What is Assisted What is Assisted Reproduction Technology?Reproduction Technology?

What is ART (Assisted What is ART (Assisted Reproduction Technology) ?Reproduction Technology) ?

►Group of high tech treatment methods Group of high tech treatment methods to improve infertility.to improve infertility.

►Techniques includeTechniques include In Vitro FertilizationIn Vitro Fertilization Artificial InseminationArtificial Insemination Gamete Intra-Fallopian TransferGamete Intra-Fallopian Transfer And many moreAnd many more

History of ARTHistory of ART

► 1978- first successful 1978- first successful birth using In Vitro birth using In Vitro FertilizationFertilization

► 1984- first successful 1984- first successful birth using Gamete birth using Gamete Intra Fallopian Intra Fallopian TransferTransfer

► 1986-first successful 1986-first successful birth using Zygote birth using Zygote Intra Fallopian Intra Fallopian TransferTransfer

What is Infertility? What is Infertility?

► Inability to conceive a baby after one Inability to conceive a baby after one year of unprotected intercourse.year of unprotected intercourse.

►Affects the reproductive organs of Affects the reproductive organs of both men and women.both men and women.

► Infertility affects about 15% of couples Infertility affects about 15% of couples in the United States.in the United States.

Factors Affecting ConceptionFactors Affecting Conception

► Production of healthy Production of healthy sperm sperm

► Healthy eggs by the Healthy eggs by the womanwoman

► Unblocked fallopian Unblocked fallopian tubestubes

► The ability for the sperm The ability for the sperm to fertilize the eggto fertilize the egg

► The ability for the The ability for the embryo to implant in embryo to implant in the uterusthe uterus

Causes of Infertility in Causes of Infertility in WomenWomen

► The older a woman is The older a woman is the higher her the higher her chances of becoming chances of becoming infertile.infertile.

► Ovulation disorderOvulation disorder► Blocked fallopian Blocked fallopian

tubes caused by a tubes caused by a pelvic inflammatory pelvic inflammatory disease or disease or endometriosis (a endometriosis (a condition that causes condition that causes adhesions and cysts).adhesions and cysts).

Causes of Infertility in MenCauses of Infertility in Men

► Lack of sperm productionLack of sperm production► Inability to ejaculate Inability to ejaculate

normallynormally► Varicocele- veins in the Varicocele- veins in the

scrotum are enlarged scrotum are enlarged which can heat the inside which can heat the inside of the scrotum and can of the scrotum and can affect sperm production.affect sperm production.

► Teratospermia- increased Teratospermia- increased percentage of abnormal percentage of abnormal shaped spermshaped sperm

StatisticsStatistics

► Infertility affects more than 15% of the Infertility affects more than 15% of the couples in the United States.couples in the United States.

► About one-third of infertility cases are About one-third of infertility cases are caused by male factors.caused by male factors.

► In about 20% of infertile couples the cause In about 20% of infertile couples the cause is unknown.is unknown.

► The remaining one-third of infertile cases is The remaining one-third of infertile cases is caused by a combination of factors in both caused by a combination of factors in both partners. partners.

► The chances of becoming pregnant The chances of becoming pregnant decreases 3-5% per year after the age of 30.decreases 3-5% per year after the age of 30.

Most Common Choices of Most Common Choices of TreatmentTreatment

► In Vitro FertilizationIn Vitro Fertilization► Artificial Artificial

InseminationInsemination► Frozen EmbryosFrozen Embryos►Gamete Intra Gamete Intra

Fallopian TransferFallopian Transfer► Zygote Intra Zygote Intra

Fallopian TransferFallopian Transfer

Artificial InseminationArtificial Insemination

► Sperm is collected Sperm is collected and placed into a and placed into a woman’s vagina, woman’s vagina, cervical canal or in cervical canal or in the uterus.the uterus.

► Sperm can come Sperm can come from your partner or from your partner or an anonymous an anonymous donor.donor.

In-Vitro FertilizationIn-Vitro Fertilization► Procedure that involves Procedure that involves

retrieving eggs and sperm retrieving eggs and sperm from the bodies of the male from the bodies of the male and female partners and and female partners and placing them together in a placing them together in a laboratory dish to enhance laboratory dish to enhance fertilization.fertilization.

► Fertilized eggs are then Fertilized eggs are then transferred several days transferred several days later into the female later into the female partner's uterus where partner's uterus where implantation and embryo implantation and embryo development will hopefully development will hopefully occur as in a normal occur as in a normal pregnancy. pregnancy.

Gamete Intra-Fallopian TransferGamete Intra-Fallopian Transfer(GIFT)(GIFT)

► A mixture of a A mixture of a woman’s eggs and woman’s eggs and sperm are placed sperm are placed into the fallopian into the fallopian tube during a tube during a laparoscopy.laparoscopy.

►Once inserted, Once inserted, fertilization is fertilization is allowed to occur.allowed to occur.

