Michael J. Tucker, PhD, FIBiol

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       "I'm with Dr. Stafl from the Medical College of Wisconsin in       Milwaukee. I need to thank you, while I'm now doing reproductive       endocrinology and don't look at too many cervixes, back in the       mid-seventies I had the opportunity to visit your clinic as a resident and       learn about colposcopy. Many things have changed in our understanding of       cervical cancer and it's detection, causes, and prevention. I wonder if       you might speak about some of that."
       
       

 "I       am quite surprised, I didn't remember that you visited us in Milwaukee.       Really in the early 1970's we started with colposcopy in the United       States. As you know, in Europe this was an advantage, which was developed       by Hinselmann in 1929, and it was a method that was considered to be       competitive to cytology. When we introduced colposcopy in the United       States, our aim was not to use it as a competitive method to cytology but       as a method for evaluation of patients who have an abnormal Pap smear.       Without any question, the Pap smear is the most acquired best method, and       economical method for cervical cancer detection. For evaluation of       patients with an abnormal Pap smear, colposcopy has a lot of advantages.       Now the problem in recent years was that the number of slightly abnormal       Pap smears or so called "ASCUS" or low grade SIL, increased       significantly. The National Institute of Health estimated that the       evaluation of a patient with an abnormal Pap smear is around three billion       dollars. This is of course, a sum which here in the most richest country,       they cannot afford. So now they are trying to find new ways, mainly better       economical ways to evaluate patients with an abnormal Pap smear. The most       acquired method without any question is colposcopy, and if it's too       expensive, we have a lot of new methods. One is called "cervicography"       which is based on the same principles as colposcopy where the instrument       is de-fan-ned. Basically, the cervicograph is a kind of photographic       camera and any gynecologist not trained in colposcopy can become a       technician after a short training period, and by this I mean half-an-hour,       he can take a microscopic picture of the cervix, and then this can be sent       to an expert for evaluation. So the principle is similar to mammography,       which again, the picture is taken by the technician and evaluate by the       radiologist. By this technique, it is possible for the expert in       colposcopy to evaluate about two-hundred patients in an hour so it is       economically a very reasonable method."
       
       

       "We have seen a combining of labs across the country so that the       number of slides that a tech in a large commercial laboratory goes through       is phenomenal. Do you find that there are quality issues in the screening,       and do you find that these newer methods of doing the Pap smear offer any       advantage?"
       
       

       "No question, about the biggest problem with the Pap smear is that       the average cytology slides contains between 50,000 and 200,000 cells.       Therefore, it is completely impossible for the cytopathologist to evaluate       all these cells, and the cytopathologist depends on the work of       cytotechnicians. Of course, in some of the laboratories the work of       cytotechnicians and the results of cytology are examined. In some       laboratories it is questionable, and unfortunately this problem cannot be       solved because there are 50 or 200,000 cells there and somebody has to       evaluate them. The cervicography is easier because the expert in       cervicography projects the slide, evaluates the slice, and he can see the       entire cervix in one view. It only takes thirty seconds for an expert       evaluation. This is a big difference in comparison to cytology."
       
       

       "Do you think from a cost standpoint, it's very easy to take a camera       and download it or attach it to your Internet port for the transfer of       information between the units? Right now it may be film that has to be       transferred from one place to the other but eventually nothing will have       to change hands as opposed to picking up a slide, sending it, and       processing the slide. Once it all goes to digital, do you think there will       be cost savings, and perhaps the cervicography will replace the Pap smear       as a tool?"
       
       

       "Eventually in the future - yes, but so far the technology is not       available because when you digitalize the picture, the apparent       magnification is achieved by projection of the slide and by observing from       a short distance. When you enlarge this digital image significantly, it       goes to pixels but I am sure that it will be available because you know       the spy satellite pictures can detect very small details, and now some of       the military technology is declassified. I expect this possibility in the       future, I am sure this will be possible but so far I haven't seen a lens       which will provide sufficient magnification."
       
       

       "There's also controversy once we find the higher stages of lesions       regarding whether LEEP is an appropriate step or whether a laser       condensation or a cold knife cone is appropriate. Would you give your view       on each of these procedures?"
       
