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Using Embryos to Put Fertility First
A Conversation with Renee A. Reijo Pera, Director, Stanford’s Center for Human Embryonic Stem Cell Research and Education
As director of Stanford’s Center for Human Embryonic Stem Cell Research and Education, Renee A. Reijo Pera, 49, a professor of obstetrics and gynecology, works at ground zero of the controversy over human embryonic stem cells. She uses human embryos to create new cells that will eventually be coaxed into becoming eggs and sperm. In other research, she has also identified one of the first genes associated with human infertility. The questions and answers below are edited from a two-hour conversation and a subsequent telephone interview.
Q. WHY ARE YOU TRYING TO CREATE HUMAN EGGS AND SPERM?
A. Because in doing so, we may find the answer to disorders like Down syndrome and some neurodegenerative diseases that develop in the egg, sperm or embryo. It’s our hypothesis that if you don’t treat your DNA right in the first day or two of life, you could end up with diseases and conditions. So by learning what nature does and repeating it in a Petri dish, we hope to find out what has gone wrong — and then, eventually, how to correct it.
Q. HOW FAR HAVE YOU GOTTEN IN THIS QUEST?
A. We’re about halfway there, though I’m not sure if we’ve completed the easy or hard half. In a dish, we’ve gotten stem cells to make meiotic germ cells, the cells that give rise to eggs and sperm. What we haven’t been able to do yet is to figure out which supplements should be fed to the cells to get them to become germ cells capable of making embryos. Optimistically, we are three to five years from being able to do that.
Q. IN SPEECHES, YOU SAY THAT STEM CELL RESEARCH SHOULD BE THOUGHT OF AS A WOMEN’S HEALTH ISSUE. WHY?
A. Because in my lab, we’re using stem cell research to look for ways to make fertility treatments safer and more rational.
Considering all the heartbreak and expense of infertility treatments, this sort of research is something I believe women have a big stake in defending.
Right now, we don’t fully know what a healthy embryo in a Petri dish looks like. Because of this, I.V.F. clinics often insert multiple embryos into women to try to increase the odds of a successful implantation. Patients frequently have multiple births or devastating miscarriages. Half the time, the embryos don’t make it. If we could figure out what a healthy embryo looked like and what the best media was to grow it in, we’d cut down on that.
Q. WHEN GEORGE BUSH ISSUED HIS AUGUST 2001 PROHIBITION AGAINST FEDERAL FINANCING OF NEW STEM CELL RESEARCH, WHAT DID YOU THINK?
A. First, I was stunned that a president was talking about biological science at all! After I caught my breath on that, I was grateful he didn’t order an outright ban on all research in this area.
As you may recall, his order banned federal funding for new stem cell lines, but permitted work on older colonies of stem cells, derived by embryos — “lines” — already in existence. Of those he permitted, there were supposed to be something like 60 or 70 lines, though reports are there are actually only about 20 lines one can work on. I believe there are really only 11 that grow well.
There’s been bad news and good news. Surprisingly, because scientists were limited to working with these very few lines, we’ve learned a lot about this one small group of embryonic stem cells. We’ve learned a lot about the genetics of these lines, and we are able to make comparisons between them. This might not have happened if researchers had been using all kinds of different lines from all over the place. The bad news was that the available lines turned out to be, generally, of poor quality — many were grown in a medium that contained animal products. For studying human reproduction at the level we are, you wouldn’t want to use them. The bottom line is: Although we have improved our methods to make embryonic stem cells, we’re still limited to using these poor-quality stem cell lines, which are not valuable for learning about human embryonic development.
We hope in the future we’ll be able to study newer lines made under less restrictive conditions. I hope there will be a change in policy.
Q. WELL, THEN, WHAT DO YOU USE IN YOUR LABORATORY NOW?
A. Our lab isn’t federally funded. We get our money from the $3 billion California stem cell initiative. We make our own stem cells from embryos donated by I.V.F. families.
Q. DO YOU HAVE MORAL QUALMS ABOUT USING HUMAN EMBRYOS IN YOUR RESEARCH?
A. I can’t say I do. And I’ve really searched myself about this. I grew up a deeply religious Christian — I’d go off into the woods and sing hymns. My sister is an Evangelical. I’m sure there have been moments in my life when I haven’t been a model Christian, but my work on embryonic stem cells isn’t one of them.
Think about it: we study embryos donated by couples who finished their I.V.F. treatments. They would be destroyed anyway. Nationally, the clinics discard about 400,000 unused embryos every year — and yet few people consider I.V.F. clinics “immoral.” Stem cell researchers use about 10,000 of those about-to-be-discarded embryos. And in learning from them, we are getting information that we can get nowhere else, that will make mothers and babies healthier.
There are people who believe that we when use embryos for research at all, our society becomes hardened. I’ve searched myself on that and I don’t think I’m hardened. I can honestly say I still get goose bumps when I see embryos develop. You hope you are humble enough to take in the information and not change your course.
If there was truly a substitute that was better for understanding human development than embryo research, that is what I’d do. But there isn’t. That’s where the data is. I think that it is not good to throw human embryos away — without studying them