IN-VITRO FERTILIZATION

Stories behind Success and Failures.

IN-VITRO FERTILIZATION
Infertility is the inability of a couple to become pregnant (regardless of cause) after 1 year of unprotected sexual intercourse -using no birth control methods. 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.

IN-VITRO FERTILIZATION
Louise Brown, 1978

IN-VITRO FERTILIZATION

HISTORY

There was a transient biochemical pregnancy reported by Australian Foxton School researchers in 1953. John Rock was the first to extract an intact fertilised egg. The first pregnancy achieved through in vitro human fertilisation of a human oocyte was reported in The Lancet from the Monash University team in 1973. There was also an ectopic pregnancy reported by Patrick Steptoe and Robert Edwards in 1976. In 1977, Steptoe and Edwards successfully carried out a pioneering conception which resulted in the birth of the world's first baby to be conceived by IVF, Louise Brown on 25 July 1978, in Oldham General Hospital, Greater Manchester, UK. In October 1978, it was reported that Subash Mukhopadyay, a relatively unknown physician from Kolkata, India was performing experiments on his own with primitive instruments and a household refrigerator and this resulted in a test tube baby, later named as "Durga" (alias Kanupriya Agarwal) who was born on October 3, 1978.

IN-VITRO FERTILIZATION

HISTORY

Steptoe and Edwards were responsible for the worlds second (confirmed) baby conceived by IVF, Alastair MacDonald born on 14 January 1979 in Glasgow. A team led by Ian Johnston and Alex Lopata were responsible for Australias first baby conceived by IVF, Candice Reed born on 23 June 1980 in Melbourne. This was followed by a total of 14 pregnancies resulting in nine births in 1981 with the Monash University team. The Jones team at the Eastern Virginia Medical School in Norfolk, Virginia, further improved stimulated cycles by incorporating the use of a follicle-stimulating hormone (uHMG). This then became known as controlled ovarian hyperstimulation (COH). The ability to freeze and subsequently thaw and transfer embryos has significantly improved the feasibility of IVF use. The other very significant milestone in IVF was the development of the intracytoplasmic sperm injection (ICSI) of single sperms by Andr van Steirteghem in Brussels, 1992.

IN-VITRO FERTILIZATION

HISTORY

Robert Edwards was awarded the 2010 Nobel Prize in Physiology or Medicine "for the development of in vitro fertilization". Carl Wood was dubbed "the father of IVF (in vitro fertilisation)" for having pioneered the use of frozen embryos. In the US, ART cycles started in 2006 resulted in 41,343 births (54,656 infants), which is slightly more than 1% of total US births.

IN-VITRO FERTILIZATION
Infertility is a growing problem. Some probable causes include;
       

Delayed marriages and later childbearing Sexually transmitted diseases Pollution Diet Lack of exercise Previous contraceptive use leading to sterility Sterility from previous abortion Falling sperm count in males (medicines, alcohol etc)

IN-VITRO FERTILIZATION
In Vitro Fertilization Test tube babies

IN-VITRO FERTILIZATION

WHAT IS IVF?
is a process by which egg cells are fertilised by sperm outside the body: in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman's ovaries and letting sperm fertilise them in a fluid medium. The first successful birth of a "test tube baby", Louise Brown, occurred in 1978. Robert G. Edwards, the physiologist who developed the treatment, was awarded the Nobel Prize in Physiology or Medicine in 2010.

The term in vitro, from the Latin root meaning in glass, is used, because early biological experiments involving cultivation of tissues outside the living organism from which they came, were carried out in glass containers such as beakers, test tubes, or petri dishes. Today, the term in vitro is used to refer to any biological procedure that is performed outside the organism it would normally be occurring in, to distinguish it from an in vivo procedure, where the tissue remains inside the living organism within which it is normally found.

IN-VITRO FERTILIZATION
INDICATIONS
IVF may be used to overcome female infertility in the woman due to problems of the fallopian tube, making fertilisation in vivo difficult. It may also assist in male infertility, where there is defect sperm quality, and in such cases intracytoplasmic sperm injection (ICSI) may be used, where a sperm cell is injected directly into the egg cell. For IVF to be successful it typically requires healthy ova, sperm that can fertilise, and a uterus that can maintain a pregnancy. Due to the costs of the procedure, IVF is generally attempted only after less expensive options have failed.