       

       "On the contrary, I think now it is very simple because in my       opinion, I think LEEP is without any question the best method. And the       laser condensation or laser vaporization is the absolute method also in       cryosurgery and electrocautery. These are absolute methods because you       don't have the specimen for evaluation, and if a mistake is done in the       diagnostic procedure, like a micro-invasive carcinoma is overlooked, then       a disaster will happen. This LEEP procedure or this LLETZ procedure       according to Prendiville, the founder of this procedure, you have a       specimen for the surgical evaluation so even if the physician misses a       micro-invasive cancer, the pathologist will find it. This is an enormous       advantage."
       
       

       "As a physician who sees infertility patients, one of the problems I       see following this is apparently a risk of cervical stenosis and cervical       amputation by someone who may be less skilled. Have you seen this, and how       are people best trained to avoid those complications?"
       
       

       "The biggest problem with the LEEP is over-treatment because the big       danger is that - say a physician in family practice or internist has a       patient with a slightly abnormal pap smear and the right ovary and half of       the cervix is gone. This is a problem. Now when the LEEP is used in       indicated procedures for the treatment of CIN, so far from the literature,       the effect on the fertility is minimal. And for the very, very long term       reports about advanced effects on fertility, we have to wait more years       until we can analyze this long-time evaluation but so far it looks like       the problem doesn't exist."
       
       

Articles

OBGYN.net Conference CoverageFrom First Congress on Controversies in Obstetrics, Gynecology & Infertility Prague CZECH REPUBLIC - October, 1999

Cervical Cancer

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       "I'm here with Michael Tucker who is well-known for his work in       embryology and is one of the leaders in IVF laboratory work. I've been       excited about all the new advances that seemed to develop and pop up over       the past year. Now maybe I'm a little naive in seeing these as appearing       all at once - I know there's a lot of work that's gone into getting there.       Can you share with us some of the things that you've been excited       about?"
       
       

       "True, it seems to me every year brings new developments, and       certainly in the last year or so there have been some which have been       fairly notable. The move toward extended culture in human IVF is certainly       something that I'm very happy to see. It allows us to transfer embryos at       a later stage of development - at the blastocyst stage, thereby allowing       us to discriminate more accurately as to which embryos have greater       potential viability. The consequences of this allow us to transfer fewer       embryos. I think there's been a dire need to move away from three or four       embryos or sometimes even more at embryo transfer in human IVF, and to       move away from that as routine to the placement of, say, just two embryos       at the blastocyst stage and reduce the potential for multiple       implantations. I think, ultimately, certain forms of embryo screening will       allow us to maybe screen for using metabolic probes to get an even better       handle on embryo viability. Potentially, it will bring us sometime in the       next few years to single-embryo transfers, which I think will be the       ultimate aim for ourselves and ART. So the shift of the extending culture       in human IVF has been very exciting. From my perspective as an       embryologist, it's a great privilege; it allows us to extend the period       during which time we can actually observe the growth of the early human       pre-implantation embryo. This is a great privilege in the IVF lab, but       beyond that probably one other area which is of great interest to me is       actually cryopreservation - the freezing of tissue. Although it has not       been held in any great way, we've started to see a greater level of       consistency in human egg freezing, bringing us to the point where now I       could probably safely say that mature human eggs could be routinely frozen       with a good 60% survival. This may not sound so exciting, but the problems       which have existed prior to this point have allowed us to get good       survival in one patient and in another we get very poor survival after       thawing the eggs. This inconsistency has been smoothed out so that across       the board we should be much more confident about offering routine mature       human egg freezing as a regular service, and that's of great comfort to       me. Of course, in the news recently has been the first potential inroads       into freezing of ovarian tissue. This clearly allows for the potential to       take tissue from the ovary of a woman about to undergo some kind of cancer       therapy and essentially put her reproductive potential on ice, and       following fully that at some point in the future allows this tissue to be       transferred back to the woman, to institute cyclicity in that woman but       also with the potential to make her reproductively capable into the       future. Now, this side of the technology is not quite so interesting to       me. I'm much more enthusiastic to take the in vitro route; that is, to       actually take the tissue and grow it out for sometimes several weeks -       maybe five, six weeks - with human ovarian tissue to actually take       primordial follicles all the way out to the mature egg stage. That would       be, I think, one of the greatest challenges, as I see it, in the ART labs       of the future. Whether it's doable or not remains to be seen, but it's one       heck of a challenge which I'd certainly like to be involved in over the       coming years. Those are some of the things that grabbed my attention in       the last year or so."
       
