2012 marek vácha it is not birth, marriage, or death, but gastrulation, which is truly the most...

2012Marek Vácha

It is not birth, marriage, or death, but gastrulation, which is truly the most important time in your life.

Lewis Wolpert (1986)

citizenship year

AR: Number of cycles

on the whole donors of oocytes women going to the IVF+ET

Czech Rep.

2007

15169 593 14576

European Union 2045 11 2034

Outside EU 528 1 527

On the Whole 17742 605 17137

Czech Rep.

2008

17300 1271 16029

EU 3328 9 3319

Outside EU 721 1 720

On the Whole 21349 1281 20068

Czech Rep.

2009

17299 1243 16056

EU 4453 1 4452

Outside EU 761 0 761

On the Whole 22513 1244 21269

Zdroj dat: Národní registr asistované reprodukce, ÚZIS ČR

Numbers of Sperms

1940 113 millions /ml

1990 66 millions /ml

the number of „normal“ sperm fell from 60 million per mL to 20 mL in the same period(Carlsen, E., Giwercman, A., Keiding, N., Skakkebaek, N., (1992) Evidence of decreasing quality of semen during past 50 years. Brit. Med. J. 305: 609-613)

Man Examination: Spermiogram

Normal spermiogram Pathological Spermiogram

Woman Examintaion Ultrasound

Ovulation cycle Anovulation

First „test tube baby“

July, 25, 1978 – Louise Brown

Louise Brown with her parents, 25-year-oldin 2003

A Delivery. LB. Patrick Steptoe right, Robert Edwards left

They persisted through more than 40 embryo transfers before obtaining their first pregnancy. Unfortunately it was ectopic and had to be aborted. Louise Brown was born from the second pregnancy.

2010: Nearly four million babies have been born using IVF fertility treatment since

1978.

Prof. Edwards and Louise Brown, 2008, in the day of her 30th birthday

1983 = donation of oocyte 1993 = ICSI 2000 = PGD

Czech Rep.

1982 - Brno – first IVF at eastern block, GIFT. But till 1987 at ČR 10 children only

1988 – first twins at ČR 1994 – first triplets at  ČR

Useful terms AIH - homologous fertilization = artificial

insemination husband AID - heterologous fertilization = artificial

insemination donor “ (Encyclopedia of Bioethics,4/2219)

IVF + ET

Therapy II. MUDr. Karel Janíček

Stimulation of Ovulation

Therapy III. MUDr. Karel Janíček

Intrauterinne insemination

Therapy IV. MUDr. Karel Janíček

In vitro fertilization (IVF)

Therapy V.MUDr. Karel Janíček

ICSI (intracytoplasmatic sperm injection)

Testicular Biopsy for ICSI e.g. here:http://www.medicalvideos.us/play.php?vid=1363

ICSI e.g. herehttp://www.dnatube.com/video/2716/ICSI--Intracytoplasmic-Sperm-Injection

USA

the average cost per delivery in 1994 was $ 66,667 for couples undergoing their first cycle of oocyte maturation...

...rising to over $ 114,250 for those couples on their sixth attempt this does not include the hospital fees for

multiple births (which often exceeded $ 100 000)

(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 77)

USA

Right now, it is strictly a market economy, and there is very little regulation put on any physician who wants to start a clinic.

If a couple knows it might be possible to have a genetically related child if only they were wealthy enough, does it frustrate more people than it helps?

(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 77)

USA

In U.S. courts, frozen embryos usually are considered property. This makes them contested items if the coupel divorces.

In February 2005, a couple undergoing IVF in Chicago found that one of their preserved fertilized eggs had been thrown out by mistake The couple filed a wrongful death lawsuit, and won. The court ruled that this embryo was a human being even

though it had not even been implanted into uterus. Currently (=2005) there are more than 100 000 frozen

embryos in storages, and this number is growing at around 20 000 embryos per year

(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 79)

Donation of gamets

up to 85 % IVF+ET is taking place with the help of ICSI Sweden: every citizen 18+ has the right to

know his or her biological parents When Sweden passed a law in 1985 requiring

that the identity of the semen donor should be recorded to enable the child at eighteen years of age to contact the biological father, this resulted in the almost total disappearance of donors in Sweden and frequent referral of couples to other parts of Scandinavia

at ČR is donation anonymous

Australia: A registry identifying donors is open to children at age eighteen, equialent to the law on adoption

