A sophisticated new microscope allows fertility doctors to monitor fertilised eggs in utero for up to five days - and proponents claim it has boosted pregnancy rates by 50%. It allows doctors to see any abnormal changes and thereby discard defective embryos so that only the best quality ones will be transferred into the womb. Doctors say the microscope has led to 1 in 2 couples having a successful pregnancy. At present, clinicians have to remove the growing embryos from their incubators, which can only be done once each day. This may lead to crucial problems and abnormal developmental changes being overlooked, thereby jeopardising chances of successful pregnancy.

Care, the UK's largest private provider of fertility services, installed the "Embryoscope" at its Manchester clinic. To date, over 1,500 embryos from 200 patients have been screened using the device, and it has increased pregnancy rates. Embryoscope monitoring is currently priced at £750 per cycle. A standard cycle of IVF costs about £5,000. ~ London Telegraph, Apr 20

A pregnant woman from Detroit who was declared dead gave birth to twins this week after being kept alive for a month with a respirator. Christine Bolden had an aneurysm on March 1 and was pronounced brain dead five days later. However, she was kept on life support in order to save her unborn twins. The boys, Nicholas and Alexander, were born on April 5 after just 25 weeks' pregnancy. Medical staff turned off her life support shortly thereafter. The children are premature and are being kept in isolation. They weigh less than 2 pounds and are less than 6 inches long.

Gestation after brain death has happened before, a fact which has led some experts to question whether “brain dead” people are truly dead. In 2007, 34-year-old Stacy Rojas of Texas gave birth to a healthy baby girl after falling into a coma following a brain aneurysm. Her life support machine was switched off two days after the birth, having kept her alive for a month. ~ London Telegraph, Apr 24

The work of Nazi doctors is a well-documented lesson in medical ethics. There was even a separate trial for them at Nuremberg and seven were hanged. But what about the nurses who assisted them? Their role has been airbrushed from history, says an Australian academic. Professor Linda Shields, of Curtin University, expressed her concerns in Nursing Review three weeks ago. “There has been a great deal of scholarship on the role of doctors and what they did in Nazi-occupied Europe, what has been neglected or overlooked is the role of nurses,” Shields said. “And yet most of the killings that we are looking at occurred in hospitals where nurses made up the bulk of the workforce. Nurses were very much involved in the killings and the camp experiments,” she said.

Survivor testimonies and available documents state that nurses actively and voluntarily participated in Nazi euthanasia programs, killing over 10,000 people, many of them children. Some estimates are as high as 30,000 victims. While it is impossible to find exact figures on the number of nurses involved - as most of the information was destroyed after the war - Shields says it was a minority of nurses but most have not been held to account for their crimes.

“The bulk of nurses working in Nazi-occupied Europe cared for their patients appropriately, but there were a handful of nurses who chose, and the word is chose, to follow the regime that declared that some of their patients should be killed. These nurses were not forced to do it. The nurses who did these things did them of their own free will,” says Shields, whose historical research into the Nazi era has earned her a place in an international nursing hall of fame, which she will formally receive in August.

Many nurses were allowed to relocate to other hospitals because they disagreed with the objectives of the programs, records state. “There is no record of anyone being sent to a concentration camp. There is no record of anyone losing their job over refusing to participate in the sterilisation or euthanasia programs,” Shields says. She and fellow researcher Dr Susan Benedict will publish a book of their research later this year. ~ Nursing Review, Apr 3

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Fertility drugs could more than double the risk of offspring developing childhood leukaemia, academics cautioned this week. Each year, tens of thousands of women in Britain undergo fertility treatment, which usually demands they take drugs to stimulate their ovaries to produce more eggs. Over 13,000 babies per year are born through assisted fertility technology. While no convincing evidence has hitherto emerged that fertility treatment leads to cancer, French researchers told a conference in London they believe ovarian stimulation drugs are associated with 2 kinds of childhood leukaemia.

Dr Jéremié Rudant, of the Centre for Research in Epidemiology and Population Health, in Villejuif, France, who led the research, said: "Previous studies have suggested a link between infertility treatments and acute childhood leukaemia, but there haven’t been many studies, most of them have been small, and they focused either on IVF or hormonal treatment. Our study was much larger and it’s the first time that a specific increased risk linked to fertility drugs has been found."