Zygote Intra-Fallopian TransferZygote Intra-Fallopian Transfer(ZIFT)(ZIFT)

►Mixture of In Vitro Mixture of In Vitro Fertilization and Fertilization and Gamete Intra Gamete Intra Fallopian Transfer.Fallopian Transfer.

► Fertilization takes Fertilization takes place outside the place outside the uterus and placed uterus and placed into the fallopian into the fallopian tubes.tubes.

Intra-Cytoplasmic Intra-Cytoplasmic Sperm InjectionSperm Injection

► Sperm is injected Sperm is injected directly into the eggs directly into the eggs in a laboratory.in a laboratory.

► Used if infertility Used if infertility originates from the originates from the male such as:male such as: Low numbers of Low numbers of

spermsperm Severe TeratospermiaSevere Teratospermia

Frozen EmbryosFrozen Embryos

► Embryos may be Embryos may be taken from an taken from an individual and stored individual and stored for later use.for later use.

►Once ready to use, Once ready to use, they can be thawed they can be thawed and then placed into and then placed into the uterus.the uterus.

► This allows a higher This allows a higher chance of pregnancy.chance of pregnancy.

Selecting an ART ProgramSelecting an ART Program

►Qualifications and Qualifications and experience of the experience of the clinic and its clinic and its personnel.personnel.

► Support services Support services availableavailable

► CostCost► Success rates of Success rates of

that specific that specific programprogram

How Does this Affect Me?How Does this Affect Me?► Knowing your body, as well Knowing your body, as well

as taking care of your body as taking care of your body increases your chances of increases your chances of becoming pregnant. becoming pregnant.

► If you are considering having If you are considering having children in the future, the children in the future, the best thing to do is practice best thing to do is practice safe sex, take care of your safe sex, take care of your body and stay away from body and stay away from harmful contaminants such harmful contaminants such as smoking and other types as smoking and other types of drugs. of drugs.

► Fertility affects us all, male or Fertility affects us all, male or female and attending the female and attending the doctor regularly can increase doctor regularly can increase your chances of becoming your chances of becoming pregnant in the future.pregnant in the future.

Moral Issues Moral Issues

►What is the moral status of the egg, What is the moral status of the egg, sperm, and the embryo? sperm, and the embryo?

►What are the individual moral What are the individual moral constraints on trying for reproduction constraints on trying for reproduction “at any cost”? “at any cost”?

►Dehumanizing aspects of procedures Dehumanizing aspects of procedures ►Social implications of widespread use Social implications of widespread use ►Complexities of surrogacyComplexities of surrogacy

What is the moral status of the What is the moral status of the egg, sperm, and the embryo? egg, sperm, and the embryo?

►Moral status before sperm and egg Moral status before sperm and egg come together come together

►Moral status after sperm and egg Moral status after sperm and egg come together but before implantation come together but before implantation in the uterine wall in the uterine wall

► Including frozen fertilized eggs Including frozen fertilized eggs ►Moral status after implantationMoral status after implantation

Left-over Embryos Left-over Embryos

Typically, during fertility treatments, women Typically, during fertility treatments, women may store fertilized eggs, embryos, as part may store fertilized eggs, embryos, as part of their treatment. of their treatment.

Kept frozen for unanticipated catastrophe Kept frozen for unanticipated catastrophe A kind of immortality A kind of immortality Many major fertility centers have thousands Many major fertility centers have thousands

of these--10,000 per year nationally of these--10,000 per year nationally No federal agency oversees this No federal agency oversees this Sometimes embryos are donated to infertile Sometimes embryos are donated to infertile

couples, but legal issues about parental couples, but legal issues about parental rights persist.rights persist.

►Dr. Griffo, at Cornell, stored embryos Dr. Griffo, at Cornell, stored embryos for a married woman who subsequently for a married woman who subsequently died. Before she died, she said she died. Before she died, she said she wanted her embryos destroyed, and wanted her embryos destroyed, and her husband agreed. But now, Dr. Giffo her husband agreed. But now, Dr. Giffo reports, "her husband has changed his reports, "her husband has changed his mind and says he wants someone to mind and says he wants someone to carry the embryos" so he can have his carry the embryos" so he can have his dead wife's babies. dead wife's babies.

Difficult Cases, 1 Difficult Cases, 1

Difficult Cases, 2 Difficult Cases, 2

► Julie Garber of Anaheim, Calif., who, in 1994, was 26, single and Julie Garber of Anaheim, Calif., who, in 1994, was 26, single and dying from leukemia. She knew her only chance of surviving was dying from leukemia. She knew her only chance of surviving was to have a bone marrow transplant. Realizing that the treatment to have a bone marrow transplant. Realizing that the treatment would leave her sterile, she decided to store some embryos would leave her sterile, she decided to store some embryos beforehand. She had one month before the transplant to beforehand. She had one month before the transplant to accomplish this, said her mother, Jean Garber. accomplish this, said her mother, Jean Garber.

