NEW REPRODUCTIVE TECHNOLOGIES

The new reproductive technologies give great hope to infertile couples and make many new
reproductive arrangements possible. They also raise many difficult moral issues. Artificial
insemination by husband is considered moral, but artificial insemination by donor raises
questions about a third party entering reproduction. In vitro fertilization is acceptable within
limits: the couple should ensure that no embryos are left in storage and that the risk of selective
termination is avoided. Commercial surrogate motherhood raises problems because it is the
equivalent of selling children, can be exploitative of the surrogate, and violates a mother's
fundamental right to raise her child. Even altruistic surrogacy raises questions about the degree
of detachment the mother must have from her unborn child to successfully give it up after birth.

On March 27, 1986, Mary Beth Whitehead gave birth to a little girl whom she named Sara. That
same day, Elizabeth and Daniel Stern named the same baby Melissa. Both were convinced that
the child (called Baby M in the press) belonged to them, and both were prepared to take drastic
measures to win custody over what they thought was their child. The Sterns had hired
Whitehead to bear their child. She was, and is to this day, the most publicized person to
perform the role of a surrogate mother. Their contest over that child was carried on in court for
almost two years, and it illustrates the potential problems and complexities involved with many
of the new reproductive technologies. 

Medicine has made some remarkable advances in the field of reproductive technology. The
term reproductive technology refers to various medical procedures that are designed to
alleviate infertility, or the inability of a couple to produce a child of their own. These include
artificial insemination, in vitro fertilization (or "test-tube" babies), and surrogate motherhood.
When successful, these technologies are the miracle of life for couples who have often spent
years trying to have a child, and who have exhausted all other avenues for conceiving a child of
their own. But many of these techniques raise major moral questions and can create thorny
legal problems that must be resolved in court. 

These new technologies make possible all sorts of interesting childbearing arrangements. Here
is a sampling of what is now possible for couples contemplating parenthood in unconventional
ways: 

(1) A man who cannot produce sperm and his wife want to have a child. She is artificially
inseminated with sperm from an anonymous donor, conceives, and bears a child. 

(2) A woman who cannot produce eggs and her husband want to have a child. They hire a
woman to be inseminated with the husband's sperm, and she bears the child for them. 

(3) A woman is able to produce eggs but is unable to carry a child to term. She and her
husband "rent the womb" of another woman and she gestates an embryo that was formed by
laboratory fertilization of the husband's sperm and his wife's egg. 

(4) A lesbian couple wants to have a child. One of the women provides an egg, and after it is
fertilized by donor sperm, the embryo is implanted in the uterus of her partner. 

(5) A couple desiring to have children cannot produce any of the sperm or eggs necessary for
conception. So the woman's sister donates the egg and the man's brother donates sperm.
Fertilization occurs in vitro, that is, outside the womb, and the embryo is transferred to the wife
of the couple, who carries the child. 

Assisted reproductive technology (ART) is a general term referring to methods used to achieve
pregnancy by artificial or partially artificial means. It is reproductive technology used primarily
in infertility treatments. Some forms of ART are also used in fertile couples for genetic reasons.
ART is also used in couples who are discordant for certain communicable diseases, i.e. AIDS, to
reduce the risk of infection when a pregnancy is desired. The term includes any reproductive
technique involving a third party e.g. a sperm donor. There is yet no strict definition of the
term. Usage of the ART mainly belongs in the field of reproductive endocrinology and infertility.

1. ARTIFICIAL INSEMINATION

Artificial insemination, or AI, is a fertilization procedure in which sperm is artificially placed into
a woman’s cervix (intracervical insemination) or uterus (intrauterine insemination). During
artificial insemination treatment, the woman’s menstrual cycle is closely monitored using
ovarian kits, ultrasounds, and blood tests. The semen to be implanted is “washed” in a
laboratory, which increases the chances of fertilization while removing unnecessary, potentially
harmful chemicals. The semen is inserted into the woman, and if the procedure is successful,
she conceives.

Success rates for human artificial insemination vary based on the type of fertility problem being
treated and the age of the patient. Most women who choose artificial insemination have a 5 to
25 percent chance of becoming pregnant with each menstrual cycle. These chances increase if
you take fertility drugs in conjunction with the procedure.

ARTIFICIAL INSEMINATION PROCEDURES

Human artificial insemination procedures are advanced forms of fertility treatment that involve
the use of a thin, flexible tube to precisely place donor sperm into a woman's reproductive
tract. Before the procedure, the sperm to be used is washed and concentrated to increase the
likelihood of a conception. The two main types of artificial insemination: intrauterine
insemination (IUI) and intracervical insemination (ICI), both of which can be performed by a
reproductive specialist at your local fertility clinic.