Strangely, the study found no increased risk in children whose mothers had undergone IVF - even though almost all of those women took ovarian stimulation drugs - or those who were artificially inseminated. Ken Campbell, of the charity Leukaemia & Lymphoma Research, said it was "plausible" that the drugs could make pre-natal conditions more conducive to subsequent development of leukaemia in childhood. He urged caution, however. "This research is a long way from proving that A causes B. There are several alternative explanations." ~ London Telegraph, Apr 24

People with intellectual disabilities, all children and people with dementia should be able to request euthanasia, the Belgian Liberal Humanist Association (HVV) has declared. Its president, Jacinta De Roeck, a former senator who helped to draft the current law, says: “We can not accept that a certain group of people should be completely excluded from self-determination over life and death.”

This is an especially touchy topic in Belgium because of  the euthanasia of mentally handicapped people in neighbouring Germany under the Nazis. However, Ms De Roeck insists that the issue has to be considered. “Even someone with mental retardation, who is found to be mature enough by the team should be able to ask for euthanasia.”

The HVV is also lobbying for children of any age to have the right to ask for euthanasia.  The HVV website states that “children who are in a hopeless situation have a high degree of maturity, especially compared to other healthy children. Setting an age is therefore completely arbitrary.”

She has predicted  that eventually minors and people with dementia will have the right in Belgium, although not in the term of the present government. ~ Humanieuws, Apr 23; Nieuwsblad.be, Apr 21

A group of Hawaii doctors is offering to write prescriptions for terminally ill patients in order to test whether physician-assisted suicide is permitted under state law, American Medical News reports. Unlike Oregon and Washington, the 2 US states in which writing such a prescription is expressly allowed and regulated, Hawaii has no law which permits physician-assisted suicide. Furthermore, Hawaii Attorney General David M. Louie issued an opinion in December 2011 saying that doctors who write prescriptions with the intention of causing death could be charged with manslaughter.

However, the legal situation is ambiguous enough for Dr Robert Nathanson to try to provoke a legal showdown. In January, he co-founded the Physician Advisory Council for Aid in Dying, which now has 5 physician members. In February, he wrote a prescription for a lethal dose of the sedative secobarbitol to help a terminally ill patient hasten his death, although the man died before using it.

“That’s the thing – I’m retired,” he said. “I think the worst that would happen is that they’d take my license away. I don’t think I’m going to put in any jail time…My livelihood doesn’t depend on it, so I can be very brave.” The council has written guidelines similar to assisted-suicide regulations in Oregon and Washington. They call for a confirmation of terminal illness by 2 doctors, testing for depression and mental competency, and referral to a psychiatrist or psychologist if necessary. However, unlike in Oregon, there is no specified 15-day waiting period. Patients are encouraged to involve family in the decision, but no witnesses are required. ~ American Medical News, Apr 17

The Texas Medical Board approved controversial regulations last Friday which are claimed to guarantee safe clinical use of stem cells and other “investigational agents”. Critics say the regulations are too permissive and open the door to dubious future treatments. Even stem cell scientists – who usually criticise attempts to use stem cells in clinics without clinical evidence – are confused as to whether the regulations aim to rein in rogue clinicians or open the door to increased use.

The regulations require those who seek to provide stem cells to patients to get approval from the US Food and Drug Administration (FDA). The FDA considers most stem cell treatments to be inside its jurisdiction and requires they be clinically verified, or approved by an institutional review board (IRB).

Leigh Turner, a bioethicist at the University of Minneapolis, told New Scientist: “They seem to have taken experimental research and swept it into the practice of medicine.” The regulations say IRBs “can be affiliated with an academic setting or a Texas licensed hospital, be accredited by the Association for the Accreditation of Human Research Protections Programs, Inc. (AAHRPP), be register by the US Departments of Health and Human Services Office for Human Research Protection… or have received national accreditation by an organization acceptable to the TMB (Texas Medical Board)”.

Turner pointed out in an 8 April letter to the TMB that this broad and ill-defined characterisation could include non-profit boards, create financial conflicts of interest and cause researchers rejected by an IRB to keep “searching for an IRB until they find one that approves whatever studies they wish to conduct”. ~ Nature News, Apr 16; New Scientist, Apr 17

Uzbekistan has a policy of secretly sterilising women, according to the BBC. According to women interviewed in neighbouring Kazakhstan, Uzbek authorities have run a program over the last 2 years to sterilise women across the nation, often without their knowledge. Apparently the government wants to control Uzbekistan’s growing population – official figures place it at 28 million.

