Dr. Aizpurua, as a reproductive physician you work with the most advanced technology. Have you any concerns that the development is going in un wanted directions?
Jon Aizpurua: It does worry me if we take a look into the future. We are able to clone humans or reprogram their genetic code, and this has already been achieved with animals; however, I'm not the moral authority to question nor stop these developments.
But it is a fact that you are in the spotlight because of the nature of your work.
Aizpurua: Indeed. I’m aware, of course, that these developments are unlikely to be stopped, but it is not relevant whether we use or don´t use cutting-edge technology here in Spain or in Switzerland. If it’s not used here, then it will be used in Korea, China or even in the US. In South Korea, for instance, discussions are now taking place as whether to limit the rights of bionic machines, whose artificial intelligence will surpass human intelligence in a future. Progress will come sooner or later, whether we like it or not.
That sounds dramatic.
Aizpurua: Not necessarily. Technological progress itself is unstoppable. But we can define rules on how to handle it in a responsible manner. It's like nuclear technology: it can do a lot of good, but also have disastrous consequences. We need to describe how to positively use this technology and how to create a monitoring authority.
Are there things or situations you would refuse to do.
Aizpurua: Of course. I will not provide help to conceive a child to a psychologically unstable couple.
In which aspects is Spanish Reproductive Medicine ahead of other countries?
Aizpurua: In all aspects. We can improve sperm and egg cell quality by means of drug administration, and thus selecting those with the best quality. The laboratory has great knowledge regarding the embryo culture. The embryos are under constant video surveillance, and we know if one cell will turn into three cells, which means it will not develop to healthy child. We also perform tests on the embryo: the Preimplantation Genetic Diagnosis (PGD) and Preimplantation Genetic Screening (PGS). This provides us with all the necessary information to test whether the embryo is, or is not, genetically fit. This is one of three condition required to conceive a healthy child.
What else is required?
Aizpurua: The embryo must be metabolically healthy in order to have the sufficient strength to grow. In Switzerland, for instance, it is not possible to determine this factor as current Swiss law provides that the embryo must be transferred on the 2nd day of its development. But on the 5th day of its development only 40 to 60% have the strength to grow. This is a law of nature.
And the third criterion?
Aizpurua: Epigenetic competence. We know very little about this, hopefully this will change in the upcoming years. It's about metabolically competent, genetically complete embryos and about the question of whether it is able to determine and organize all the steps required to ultimately create a human being. Nevertheless, genes are not the ones responsible, but mechanisms that regulate which genes are activated and determine when they are activated. If we knew that, we would have 80% of successful fertilisations. The rest, however, is up to the mother: What makes a top quality embryo successfully implant in one case and fail in another
In Switzerland, opponents of the new law fear a lower number of people with disabilities, and as a result a decrease of the tolerance towards disabled people
Aizpurua: If this is an argument against the law, then you have not understood the true nature of Preventive Medicine. The best treatment is not the one that cures an illness; the best treatment is the one that prevents suffering from an illness or medical condition. The first human genome was sequenced 10 years ago – it had a cost of $3 trillion and lasted 13 years. Today it costs $1,000; in 20 years it will cost $ 10.
But do you really want to know what is inside?
Aizpurua: If I know by this means that I have a risk of suffering a heart attack and, for instance, I can avoid dying from it by not eating white fat, yes. And you would too. We all cling to life. If we can prevent people from suffering, for example, by not using a sick embryo, then we should do that.