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Problems with the In Vitro Fertilisation Treatment of Heterosexual Couples

Problems with the In Vitro Fertilisation Treatment of Heterosexual Couples. Health Law and Bioethics Georgi Avramov, Student Number: 004794, Erasmus + Student from Sofia University “St. Kliment Ohridsky ”. What Is Inferitily?.

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Problems with the In Vitro Fertilisation Treatment of Heterosexual Couples

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  1. Problems with the In Vitro Fertilisation Treatment of Heterosexual Couples Health Law and Bioethics Georgi Avramov, Student Number: 004794, Erasmus + Student from Sofia University “St. KlimentOhridsky”

  2. What Is Inferitily? • One possible definition: infertility is the failure to conceive after a specific period of time of regular, unprotected sexual intercourse, or the occurrence of three or more consecutive miscarriages or stillbirths. • Specific period of time: • standard definition – 12 months; • World Health Organisation (WHO) – 2 years; • some demographers – 5 years. (Image source: http://portugalresident.com/facing-and-treating-infertility) • Actual incidence of fertility problems – unknowable; now assumed - one in six heterosexual couples.

  3. What are assisted reproductive technologies? • Assisted reproductive technology (ART) is the use of reproductive technology to treat infertility. Examples include in vitro fertilization (IVF) and its possible expansions, such as: • cryopreservation of sperm, oocytes, embryos; • artificial insemination; • in vitro generated gametes; • IVF; • cloning etc.

  4. 1. Cryopreservation (Image source: http://sites.davidson.edu/bio362_art/?page_id=38) • What is Cryopreservation? Freezing of: • sperm (first frozen 1949); • embryos (first frozen 1983); • eggs (until recently considered as unsafe procedure, now possible).

  5. 2. Assisted Insemination by Husband/Partner (AIH/AIP) • It is the assisted insemination with sperm of the husband or the partner. • No longer the optimum treatment for men with poor quality sperm. • Continues to be used in case of treatments such as chemotherapy, that will render the man infertile.

  6. 3. Donor Insemination (DI) • 1st recorded DI – end of the 19thcentury. • Disapproved and not acceptable until recently. • Common reasons – partner’s infertility, genetic disease, sexual dysfunction. • DI – still the only chance in cases of a man, who could not produce any sperm, or a woman without a partner. • Low success rates. (Image source: http://ivfmohali.com/our-services/donor-insemination-d-i/)

  7. 4. Oocyte (Egg) Donation (Image source: http://www.simpledonations.com/egg-donors/) • Important differences from DI: • Finite number of eggs; • Much more uncomfortable and invasive; • First used in IVF treatment in 1984; • The freezing of eggs is also in infancy compared to the freezing of sperm; • Some countries prohibit it. • Common reasons - ovarian failure, a serious genetic abnormality; also multiple failed IVF treatment with own eggs. • Procedure – like the IVF treatment. • Advantage – biological connection to the child, always a legal mother of the child.

  8. 5. Gamete Intra-Fallopian Transfer (GIFT) • In Vivo - egg retrieval in the same way as IVF, but instead of being placed in a petri dish with the sperm, the eggs and the sperm are injected into the woman’s fallopian tube. • Common reasons - no abnormality in a woman’s fallopian tubes and the couple’s infertility is “unexplained”. (Image source: http://lakecharlesobgyn.com/Complete/397-GIFT.aspx)

  9. 6. Micromanipulation: Intra-Cytoplasmic Injection (ICSI) and Sub-Zonal Insemination (SUZI) • ICSI: • injection of a single sperm into an egg with a very fine glass needle; • if fertilisation occurs - zygote(s) will be transferred to the women’s uterus in the same way as in conventional IVF; • common reasons - sperm cannot penetrate an egg naturally (extremely low sperm count or poor motility). • SUZI: • microinjection of a small number of sperm into the egg; • it might be used if normal fertilisation has failed to occur. • Success rates improved dramatically over the years.

  10. 7. Cloning • Dolly the sheep – 1997. • In theory could be used to increase the numbers of embryos created in an IVF cycle, or to create a duplicate embryo that could be tested for genetic abnormailities and discarded, while its intact “twin” could subsequently be implanted. (Image source: http://usatoday30.usatoday.com/tech/science/genetics/2006-07-04-dolly-anniversary_x.htm)

  11. (8.) In Vitro Fertilisation (IVF) History: • Research began in the 1930s. • 1st successfully performed on mouse in 1958. • IVF with human gametes - pioneered by Robert Edwards and Patrick Steptoe during the 1960s and 1970s -> first IVF baby, Louise Brown (25.07.1978). • Initially - hostility to IVF and scepticism about its safety and efficacy. (Imagesource: http://www.dailymail.co.uk/news/article-2515585/Louise-Brown-Worlds-test-tube-baby-pays-emotional-tribute-parents.html) (Imagesource: http://www.dailymail.co.uk/health/article-3173446/World-s-test-tube-baby-reveals-mother-received-blood-splattered-HATE-MAIL-born-including-letter-containing-plastic-foetus.html)

  12. In Vitro Fertilisation (IVF) (Imagesource: http://www.mexicalihealthcare.com/procedure/In-Vitro-Fertilization/21) Procedure: 1. Commonly hormonal treatment – producing more eggs. 2. Removal of the eggs from the ovarian follicles through laparoscopy or transvaginal aspiration and placing them in a culture that allows them to mature further. 3. Providing of sperm. 4. Putting the mature eggs into a petri dish with sperm (usually from the woman’s partner). 5. If fertilisation occurs the resulting zygote(s) may be places in the woman’s uterus, or frozen to be used at a later date.

  13. In Vitro Fertilisation (IVF) Nowadays: • IVF is now the most common treatment for infertility (99 % of all procedures). • Success rates - depend on a number of factors. The most recent report from 2009 found: • Pregnancy achieved - 29.4% of all cycles (higher or lower depending on the age of the woman); • Live births - 22.4% on average (higher or lower depending on the age of the woman). • More than 5 million babies have been born in the world as a result of an IVF treatment.

  14. The Steinkamp Family (in 2008) (Image source: http://www.kinderwunsch-nrw.de/templates/media/pdf/SpiegelDokumente-25_05_2008.pdf)

  15. The Steinkamp Family nowadays

  16. Problems with IVF Treatment • Unnaturalness • Child welfare • Ignoring Infertile Women • Equality • Low success rates • Multiple pregnancies • Informed decision – not informed enough • Infertility treatment “takes over” patient’s lives • Extremely expensive

  17. What and How Should We Regulate? • Access to treatment • Consultation and informed consente • Status and Use of Gametes • Status and Use of Gametes • Procedure • Paternity • Regulating new technologies

  18. Thank You for Your attention and participation!

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