FUTURE FORECASTS for 2000

INFERTILITY More and more 'future babies'

According to Zev Rosenwaks, M.D., internationally renowned infertility specialist and director of The Center for Reproductive Medicine and Infertility at New York Presbyterian Hospital-Weill Medical College of Cornell University, the outlook for the millions of American couples affected by infertility is much less bleak today than it used to be, and promises to be even more encouraging as we move into the new millennium - due to continuing advances in Assisted Reproductive Technology (ART). "Twenty-five years ago we could help 60-65 percent of infertile couples; today that figure is somewhere between 90 and 95 percent," he reports.

The era of assisted reproduction in humans began with attempts at in-vitro fertilization by teams in England and Australia, culminating in the successful birth of the first "test-tube baby" in 1978. Since then, there has been a surge of new advances: problems with ovarian stimulation have been reduced, egg retrieval has been simplified by the development of ultrasound-guided follicle aspiration, assisted hatching has significantly increased the success rate, embryo freezing has allowed for additional pregnancy without the risk or cost of another stimulation and egg retrieval, and several procedures have revolutionized the treatment of male factor infertility.

The most common ARTs now used include:

* IVF (InVitro Fertilization) where egg and sperm are combined in a laboratory and incubated, with the resulting embryos transferred into the woman's uterus.

* GIFT (Gamete IntraFallopian Transfer), where eggs and sperm are transferred into the fallopian tube during a laparoscopy, allowing fertilization to occur in the normal location.

* ZIFT (Zygote IntraFallopian Transfer), a combination of IVF and GIFT, where fertilization occurs in-vitro (outside the body) but fertilized eggs (zygotes) are placed into the fallopian tube.

* ICSI (IntraCytoplasmic Sperm Injection), in which fertilization is achieved by the direct injection of a single sperm into the egg.

* AH (Assisted Hatching), a variation of IVF in which a small hole is made in the shell surrounding the embryo to facilitate implantation.

What does the future hold? Dr. Rosenwaks, who served as the first director of the country's first IVF clinic, says current research is focusing on several areas. One is the development of new techniques to help stimulate the maturation of immature eggs from women undergoing IVF. Others are the micro-manipulation of eggs and embryos, and the identification and isolation of young sperm cells from men with testicular failure and azoospermia (complete absence of sperm in the ejaculate). The refinement of techniques of pre-implantation genetic diagnosis (testing for chromosomal abnormalities in an embryo before it is implanted into the woman's body) can potentially decrease the births of infants with disorders such as sickle cell anemia or Tay Sachs.

Other anticipated advances, continues Dr. Rosenwaks, are finding ways to create new eggs from regular cells in a woman's body, creating new sperm or repopulating sperm in men whose sperm quality is poor, and using a variety of culture media in the laboratory to grow embryos until they can be safely implanted in the woman's body. Dr. Rosenwaks also hopes we will increase our knowledge of markers of embryo viability (survival), leading to fewer eggs implanted during in-vitro fertilization.

In addition, new treatment techniques for women with Polycystic Ovarian Syndrome are expected to reduce infertility problems often associated with this disorder. The recent FDA approval of Antagon, a drug which delays the surge of leutenizing hormone, will reduce the amount of medication needed to treat certain types of infertility. And advances in non-surgical aspiration of sperm present effective alternatives to vasectomy reversal.

As we move forward, the future for people yearning to experience the joys of parenthood is bright indeed.

PEDIATRICS New vaccines, gene therapy, stemming serious disease

The 20th century has seen enormous progress in the diagnosis and treatment of childhood illnesses. Advances in pediatric clinical medicine, improved access to prenatal and health care, improved nutrition, environmental interventions, the development of immunizations against common childhood illness, and the discovery of anti-microbial agents such as penicillin and the sulfonamides have all contributed to a substantial decrease in infant mortality and more effective treatments for numerous childhood conditions. Since the development of the oral polio vaccine in 1963, for example, the incidence of poliomyelitis has decreased to less than 10 cases per year; and the Hib vaccine, first developed in 1987, protects against Haemophilus influenza B infections and has greatly reduced the incidence of meningitis and other serious childhood illnesses caused by this bacteria.