       

       "The issues of dealing with the immature ovocyte, whether it's a       cryopreserved primordial follicle or one that's retrieved in a woman who's       not undergone drug stimulation, I think is a real challenge. A few years       ago there was a paper where they were transferring these follicles to mice       whose immune systems had been ablated. Have you seen that work continue in       mouse models, or do you think we're going to move to a pure in vitro model       for maturing immature eggs?"
       
       

       "I think you know that the problems with complete maturation in vitro       from primordial follicle stage all the way to the antral follicle stage       with new eggs is that there are several stages which need to be focused       upon. Each stage of development has it's own requirements, nutritionally       and tissue culture-wise. The utilization of the new mass to maybe transfer       tissue into a lab animal, giving a sort of in vivo environment to develop       the follicles, is a neat - how can I say - a neat system, but I think       ultimately it needs to be overcome. It's enabling the animal to carry the       development of the follicles as a stopgap, as it were, for the       inadequacies of what we currently provide in vitro. I think the problem       with that technique - although it allows us to explore further the ability       to develop those follicles, at least observed in the males - the problem       with that is that there's some inherent reluctance to take that course,       certainly for clinical use. But certainly that improves our ability to at       least examine development through that stage."
       
       

       "So it may be a good model for testing our capability of freezing       these follicles or preserving them and then looking at what they do, but       long-range clinically, we'll have to bypass that and be able to replace       what's precise now. You brought up an interesting point about the       nutritional aspects of the egg from the stage of an immature follicle to       the time for ovulation. Analagous changes come about in embryo culture       that have allowed us to proceed to the blastocyst stage. Could you tell us       a bit more about some of those changes, and what's happening in the lab       now that we can do this?"
       
       

       "Just as a sort of micro view of the weeks that will be required for       ovarian tissue development, it's interesting that the compression of those       five or six phases' extended culture from the human embryos has taken us       this long to achieve some analysis of the requirements from one day to the       next. I certainly can't claim to be at the forefront of developing that.       There's been some good basic science applied by some basically       reproductive physiologists into the nutritional requirements of the early       human embryo, and in that regard, there are probably three distinct phases       which have been dissected. First are the requirements necessary for in       vitro fertilization to occur. What seems to be optimal to allow sperm to       attach and fuse with the human egg and fertilize it is the first stage       requiring one form of medium, principally with a good energy source with       some glucose kicking around. But secondly, the development stage from the       zygote from the one cell pronucleate embryo through to the cleavage stage       is the next phase. This is the phase that we're most comfortable with       because that's the period in which we've been observing early development       for the last ten, fifteen years or more. It's been interesting that many       of the cultural media that we've used routinely over the years have       amusingly or frustratingly been inadequate, in as much as they've provided       the wrong nutritional sources for the early embryo, or at least the wrong       balance of those nutritional elements. That's been resolved to some extent       now by using low glucose or no glucose in early stage development with the       removal of phosphates. This seems to improve the consistency of the early       cleavage stage embryo with the provision, then, that as the embryonic       genome kicks in around the eight cell stage in the human embryo, the       nutritional requirements shift to the next stages of development through       day three to day five, day six and the blastocyst development where,       again, glucose reappears as a major source of energy. The dissection of       which amino acids seem to be a benefit amongst the essential and       non-essential amino acids has been interesting as we've moved away from       just-off-the-shelf tissue culture media, which have been developed       historically for totally different somatic cell growth. Those media have       been largely replaced with much more specifically designed blastocyst       growth media with which I feel much more confident after years of only       really having confidence with co-culture as a means to allow us to       routinely grow out blastocysts. Now, to see that we have much more fully       defined media which can routinely take embryos out to the blastocyst stage       at a good 50% rate of all fertilized eggs is something which I think is to       be noted and applauded."
       
       

       "This technology is obviously in place, and there've been dramatic       improvements in pregnancy rates in the bigger, more experienced, well-run       laboratories. Do you think that this technology is trickling down to the       point where patients across the board can expect to find improvements       wherever they go? Do you think that the media is, in a way, making up for       labs that may not have been up to par in the past?"
       