1. INTRACERVICAL INSEMINATION (ICI)

Intracervical insemination, or ICI, is one of the most commonly performed types of artificial
insemination. ICI is a relatively quick and usually painless procedure that deposits donor sperm
directly into the cervix, dramatically increasing the chances that the sperm will make its way
through the uterus and fallopian tubes, where it can fertilize the egg. Typically less costly than
intrauterine insemination (see below), the ICI procedure produces high success rates.

2. INTRAUTERINE INSEMINATION (IUI)

Intrauterine insemination, or IUI, is the most commonly performed method of artificial

insemination by husband (AIH). Often simpler and less expensive than in vitro fertilization
(IVF), intrauterine insemination is an effective treatment for some forms of infertility. When
combined with ovarian stimulation, IUI – which places sperm in the fallopian tubes – produces
high fertilization success rates. As a form of artificial insemination, IUI is good for couples with
unidentifiable sources of infertility as well as for couples in which the man has some sperm
deficiencies or the woman has cervical mucus problems.

BENEFITS OF ARTIFICIAL INSEMINATION

Human artificial insemination is a revolutionary fertility procedure with numerous benefits. The
AI technique creates an avenue to pregnancy for couples faced with male infertility or female
infertility. Further, AI by donor allows sperm to be tested and screened prior to insemination,
reducing the likelihood of passing a genetic disorder on to the child. Another benefit of artificial
insemination is that it allows same-sex couples to conceive a child. A fertility specialist in your
area will be able to provide you with additional information on the benefits of human artificial
insemination.
INDICATIONS FOR ARTIFICIAL INSEMINATION:
Male Partner:
1. Inability to ejaculate into the vagina.
2. This can occur in a number of clinical conditions such as diabetes and multiple sclerosis.
3. Trauma or injury to the spinal cord following a road traffic accident.
4. Retrograde ejaculation.
5. A condition where the sperms enter the urinary bladder rather than coming down the male
urethra. This can be caused due to diseases like diabetes.
6. It can also result from an operation or surgery that destroys the value that prevents the
backflow of sperms into the urethra.
7. Less commonly it can be the result of some drugs used for treatment purposes.
8. Men with sperm count lower than that required for successful fertilization
9. Men with poor quality sperms that poses difficulties with fertilization
10. Mechanical difficulties with intercourse (Structural abnormalities of the penis owing to
trauma or injury).
11. Patients who wish to store their sperms prior to radiotherapy or chemotherapy
12. Patients who wish to store their sperm before vasectomy (Reversal of vasectomy is
surgically expensive invasive and the success rate is highly variable.
13. Utilization of stored semen sample for fertilization when husband is not
available at the appropriate timing for treatment. It is indeed frustrating when the male partner
is unavailable during optimal time for the procedure. It also helps preserve the time and
finances from being wasted due to unforeseen circumstances.
14. Unexpected changes in a patient’s life such as new marriage, death of child or desire to
have more children.

Female Partner:
1.Cervical mucus insufficiency
2.Poor quality cervical mucus
3.Structural abnormalities associated with the female reproductive tract
4.Contact allergy to semen (very rare)
5.Women with endometriosis

Couple:
1.Idiopathic or unexplained infertility

ADVANTAGES:
1. Quick procedure can be done in the out patient clinic itself. Does not need medical
admission.
2. Relatively less invasive and uncomplicated than IVF.
3. It is a more natural way of fertility treatment. 
4. Less expensive when compared to other advanced treatment options.

DISADVANTAGES:
The fertilization outcome cannot be predicted because the fertilization takes place inside the
human body.

Success Rate:
1. The pregnancy rates for IUI treatment cycles lie somewhere around 15-20% per cycle.

2. The average time frame for IUI is about three or 6 treatment cycles, provided all other
parameters are taken into consideration or treated.

Risks Involved: Super ovulation, commonly used in conjunction with AI, is associated with
mood or behavioral changes in women. In addition, it may also be responsible for multiple
pregnancies. This also increases the risk of low birth weight babies. It can also result in the
formation of ovarian cysts, leading to abdominal pain.
 Infection: The procedure has to be done under strict aseptic conditions. Although the process
of sperm preparation reduces the chances of infection, the procedure can result in infection in
less than 1 % of the cases. Symptoms of infection include lower abdominal pain, fever, vaginal
discharge or bleeding. This can be treated with oral anti-biotics in a majority of the cases.

2. IN-VITRO FERTILIZATION
Infertility affects about 6.1 million people in the United States, about 10% of men and women
of reproductive age. New and advanced technologies to help a woman become pregnant
include in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and other similar
procedures.

IVF was used successfully for the first time in the United States in 1981. More than 250,000
babies have been born since then as a result of using the in vitro fertilization technique. IVF
offers infertile couples a chance to have a child who is biologically related to them.

