Biological developments in assisted reproductive technology

a.R.T.

Assisted Reproductive technology has received a great deal of attention in recent years. Couples who have difficulty having children are now seeking out assisted reproductive technology to conceive children. The purpose of this discussion is to examine the developments and advancements in assisted reproductive technologies. The technologies examined will include: Zygote intrafallopian transfer, Donor egg or embryo, Surrogacy/gestational carrier, in vitro fertilization, Intracytoplasmic sperm injection and Gamete intrafallopian transfer.

Zygote intrafallopian transfer

According to Becker (2000) Zygote intrafallopian transfer (ZIFT) is a form of reproductive technology that takes place after controlled ovarian hyperstimulation, oocyte retrieval, and in vitro fertilization. For the purposes of this technology, the zygote (the early embryo) is positioned in the fallopian tube through the use of laparoscopy. The author explains that the purpose of ZIFT is to "combine the advantages of IVF-ET and GIFT by utilizing the fallopian tubes in their physiological role as the site of zygote transport, at the cost of subjecting the patient to two separate anesthesias (Becker 2000, 264)."

According to the American Pregnancy association ZIFT is carried out using several steps. The first of which is a woman's ovaries are stimulated with medications to increase the probability of producing multiple eggs (hyperstimulation) (Zygote intrafallopian transfer: ZIFT). The eggs are then gathered via aspiration; the eggs are fertilized in the same manner that they are fertilized during IVF; fertilized eggs are transmitted via laparoscopic method; the catheter is positioned in the fallopian tube and the fertilized eggs are injected; the patient and physicians and patients then wait to see if pregnancy occurs (Zygote intrafallopian transfer: ZIFT).

Donor egg or embryo

In addition to the ZIFT procedure, donor eggs or embryos are also an option that is available to infertile couples (Tomlins, 2003). According to Tomlins (2003) eggs can be donated when the woman is unable to produce eggs, there is a risk that a genetic disease will passed on to the child, when the eggs that a woman produces is not of good quality, the woman has experience chemotherapy or gone through other illnesses or treatments that have left her eggs unviable, or there has been attempts at other reproductive technologies that have not been successful (Tomlins, 2003).

In addition to egg donation, embryos can also be donated. In most cases embryos are donated by couples that have undergone IVF and still have some additional frozen embryos; couples can choose to donate these embryos, have them used for medical research or have them destroyed. When the embryos are donated they are given to couples that have problems creating their own embryos.

The author also points out that as it relates to having to use donor eggs, there are certain emotions that a woman may experience. The author asserts that these emotions are similar to the emotions that a man may experience when he discovers he is sterile. Relying on a donor egg or embryo also means that the woman will have no genetic link to the child (Tomlins, 2003). For this reason, women are often advised to sort these feelings out before using donor eggs or embryos (Tomlins, 2003). The author explains that donor eggs are provided to couples in different ways. These ways are inclusive of the following Known Donor- a donor that is known to the couple. In many cases the woman is a sister in law, sister or a friend of the couple (Tomlins, 2003).

Through an advertisement- the donor may be a woman who has acted in response to an advertisement placed by a couple (Tomlins, 2003).

Anonymous donor- a donor unknown to the couple. The donor might be a woman who has donated eggs to a clinic anonymously (Tomlins, 2003).

Surrogacy/gestational carrier

Surrogacy is also an option that many couples are choosing. Surrogacy occurs when a woman carries a child for another woman who does not have the capacity to carry the child or give birth (Tomlins, 2003). Surrogacy is often chosen when a woman does not have a uterus or because there is damage to the uterus or pregnancy may endanger a woman's life (Tomlins, 2003).

The author explains that two types of surrogacy can be utilized. The first type of surrogacy is referred to as gestational carriage and occurs when a couple creates an embryo from their egg and sperm and this embryo is placed in the surrogate mother (Tomlins, 2003). This type of surrogacy ensures that the baby will not have any genetic connection to the surrogate mother (Tomlins, 2003). The other type of surrogacy involves the surrogate providing the egg and carrying the child, and in this case the baby is the biological child of the surrogate.