► Ms. Garber and her father, Dr. Howard Garber, a retired Ms. Garber and her father, Dr. Howard Garber, a retired optometrist, selected a sperm donor from a sperm bank to fertilize optometrist, selected a sperm donor from a sperm bank to fertilize her eggs. She ended up with 12 embryos, which are stored in her eggs. She ended up with 12 embryos, which are stored in Anderson's tanks, but she died last December. Her parents are Anderson's tanks, but she died last December. Her parents are now deciding between two potential surrogates who have agreed now deciding between two potential surrogates who have agreed to carry the embryos -- their grandchildren -- to term.to carry the embryos -- their grandchildren -- to term.

► "This is a love situation," Jean Garber said. The embryos, she "This is a love situation," Jean Garber said. The embryos, she added, "are so precious to me." They are a bit of her daughter, she added, "are so precious to me." They are a bit of her daughter, she said, "my friend and my business partner and my confidante. I said, "my friend and my business partner and my confidante. I miss her so much." miss her so much."

Difficult Cases, 3 Difficult Cases, 3

► A more typical situation, according to Dr. Sauer, is that of a A more typical situation, according to Dr. Sauer, is that of a couple in their early 30s who had in vitro fertilization and couple in their early 30s who had in vitro fertilization and completed their family. Now they have 10 embryos frozen at completed their family. Now they have 10 embryos frozen at Columbia-Presbyterian, and they have not replied to letters Columbia-Presbyterian, and they have not replied to letters asking them whether they want to keep the embryos or have asking them whether they want to keep the embryos or have them discarded. Dr. Sauer understands. Infertility is a them discarded. Dr. Sauer understands. Infertility is a devastating disorder that wreaks havoc on people's lives. The devastating disorder that wreaks havoc on people's lives. The young couple "have a family now," Sauer said. "They don't young couple "have a family now," Sauer said. "They don't want to be reminded of that period of their lives." So their want to be reminded of that period of their lives." So their embryos remain, frozen in perpetuity.embryos remain, frozen in perpetuity.

► Ethical Questions: Ethical Questions: ► What is the moral status of these embryos? Are they What is the moral status of these embryos? Are they

persons? persons? ► Should the embryos be destroyed? Should they be given to Should the embryos be destroyed? Should they be given to

couples or individuals who wish to have children? With whose couples or individuals who wish to have children? With whose permission? permission?

What are the individual moral What are the individual moral constraints on trying for constraints on trying for

reproduction “at any cost”? reproduction “at any cost”? ►Sex selection Sex selection ►Genetic screening for so-called Genetic screening for so-called

“defects” “defects” ►Selective abortion with multiple Selective abortion with multiple

fetuses fetuses ►Pregnancies and older women Pregnancies and older women ►Surrogate motherhood Surrogate motherhood ►CloningCloning

Dehumanizing aspects of Dehumanizing aspects of procedures procedures

►Greater freedom of choice Greater freedom of choice ►Much less natural process Much less natural process ►Conception as a medical event vs. an Conception as a medical event vs. an

act of love act of love ►Tacit pressure to use such Tacit pressure to use such

technologies if they are available technologies if they are available

Social implications of Social implications of widespread use widespread use

Vast demographic changesVast demographic changes

►Shift in male/female ratio Shift in male/female ratio ►Shift in age of parents relative to Shift in age of parents relative to their children their children

►Possible decline of two parent Possible decline of two parent family family

►Possible homogeneity in societyPossible homogeneity in society

Surrogacy Surrogacy

• Surrogacy occurs when 1 woman agrees Surrogacy occurs when 1 woman agrees to carry to term the fetus for another to carry to term the fetus for another person.person.

• That fetus may be from the egg and That fetus may be from the egg and sperm of the couple who want to raise sperm of the couple who want to raise the child or it may b donor eggs or donor the child or it may b donor eggs or donor sperm.sperm.

• What are the rights of the surrogate What are the rights of the surrogate mother? Of the individuals who ask her mother? Of the individuals who ask her to be a surrogate?to be a surrogate?

Surrogacy: The Possibilities Surrogacy: The Possibilities

► Intentional motherIntentional mother the woman who wants to have the the woman who wants to have the child child

► Intentional fatherIntentional father the man who wants to have the child the man who wants to have the child ► Genetic motherGenetic mother the woman who supplies the egg for the woman who supplies the egg for

the embryo the embryo ► Genetic fatherGenetic father the man who supplies the sperm for the the man who supplies the sperm for the

embryo embryo ► Gestational motherGestational mother the woman who carries the embryo the woman who carries the embryo

to term and gives birth to it to term and gives birth to it ► Nurturing motherNurturing mother the woman who raises and nurtures the woman who raises and nurtures

the child from infancy as her own the child from infancy as her own ► Nurturing fatherNurturing father the man who raises and nurtures the the man who raises and nurtures the

child from infancy as his own child from infancy as his own