American states, however, have uniformly protected the identity of donors and recipients

(Dorff, E.N., (2003) Matters of Life and Death. A Jewish Approach to Modern Medical Ethics. The Jewish Publication Society, Philadelphia, PA, p. 86)

prenatal sex selection

there are 100 million fewer living women than we should expect 44 million fewer in China 37 million fewer in India

(Blackburn, S., (2001) Ethics. A Very Short Introduction. Oxford University Press, Oxford, p. 50)

A study based on 1,1 million Indian household in 1997 showed that although

numbers of boys and girls born were almost equal for the first child

759 girls were born per thousand boys for second children

and only 719 girls per thousand boys for third children

this practice accounted for 10 million fewer indian girls being born over the last 20 years

(Mepham, B., (2008) Bioethics. An Introduction for the Biosciences. Oxford University Press, Oxford, p. 125)

http://www.bbc.co.uk/news/world-south-asia-13264301

preimplantation genetic diagnosis

the American Medical Association has advised physicians that sex selection of this kind in the absence of any accompanying health problems is not something that physicians should do.

(Richards, J.E., Hawley, R.S., (2005) The Human Genome. A User´s Guide. 2nd ed. Elsevier Academic Press, Burlington, MA, USA, p.386)

- if PGD is not permitted, pregnancy and abortion might occur instead

following a public consultation exercise in the UK, the HFEA announced in 2003 that it had decided to ban sex-selection for „family balancing“, although permitting it where a child of one sex would risk inheriting a serious genetic disorder

„Your child will be female, which increases the risk of sexual abuse, domestic violoence and poverty.“

the American Medical Association has advised physicians that sex selection of this kind in the absence of any accompanying health problems is not something that physicians should do.

(Richards, J.E., Hawley, R.S., (2005) The Human Genome. A User´s Guide. 2nd ed. Elsevier Academic Press, Burlington, MA, USA, p.386)

generally, the sex selection in USA is made for the second or third baby, not for the first

Ovum donation

UK

In 2003 in the UK only 20 eggs were donated for research, and in general those that are surplus to requirements in IVF programmes tend to be of poor quality.

this led the HFEA in 2007 to permit researchers to reimburse women up to £250 for their eggs, although the donors will be required to show that they are „acting altruistically“

women donating eggs in this way may also have the fee for their own IVF treatment halved, which would be equivalent to a payment of about £1500

UK

critics suggests that this is likely to result in the exploitation of poorer women, many of whom may be induced to travel to Britain from abroad to sell their eggs.

(Mepham, B., (2008) Bioethics. An Introduction for the Biosciences. Oxford University Press, Oxford, p. 143)

Possible scenarios of the future

Collins, F., (2006) The Language of God. Free Press, New York, p. 269)

notable cases in the UK were the applications to the HFEA from two set of parents (the Hashmi and Whitaker families) for permission to select embryos (=saviour siblings) to treat their existing children, who suffered from beta-thalassaemia and rare non-inherited disease Diamond-Blackfan anaemia respectively

in each case, the proposed strategy was to harvest stem cells from umbilical cord blood following the birth of the younger sibling,with the aim of using stem cells in a bone marrow transplant and subsequently curing the disease in the older child through the production of healthy blood cells

Saviour Siblings

The Hashmis were granted permission by the HFEA in 2001 to create and tissue-type embryos, because it was argued that the use of PGD would be in the interests of both the prospective child and its older sibling

by contrast, the application made to the HFEA in 2002 by Whitakers was refused, on the grounds that the unborn child should not be exposed to the hazards of PGD when there was no direct benefit to the younger sibling – because DBA is not inherited

Saviour Siblings

…consequently, the couple went to the USA to receive PGD treatment,resulting in the birth of a son in 2003.

following a subsequent House of Lords ruling, the HFEA granted a license for use of saviour sibling PGD in the case of the Fletcher family, whose son also suffered from DBA

Saviour Siblings