IVF can also be used with egg donation or surrogacy where the woman providing the egg isn't the same who will carry the pregnancy to term. IVF can also be combined with preimplantation genetic diagnosis (PGD) to rule out presence of genetic disorders. A similar but more general test has been developed called Preimplantation Genetic Haplotyping

IN-VITRO FERTILIZATION

METHODS
Step 1: Stimulation, also called super ovulation Medicines, commonly called fertility drugs, are given to the woman to boost her egg production. Normally, a woman produces one egg per month. Fertility drugs tell the ovaries to produce several eggs. During this step, the woman will have regular transvaginal ultrasounds to examine the ovaries and blood tests to check hormone levels.

Step 2: Egg retrieval A minor surgery, called follicular aspiration, is done to remove the eggs from the womans body. The surgery is normally done as an outpatient procedure in the doctors office. The woman will be given medicines so she does not feel pain during the procedure. Using ultrasound images as a guide, the health care provider inserts a thin needle through the vagina and into the ovary and sacs (follicles) containing the eggs. The needle is connected to a suction device, which pulls the eggs and fluid out of each follicle, one at a time. The procedure is repeated for the other ovary. The woman may have some cramping after the surgery, but it usually goes away within a day. In rare cases, a pelvic laparoscopy may be needed to remove the eggs. If a woman does not or cannot produce any eggs, donated eggs may be used.

IN-VITRO FERTILIZATION

Step 3: Insemination and Fertilization The mans sperm is placed together with the best quality eggs and stored in an environmentally controlled chamber. The mixing of the sperm and egg is called insemination. The sperm usually enters (fertilizes) an egg a few hours after insemination. If the doctor thinks the chance of fertilization is low, the laboratory staff may directly inject the sperm into the egg. This is called intracytoplasmic sperm injection (ICSI). Many fertility programs routinely do ICSI on some of the eggs even if everything is normal.

Step 4: Embryo culture When the fertilized egg divides, it becomes an embryo. Laboratory staff will regularly check the embryo to make sure it is growing properly. Within about 5 days, a normal embryo has several cells that are actively dividing. Couples who have a high risk of passing a genetic (hereditary) disorder to a child may consider preimplantation genetic diagnosis (PGD). The procedure is done about 3 -4 days after fertilization. Laboratory scientists remove a single cell from each embryo and screen the material for specific genetic disorders. According to the American Society for Reproductive Medicine, PGD can help parents decide which embryos to implant, which decreases the chance of passing a disorder onto a child. The technique is controversial and not offered at all centers.

IN-VITRO FERTILIZATION

Step 4: Embryo selection Laboratories have developed grading methods to judge oocyte and embryo quality. In order to optimise pregnancy rates, there is significant evidence that a morphological scoring system is the best strategy for the selection of embryos. However, presence of soluble HLA-G might be considered as a second parameter if a choice has to be made between embryos of morphologically equal quality. Also, two-pronuclear zygotes (2PN) transitioning through 1PN or 3PN states tend to develop into poorer-quality embryos than those that constantly remain 2PN. .

Step 5: Embryo transfer Embryos are placed into the womans womb 3 - 5 days after egg retrieval and fertilization. The procedure is done in the doctors office while the woman is awake. The doctor inserts a thin tube (catheter) containing the embryos into the womans vagina, through the cervix, and up into the womb. If an embryo sticks to (implants) in the lining of the womb and grows, pregnancy results. More than one embryo may be placed into the womb at the same time, which can lead to twins, triplets, or more. The exact number of embryos transferred is a complex issue that depends on many factors, especially the womans age. Unused embryos may be frozen and implanted or donated at a later date. .

IN-VITRO FERTILIZATION

IN-VITRO FERTILIZATION

IN-VITRO FERTILIZATION
SUCCESS

RATES

IVF success rates are the percentage of all IVF procedures which result in a favorable outcome. Depending on the type of calculation used, this outcome may represent the number of confirmed pregnancies, called the pregnancy rate or number of live births, called the live birth rate.

Live birth rate The live birth rate is the percentage of all IVF cycles that lead to a live birth. This rate does not include miscarriage or stillbirth and multiple-order births such as twins and triplets are counted as one pregnancy. Pregnancy rate Pregnancy rate may be defined in various ways. In the United States, the pregnancy rate used by the Society for Assisted Reproductive Technology and the Centers for Disease Control (and appearing in the table in the Success Rates section above) are based on fetal heart motion observed in ultrasound examinations.

