Name: Jastine Jane D.

Bongalbal

Level: II

Block: A

Topic: ISSUES IN ARTIFICIAL REPRODUCTION, ITS MORALITY AND

ETHICO-MORAL RESPONSIBILITY OF NURSES

 ARTIFICIAL INSEMINATION
 IN-VITRO FERTILIZATION

ARTIFICIAL REPRODUCTION

 the creation of new life by other than the natural means available to an organism
ASSISTED HUMAN REPRODUCTION (AHR)

 medically assisted artificial fusion of sperm and ovum (gametes) of a donor, or

genetic parents, if it is very difficult or impossible to conceive a child naturally
 any procedure that involves the handling of eggs, sperm, or both, outside the
human body.
 includes artificial insemination, intrauterine insemination, in vitro fertilization,
and ovarian stimulation (with medications
 about 2-4% of pregnancies are now a result of AHR

ASSISTED REPRODUCTIVE TECHNOLOGY (ART)

 used to treat infertility
 includes fertility treatments that handle both eggs and sperm
 works by removing eggs from the ovaries
 the eggs are then mixed with sperm to make embryos
 the embryos are then put back in the parent's body

WHY ARE THERE PEOPLE WHO GO FOR ARTIFICIAL REPRODUCTION?

 The number one reason is infertility. According to World Health Organization, it

is a disease of the male or female reproductive system defined by the failure to
achieve a pregnancy after 12 months or more of regular unprotected sexual
intercourse.
ARTIFICIAL INSEMINATION

 The first reported case of artificial insemination by donor occurred in

1884: William H. Pancoast, a professor in Philadelphia, took sperm from his "best
looking" student to inseminate an anesthetized woman without her knowledge.
 Medical procedure of injecting semen into the vagina or uterus by means of
planting of a sperm in the woman’s body to facilitate conception.

TYPES OF ARTIFICIAL INSEMINATION

 Homologous
 the sperm come from the woman’s partner
 it generally involves masturbation on the part of the man
 Heterologous
 A donor’s sperm from a sperm bank is used

INTRAUTERINE INSEMINATION (IUI)

 A type of artificial insemination that is a procedure for treating infertility to

increase ovulation function.
 Also known as “washed sperm”. The doctor places sperm, that was previously
collected and processed in the lab, into the uterine cavity. Before insertion, the lab
“washes” the sperm by removing seminal fluid and concentrating the sperm,
removes debris and removes hormones that may cause the uterus to cramp.

WHEN IS IUI USED?

 Male infertility
 Unexplained infertility
 Desire to have child without a male partner

ETHICO-MORAL RESPONSIBILITY OF NURSE IN ARTIFICIAL

INSEMINATION

 Informed Consent. The Physician or advanced practice nurse is

responsible for informing the client about the procedure and obtaining
consent by providing a detailed description of the procedure or treatment,
its potential risks and benefits, and alternative methods available.
 Assesses the couple’s emotional status relative to infertility.
 Counsels and informs about the side effects of the procedure.
 S/E: Nausea, vomiting, ovarian enlargement, occurrence of ovarian
cyst
  Describes the legal ramifications of the procedure.
 The laws on the subject frequently provide that the children of the
insemination can be told the identity of the donor when they reach
age 18.
 Assists in interviewing donors for the program.
 Thorough medical histories must be taken of all candidates for
anonymous semen donation. All potential donors must also be
screened for infectious or inheritable diseases which could
adversely affect the recipient or the resultant child. Frozen semen
should be used for artificial insemination because it enables the
donor to be tested for communicable disease agents and diseases at
the time of donation, and again after an interval before the original
semen is used, thus increasing the likelihood that the semen is free
of blood-borne pathogens.

LOUISE BROWN

 On July 25, 1978, a few days before term, a baby described by her doctors as
being “nice, healthy, normal,” was born and given the name of Louise Brown.
The only thing not normal was that Louise had been conceived outside the human
body in a laboratory dish and then implanted in her mother.
 Her birth received enormous press attention as the world was alerted to the birth
of the first “test tube baby.”
 Actually the term is somewhat misleading; she should perhaps have been titled
the first “test tube embryo”, which was then followed by the “first embryo
transfer” into the mother.
 The normal medical expression used for the process is in vitro fertilization
(fertilization in glass).

IN-VITRO FERTILIZATION

 Process of fertilization where an egg is combined with sperm outside the body.
 In the procedure, eggs are removed from a woman and fertilized in laboratory
dish (by either the husband or another woman). The embryos are then implanted
in a woman (the donor or some other man), where the egg may be brought to
term.

TYPES OF IVF

 Homologous IVF- involves the gametes from both spouses; no third party is
involved.
  Heterologous IVF- involves the gametes of a donor (a third party supplies
necessary gametes).