       

       "I think IVF is really a team effort. It would be incorrect to focus       on one element, such as the culture media, in isolation from every other       element of the IVF program. At least as far as the tissue culture side of       IVF is concerned, the consistency and the culture medium is now there       where it wasn't previously, but there are a bunch of different elements       that you need to apply to human IVF to make it work. I think, inevitably,       there's a trickle down throughout the programs throughout the U.S. I think       you'll see overall improvements in consistency, but I think these have       gone hand-in-hand not just with culture media, but also in improved       investigation of each individual embryo as it grows. The analysis of the       pronucleus status of the embryos is certainly of note. Instead of just       saying, 'yes, there are two pronuclei here,' actually defining sizes of       pronuclei, the nucleoli elements within those, and how that relates to       potential embryo quality has been exposed much more over the last year or       so, as have the inadequacies of screening at the two to three day stage of       development. At the cleavage stage, we're starting to discern that many of       the factors that we thought were important morphologically are not so, now       that fragmentation and later development up to day three is not always       necessarily correlated with blastocyst formation. Indeed, in a study that       we undertook recently in a program I'm involved with in Rockford,       Maryland, we actually individually cultured embryos in over one hundred       cycles to observe embryos that we would have selected on day three of       development and correlated that with ultimate utilization on day five and       day six. To our great surprise, it was actually only 50% of the embryos       that we had assumed, based on morphological assessment on day three, ended       up being the ones that were ultimately utilized for freezing or fresh       transfer at the blastocyst stage on day five and day six. A fairly       embarrassing testament."
       
       

       "So we're still not too good at picking out on day three which       embryos are going to do well by day five."
       
       

       "No. Clearly, we've compensated for that in the past by throwing back       more embryos into the uterus. It's an acknowledgment of our inability to       choose, or at least we weren't aware of that - we just simply thought that       we were making more embryos, which were of lesser viability on day three.       The reality was that we were miscalculating which ones were the viable       embryos. So it's been fairly ironic, to say the least, and I think that       helps define why blastocyst development and transfers are so very       essential to reducing the number of embryos that we transfer, but       improving the implantation potential of each embryo we put back. Another       area in which I've been involved fairly routinely for several years now       has been pre-implantation and genetic diagnoses. I helped out in one of       the first collaborative studies which actually showed a benefit from the       day three embryo biopsy, first by taking out one or two cells from a day       three embryo and then analyzing it for chromosomal content. Then we       transferred those embryos on the basis of that screening versus what we       had done traditionally, which was to discriminate embryos on day three       based on their morphology. In a head-to-head study, they actually showed       not an improvement in initial pregnancy rates relative to whether we put       back chromosomally screened embryos versus morphologically chosen embryos,       but ultimately the implantation rates and delivery pregnancy rates were       higher in the aneuploidy, chromosomally-screened embryos. This is the       first study ever to do that. But the problem was that that screening was       all undertaken on day three, and what appears to be the case is that a       fairly hefty number of aneuploidies, especially monosomics, which drop out       during the compaction and morulus stage, day three through day five. So in       essence, the simple expedient of growing out embryos to day five or day       six, you actually passively screening out the…"
       
       

       "You may not apply this type..."
       
       

       "Yes exactly, so you know this is clearly another benefit of extended       culture."
       
       

       "Do you see that there are two prominent routes of testing?       Obviously, the fluorescent studies... There is a device to screen for the       common aneuploidies and then also using PCR to pick up specific gene       anomalies. Do you see those as complimentary techniques, or that one may       be rushing to the forefront more than the other, or are we going to try to       look at chromosomal spreads on a couple of cells that we pick up? Where do       you see the direction or even biochemical testing?"
       
       

       "I think those developments will run hand-in-hand. I think FISH       technology first in situ hybridization screening for individual       chromosomes will become much more routine. I see the turn-around time on       these tests has improved enormously, and the ability to recycle tissue       even if it's only one or two nuclei for both FISH and for PCR is there       currently. I see the potential for that tissue to be maximized in its       screening potential through both FISH and PCR technologies in the future,       particularly if we move to the biopsy of the trophectoderm that is       non-embryonic material from the blastocyst. While that reduces the amount       of time you might necessarily have for the screen using either of those       technologies, the fact of the matter is that the turn-around time on the       test is much faster now than it was even three or four years ago. Taking       several cells - maybe five or ten- from the trophectoderm will not only       increase the amount of material you have to analyze, but will allow you to       piggyback many of these tests within a matter of hours. This allows one to       get some very clear screens, not only on chromosomal status and point       genetic mutations, but also to actually get an actual DNA fingerprint on       the embryo itself. In a sense, given the potential parents of that embryo,       we can actually have the ultimate say on whether that embryo belongs - as       it were, 'is destined' - to go back into that particular couple. So yes,       you can have a DNA fingerprint and say, 'this is your embryo.' They're       happy not only that it's chromosomally normal and genetically normal, but       that it's also destined to be transferred to you. Those technologies are       definitely out there."
       