Although surrogacy has become popular in recent years, it still remains a controversial procedure. In many states, it is still not legal because of the litigation that it has brought in the past. In addition, many psychologists believe that it is extremely unhealthy for the surrogate mother on a psychological level because of the natural bonds that occur when a woman is carrying a child.

In vitro fertilization

As it pertains to assisted reproductive technology, in Vitro fertilization (IVF) is one of the most popular methods. This method was developed in 1978 and since this time it has become a successful technology. According to Burfoot (1999) IVF is a female reproductive technology that include the following steps

Women must undergo controlled hyper-ovulation. Hyper-ovulation is used to create more than the common single mature egg per menstrual cycle. The process of hyper-ovulation produces as many as twenty eggs per ovary (Burfoot 1999).

Once the ova eggs are produced, they are retrieved and inseminated with sperm. After forty-eight hours fertilization and cell division, take place and produces a number of embryos (Burfoot 1999).

Once the quality of the embryos has been verified, a few of the most viable are implanted in the woman's uterus. In addition the embryos can be frozen for future implantations or research (Burfoot 1999).

The author explains further that IVF was created to treat infertility that occurred as a result of blocked fallopian tubes. However, today IVF is commonly utilized to overcome male-factor and idiopathic infertility in addition to female infertility caused by endometriosis. The author also explains there should be special attention paid to patient selection to guarantee that treatment is provided to individuals who will benefit from the use of the technology (Burfoot 1999). In addition patient selection is essential in ensuring that the right technology is utilized for patients with idiopathic or tubal infertility that usually experience the best prognosis following IVF (Burfoot 1999).

There are some studies that have suggested that women suffering from endometriosis have an inferior prognosis than women with other types of infertility (Burfoot 1999). The author also asserts that such a prognosis is usually dependent upon the state of the endometriosis (Burfoot 1999). For instance, if the disease is more advanced the poorer the prognosis will be. Other studies have asserted that the success rates of IVF are similar for women with or without endometriosis. Also, couples that are confronting male-factor infertility, the IVF success rate is poor (Burfoot 1999).

However, the author explains that if fertilization does occur, implantation and pregnancy rates are comparable to those of couples without male factor infertility (Burfoot 1999).

According to the National Institutes of Health (NIH) this procedure necessitates a significant amount of commitment as it relates to physical, emotional, financial, and time factors ("In Vitro Fertilization"). The NIH also points out that depression a stress are two ailments that infertile couple often have to confront. In addition to these emotional issues, a woman taking the fertility treatments that are required with IVF may also experience abdominal pain, headaches, bloating, and mood swings ("In Vitro Fertilization").

In addition, the IVF medications are often given via injection multiple times per day; these injections may result in bruising ("In Vitro Fertilization").

The NIH also explains that in some cases the fertily drugs result in ovarian hyperstimulation syndrome (OHSS). This syndrome creates a build up of fluid in both the chest and abdomen ("In Vitro Fertilization"). It can result in the gaining of 10 pounds within a 3-5 day period. It also results in bloating, abdominal pain, vomiting, shortness of breath, decreased urination and nausea ("In Vitro Fertilization"). In less severe cases, it can be treated with bed rest but more severe cases may neccessitate draining the fluid from the body through a needle ("In Vitro Fertilization"). In additon there are risks associated with the egg retrival that are inclusive of bleeding, infection, damage to areas surrounding the ovaries and adverse reactions to anesthesia ("In Vitro Fertilization"). In addition to the aforementioned risks, there are also risks associated with multiple pregnancies that often occur when multiple embryos are placed into the womb ("In Vitro Fertilization"). The NIH explains that carrying more than one child at a time increases the risk low birth rate and premature birth. It is not yet known whether IVF increases the risk of birth defects.

