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Fertility, infertility, and pregnancy. The phenomena Ethical issues. How to become pregnant. 1. Engage in sexual intercourse repeatedly. 2. If not yet pregnant, repeat step 1. For most couples, that script works well. For some couples, it doesn’t: Infertility. Conception.

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Fertility infertility and pregnancy

Fertility, infertility, and pregnancy

The phenomena

Ethical issues


How to become pregnant
How to become pregnant

  • 1. Engage in sexual intercourse repeatedly.

  • 2. If not yet pregnant, repeat step 1.

  • For most couples, that script works well.

  • For some couples, it doesn’t: Infertility


Conception
Conception

  • Sperm meets ovum: Zona pellucida

  • Sperm action: Enzymes and exocytosis

  • Fertilization: Chromosome pairing

  • Implantation:

    • Amnion, chorion, and placenta

    • Umbilicus

  • Zygote-morula-blastocyst-embryo-fetus


Infertility
Infertility

  • Inability to conceive

  • Identifying the contributing partner


Male problems
Male problems:

  • Low sperm count

  • Defective sperm

  • Low motility

  • Disease effects: diabetes, STIs

  • Drug effects, especially alcohol

  • Damaged testes: cryptorchidism, mumps, trauma

  • Autoimmune response to sperm

  • Hormonal problems: pituitary, thyroid


Female problems
Female problems:

  • Irregular ovulation, anovulation

  • Low body fat

  • STI damage to Fallopian tubes: PID

  • Reproductive system disease

  • Endometriosis

  • Aging

  • Allergic reactions to sperm or semen


Methods for dealing with infertility
Methods for dealing with infertility

  • Behavioral methods

    • Timing methods, male and female

      • Calendar method: Day 14

      • Basal body temperature

        • Take oral temperature with an electronic thermometer early in the morning, before rising.

        • Temperature is 97.8oF a few days before ovulation

        • Dips 0.4o to 0.8o the day before ovulation

        • Rises to 98.4o after ovulation.

        • The woman is fertile for 4 to 20 hours after ovulation

        • After 3 days of 98.4o, the couple is no longer fertile.


More behavior methods
More behavior methods

  • OTC test kits for LH in urine or saliva

  • Cervical mucus: roll between fingers

    • Thin, slippery, and clear around ovulation time

    • A mucus plug indicates the end of fertility

  • Males should reduce frequency of intercourse to increase sperm count


More methods
More methods

  • Control position to recruit gravity

  • Reader’s Digest method: Male should penetrate deeply, hold position for ejaculation, withdraw slowly

  • Change of venue

  • Change of underwear

  • Change of ambient temperature

  • Decrease athletic activity

  • Relax


Artificial enhancement of fertility
Artificial enhancement of fertility

  • Artificial insemination, husband donor

  • Artificial insemination, third party donor

  • In vitro fertilization

  • Fertility enhancing drugs

  • Ovum and oocyte transplants


Ethical and social issues
Ethical and social issues

  • Whose sperm? Whose eggs?

  • What do we do with extra embryos?

  • Eugenics

  • Selective reduction/abortion

  • Use of tissue from aborted babies

  • Sex selection

  • Surrogate motherhood


Contraception
Contraception

  • Why use contraceptive procedures?

    • Margaret Sanger and the Comstock laws

    • The Pivot of Civilization

      • http://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=1689

  • Why not use contraceptive procedures?

    • Roman Catholic teaching


Choosing contraceptive procedures
Choosing contraceptive procedures

  • Effectiveness

  • Convenience

  • Aesthetics

  • Equality/sharing

  • Availability

  • Consequences


Contraceptive methods
Contraceptive methods

  • Contraception vs. contra-implantation

  • Abstinence and calendar methods

  • Barrier methods

  • Spermicides

  • Implantation blockers

    • IntraUterine Devices (IUDs)

      • Progestasert T

      • Copper T 380A


Hormonal methods
Hormonal methods

  • Female

  • Male

  • The pill(s)

  • Norplant

  • Depo-Provera

  • Patch

  • Emergency contraception

  • Mifepristone (RU-486)


  • Sterilization procedures
    Sterilization procedures

    • Tubal ligation

    • Ovariectomy

    • Hysterectomy

    • Vasectomy

    • Orchidectomy


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