       

 "I       know we've seen reports about this being applied in specific cases where       there are risks. Are any programs doing this on a routine basis, or       offering it on a routine basis, and how far away do you think we may be       from routine aneuploidy screening?"
       
       

       "I would say probably in the next four to five years it will become       not just something which is dabbled in at one or two of the major centers       in the states, but I think that it will become more routinely accessible       to clinics in general. I think what that's going to take is an improved       comfort level with extended culture, and that's only just beginning to       happen. Just as we saw the introduction of ICSI in 1992-1993, it probably       took five to six years before everyone became truly comfortable with the       technology, so that at a meeting like this here in Prague, you can       actually go in and see all the issues about ICSI - should it or shouldn't       it be done being dissected? Basically, the answer now is that ICSI is so       routine, it's almost interchangeable with conventional IVF. That's amusing       to me when I look back five or six years ago, the agonizing that went on       over whether that technique should have been applied or not. These things       are evolutionary, I would say there needs to be a comfort level both with       blastocyst culture becoming routine and, secondly, with people's abilities       with micro-manipulation to routinely biopsy these embryos. Certainly at       the cleavage stage to pop out a cell or two to retrieve the nucleus has       never become as consistent or comfortable a technique as perhaps ICSI.       Certainly its consistency has never reached the level of the application       of ICSI. However, trophectodermal biopsy where you're not dealing with the       embryonic tissue itself, where you're actually scavenging several cells       from the non-embryonic tissue, I think, is a less exacting procedure, and       therefore will probably appeal to a broader group of embryologists who       will say, 'yes we can do this.'"
       
       

       "So you run the risk that trophectoderm may not represent what's       going on genetically inside the embryo."
       
       

       "Currently there has been a hypothesis that the trophectoderm, in       essence, was like a trash can, particularly in terms of mosaicism. In many       cases a lot of the abnormal cell lines from the early differentiation of       cells in the embryo, that high rate of chromosomal abnormality, would be       picked up in the trofectoderm because it was basically the dumping ground,       as it were, for those cells, and thereby screening the trofectoderm would       give you a poor read on the embryo itself. That has not actually proven to       be the case, and in fact, actually, it's given in the one specific area of       chromosomal aneuploidy screening. It actually doesn't seem to be born out.       So I don't think..."
       
       

       "The CVS literature, chorionic villi sampling... I know the early       literature suggests that there were some discrepancies between the fetus       and the placenta. I just haven't kept up with the literature. I've been       too busy with some of the changes that are coming in Atlanta, and that's       exciting for me because I'm a part of it, but I'm going to let you tell us       about what's going on in Atlanta."
       
       

       "Over the years, I've pretty much stayed in the realms of clinical       IVF and have just not really concerned myself with the overall IVF       program... as it were, the running of the clinic. But one of the       increasing areas of interest to me has actually been the impressions-- the       running of the IVF program in general - what it is that couples who come       in for treatment actually appreciate when they come through for their       therapy. Increasingly, although to some extent with my head in the lab you       know it shouldn't be so much my business, but it's occurred to me that       maybe by creating a more appropriate environment, one more conducive or       more appealing to the couples, that I would like to work in an IVF program       that offers more than just a regular IVF program. What I'm trying to say       is that I've developed an interest in starting up a new program in       Atlanta, and you're on board with that as you are fully aware, to provide       a more comfortable and more appealing personalized service for IVF and to       combine that with what I hope will be one of the more technologically       advanced laboratories in the U.S. And to try and fuse those two approaches       to perhaps give us the potential to have a very holistic approach, both       patient-couple treatment lies, providing a good breath of infertility       therapies but coupling that with certainly some of the best high       technology that the IVF lab can provide."
       