IN-VITRO FERTILIZATION

FAILURE

RATES

Stress Acupuncture Tobacco smoking A body mass index (BMI) over 27 causes a 33% decrease in likelihood to have a live birth after the first cycle of IVF

Success with previous pregnancy and/or live birth increases chances Low alcohol/caffeine intake increases success rate The number of embryos transferred in the treatment cycle Other factors of semen quality for the sperm provider Aspirin

IN-VITRO FERTILIZATION
RISKS

As with most medical procedures, there are some potential risks. The risks of in vitro fertilization depend upon each specific step of the procedure. Ovary stimulation carries the risk of hyperstimulation, where the ovaries become swollen and painful. This condition, "Ovarian Hyper stimulation Syndrome", is usually rare, mild, and involves the following potential side affects: nausea, vomiting, lack of appetite, or a feeling of being bloated. More severe symptoms which occur in 1% of cases, include the following: Severe abdominal pain Severe nausea or vomiting Decreased urinary frequency Dark-colored urine Shortness of breath Ten pound weight gain within three to five days

IN-VITRO FERTILIZATION
COMPLICATIONS
Multiple Births The major complication of IVF is the risk of multiple births. This is directly related to the practice of transferring multiple embryos at embryo transfer. Multiple births are related to increased risk of pregnancy loss, obstetrical complications, prematurity, and neonatal morbidity with the potential for long term damage..

Birth defects The issue of birth defects has been a controversial topic in IVF. Many studies do not show a significant increase after use of IVF, and some studies suggest higher rates for ICSI, whereas others do not support this finding.

IN-VITRO FERTILIZATION
COMPLICATIONS

Other Risks Another risk of ovarian stimulation is the development of ovarian hyperstimulation syndrome, particularly if hCG is used to "trigger ovulation".

Depression A negative pregnancy test after IVF is associated with an increased risk for depression in women, but not with any increased risk of developing anxiety disorders. Pregnancy test results do not seem to be a risk factor for depression or anxiety among men.

IN-VITRO FERTILIZATION
The inseparable connection: ETHICS union and procreation
The Church's teaching on marriage and human procreation affirms the inseparable connection, willed by God and unable to be broken by man on his own initiative, between the two meanings of the conjugal act: the unitive meaning and the procreative meaning. By safeguarding both these essential aspects, the unitive and the procreative, the conjugal act preserves in its fullness the sense of true mutual love and its ordination toward man's exalted vocation to parenthood see Humanae Vitae 12

IN-VITRO FERTILIZATION
ETHICS

Pregnancy past menopause

Although menopause is a natural barrier to further conception, IVF has allowed women to be pregnant in their fifties and sixties. Women whose uterus has been appropriately prepared receive embryos that originated from an egg of an egg donor.

IN-VITRO FERTILIZATION
ETHICS

Same-sex couples, single and unmarried parents

A 2009 statement from the ASRM found no persuasive evidence that children are harmed or disadvantaged solely by being raised by single parents, unmarried parents, or homosexual parents. It did not support restricting access to assisted reproductive technologies on the basis of a prospective parent's marital status or sexual orientation. Ethical concerns include reproductive rights, the welfare of offspring, nondiscrimination against unmarried individuals, homosexual, and professional autonomy.

IN-VITRO FERTILIZATION
ETHICS

Catholic Objections

The Catholic Church opposes all kinds of in vitro fertilisation because, as with contraception, it separates the procreative purpose of the marriage act from its unitive purpose:

IN-VITRO FERTILIZATION
ETHICS

Catholic Objections

2. Massive destruction of human life

Currently the number of embryos sacrificed, even in the most technically advanced centers of artificial fertilization, hovers above 80%.

IN-VITRO FERTILIZATION
ETHICS

Catholic Objections

3. The child must be a gift not a product The child has the right to be the fruit of the specific act of the conjugal love of his parents.

IN-VITRO FERTILIZATION
ETHICS

Catholic Objections

The child becomes a manufacturing product and not a gift

A child cannot be desired or conceived as the product of an intervention of medical or biological techniques; that would be equivalent to reducing him to an object of scientific technology.

IN-VITRO FERTILIZATION
ETHICS

Catholic Objections

You formed my inmost being; you knit me in my mother's womb. Fearfully and wonderfully made!
Psalm 139

IN-VITRO FERTILIZATION
ETHICS

Catholic Objections The Church is announcing a big YES to life!

The Churchs mission to protect the poorimplies courageous opposition to all those practices which result in grave and unjust discrimination against unborn human beings, who have the dignity of a person, created like others in the image of God. Behind every no in the difficult task of discerning between good and evil, there shines a great yes to the recognition of the dignity and inalienable value of every single and unique human being called into existence.

IN-VITRO FERTILIZATION

Thank you!

IN-VITRO FERTILIZATION

Questions:
1. 2.

3.

If you are asked as a Catholic on what basis does the Church say no to IVF? can you now explain it? How do you understand the inseparability of the unitive and procreative dimensions of the conjugal act? What is your ethical opinion about embryo destruction and freezing?