malformation in cases of use of spermatozoids of testicular origin. "There is also another possible explanation which, I think, poses an insoluble problem. [In ICSI techniques] babies are conceived from gametes of infertile patients who, by definition, may not be in perfect health," said Maryse Bonduelle. "With less than 20 million spermatozoids per milliliter, the risk of chromosomic anomalies discovered between the 12th and 15th week of pregnancy is around 2.3% as compared to 0.5 % in normal pregnancies. This risk is without doubt associated with the quality of the sperm."

In men, various genes carried on chromosome Y govern spermatogenosis. Anomalies of certain of these genes can result in total or partial azoospermia. As a result male infants conceived by ICSI using spermatozoid carrying these anomalies risks the chance of being sterile. In a few years, boys and young men conceived by ICSI will reach the age when they can beget children or provide sperm for research, and then we will know for sure.

"It is certain that this is a subject to follow through several generations," said Jacques Testart, director of research at the Institut National de Science et de Recherche Medicale Paris and one of the "fathers" of France's first test-tube baby. "But if a couple demands an IVF procedure, even if there is a risk, and remembering that the risk is small, it is not ethical to refuse them," he said. A new major European research study is under way to compare babies born by IVF, ICSI and naturally. Sadly, France is not taking part in the project.

British fertility rate falls to lowest in 78 years

The fertility rate in Britain has dropped to its lowest level since records began in 1924, with the average family having just 1.6 children. Today's trend toward having children later has made the typical nuclear family of 2.4 children a thing of the past, according to the latest figures from the Office for National Statistics. The total fertility rate fell to a new low of 1.64 in 2001 from 1.66 in 2000. The two previous low points in fertility occurred in 1939 and 1977, times of war and economic uncertainty.

While in 1975 a 40-year-old woman would, on average, have 2.4 children, women aged 40 today have on average only 1.9. Kathleen Kiernam, professor of social policy and demography at the London School of Economics, said the figures showed that Britain has been going against the trend in countries of increased fertility. "Until now, we've had amazingly similar trends to those of France in fertility, but suddenly we have diverted," she said. The two main causes of falling fertility rates are women postponing having children and an increasing number of women remaining childless — more than in any other European country.

PACS in Europe

As in the U.S., many European hospitals have invested or are planning to invest in a picture archiving and communication system (PACS) so as to meet their current and future needs for storing and archiving medical images.

Telemis (Brussels, Belgium) has developed a separate image distribution system that is linked to the PACS and delivers images to viewing stations around the hospital in a cost-effective manner. At its latest installation at the Institut J les Bordet (Brussels, Belgium), the company's Telemis-Medical image distribution system automatically receives images from the Eastman Kodak (Rochester, New York) Archive Manager PACS system and provides them to 15 Telemis viewing stations, with distribution speed being enhanced by a proprietary image compression technique.

Siemens' (Erlangen, Germany) Sienet PACS system now includes an integrated FingerTIP sensor in the IDmouse that enables a user to log in without a password, with the mouse exclusively programmed to a pre-selected shortlist of users authorized to access patient data.

Delft Instruments (Delft, the Netherlands) has increased its shareholding in Rogan Medical Systems (Zeist, the Netherlands) from 52% to 70%. Rogan specializes in the development of software for PACS. Rogan's latest product combines the everything-on-line (EOL) concept with a Multiple Archive Storage Server, allowing radiologic studies to be delivered many times faster. The EOL concept enables all image material needed by physicians, nursing and support staff to be accessed instantly at all times and at all workstations. This represents an advance over many existing systems where users have to make a choice of which images are displayed at what time and at which workstation.

Phonak seeks new CEO

Phonak (Zurich, Switzerland), one of the world's top three hearing aid manufacturers, is seeking a new chief executive to replace Peter Pfluger, who left in April. Andy Rihs, Phonak founder and chairman, who resumed the role of chief executive temporarily, said the search was well under way. The group needs to revive shareholder confidence following a collapse in profitability and a marked slowdown in sales which brought about Pluger's abrupt departure.

Phonak has just reported a 35% fall in net profits to $27 million for the year ending March 31. Sales grew by 25% to $370 million, but almost all the increase was accounted for by the first full-year contribution of Unitron (Kitchener, Ontario), a rival bought early last year for $128 million.

Bespak/Deka set up inhaler collaboration

Bespak (London) has entered into an exclusive agreement with Deka (Manchester, New Hampshire) to research ways to develop innovative concepts to precisely control, monitor and deliver aerosolized drugs to specific locations in the human respiratory tract.