The annual conference of the European Society of Human Reproduction and Embryology took place in Berlin earlier in the week. After the lurid stories which emerged from last year's event in Madrid, some specialists apparently suggested that the media should be banned. Fortunately this did not happen. Below are some of the conference highlights.

        Confront Nazi past of German fertility medicine, says historian
        Monash device could screen for all genetic diseases
        First pregnancy from frozen ovaries
        Cloning errors could affect cure potential for embryos
        Expansion of EU will lead to "fertility tourism"
        Most embryo donation parents don't tell their child
        Human stem cells used to treat rats with Parkinson's

Confront Nazi past of German fertility medicine, says historian

German doctors need to exorcise Nazi ghosts so that they can come to grips with contemporary ethical issues in reproductive medicine, a German medical historian told the ESHRE conference. Until recently, studying the role of doctors in the Nazi regime was taboo. Dr Rolf Winau, of the Centre for Humanities and Health Sciences at the Charit? (medical faculty) in Berlin, cited a number of examples of how doctors in reproductive medicine cooperated with the Nazis.

The president of the German Society of Gynaecology, Walter Stoeckel, for instance, expelled Jewish doctors from his society and expressed his "enthusiastic admiration" to Hitler in a telegram. Compulsory sterilisation of children prompted no discussions in medical journals about whether the law was ethically justified, but only about how to implement it. Anatomist Hermann Stieve studied ovulation between 1942 and 1944 by examining the bodies of executed women in Berlin's Ploetzensee prison.

At the moment, Germany has some of the strictest laws in Europe in reproductive medicine. Pre-implantation genetic diagnosis, freezing embryos, embryo experimentation, surrogacy, egg donation, and therapeutic cloning are all banned. Understanding the rationale of Nazi medicine might help Germans to grapple with some of these issues.

It was not clear from media reports whether Dr Winau was suggesting that vanquishing the taboo would open the doors to these practices or show the wisdom of the bans. However, an overview of contemporary German bioethics in the latest issue of the journal The New Atlantis reports that pressure is building up for a less restrictive view of bioethics to allow Germany to compete in biotechnology. Despite fierce opposition, for instance, Justice Minister Brigitte Zypries says that human embryos are not entitled to current levels of protection. And a Berlin IVF clinic told the ESHRE conference four out of five Germans surveyed thought that pre-implantation genetic diagnosis should be allowed. It looks as though the "dictatorship of virtue" (in the words of prominent intellectual Peter Sloterdijk) imposed upon German medicine by the post-War generation is crumbling.

Researchers at Monash University have used gene chip technology to develop a 100% accurate test for one of the most common mutations for cystic fibrosis. Within two or three years, it will be possible for parents to test their embryos for many of the 1000 mutations which cause CF.

The technology was developed by Chelsea Salvado, a PhD student working with Professor Alan Trounson at the Institute of Reproduction and Development at Monash. She foresees that gene chips -- or microarray technology -- will make possible a uniform, single, quick test for genetic mutations. Doctors will be able to offer pre- implantation genetic diagnosis for all genetic diseases in the future, she says.

A woman who underwent aggressive chemotherapy and radiotherapy has become pregnant naturally after fertility doctors reimplanted strips of her frozen ovarian tissue. The woman is now 24 weeks pregnant with a girl after treatment at the Catholic University of Louvain in Brussels, Belgium. This landmark technique offers the hope of renewed fertility for cancer patients, many of whom become infertile and menopausal after treatment for their illness.

Frozen ovarian tissue has produced embryos before, but only through IVF. This is the first time that a natural pregnancy has been achieved. Although researchers presented the technique as a way for younger women to beat cancer, it also prompted media speculation about women bypassing menopause by freezing ovaries in their 20s and having children in their 50s or 60s.   

Cloning errors could affect cure potential for embryos

Cloning creates potentially dangerous abnormalities in embryos, scientists from Cornell University told the ESHRE conference. Only 30% of cloned mouse embryos reached the blastocyst stage of development, while the proportion of parthenogenetic and ICSI embryos was about the same as naturally conceived embryos, Takumi Takeuchi and Gianpiero Palermo found. The reason for this, they think, is that the gene activity in the cloning process is abnormal.

Although the researchers' take-home message was that reproductive cloning is unsafe, the executive director of ESHRE, Professor Andre van Steirtegheim, also warned that these problems had to be solved before therapeutic cloning could be used to treat human diseases. "It would be a grave mistake, if there was something wrong with the epigenetics of these stem cell lines, to transfer them back into patients," he said.

The eastwards expansion of the European Union will result in couples in Western Europe travelling to countries like Slovenia and Hungary for IVF treatment which is cheaper but still comparable in quality. Suzi Leather, the head of the UK's Human Fertilisation and Embryology Authority, says that she understands the temptation to cut costs but she warns that "there is no way that patients can be sure of safety or of the results advertised by clinics".

According to data presented to the ESHRE conference by Dr Anders Nyboe Andersen, of Copenhagen University Hospital, in Denmark, Denmark is still the country where IVF was most popular, with 1,923 cycles per million people. There were 1,133 cycles per million in Sweden, 1,122 in Slovenia, 963 in the Netherlands, 593 in the UK, and 578 in Hungary.

