1. Reproductive Technology
Chapter 21

2. Assisted Reproduction
When a couple is sub-fertile or infertile they may need Assisted Reproduction to become pregnant:
Replace source of gametes
Sperm, oocyte or zygote donors
Aid in the fertilization process
Replace the uterus
Surrogate mothers
Treat cause of infertility

3. Infertility
Clinically defined as inability to conceive after more than one year of intercourse without contraception
World Health Organization
Defines sub-fertility as diminished ability to conceive
Infertility as complete inability to ever conceive
Personally
Means changing your entire life plan

4. Infertility Statistics
Affects about 1 in 6 couples in USA
Cause can be identified in about 85% of cases
Can be treated successfully in about 85 – 90 % of couples
Problem in female – 50%
Problem in male – 30%
Problem in both partners – 20%

5. Male Infertility Problems: Oligospermia – low sperm count
Caused by: hormones, environment, physical
Poor sperm quality
Motility – sperm can’t swim
Abnormality – sperm are abnormally shaped
Antibodies against own sperm
Autoimmune disorder

6. Genetics of Male Infertility
Oligospermia – low sperm count
Genes: hormones, Y chromosome abnormalities, testicular/prostrate development
Environment: drugs, toxins, heat (kills)
Poor sperm quality
Genes: hormones, enzymes to harness energy
Environment: drugs, toxins, heat (mutates)
Antibodies against own sperm
Genes: Immune system malfunctioning

7. Treatment of Male Infertility
Primary – change environment
Avoid heat, drugs, toxins
Timing intercourse
Secondary – correct hormone levels, surgery corrects physical problems, immune suppressants
Final – Assisted Reproduction Technologies

8. Female Infertility Problems: Irregular/malfunctioning ovulation
Hormone imbalance, malfunctioning or absent ovaries or tubes
Physical blockage
Fibroids or Endometriosis
Blocked/abnormal Fallopian tubes
Vaginal secretions
Hormones or certain diseases

9. Female Infertility

10. Genetics of Female Infertility
Irregular/malfunctioning ovulation
Genes: Hormones, thyroid, pituitary problems
Environment: Birth control, stress
Physical blockage
Genes: Cancer, developmental defect
Environment: Cancer or infections
Vaginal secretions
Genes: Hormones, mucus disorders, immune

11. Treatment of Female Infertility
Primary – change environment
Timing intercourse - checking for ovulation
Decrease stress, diet, exercise, etc
Secondary – correct hormone levels, surgery to correct physical problems
Final – Assisted Reproduction Technologies
More often necessary for female infertility

12. Infertility Testing
Couple seek testing after trying for more than one year
Tests:
Semen Analysis (male)
Hormone levels checked (female)
Physical exams (both)
Hysterosalpingogram (HSG; female)
Endometrial Biopsy (female)
Post coital exam (done on female)

13. Assisted Reproductive Technologies (ART)
Donating gametes
Surrogate mothers
Helping bring gametes together (fertilization)
Putting zygote in correct place
Preimplantation screening

14. Donating gametes Sperm donation: Oocyte donation:
For Lesbian couple or male infertility
Sperm can be inseminated into uterus or cervix (artificial insemination)
Or sperm can be mixed with oocyte and zygote implanted
Oocyte donation:
Mixed with sperm and implanted as zygote
More costly and harder to come by than semen

15. Surrogate Mothers Book defines as “donating uterus” Surrogate mothers:
What else?
Also time, energy, effort, hormones, blood, diet, health care
Surrogate mothers:
Inseminated with father’s semen, using her own oocytes
Or may be implanted with a zygote from couple’s gametes
Legal rights of surrogate mothers vary by state and country

16. Helping Fertilization
IVF – in vitro fertilization
Sperm and oocyte are mixed in Petri dish
Embryo at 8 or 16 cell stage implanted into uterus
ICSI – intracytoplasmic sperm injection
Sperm actually microinjected into oocyte
Then embryo implanted into uterus
Important when father has low sperm count or large number of abnormal sperm

17. in vitro Fertilization (IVF)
Problem is that egg and sperm can’t meet:
Blocked tubes or abnormal structures
Not enough healthy sperm
Put sperm and egg together in dish and then implant early embryo into uterus
Costs $5,000 to 15,000 each try
Success rate ~ 30%
Children have ~ twice rate of birth defects

18. ICSI
IVF where sperm is injected into oocyte

19. Improving IVF’s chances:
Use ICSI
Implanting more than one embryo
What is the problem there?
Implant embryos at later stage in development (blastocysts)
Culturing zygote with “helper” cells that normally surround embryo
Screening embryos for chromosomal abnormalities

20. Helping Fertilization
ZIFT – zygote intrafallopian transfer
Same as IVF only implanted into fallopian tube rather than uterus
Less successful than IVF (~23%)
GIFT – gamete intrafallopian transfer
Deposit the sperm directly into fallopian tubes
Or deposit sperm and oocytes (mother’s or donor’s) into fallopian tubes
Like IVF that happens internally (~26%)

21. Preimplantation Screening
Screening for genetic disorders BEFORE pregnancy begins:
One cell of 8 cell embryo is removed
Single cell is karyotyped and probed with FISH for specific genetic disorders
Preimplantation Genetic Diagnosis (PGD)
Only genetically “healthy” embryo is implanted (IVF)
~ 29% success rate

22. PGD
Screen for:
Large chromosomal abnormalities
Rare Mendelian Disorders
Boys with X-linked disorders
PGD often done on IVF embryos to screen for chromosomal abnormalities commonly associated with IVF procedure
Weigh risk of disease vs. IVF not working
Who could help make this decision?

23. “Spares” Every time IVF is done more embryos are made than are used
~ 500,000 embryos are currently in deep freeze in USA today from IVF
Choices:
Research – example: stem cells
Donation to infertile couple
Discard them
Who should make this choice?

24. Adoption Domestic Adoptions: International Adoptions:
$5,000 to $40,000
Must pass stringent screening process:
Salary, housing, marital situation, criminal records
International Adoptions:
$7,000 to $30,000
Different screening processes
Foster Care Adoptions:
Free or subsidized – older and abused children

25. Lets Talk about Ethics…
Get into groups of four
Discuss what you think of each of these ART situations as if you were:
One member of couple in question
Politician (pro life and pro ART)
Insurance company representative
Genetic counselor

26. Ethics of ART
1. A young, married couple is infertile. They have basically no insurance because he works as a free lance consultant and she works two part time jobs. Although they own a home and can afford to raise a child they can not afford to undergo the testing or treatments for their infertility. Neither can they afford adoption.

27. Ethics of ART
2. A lesbian couple has one child. The mother was inseminated from a sperm donor and carried the baby produced from her own oocyte. They happily raise the child together for 6 years, until the mother suddenly finds religion and decides that homosexuality is wrong. When they break up the mother wants the child but so does her ex.

28. Ethics of ART
3. An infertile couple has insurance that covers IVF but they don’t believe in using ART because of their religion. They would rather adopt, but their insurance doesn’t cover adoption (most don’t) and they can’t afford it.

29. Ethics of ART
4. An infertile couple uses Clomid (a drug that stimulates ovulation) to become pregnant. Suddenly they find themselves pregnant with 6 embryos. They don’t believe in selective reduction so they are going to try to carry all 6 babies to term. Their doctor knows that the babies won’t be healthy. The father concurrently loses his job, so now they have no insurance.

30. Ethics of ART
5. A couple wants to use PGD to make sure they have a girl.
What would you think if:
They have 5 boys and want a girl
They live in China and can only have one child
They know the mother carries an X linked disease