Jaffar Ali

Controversies and considerations regarding the termination of pregnancy for Foetal Anomalies in Islam

BackgroundApproximately one-fourth of all the inhabitants on earth are Muslims. Due to unprecedented migration, physicians are often confronted with cultures other than their own that adhere to different pdigms.DiscussionIn Islam, and most religions, abortion is forbidden. Islam is considerably liberal concerning abortion, which is dependent on (i) the threat of harm to mothers, (ii) the status of the pregnancy before or after ensoulment (on the 120th day of gestation), and (iii) the presence of foetal anomalies that are incompatible with life. Considerable variation in religious edicts exists, but most Islamic scholars agree that the termination of a pregnancy for foetal anomalies is allowed before ensoulment, after which abortion becomes totally forbidden, even in the presence of foetal abnormalities; the exception being a risk to the mother’s life or confirmed intrauterine death.SummaryThe authors urge Muslim law makers to also consider abortion post ensoulment if it is certain that the malformed foetus will decease soon after birth or will be severely malformed and physically and mentally incapacitated after birth to avoid substantial hardship that may continue for years for mothers and family members. The authors recommend that an institutional committee governed and monitored by a national committee make decisions pertaining to abortion to ensure that ethics are preserved and mistakes are prevented. Anomalous foetuses must be detected at the earliest possible time to enable an appropriate medical intervention prior to the 120th day.

Time-lapse videography of human oocytes following intracytoplasmic sperm injection: events up to the first cleavage division.

A total of 341 fertilized and 37 unfertilized oocytes from 63 intracytoplasmic sperm injection (ICSI) treatment cycles were included for retrospective assessment using the Embryoscope time-lapse video system. The second polar body (pb2) extrusion occurred at 2.9±0.1 h (range 0.70-10.15 h) relative to sperm injection. All oocytes reduced in size following sperm injection (p<0.05) with shrinkage ceasing after 2h in the unfertilized and at pb2 extrusion in the fertilized oocytes. Pb2 extrusion was significantly delayed for women aged >38 years compared to those <35 years (3.4±0.2 vs. 2.8±0.1, p<0.01) or 35-38 years (3.4±0.2 vs. 2.8±0.1, p<0.01), but timing was not related to the Day 3 morphological grades (1-4) of subsequent embryos (2.9±0.1, 2.9±0.1, 2.8±0.2 and 3.0±0.1; p>0.05 respectively). A shorter time of first cleavage division relative to either sperm injection or pb2 extrusion is associated with both top grade (AUC=0.596 or 0.601, p=0.006 or 0.004) and usable embryos (AUC=0.638 or 0.632, p=0.000 respectively) on Day 3. In summary, (i) pb2 of human oocytes extrudes at various times following sperm injection, (ii) the timing of pb2 extrusion is significantly delayed when female age >38 years, but not related to subsequent embryo development, (iii) all human oocytes reduce in size following sperm injection, (iv) completion of pb2 extrusion in the fertilized oocytes is a pivotal event in terminating shrinkage of the vitellus, and (v) time to first cleavage division either from sperm injection or pb2 extrusion is a significant predictive marker for embryo quality on Day 3.

Selenium: a brief review and a case report of selenium responsive cardiomyopathy

BackgroundThe authors review the role of selenium and highlight possible low selenium levels in soil that may result in deficient states in Saudi Arabia.Case presentationThe authors report a case of selenium-responsive cardiomyopathy in a 15-month old Saudi Arabian boy. This case of selenium deficiency causing dilated cardiomyopathy is presented with failure to thrive, prolonged fever and respiratory distress. The investigations revealed selenium deficiency. Selenium supplementation along with anti-failure therapy [Furosimide, Captopril] was administered for 6 months. Following therapy the cardiac function, hair, skin and the general health of the patient improved significantly.ConclusionThe patient with dilated cardiomyopathy of unknown etiology, not responding to usual medication may be deficient in selenium. Serum selenium measurements should be included in the diagnostic work-up to ensure early detection and treatment of the disease. The selenium level in the Saudi population needs be determined. Vulnerable populations have to undergo regular selenium measurements and supplementation if indicated. Dependence on processed foods suggests that the Saudi population fortify themselves with nutrient and micronutrient supplements in accordance to the RDA.

Permanent neonatal diabetes mellitus.

Summary Background: Neonatal diabetes is a rare cause of hyperglycemia, affecting 1: 500,000 births, with persistent hyperglycemia occurring in the first months of life lasting more than 2 weeks and requiring insulin. This condition in infants less than 6 months of age is considered as permanent neonatal diabetes mellitus. Case Report: A rare case of permanent neonatal diabetes mellitus presented with intrauterine growth retardation (IUGR; birth weight: 1460 grams; female), hyperglycemia, glycosuria, and mild dehydration, a normal Apgar score of 8 and 9 at 1 and 5 minutes, respectively. The parents, of consanguineous union, had no prior history of diabetes mellitus. Of their 4 children, the first child had a diagnosis similar to the patient (their last child). The patient was initially started on continuous infusion of insulin, and then switched to regular insulin subcutaneously, but response was sub-optimal. She was started on neutral protamine Hagedorn, following which her condition improved. She was discharged on neutral protamine Hagedorn with regular follow-up. Conclusions: In view of widespread consanguinity in Saudi Arabia it appears prudent and pertinent to suspect permanent neonatal diabetes mellitus following diagnosis of hyperglycemia in small-for-age infants, especially those with positive family history of diabetes. Close blood glucose monitoring is essential as long as hyperglycemia persists. Prolong follow-up is imperative.