FILIPINO CELEBRITIES WHO HAVE BABIES THROUGH IVF PROCEDURE

 The King of Scents, Aficionado owner Joel Cruz, has eight children through IVF.
They are Prince Sean, Princess Synne, Harry, Harvey, Prince Charles, Princess
Charlotte, Zeid, and Ziv.
 Child celebrity Scarlet Snow is one of the IVF babies. The beautiful daughter of
cosmetic doctor couple Hayden Kho Jr. and Vicki Belo was carried by an
American-Mexican mother.
 Celebrity couple former Department of Interior and Local Government (DILG)
Secretary Mar Roxas and Korina Sanchez have long wanted to have a child of
their own. Through an IVF, they were blessed with a twin – Pepe and Pilar. They
were born in Pittsburg, Pennsylvania and were named Pepe Ramon Gerardo
Manuel Denzel Sanchez Roxas and Pilar Judith Celia Ester Korina Sanchez
Roxas.

ETHICO-MORAL RESPONSIBILITIES OF NURSE IN IN-VITRO

FERTILIZATION

 Roles Knowledge and attitude of nurses can have a profound impact on the
quality of healthcare received by patients undergoing in vitro fertilization (IVF)
techniques.
 Hospital nurses could play an important role in IVF cycle, because they are close
to the couple and have good knowledge of health criteria, worries, symptoms,
drugs and pregnancy complications that could arise.
 Given their unique position in cycle control, treatment and recording the problems
of pregnancy, nurses are well placed to monitor the patients’ response to IVF
treatments. They are often the source in alerting the responsible
gynaecologist/physician about possible complications.
 Acting as coaches, guides, and support, in vitro fertilization (IVF) nurses assist
patients in streamlining the processes involved in IVF. They coordinate diagnostic
and treatment schedules and educate patients and their partners about medication
administration, testing preparation, and specimen collection.
 In IVF practice, the nurses give counseling in addition to routine nursing care
services, including group education and individual interviews about treatment and
coping strategies.
 The nurses also provide support by accompanying the women during the invasive
procedures.
CONDITIONS AND RESTRICTIONS

 You have the right to conceive a child artificially, if it is very difficult or

impossible to conceive a child naturally. This right is protected by the human
right to a private and family life.
 However, work with human gamete is linked with certain legal and ethical issues,
therefore the exercise of this right may be subject to certain conditions and
restrictions.

ETHICS IN ASSISTED REPRODUCTIVE TECHNOLOGY

1. INTENDED PARENTS
 Who’s going to be the real parent? (Genetically, you may say wouldn’t
the real parent be the person who, you know, donated their genetic
material to create the embryos that resulted in the child?”
Understandably, the answer is yes, that’s the maternal or paternal genetic
connection to the resulting child.
 But legally, in assisted reproduction, the parent is the person who is
intended or who the intent is to become the parent.
 That’s why in assisted reproduction, we often refer to the recipients of
gametes and the recipients of donated eggs or sperm as intended parents.
2. SUBJECTIVE THAN OBJECTIVE
 For instance, there’s a doctrinal statement that was issued by the Roman
Catholic Church that IVF using a donor other than the husband of the
woman carrying the child removed reproduction outside of the context of
marriage.
 So, it removed the conjugal and procreation and it thus severed really the
paternal connection between the husband and that child some believe.
 So, for instance, if that is something that you subscribe to, then for you,
you may look at assisted repreoductive technologies as unethical.
Whereas, is that’s not the type of statement or belief system that you have,
then you may not be bothered by that at all. Again, this is where I believe
some of the ethics of assisted reproductive technologies becomes
subjective.
3. HUMAN PROCREATION DISSOCIATED FROM SEXUAL PARTNERS
 The naturally devised means of transmitting life is no other than the marital
act. Now, by the Artificial Insemination, the said act is deliberately excluded
from procreation and replaced with a medical means, that is, the insertion of a
think and sfot catheter containing sperm into the wife’s reproductive tract- a
procedure enormously contrary to nature.
4. OPTION TO CHOOSE WHICH EMBRYO TO USE
 We also have some ethical issues or concerns or question marks around the
embryos and genetic material when we talk about selection. One of the
benefits that assisted reproduction affords is the option to choose which
embryo to use in implanting for procreation.
 So, one of the things that we have to think about here is how do you choose
one embryo over the other? For places, individuals or cultures who look at
embryos as living children, it may seem like you’re choosing 1 child over the
other. So, that’s another thing that’s called into question when people think
about the ethics of assisted reproduction.

5. DISPOSAL OR DISPOSITION OF GENETIC MATERIAL

 Disposition simply means how you want to use it. So, when we are talking
about disposition, a lot of times it results in the use of the embryo in IVF
to transfer to the uterus of the mother or to a surrogate to carry to full
term.
 Now, what do we do though with embryos that are unused when you
finish growing your family. So, the question becomes do you freeze those
embryos for future use for a sibling journey down the road? Do you
simply dispose of them, you thaw them and let them demise? Do you
donate them to medical science? Do you donate them to another person or
couple to help them grow their family?
 This is one of the most talked about ethical issues in assisted
reproduction. And a lot of people point to a number of things, they point to
the interests of the unborn embryo or resulting fetus that could be possible
and people point to a number of different issues on this topic. Some people
look at the rights of the unborn embryo, some people talk about the rights
of the intended parents, and some people talk even about the rights of the
donor.

