Impacting the way we approach family planning

In the United States, 45% of pregnancies are unintended. Just under half of those pregnancies are aborted. Since the conception of birth control pills in the 1960s, the role of preventing unplanned pregnancy has largely been seen as a “women’s issue”. Andrologist John Amory is determined to change that, by enabling men to share greater responsibility for family planning with the development of a better, novel form of male contraception. For over 100 years, there have only been three forms of male contraception – condoms, vasectomy, and abstinence.

Dr. John Amory in his lab at the University of Washington Health Sciences in Seattle, WA.

The development of male contraceptives poses unique physiological challenges. Unlike the female reproductive system which experiences periods of fertility and infertility at regular intervals each month, the male reproductive system is constantly fertile, making 1,000 sperm every day from puberty until death. John is exploring the use of testicular retinoic acid biosynthesis inhibitors to block sperm development as a reversible male contraceptive. Undaunted by the many challenges of his work, John is committed to creating a contraceptive that promotes greater sharing of responsibility between both sexes when making decisions about family planning.

While John is helping parents delay pregnancy until the time is right, for many parents the decision of when – or whether – to have a baby is influenced by biological factors outside of their control. When pregnancy does occur, the fertilized embryo has three genomes: one set of nuclear DNA from dad and one set of nuclear DNA from mom, plus an additional mitochondrial DNA (mtDNA) inherited exclusively from the mother. Mitochondria, or “powerhouses of the cell”, have their own set of DNA which codes for proper energy production and cellular function. Mutations in mtDNA result in a spectrum of incurable diseases, commonly presenting with symptoms like muscle weakness, seizures, developmental delay, or organ failure.

So what if a woman with unhealthy mtDNA wants to become a mother without risking the health of her baby? University of Newcastle professor Mary Herbert provides a solution by transferring a woman’s nuclear DNA and a man’s nuclear DNA into a donor egg containing healthy mtDNA, from which the existing nuclear DNA has been removed. This allows the woman affected by mitochondrial disease to have a child without passing on mutations in mtDNA. The donor egg provides a subset of DNA to the baby, but the genetic characteristics of the baby are completely determined by the nuclear DNA, not by the mitochondrial DNA of the donor. Through this work, Mary is pushing the limits of our understanding of reproduction and looking toward a future where certain mitochondrial diseases can be eliminated from a family for generations to come.

Mary is helping women who carry genes for devastating diseases conceive healthy babies, but what is being done to help women have safe deliveries during childbirth?

Compared to countries of similar wealth, women in the United States have a greater risk of maternal mortality with rates increasing 27% since the year 2000. According to the CDC, 60% of these deaths are preventable, commonly resulting from complications like maternal hemorrhage which can arise without the warning flags of predisposing risk factors, making it difficult to predict. Siddarth Satish, founder of Gauss Surgical, realized that every vital sign is carefully measured in an operating room – except for blood loss. He created Triton OR, an FDA-approved blood loss monitor that provides real time feedback on blood loss, optimizing transfusion decision making and predicting postoperative hemoglobin levels. Siddarth’s innovation helps improve patient outcomes, with the ability to help make childbirth safer – for both the child and the mother.

These 2017 TEDMED Speakers and Hive Innovators are moving beyond what were once thought to be limits when it comes to family planning and childbirth. Join us this November to hear their stories.