“Every year we are presented with a plan. Every doctor is told how many women we are expected to give contraception to; how many women are to be sterilised,” says a gynaecologist from Tashkent, the Uzbek capital. "There is a quota. My quota is four women a month,” she says.

The push for sterilisation is strongest in rural Uzbekistan, where some gynaecologists are expected to sterilise eight women per week. One woman says she faced months of strange pains and severe bleeding after she gave birth to her son. She then had an ultrasound check and discovered her uterus had been removed. “They just said to me, ‘What do you need more children for? You already have two,’” she told the BBC.

“On paper, sterilisations should be voluntary, but women don't really get a choice,” says a senior physician from a provincial hospital. “It's very easy to manipulate a woman, especially if she is poor. You can say that her health will suffer if she has more children. You can tell her that sterilisation is best for her. Or you can just do the operation.” ~ BBC, Apr 12

Two recent studies have shown that the incidence of birth defects and long-term circulatory problems is much higher among children conceived with IVF.

A group from Nanjing Medical University in China did a meta-analysis of all studies of children conceived through IVF and ICSI and found that they are at “significantly increased risk for birth defects”. The research, published in the journal Fertility and Sterility, indicated that these children had a 37% higher risk of a birth defect across a range of body systems.

According to the Centers for Disease Control and Prevention, major birth defects occur in about 3 out of every 100 babies born in the US. This data indicates that the corresponding figure for IVF babies is 4 in every 100.

However, the reasons for this are far from clear. There are three main theories: people who have trouble conceiving also tend to have babies with birth defects. The IVF drugs, culture media and techniques themselves could cause the defects. Or finally, there seem to be more defects simply because the children are more closely observed.

None of this is news. It merely “confirms what most people accepted anyway, that, yes, there is an increased risk in congenital abnormality associated with assisted reproductive technology," William Buckett, a professor at McGill University, told Reuters.

The long-term effects of IVF are even less clear. But a provocative study in the journal Circulation suggests that there may be significant circulatory problems in later life. Sixty-five 65 12-year-olds were examined. The researchers found “significant vascular dysfunction” – “adverse changes in both the systemic and pulmonary circulations, including structural and functional alterations”. Some of these are associated with higher risk of heart disease. “This problem does not appear to be related to parental factors but to the ART procedure itself,” the authors, from the Swiss Cardiovascular Center Bern, state emphatically.

In an associated editorial, David Celermajer, of Sydney University Medical School, says that this is a small but significant study. However, he says, IVF is here to stay. Hence, “the urgent need for us to understand the possible adverse late outcomes of ART and to focus on finding possible technical changes to the in vitro procedures that might ameliorate or reverse any potentially harmful health consequences.” 

The General Medical Council, the UK body which registers and disciplines doctors, is proposing controversial amendments to its guidelines for good patient care. A proposed draft, released this week, declares that doctors may not even refuse requests for sex-change surgery.

The new guidelines stipulate that unless conscientious objectors are protected by law – British doctors have the right to refuse to participate in abortions – they may not refuse access to “appropriate” services or cause “distress” to patients. “We expect doctors to be prepared to set aside their personal beliefs so they can provide effective patient care in line with Good Medical Practice,” says the GMC.

It would be possible to opt out of providing particular service, but never for a particular patient or class of patients. In fact, the GMC specifically exempts sex-change surgery from conscientious objection because “this procedure is only sought by a particular group of patients.” A refusnik would breach the UK’s 2010 Equality Act which forbids discrimination after gender reassignment.

Furthermore, although a doctor could refuse to prescribe contraceptives, he cannot do this for married women and not for unmarried women. “This would be a breach of our guidance as you would be refusing to treat a particular group of patients (unmarried women) rather than refusing to provide a particular treatment (contraceptive medication).” It would also breach the Equality Act.

Dr Peter Saunders, of Christian Medical Comment, says that the guidelines will “marginalise Christian health professionals in Britain”. Some could even be deregistered if they follow their consciences.

“The problem is that 21st century British medicine now involves practices which many doctors regard as unethical. This latest guidance by the GMC will therefore be seen by a many as a further attack on the right to practise independently in accordance with one's conscience which lies at the heart of being a true health professional. I suspect it will also further undermine the credibility of the GMC.”