Embryo Culture Media, Culture Techniques and Embryo Selection: A Tribute to Wesley Kingston Whitten

This review article gives a brief history of the classical experiments that led to the development of the embryo culture medium and in vitro embryo culture. It proposes that, in view of the outstan...

Impact of elemental iron on human spermatozoa and mouse embryonic development in a defined synthetic culture medium

There is a paucity of studies on effect of iron in embryo culture procedures. This study aims to ascertain the optimal, tolerance and toxic levels of iron in a protein-free embryo culture medium (PFM) to determine the effect of iron on embryonic development. The application of PFM in assisted reproductive technologies (ART) is intended to eliminate disease transmission and improve ART treatment outcome. The optimal, tolerance and toxic levels of iron on human spermatozoa and mouse embryos were determined by challenging them with different levels of iron (ferric iron; Fe+3). Human normozoospermic semen samples (n=24) and days 1-4 Quakenbush Special (Qs) mouse embryos (n=1160) were incubated in PFM supplemented with different concentrations of Fe+3 over different periods of time. 2.0μg/mL (35.8μM) of Fe+3 was the optimal level of Fe+3 for human spermatozoa with a tolerance range of 0.5-2μg/mL; whereas a level of 0.11μg/mL (2μM) of Fe+3 was the optimum for day 2 embryos. Levels of ferric iron at 0.11 to 2.8μg/mL appear to enhance spermatozoa motility, preserve its DNA integrity and possibly increase percentage of blastocysts developed but levels of ferric iron >16μg/mL is hazardous for both spermatozoa and embryos. In spite of beneficial effects of iron it is premature to recommend its supplementation in embryo culture media because of the known deleterious nature of iron and the paucity of toxicological data. Toxicological studies must be performed following which it can be decided whether it is safe to consider iron as a supplement in human embryo and spermatozoa culture media.

Embryo culture conditions are significantly improved during uninterrupted incubation: A randomized controlled trial

A parallel group superiority prospective randomised controlled trial was devised to compare the culture characteristics of human pre-implantation stage embryos during uninterrupted culture in a time lapse incubator (TLI) versus the conventional model of interrupted culture in a standard incubator (SI) under low oxygen tension using a single step medium. 221 patients aged 35-and-under, 124 patients aged between 36 and 39 and 86 patients aged 40-and-over years were randomised and cultured either in a SI or in a TLI. Patients in the three age groups were distributed between the TLI and SI in a 1:1 ratio. The development of embryos on days 2, 3 and 5, and the clinical pregnancy and implantation rates were recorded. The fertilisation rate, development of day 2 and clinical pregnancy rates were similar in both treatments but the 8-cell development rate in all age groups combined (p = 0.016), blastocyst development rate (p = 0.0022) and the implantation rate (p = 0.0022) was significantly higher for the uninterrupted culture. These findings demonstrated significant differences between the two incubation groups. It also indicated less efficacious embryonic development with age in both treatments which appeared more pronounced in the conventional incubator. In conclusion uninterrupted culture is superior compared to the interrupted incubation culture system.

A survey of scientists’ awareness of and attitudes to the use of human blood products and alternatives in human assisted reproductive technology

Abstract Scientists working in assisted reproduction [members of Scientists in Reproductive Technology (SIRT) Australia, and subscribers of the online forums EmbryoMail and Quartec] were invited to complete an online questionnaire on the use of human blood products in assisted reproductive technologies (ART). A total of 260 started the questionnaire, with 208 (80%) completing it. A total of 62% of respondents had worked in human ART ≥8 years and 68% had post-graduate qualifications. The majority (82%) reported using products of animal or human origin, with 75% knowing why protein was added to culture media and 41% not worried by this. Almost half (49%) of respondents were unaware of regulations surrounding the use of human blood products in health care and 70% were unaware of adverse events involving human blood products in human ART. Most respondents (70%) indicated that they were not concerned about infections such as hepatitis, but agents such as prions were a cause for concern (57%). A total of 57% of respondents were unaware of alternatives, but 77% would use a suitable alternative. Using blood products in human ART is surrounded by a lack of awareness, often independent of respondents’ qualifications or experience. A better understanding of these products and possible alternatives is required if informed decisions about their suitability are to be made.