Following the transfer of the embryo woman ussually have to rest for the remainder of the day ("In Vitro Fertilization"). The majority of women can return to their normal routine the next day ("In Vitro Fertilization"). In most cases total bed rest is not required unless there is some risk associated with the development of OHSS ("In Vitro Fertilization").

The NIH further explains that women who utilize IVF must take the hormone progesterone for at least two months following the embryo transfer ("In Vitro Fertilization"). The hormone is taken through daily shots or pills. Progesterone is a naturaly produced hormone produced that assists in thickenign the lining of the uterus ("In Vitro Fertilization"). This thickening makes it easier for the embryo to implant to the wall of the uterus. If there is ot enough progesterone the woman will miscarry ("In Vitro Fertilization").

In additon to the risks associated with this type of reproductive technology, IVF is very expensive ("In Vitro Fertilization"). The NIH explains that many states require that insurance companies cover the procedure in some capacity. However there are many insurance plans that do not cover any type of infertility treatment. This can be problematic because fees for just one IVF cycle -- including costs associated with surgery, medicines, anesthesia, blood tests, ultrasounds, processing the eggs and sperm, embryo storage, and embryo transfer -- can cost between $12,000 - $17,000 ("In Vitro Fertilization"). This price varies for each patient.

The NIH also explains that statistics for the success rates of IVF vary from clinic to clinic. The rates are representative of the amount of women who became pregnant as a result of IVF but all of these pregnancies did not result in live births ("In Vitro Fertilization"). In addition the live birth rates represent the amount of women who deliver a living baby. The Society of Assisted Reproductive Technologies (SART) presents the statistics, related to the chance of giving birth to a live baby after IVF is: 41-43% for females under 35; 33-36% for females 35-37; 23-27% for females 38-40; and 13-18% for females over 41("In Vitro Fertilization").

Intracytoplasmic sperm injection

Although many assisted reproductive technologies are centered on female reproductive problems, the Intracytoplasmic sperm injection (ICSI) has to do with male reproductive problems. Sparks (2000) explains that this type of technology assist couples in conceiving when there is below-normal sperm count and insufficient sperm-producing capacity. ICSI occurs by circumventing all normal or assisted reproduction techniques...Life starts with the union of a single sperm and one ovum, an event that can be duplicated in the laboratory. This revolutionary technique is referred to as intracytoplasmic sperm injection (ICSI). The ICSI process is fascinating to some but disturbing to others, for more so than any other method of assisted reproduction, ICSI utilizes human sperm and ova as if they were little more than reproductive spare parts (Sparks 2000, pg 358)."

The author explains that for conception to occur there not only must be a bringing of the sperm and ova together, the sperm also has to penetrate the out covering of the ovum known as the zona pellucida. Normally the zona provides a protective barrier for the ovum, and it only surrenders to the fittest and most vigorously swimming sperm, while also rejecting the sluggish and defective sperm (Sparks 2000). However, it is apparent that a woman's ovum is not completely unreceptive to these rejected sperm. This is because when the environment is right the ovum can be persuaded to accept sperm that is not perfect (Sparks 2000).

This is what makes this form of reproductive technology different from other forms of reproductive technology (Sparks 2000). The author explains that even though is has many of the same steps as other forms of reproductive technology, it differs in that it involves micromanipulation techniques (Sparks 2000). These techniques are used to introduce a single selected sperm through the zona pellucida and into the body of the ovum (Sparks 2000).

Like many of the other reproductive technologies ICSI also require hyperovulation (Sparks 2000). In addition, men must produce a sperm sample and in some cases sperm has to be extracted from the testicle or sperm-transporting ducts (Sparks 2000). During ICSI a single ovum is isolated and steadied so that a single sperm can be injected into the cytoplasm of the ovum so that fertilization can begin (Sparks 2000).