       

       "Unfortunately, in many programs today you have the lab over here and       you have the physicians over there and the patient gets caught in the       middle. So I think this approach of working together as a team is going to       be the best of both worlds. It bolsters us and the interaction we have as       physicians with laboratory personnel. But for our knowledge, I think we       can make better decisions by working together with the lab as a team and       involving the patients."
       
       

       "It's intrigued me over the years because I've traveled enough and       actually consulted at enough clinics throughout the world that when people       actually approach me and say, 'what's the most common problem that you'll       ever observe in the clinics that you go to?,' they expect me to say, 'the       embryo incubators are often out of whack' or 'the air quality is wrong' or       'the stimulation protocols are just not up to snuff.' But in reality the       main, most consistent problem I run into is actually communication within       the clinics. It's just as you say - you've got various camps and if       they're not communicating in a harmonious way, I think the service that's       provided by that clinic is sub-optimal. Certainly it's also been one of my       observations that certain couples that come through, for IVF treatment in       particular, often feel very short changed when it comes to access to the       laboratory personnel. It's like this black box - what the heck is       happening? Yes, they'll sit and have free full consultations with the       physicians, but it's just like they reach a certain point and then access       to information stops. It's not that anyone in particular is trying to keep       anything from them in the IVF lab, but traditionally we've not been so       accessible. Certainly that would be a hallmark of the clinic that we're       starting up in Atlanta, Georgia - reproductive specialists. I think a       hallmark of that will be open accessibility of the couples to all the       staff in that clinic. I think that will be absolutely key, while for us       scientists sometimes it's a little bit scary to feel - how shall we say it       - more exposed, I think we owe it to the people that we serve to give them       better access to that side of things."
       
       

       "In the past, what's gone on in the laboratory has been considered a       black box. The patients' exposure has been to come in and get their       injections, and then they really don't know what's going on until they get       back an embryo that's transferred, or two embryos. They're really not as       involved. So I think that this is a new approach that's going to be       exciting. But it's obviously not just the two of us... you've brought       along some others."
       
       

       "You've brought along an experienced team, and you may want to say       something about the other people."
       
       

       "I'm very fortunate in having two other colleagues that I have worked       with over the last seven years, previously in Atlanta, and latterly in       several consultation projects that I've help run the last year or so.       They're a very experienced lab team from everything from andrology to       endocrine lab to especially the ART lab itself, bringing expertise in the       form of two other embryologists, Cindy Sweitzer and Paula Morton, who as I       said previously, worked with myself in Atlanta. We're very privileged to       have them come on board, in terms of the lab team. But it has to be said,       you can't have a program which is small but, nevertheless, successful in       the Atlanta area. I think that takes bringing a whole nursing staff team       which is well experienced on board, and with the addition of Dr. Carolyn       Kaplan and also Dr. Scott Sills from your current program, I think this       will be a very cohesive and harmonious team. I think we have a lot to       offer in terms of expertise and stuff. It's very exciting."
       
       

       "One of the things that I hope happens is that you'll be too busy to       do all the traveling and fix programs abroad, or at least maybe a little       bit less than you've done in the past. Will there be opportunities for       people to come in and visit the lab and learn on site?"
       
       

       "Certainly. Something I've always encouraged in the past has been a       pretty open lab policy to allow anybody to come in - physicians and       scientists from other clinics. I've always done that, I think it's       important in this area of medicine to share knowledge as much as we can,       because I think we all learn so very much. Yes, it would be very much an       open door policy in the lab that we set up, and that said, the extent of       my consultations and experiences in labs outside will be wound down, not       because it's not a pleasure and a privilege to work in the many other       places I have; it's simply that traveling can get a little bit onerous       after a while. I will certainly maintain my principal relationship with       the Shady Grove group I've been with in Rockford, Maryland, who have given       me a great opportunity this last year. It's been a privilege to work with       them in a very large program up in the Washington, D.C. area. We will       maintain that relationship, and I think by maintaining that relationship       and the several other regional laboratory programs which I help in, it       fosters a network of groups which improves your level of understanding,       appreciation, and overall currency with what's happening in the field. The       more cycles you undertake, the more exposure you have to day-to-day       running of IVF, the more you keep your finger on the pulse of what's going       well and what's not. So I think that will be a great benefit to ourselves       in Atlanta, and I hope that the spin off is that we'll be able to help a       lot of other programs too."
       
       

Author | Michael J. Tucker, PhD, FIBiol

Articles

Cervical Cancer

New Developments in IVF