Welcome to Journal of Reproductive Biotechnology and Fertility

The mission of Journal of Reproductive Biotechnology and Fertility (JRBF) is to provide a much-needed forum for freely available research into reproductive biotechnology and fertility, with the aim of making this research more accessible to both developed and less developed areas of the world. The open access model intends to provide access to publications to every individual, irrespective of their means or circumstance. The advent of open access has helped authors disseminate and publicize their work widely. Assisted reproductive technology (ART) is without doubt an incredibly important area of research, evidenced by its unprecedented growth in the last three decades which is comparable to that of information technology. In the mid-1970s, there were no more than about four centres worldwide that performed ART, but this has now grown exponentially to well over 5400 centres in the present times. This astounding growth is baffling. Why did this happen? It must be humankind’s insatiable desire to fathom the mysteries of life. Perhaps reproductive biotechnology seeks to answer the very fundamental questions concerning life itself. It is driven by a curiosity to learn how life begins and how the knowledge accrued can be applied for the betterment of all life forms on earth. Those working in this area need not be told that it is an intriguing area of research that challenges the mind, and research in this area has taken off on an enormous scale and at a colossal pace. There is no stopping it. A more practical reason for the increase in research into reproductive sciences since the early 1980s is the alleviation of subfertility and childlessness among couples who have tried but have not succeeded in becoming parents. In the early 1980s, the clinical pregnancy rate following ART treatment ranged from about 9% to 15%, which meant that about 85% to 91% of couples failed to achieve pregnancy. These dismal statistics had enormous social and personal implications to hapless couples who suffered the misfortune of failed ART treatment. The despair childlessness wrought, especially in less developed societies, is known to drive some women in unproductive marital unions to experience mental health problems – or in extreme cases to commit suicide. Others have been reduced to the status of labourers in societies that practiced joint or extended family life. The exponential growth in ART research over the last 30 decades has helped increase pregnancy rates by between two and four times the rate previously obtained in the early 1980s. This has helped prevent serious social problems and helped many become biological parents. Reproductive research in agriculture is also crucial and has helped humankind increase food production, especially in the meat and dairy industries to help feed the expanding population of the world. Reproductive research is not a luxury but a necessity. In light of this, JRBF is committed to furthering this necessary research and providing an open environment for debate and discussion around the most important topics. Launched in 2010, JRBF was formerly published by Androcryogenics Malaysia (under the name Journal of Reproductive and Stem Cell Biotechnology) and rapidly achieved acceptance within the ART community. It aimed to publish reproductive research free of cost to all and acknowledged that scientific development can be thwarted in some less developed countries due to the high costs involved in conducting and accessing research. With this modus operandi, we hoped that scientific workers of all nations, developing as well as advanced, could benefit from the information freely. Unfortunately, due to a dearth in funding, Androcryogenics was unable to continue publishing and therefore decided to handover the journal to SAGE Publications. With the transfer to SAGE Publications, the journal is now assured of a new lease of life, hopefully, on a permanent basis.

Synthetic Biology in Healthcare and Conservation: II. Successful Formulation of a Synthetic Spermatozoa Cryopreservation Medium

Present-day Embryo Culture (ECM), Cell, Gamete and Embryo Cryoprotectant (CM), Stem Cell Culture (SCCM), Cell-based Vaccine Production Media (VPM), etc contain donor serum proteins (DSPs) which carry risk of disease transmission to patients/their babies/healthcare workers. The dependence on DSPs proved difficult to overcome. The European Union recommends avoidance of non-uniform biologicals in healthcare products (EU Tissue Directive No.2004/23/EU) by April 2007. However to-date most manufacturers of healthcare products have not fully complied with this directive. The pioneering research of this author in Australia led to development of synthetic human embryo culture media devoid of DSPs. A clinical trial was performed successfully [Ali, 1997, 2004; Ali et al., 2000] and patented in USA (US Patent 8415094) / PCT protected in Canada/ EU/ Australia/ Russia/ Israel/ worldwide and licensed to Cellcura ASA Norway (www.cellcura.com). The present communication reports development of synthetic spermatozoa cryopreservation medium (SCM). The nature of this intellectual property is proprietary. Patent application is pending. Therefore it shall not be described in detail here but events leading to its development will be presented. In the SCM the mean% +1SD spermatozoa motility pre- and post- freeze-thaw was similar 55.7+17.4 vs 54.9+13.3; n=10 (p>0.05). In previous studies after freeze-thaw using DSP-containing CM the pre and post-thaw spermatozoa motility was significantly different 45+11 Vs 23+12, p=0.047; n=64 that showed a loss of 22% in motility (p=0.047). A prospective study found SCM statistically similar to DSP containing-CM. Proof of principle was demonstrated following human pregnancy after generation of human embryos by intracytoplasmic spermatozoa injection (ICSI) using SCM frozen-thawed testicular spermatozoa. An efficacious SCM for human, possibly mammalian spermatozoa was formulated that may be regulation-compliant, and very safe. The availability of SCM eliminates batch variation and potential for disease transmission in routine spermatozoa cryopreservation in medicine, meat and dairy industries, and species conservation.