But how old, how safe, and how much?: Fiammetta Rocco talks to the Italian obstetrician, Dr Severino Antinori

DR SEVERINO Antinori, the Italian obstetrician at the centre of the storm over fertility treatments for older women, is very angry. Indeed, ever since it emerged that one of his patients - an unnamed Englishwoman of 58 - is expecting twins in December, he has been apoplectic at what he believes to be 'a conspiracy by certain British scientists' to destroy his professional reputation.

Between bouts of shouting, Antinori sucks on his bristly moustache, and, bull-like, snorts breath from his nose. 'They have said that I'm unprofessional. That I'm an extortionist, a blackmailer. No one does that to me. I shall fight. I have an English lawyer coming here tomorrow,' he says.

'I have sued before, and I shall do so again. I want to see them in prison,' he concludes, crashing an open hand down on to the leather-topped desk. His blonde wife, Caterina, a biologist, smokes long ultra-thin cigarettes in the corner of his office and occasionally murmurs: 'Calma Severino. Calma.'

The shutters in Antinori's Rome clinic were closed last week to keep out the spiteful summer heat that has already sent many Romans to the hills. On one wall of his office are blown-up photographs of a fertilised human embryo in the early stages of development, where a single cell divides into two, and then four. Beside them, huge studio snaps show the doctor in theatre greens. He cradles in his arms those same embryos, now plump infants with curly hair and dimpled cheeks.

No more potent image exists for the barren couples who visit Antinori's clinic than these baby pictures - Kodacolor proof that God rewards those who persist in their quest to reverse the failures of the human body. Is it surprising that so many of the parents look slightly startled?

Antinori denies absolutely that there is anything wrong in what he does. 'Every woman has the right to have a child. These women come to me when they have nowhere else to go, and I help where I can. Of course, there are ethical issues to be discussed. And they should be discussed, freely and openly. But who says it's not right for a woman to have a child at 55? A man can have a child at that age, and everyone says, 'Isn't he clever'. But those same people say that a woman of 55 is a dishrag, good for throwing out on the dungheap. It's a disgrace. Una vergogna.'

Anita Blokziel is 56-year-old former circus acrobat from Amsterdam. Last month, she gave birth to a baby girl. Ms Blokziel's only child, born when she was 22, died in an accident. She and her boyfriend went to Antinori after reading about his work in a Dutch newspaper. 'The doctor has made me the happiest of women,' she says. 'He has given me a miracle. He, and the Pope who gave me his blessing.' She was blessed, with hundreds of others, during an audience given weekly by His Holiness.

Antinori's Raprui clinic, where Ms Blokziel was treated, is a stone's throw from the Vatican. It was established in 1987 to implement a number of the new treatments from the cutting edge of infertility research.

Over the years, Antinori has made many women happy. Anita Blokziel is just one. But behind the happy photographs lies another story - one of new medical techniques, professional jealousy that borders on the obsessive and, not least, money.

At stake, for the handful of doctors and research scientists involved, is the promise of phenomenal scientific and academic acclaim and untold wealth. 'The only real problem that hasn't been solved in this area,' says Simon Fishel, a former associate of Antinori's and now scientific director of Nottingham University's infertility unit, Nurture, 'is how old the woman, and how safe the treatment. Nobody has that data.'

At any one time, Antinori estimates, more than 30,000 women worldwide are being offered the most sophisticated techniques available to assist conception. They spend an estimated pounds 230m a year. His own clinic, he says, last year posted profits of more than pounds 400,000 after taxes and overheads.

Antinori was born in 1945 in Abruzzo, the same mountainous region east of Rome that is home to Antonio di Pietro, the judge in charge of Italy's anti-corruption drive. 'We are one and the same, di Pietro and I. Men of stone,' he says, not acknowledging the pun.

Antinori trained in Rome as a vet, specialising in embryology research. 'That is what first interested me in the sphere of human reproduction.' He went on to study gynaecology and obstetrics, and began treating infertility in Venice and then at the Istituto Materno Regina Elena, a Rome hospital.

It was there that he first came across the work of Simon Fishel, whose research into male infertility led him to develop a technique of injecting a single sperm into the outer membrane of the ovum (female egg). Until recently Fishel's pioneering work, known as the Suzi method, was not authorised by the British authorities, and he was forced to go to Italy where he helped Antinori set up the Raprui clinic.

At the same time, Antinori also learned of the work of an Australian scientist, Peter Lutjen. In a Nature article in 1984, Lutjen described his success in helping a 25-year-old woman who had suffered a premature menopause to conceive and bear a child. He used a combination of hormone treatments to re-invigorate the uterus and in vitro fertilisation of a donated egg.

It was this technique that Antinori began to offer women past normal menopausal age.

All women are born with their life's quota of ova. What stops conception is not so much the extinction of the ova as the failure of the uterus.