6. LEGAL IMPLICATION AROUND UNUSED EMBRYOS

 They are simply simply the fact that sometimes, marriages or relationships
do not work out and what happens when a couple that once was
together and created embryos together splits up, what do you do with
those embryos?
 Could one of the individuals in the couple use those embryos to get
pregnant and have a baby without the authority or the authorization of the
other person in the relationship?
 One of the main problems in IVF are about the left over embryos. For the
clinic to store the frozen embryos, the couple have to pay a fee. There are
couples who do not know what to do about the left over embryos that they
 just stop paying. For ethical and legal reasons, most clinics are reluctant to
throw away the embryos without the consent of the couple.

7. SPERM BANK
 If the sperm donor dies, they usually have a sperm bank for this, those
who want to donate their sperm can go there, usually if you donate a
sperm then you can get aid. So if the sperm donor dies, is it still ethicalto
use his sperm that is in the bank. Sperm donor must leave a written
consent for the use of his sperm after his death. Some counter this the
child will lose his inheritance rights.

8. WOMEN ALONE CAN CHOOSE TO HAVE A CHILD EVEN WITHOUT

A HUSBAND OR A BOYFRIEND. ALL THEY NEED IS A SPERM
DONOR.
 In a situation like this, it is said to create a paradox on the right to
reproduction since it is supposed to be a couple decision. People question
the welfare of the child in this situation also. The child has the right to
have a mother and a father.
 Should the identity of the sperm donor be revealed? What information will
be given to the child in the future?

9. ASSISTED REPRODUCTION IS NOT INEXPENSIVE

 Assisted reproduction is not inexpensive. From IVF to egg donation and
all of the assisted reproductive technologies, it costs, but are the costs
justified?
 What is the price that you can put on when your body may say you can’t
have a child but science says, “No, that’s not right, We can help you.” You
know what is it to you? And I do believe that that comes down to a
personal evaluation of an individual’s resources and their desire to grow
their family.
 So, there are a lot of factors that come into play when we talk about giving
someone compensation to undergo a medical procedure for someone else.
 So you have to make sure that you’re going through the process with open
eyes, surrounding yourself with professionals who can make sure that you
are not getting yourself into a situation where it is ever even dreamed of
that you are taking advantage of someone financially and with the use of
compensation.

10. RISKS
 There are definitely some risks to assisted reproduction whether you’re
caring for yourself and only using IVF to help yourself get pregnant.
  There is a risk everything involving medicine.

11. ACCESS TO THE SCIENCE

 Unfortunately, not everyone has acces to assisted reproductive
technologies and this can be for a number of reasons.
 It could be cost prohibitive to some.
 Some could live in a location that doesn’t allow them to utilize these
services.
 You have to make sure that you understand the way the laws are created
around assisted reproduction where you live. And some people say that
this creates an ethical issue. Is it right for some people to have access to
this technology and some people not to have access to this technology?
Ultimately, that’s more of a political question than anything else because
it’s going to be the laws that determine what’s legal in one location versus
another. But many people bring it back to the question of is that ethical?

DID YOU KNOW?

 There are no specific laws and regulations on IVF in the Philippines. With
regards to the subject of reproduction and fertility awareness, the
Philippine Family Code only recognises artificial insemination. The laws
have not been revised to regulate, or at the very least recognise, the latest
scientific advancements on ART, such as IVF.
 Under DOH Administrative Order (“AO”) No. 0012-12, or the Rules and
Regulations Governing New Classification of Hospitals and Other Health
Facilities in the Philippines, a facility performing IVF services is classified
explicitly as a specialised out-patient facility.
 The price of intrauterine insemination (IUI) in the Philippines may range
from Php 20,000 to Php 70,000 or more and Php 200, 000 to Php 400, 000
for In-vitro Fertilization (IVF) depending on the service provider and other
medical expenses. There may be a need to undergo more than one cycle of
procedure.

REFERENCES:

Morrison, E. E., & Furlong, B. (2018). Health care ethics (4th ed.). Jones and Bartlett.

https://clinmedjournals.org/articles/ogcr/ogcr-1-005.pdf

https://www.zicolaw.com/wp-content/uploads/2021/07/ASEAN-INSIDERS_In-Vitro-
Fertilisation-Laws-and-Regulations.pdf
https://clinmedjournals.org/articles/ogcr/ogcr-1-005.pdf

https://medlineplus.gov/assistedreproductivetechnology.html

https://www.cilvektiesibugids.lv/en/themes/family/reproductive-rights/artificial-
reproduction

https://amazetify.com/filipino-celebrities-who-have-babies-through-ivf-procedure/