Reproductive technology
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Reproductive Technology. Learning Objectives. By the end of this class you should understand: Causes of infertility in men and women The different types of assisted reproductive technologies The primary sources of ethical issues surrounding ART

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Reproductive Technology

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Reproductive technology

Reproductive Technology


Learning objectives

Learning Objectives

By the end of this class you should understand:

  • Causes of infertility in men and women

  • The different types of assisted reproductive technologies

  • The primary sources of ethical issues surrounding ART

  • The technique and concerns for genetic screening

  • The potential for treatments such as gene therapy and cord blood

  • The process and benefits of genetic counseling


Fertility

Fertility

  • Not all people are naturally able to produce children

  • Infertility is approximately equally common in men and women

    • Increases with age in women


Types of infertility

Types of Infertility

  • Primary infertility is inability to have a first child

  • Secondary infertility is when a couple has already had one or more children but is having difficulty having more

    • Focus is on primary infertility here


Female infertility causes

Female Infertility Causes

  • Problems with hormonal levels

    • Since hormones are required for ovulation

  • Ovarian problems

    • Since ovaries produce eggs

  • Oviduct/Uterine problems

    • Since this is where the fetus is fertilized/grown


Female infertility

Female Infertility


Male infertility causes

Male Infertility Causes

  • Low sperm count

    • Fewer sperm than typical

  • Low sperm motility

    • May be partially genetic in origin

  • Genetic infertility

    • Mutations on Y chromosome in particular

  • No sperm produced

    • Kilefelter's syndrome, infection, damage to testes, hormonal imbalance including steroids, etc


Male infertility

Male Infertility


Assisted reproductive technologies

Assisted Reproductive Technologies

  • Refers to all techniques to improve fertility

  • Primary techniques include artificial insemination and in vitro fertilization

  • The exact choice depends on which parent has the problem and what kind


Artificial insemination

Artificial Insemination

  • Artificial Insemination uses some means of artificially creating a fertilization event

  • Only viable if the mother's uterus is healthy

    • Major use is when father is infertile or mother wants to become a single parent

    • May also be applied after IVF


In vitro fertilization

In Vitro Fertilization

  • Creation of a fertilization event outside a person's body

    • “In vitro” means “In glass” referring to a test tube

  • May apply when female is infertile or male sperm has motility problems

    • Must be implanted into healthy uterus, either the mother's or a surrogate


Sperm injection

Sperm Injection

  • A particular type of in vitro fertilization is called intracytoplasmic sperm injection

  • Performed by injecting a single sperm cell directly into an egg

    • Typically for sperm count or motility problems

  • Egg is then implanted as normal


Egg acquisition

Egg Acquisition

  • For in vitro fertilization to work, eggs must be removed from the mother

    • If the mother's ovaries are not functioning (e.g. Turner Syndrome, etc), eggs must be collected from a donor

  • Mother's eggs are typically removed via surgery

    • Extra eggs can be stored


Ivf implantation

IVF Implantation

  • Fertilized eggs are incubated for several weeks before implantation

  • Implantation is accomplished via catheter

    • The same kind of catheter used for chorionic villus sampling

  • Leftover eggs may be harvested for embryonic stem cells or discarded


Ivf analogues

IVF Analogues

  • Gamete intrafallopian transfer (GIFT)

    • Sperm is placed directly into woman's oviduct during ovulation

  • Zygote intrafallopian transfer (ZIFT)

    • Fertilization accomplished via IVF then implanted directly into mother through surgery


Surrogacy

Surrogacy

  • An arrangement can be made with another woman if the mother's uterus cannot sustain a baby

    • May be artificially inseminated or have the embryo implanted, for different types of surrogacy

  • This has the potential to introduce complications

    • Not legal in every state


Risks of art

Risks of ART

  • As with any pregnancy, individual chances of fertilization and implantation are not 100%

    • Even fertile couples must typically “try” for months

  • To minimize costs, multiple fertilizations and implantations are carried out with each procedure

    • Half of all IVF births are multiple births


Major risks of ivf

Major Risks of IVF

  • Multiple births

    • Premature birth, low birth weight, etc

  • Ectopic pregnancy

    • Implantation in fallopian tube, extremely dangerous

  • Increased risk of chromosomal deletions using ICSI


Genetic screening

Genetic Screening

  • Genetic screening is testing for a disease without prior indication that the disease is present

    • Predictive instead of diagnostic

  • The entirety of the US performs newborn screening for PKU (most common metabolic disorder)

  • Some states test only a few diseases, some test many


Newborn screening

Newborn Screening

  • California's full list of screening targets:

    http://www.cdph.ca.gov/programs/nbs/Documents/NBS-DisordersDetectable011312.pdf

  • This is relatively uncontroversial and in general a very good preventative step


Preimplantation genetic diagnosis

Preimplantation Genetic Diagnosis

  • When creating embryos via IVF, a single cell from the blastomere (ball of cells) can be removed and tested for genetic disorders

    • Called preimplantation genetic diagnosis (PGD)

  • Typically performed when child is at risk for a genetic disorder


Pgd controversy

PGD Controversy

  • These parents had a daughter with Falconi anemia

  • They had a son who they screened with PGD to ensure he would not have the same disorder

  • The son's cord blood was used to treat the daughter's disorder

    • Was he grown specifically to be a donor for the daughter?

    • Is that legit?


Cord blood

Cord Blood

  • Blood from the umbilical cord of a baby contains adult stem cells just like red bone marrow

  • Some hospitals save it for research and transfusion

    • No database for it so it's more hit-or-miss


Gene therapy

Gene Therapy

  • Gene therapy has been studied for some time

    • Curing genetic diseases by inserting the missing gene into a patient's cells

    • Usually uses a retrovirus to write the DNA into your cells

  • Early experiments seemed promising but many patients died in bad reactions to the viral vector

    • Also some patients contracted cancer from the gene being inserted into another gene


Gene therapy categories

Gene Therapy Categories

  • Currently the only type of gene therapy is somatic gene therapy

    • Modifying adult cells in a patient

    • Most successful in fighting cancer

  • Potential for germ-line gene therapy

    • Modifying the genes of gametes or embryos so all cells will have DNA

    • Any future children will also have same gene!

  • We already discussed the potential for Enhancement gene therapy


Genetic counseling

Genetic Counseling

  • Genetic counseling is a process where a geneticist will analyze the DNA of parents and advise them on the risks for genetic disorders

    • Accomplished using pedigrees, DNA sequencing, and medical history

  • Genetic counseling is important for anyone with risk to their pregnancy


Have a good weekend

Have a good weekend!


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