However, two breakthroughs helped accelerate the use of the technique that so far remains nameless: the development of hormone treatments that gives a shrunken post-menopausal uterus a new lease of life, and the possibility of extracting donors' eggs without the added complication of using a general anaesthetic. 'These were the most important frontiers that we crossed,' he says.

Although similar work is being done in a number of US clinics, principally in California, and in Australia, Italy's lax rules on fertility treatments allowed Antinori to forge ahead, creating a group of women now known as le mamme-nonne, or 'granny- mummies'.

Unlike in Britain, for example, where the authorities allow a maximum of three fertilised embryos to be implanted, Italy sets no such limit. Also, the rules on who decides whether a women can be given such treatment are far less rigid than they are here. As a result, Antinori says, 45 babies have been born over the past two years to women in their mid- 50s and early 60s.

One of Antinori's earliest successes was with a 53-year-old Sicilian housewife, Giuseppina Maganuca, who gave birth to a daughter 19 months ago after 32 years of marriage in which she remained childless. 'My baby is an angel,' she says, 'and the doctor is a saint . . . . Motherhood is marvellous, especially at my age. The only difficulty I have is keeping up the energy looking after my baby. But it is wonderful. At the end of each day, I am not tired. Just deliriously happy.'

Some of his other cases, however, have been less orthodox. In 1988, a young woman named Maddalena gave birth after Antinori implanted in her uterus an egg donated by her mother and fertilised with the sperm of the mother's boyfriend. In 1992, a 61- year-old widow from Palermo gave birth after Antinori implanted in her uterus an embryo fertilised with the husband's sperm, which had been frozen before his death seven years earlier. It is uncertain whether the sperm was really her husband's, given that helping post-menopausal women to give birth was unthinkable in 1985. 'But,' says Antinori, 'she came introduced by her priest. So I believed her.'

Although many of the women he helps are unstinting in their praise of his work, Antinori's critics in Italy condemn him loudly, not least for his taste for publicity. Last year the doctor let slip to reporters that he had been contacted by an associate of Cable News Network chairman Ted Turner asking if Antinori would treat 55- year-old Jane Fonda whom Turner had just married. Mr and Mrs Turner denied being behind the call.

It is not just the self-publicity that his critics deplore. Monsignor Elio Sgreccia, who is in charge of the bio-ethical commission at Rome's Catholic University, has condemned his work as 'horrifying', while the Catholic daily Avvenire says he is 'creating pre-fabricated orphans' whose parents will be too old to see their children through adolescence. The Archbishop of Ravenna, Monsignor Erzivio Tonini, regarded as a barometer of Papal opinion, has attacked him at every opportunity, even comparing Antinori to Hitler. 'This is the road to self-destruction,' he said recently.

Antinori believes the Holy See is out to destroy him, despite the fact that several of his Italian patients have been introduced by their parish priests. He hints darkly at Papal investigators interrogating his patients and adds: 'The Church burnt Giordano Bruno at the stake. They persecuted Galileo Galilei. And now they're persecuting me. And look at the mess they've made of their own affairs, like the Vatican Bank.'

International criticism of Antinori focuses not just on the ethics of helping women who are simply too old to conceive naturally - a technique which is hardly unique to Antinori - but on the legal framework within which his work is being carried out. Much of the criticism borders on the hysterical. But in a trenchant article published last week, Robert Winston, professor of fertility at the Hammersmith Hospital in London, argued that although on the face of it, Antinori's work may seem laudable, it reduces 'IVF treatments to the status of trading in a commodity.'

Helping post-menopausal women have children not only risked enormous potential problems for the expectant mothers and their babies, but posed a serious ethical dilemma for the egg donors who have no say in how their unique genetic material is used. Moreover, he added, the controversy that surrounds Antinori's work 'risks bringing an important technique into disrepute'.

Antinori, by contrast, sees even the most constructive criticism voiced by British doctors and researchers as an organised conspiracy, motivated by greed and envy, to ruin his reputation and destroy him. 'They are all in it,' he shouts, placing most of the blame on Winston and Antinori's former colleague Simon Fishel. 'I have had death threats. Last Tuesday, I received a call from a man who said he was a friend of Fishel and Winston, and that he would kill me if I came to Britain.' Antinori, who had been planning to fly to London the following day, cancelled his trip.

Already, Antinori is preparing to fight back. A British lawyer flew to Rome on Friday to advise him on bringing a libel case against a tabloid newspaper. Another defamation suit he has brought against a British scientist working in Naples, Brian Dale, will have its final hearing in Rome on 16 November.

Antinori is considering whether to bring yet more lawsuits against those he believes have defamed him. Meanwhile, Jennifer F, the Englishwoman pregnant with twins - whose desperation for a child embodies the longings and fears of every woman seeking medical treatment for infertility - has been calling Antinori daily in tears. And a Rome photographer, who took pictures of her smiling alongside Antinori at the time of her treatment, has been instructed by the doctor to lock them away in a safe until the row dies down.

(Photographs omitted)

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