With IVF, a method of assisted reproduction, a man's sperm and the woman's egg are
combined in a laboratory dish, where fertilization occurs. The resulting embryo is then
transferred to the woman's uterus (womb) to implant and develop naturally. Usually, 2-4
embryos are placed in the woman's uterus at one time. Each attempt is called a cycle.

The term test tube baby is often used to refer to children conceived with this technique. The
first so-called test tube baby, Louise Brown, reached age 25 years in 2003. She was born in
England.

Less than 5% of infertile couples actually use IVF. IVF is usually the treatment of choice for a
woman with blocked, severely damaged, or no fallopian tubes. IVF is also used to overcome
infertility caused by endometriosis or problems with the man's sperm (such as low sperm
count). Couples who simply can't conceive and have tried other infertility methods that have not
worked for them can also try IVF.

Factors to Consider

 Age: Women younger than 35 years who do not have problems with their partners'
sperm may try IVF.

 Multiple births: Generally, in women who use IVF to establish a live birth, about 63%
are single babies, 32% are twins, and 5% are triplets or more.

 Cost: One cycle of IVF costs an average of $12,400.

 Reduced surgery: If a woman has IVF, she may not have to undergo surgery on her
fallopian tubes. It is estimated that the IVF technique has reduced such surgeries by half.

 Safety: Studies suggest that in vitro fertilization is safe. A recent study covered nearly
1,000 children conceived through these methods in 5 European countries and found that the
children, monitored from birth to age 5 years, were as healthy as children conceived
naturally. However, other studies have found a slightly increased risk of genetic disorders in
children conceived through assisted reproductive technologies.

Technique

With in vitro fertilization, eggs are surgically aspirated from the woman's ovary under
ultrasound guidance and mixed with sperm outside the body in a laboratory dish. After about
40 hours, the eggs are examined to see if they have become fertilized by the sperm and are
dividing into cells. These fertilized eggs (now called embryos) are then placed in the women's
uterus, thus bypassing the fallopian tubes where this process normally occurs.
 IVF is now recognized worldwide as an established treatment for infertility.

This is how the procedure takes place:

 The woman may be given certain drugs (hormones) to stimulate her ovaries to produce
several eggs before the procedure to remove them.

 A surgeon then inserts a needle through the vagina into the woman's ovary to remove
eggs. This procedure used to be done with laparoscopic surgery, but the needle technique is
much less invasive and much easier. General anesthesia is not required for this part of the
procedure, but the woman may be given some sedating medication.

The fluid removed is examined in the laboratory to make sure eggs are present.

 At the same time, the man provides a semen sample. He is asked not to have sexual
intercourse for a few days before the eggs are retrieved from the woman and before he
produces a semen sample (usually by masturbation). The sperm are separated from the semen
in a laboratory procedure.

 The active sperm are combined in the laboratory dish with the eggs. This may be
referred to as in vitro fertilization.

 About 18 hours after this fertilization procedure, it is possible to determine if the egg or
eggs have been fertilized and have begun to grow as embryos. They are incubated and
observed over the next 2-3 days or longer.

 The doctor then transfers the embryos into the woman's uterus through the cervix with
a catheter (a long slender tube). The woman should then remain in a resting position for the
next hour or so.

 She is given certain hormones for the next 2 weeks. If implantation works (the egg or
eggs attach to the uterine wall and grow), the pregnancy test result is positive.

Success Rate

Techniques for assessing the viability of an embryo when genetic issues are present are cell
biopsy and evaluation and pronuclear biopsy and evaluation.

The pregnancy rate by age is similar to that of normally conceived pregnancies: 37% among
women younger than 35 years and 28% for those aged 36-39 years. The success rate is about
13% in those older than 40 years. Pregnancy in women older than 44 years is rare.

The rate of miscarriages with IVF pregnancies is the same as that with normally conceived
pregnancies. Ectopic pregnancy occurs in about 3-5% of cases. An ectopic pregnancy is a
serious condition that requires emergency medical care. The embryo is growing outside the
uterus and does not survive.

Egg and sperm donors

Donors may contribute the egg or the sperm (or even a frozen embryo) to an IVF program
when a partner is not able to produce the egg or sperm.

 Egg donation: Sometimes eggs are used from another woman if the recipient has
impaired ovaries or has a genetic disease that could be passed on to her baby. The egg
donor may be anonymous or known (such as a younger relative for an older woman or a
designated donor). Ideally, the donor should be aged 21-30 years. The donor's eggs are
removed the same way they are with IVF. The recipient takes increasing doses of estrogen
to synchronize her hormone levels in preparation for the embryo transfer. Both the donor
and recipient should talk with a counselor about the psychological aspects of this procedure.
 Everyone signs a consent form to cover the legal issues of such a donation. Success rates for
this type of donation are higher than the rates with conventional IVF. The rate of multiple
pregnancy is high, so doctors try to transfer only 2 embryos at one time.