Only a third of parents whose child began life as a donated embryo tell them about their origins, compared with 100% of parents of adopted children and 90% of parents who used their own eggs and sperm. Fiona MacCallum, a psychologist at City University in London, told the ESHRE conference that parents believed that knowledge of their origins would upset the child and that since the mother bore the child, she was in fact the real mother.

Embryo donation parents also have a different parenting style. They tend to score higher on emotional over-involvement. Mothers tend to put the needs of the child over other family members and are reluctant to use babysitters or other care-givers. "This trait could produce children who are very dependent on their parents and who do not develop autonomy appropriate to their age," speculated Ms MacCallum. However, the mothers' focus on the child is not extreme and children do not suffer as a result.

Israeli scientists have found that human embryonic stem cells have helped rats with symptoms of Parkinson's disease to recover. Dr Benjamin Reubinoff told the ESHRE conference that his team had directed the stem cells to grow into specialist neuron cells and had then injected them into the rats' brains. The results were encouraging and "set the stage for future development". Animal embryonic stem cells have been used before to treat animal models of Parkinson's disease, but this marked the first time that human cells have been used.

A Sydney IVF clinic has created Australia's first embryonic stem cell line from a left-over IVF embryo donated by a couple interested in scientific research. The line was developed by Sydney IVF about a month it obtained a research licence.

The medical director of Sydney IVF, Professor Robert Jansen, says that the stem cells will be used for research. He predicts that they will eventually lead to therapies for degenerative diseases. "There are several hurdles but there's a small chance it will be inside five years." He also hopes to be able to create stem cell lines from genetically defective embryos to test drugs. "The potential of stem cell research is boundless," he says.

Rather than pass on the $500,000 spent on developing the stem cell line to its customers, Sydney IVF said that it plans to charge a commercial fee for other researchers to use its cell lines. A day later, however, a Melbourne competitor, Stem Cell Sciences, vowed that it would treat the stem cell lines it is developing with another licence as "a resource for mankind" and make them freely available to researchers around the world.

New South Wales Premier Bob Carr said that Sydney IVF's achievement was heartening and that embryonic stem cell research should be encouraged. Taking a completely different line on the controversial issue was Tasmania's Senator Brian Harradine, who said that human embryos were being treated like laboratory rats. "This research destroys human embryos for the commercial benefit of Sydney IVF," he said

Faced with a lengthening list of candidates for heart transplants and a tiny list of donors, Japanese patients are going overseas to the US, Canada and Germany. Some parliamentarians claim that their law on organ donation is too restrictive and are calling for changes in the consent law. At the moment, Japan does not allow organs to be harvested from brain-dead patients unless they have expressed their wishes in writing. Without this in hand, even their relatives are not allowed to authorise a transplant. As a result, since 1997, only 29 Japanese diagnosed as brain dead have become organ donors, even though 3,000 suffer brain death each year.

Good intentions are not the problem. Although more than a third of Japanese say that they would be willing to donate their organs, only about 5% have signed donor cards. However there is also a deep cultural bias against harvesting organs from the brain-dead. A lobbyist against liberalising the law, Eiji Tsunakawa, says that removing the decision from a patient's hands would violate the most precious of human rights. "It's partly emotional, partly common sense," he says. "How can you say that somebody whose heart is beating and body is warm and sweats is really dead?"

The scandal of Japan's first heart transplant in 1968 hasn't helped the cause of reform. The surgeon was investigated for allegedly removing the heart of a patient who was not dead and transplanting it to a patient who did not need it. He was never charged, but heart transplants were banned until 1997.

Indian social scientists are predicting a rise in sexual violence and wife-sharing because 40 million aborted girls are missing from the population. It is estimated that 5 million girls are aborted each year. "In Haryana [state] a whole generation of young men is failing to find wives because a quarter of the female population has simply disappeared," says the London Times.

"All over India, since the 1980s when the country was flooded with cheap ultrasound technology, this mobile killing machine, wielded by doctors with no ethics, has been doing its lethal work," the Times reports. "Villages may not have clean drinking water or electricity, but they have access to ultrasound tests. Some clinics in towns load the machine onto a van, along with a generator, and go to remote towns offering sex-selection services. In some villages no girl has been born for years."

Women's groups have reported cases of fraternal polyandry. A young woman is formally married to one man but shared with his brothers. Police in Uttar Pradesh also say that there have been five cases of fratricide in the past year motivated by sexual jealousy or rivalry.

Forty-eight Nobel-Prize winning scientists have backed Democrat presidential hopeful John Kerry as the best hope for American science. President George Bush, they charge, had short- changed scientific research by accepting biased advice, reducing funding and restricting immigration of scientific migrants. "John Kerry will change all this," they said. "John Kerry will restore science to its appropriate place in government." Mr Kerry has promised to place America at the forefront of scientific discovery and amongst other moves, has promised to lift barriers to human embryonic stem cell research.