 Sperm donation: This can be routinely done for women whose male partners have
impaired sperm or low sperm counts. Donation may be anonymous from a sperm bank. In
some cases, a male partner may "bank" sperm if he anticipates problems with chemotherapy
or other medical conditions that may affect his sperm later in life.

 Embryo donation: Receiving a donor embryo (usually from a frozen embryo created in
the laboratory from another couple) is the earliest form of adoption. The donor couple must
sign an advance directive regarding embryo ownership and disposition. Those directives
should include statements regarding (1) embryo donation to another couple, (2) donation of
the embryos for research, or (3) disposition of the embryos after thawing.

3. SURROGACY

Surrogacy is an arrangement in which a woman carries and delivers a child for another couple
or person. This woman may be the child's genetic mother (called traditional surrogacy), or
she may carry the pregnancy to delivery after having an embryo, to which she has no genetic
relationship, transferred to her uterus (called gestational surrogacy). If the pregnant woman
received compensation for carrying and delivering the child (besides medical and other
reasonable expenses) the arrangement is called a commercial surrogacy, otherwise the
arrangement is sometimes referred to as an altruistic surrogacy.

Traditional Surrogacy
The typical definition of surrogacy refers to an arrangement in which the surrogate is the child's
genetic mother. The woman's egg is fertilized in a lab using sperm from the man who wishes to
raise the child. This form of surrogacy may be used by a woman with medical issues that affect
her ability to ovulate normally. In addition, some women choose surrogacy as an option if they
have a serious illness that would decrease their ability to carry a pregnancy to term or could be
potentially passed to the child.
Gestational Surrogacy
The other form of surrogacy is more accurately referred to as gestational surrogacy. In this
case, the pregnant woman is not biologically related to the baby. She is implanted with a
fertilized egg and agrees to turn over the baby at the end of the pregnancy. This option is often
used by women with normal ovarian function who have problems with their uterus. For
example, Asherman's Syndrome or leiomyoma may cause scarring that would make it difficult
for a woman to carry her pregnancy to term.

In a traditional surrogacy the child may be conceived via home artificial insemination using

fresh or frozen sperm or impregnated via IUI (intrauterine insemination), or ICI (intracervical
insemination) performed at a health clinic.

The social parents (that is, those that intend to raise the child) may arrange a surrogate
pregnancy because of female infertility, or other medical issues which may make the pregnancy
or delivery impossible, risky or otherwise undesirable. The social mother could also be fertile
and healthy, and prefer the convenience of someone else undergoing pregnancy, labor, and
delivery for her. The intended parent could also be a single man or woman wishing to have
his/her own biological child. Some same-sex couples turn to surrogacy as an option to
becoming parents.
Ethical views:
1. Artificial Insemination -

requires male masturbation, which is prima facie wrong, since it is an act that can be
considered to be unnatural, given the natural end of sex, even when semen from the
husband is used. AI tends to destroy the values inherent in the married state. It makes
conception a mechanical act.

2. In vitro fertilization

Same objections. In addition, the process itself involves the destruction of fertilized ova
which amounts to the destruction of human life.

3. Surrogacy

Before deciding to pursue surrogacy as an option for having a child of your own, it's
wise to spend some time considering both sides of the issue. Arguments for surrogacy
include:

 The process provides a genetic link between parent and child. Even if the woman is not
the child's genetic mother, her husband is the biological father. For many couples, this is
considered extremely important.
 It allows you to avoid common adoption pitfalls. While adopting a child can be a
wonderful way to achieve your dream of becoming a parent, the adoption process is
rather complicated. It's often difficult to adopt a newborn infant and many older children
have physical or emotional issues associated with their early living conditions.
 It's sometimes the only option available. While most people who use surrogacy to
achieve their dreams of parenthood are married heterosexual couples, surrogacy is
becoming increasingly popular among gay men who wish to become parents.

4. Utilitarian View:

No reproductive technology is in itself objectionable when the use of any particular

procedure, in general or in a certain case, is likely to lead to more good than not.

However, a rule utilitarian might oppose any or all of the procedures if there is strong
evidence to support the view that the use of reproductive technology will lead to a
society in which the welfare of its members will not be served.

5. Ross’s Ethical theory:

Based on the prima facie duties of beneficence, there is an obligation to assist others in
bettering their lives which justifies the use of reproductive technology as a means to
promote the well-being of others for as long as there is informed conscience.
 GROUP 3

NEW REPRODUCTIVE TECHNOLOGY:

a. ARTIFICIAL INSEMINATION
b. IN-VITRO FERTILIZATION
c. SURROGACY

Submitted by:
Pacateo, Judith Kris S.

Cabales, Djane Ross S.

Sinagandal, Shetti Hanna U.

Sajelan, Lambert Jae

Submitted to:
Sir Jay C. Tillo,RN