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Assisted Reproductive Technology (ART)

Assisted Reproductive Technology (ART). Adapted from Mary L. Davenport, M.D. (UCLA at Berkeley), 2009. What is ART?. Assisted Reproductive Technologies: Fertility therapies where eggs and sperm are manipulated

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Assisted Reproductive Technology (ART)

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  1. Assisted Reproductive Technology (ART) Adapted from Mary L. Davenport, M.D. (UCLA at Berkeley), 2009

  2. What is ART? Assisted Reproductive Technologies: • Fertility therapies where eggs and sperm are manipulated • Usually involve surgically removing eggs from women and combining them with sperm in the laboratory

  3. ART: Assisted Reproductive Technology • Predominantly IVF – In Vitro Fertilization • Expensive • Most attempts fail to produce a live birth • Large loss of embryos

  4. REPRODUCTIVE CHRONOLOGY • 1934 Gregory Pincus: First animal IVF • 1944 John Rock: First human IVF • 1960 FDA approves “the pill” • 1978 First IVF baby • 2001 421 U.S. ART clinics with 41,000 live births annually

  5. GREGORY PINCUS • 1934 First in vitro fertilization of rabbit eggs • Criticized as “mad scientist” • Developed oral contraceptives in 1950’s

  6. Dr. John Rock1890-1984 • 1936 First doctor to open a Rhythm clinic in Boston • 1944 First IVF; created four embryos in secret • 1954 Collaborated with Pincus on U.S. clinical trials of the pill

  7. STEPTOE AND EDWARDSBirth of Louise BrownFirst IVF Baby, 1978

  8. Why ART?

  9. Infertility: Extremely Prevalent • Definition: inability to achieve pregnancy in one year • 17-26% of couples worldwide (90 million women) • 27-47% of infertile couples have impaired male fertility; decline in semen quality worldwide over last 50 years

  10. Why the increase in infertility? • Delayed marriage and child-bearing • Sexually transmitted diseases • Hormonal contraception • Abortion • Obesity • Environmental Pollution

  11. FERTILITY CLOCK

  12. What is IVF?

  13. IVF (in vitro fertilization) is a method in which egg cells are fertilized by sperm cells outside the mother’s womb (in vitro). The resulting embryos are then transferred back into the uterus.

  14. STEPS IN IVF • Follicle suppression • Controlled ovarian hyperstimulation • Aspiration of eggs from follicles • Fertilization, incubation and selection of embryos • Embryo transfer • Pregnancy test

  15. FOLLICLE SUPPRESSION ANDCONTROLLED OVARIAN HYPERSTIMULATION

  16. ASPIRATION OF EGGS

  17. IVF LAB: FOLLICULAR FLUID

  18. HIGH QUALITY EGG

  19. LOW QUALITY EGG

  20. EMBRYOLOGIST MANIPULATING OVA AND SPERM

  21. ICSI

  22. INCUBATOR

  23. HIGH QUALITY THREE DAY OLD EMBRYO

  24. EMBRYO TRANSFER

  25. IVF:WHY NOT?

  26. IVF why not? • IVF permits the use of donor ova and sperm and cloned embryos • Violates traditional Judeo-Christian concept of marriage • Legal and biologic confusion • “Commercialization” of human life—sale of ova and sperm • Donor ova and sperm illegal in many countries • Cloned embryos? • Issues with loss of embryos

  27. IVF Why not? MULTIPLE BIRTHS

  28. IVF why not? Multiple births • Multiple pregnancies with IVF (37.4%) • Triplets or more 8.4% (4.9% of live births) • Prematurity: Average with triplets 33 weeks; 85% survive • Prematurity: Quadruplets average 29 weeks; 70% survive • Fetal risks: mental/physical disabilities such as blindness, cerebral palsy; 5% in twins, 10% in triplets, 50% in quadruplets • Fetal risks: death; seven times more likely to die in the first year; 40x more likely to die in infancy • Maternal risks: toxemia, diabetes, hemorrhage • Family risks: depression, social isolation, divorce

  29. IVF: Expensive • Medication: $1,500-$7,000 per cycle • Office visits, egg retrieval, fertilization, assisted hatching, cryofreezing of embryo (six months),ultrasound, lab tests: $12,000-18,000 PER CYCLE; • Egg donation $3,000-$50,000

  30. IVF: Additional Costs • Hospital costs - Singleton $10,000; Twins $20,000; Triplets $40,000 • Intensive care of baby: $100,000-$150,000 per month • Work time lost--daily medical visits • Frequently not covered by insurance

  31. Benitez v North Coast Women’s Medical Group • Lesbian couple desired pregnancy • ObGyn group declined to perform IUI (Intrauterine insemination) because of marital status (or sexual orientation ?) based on physicians’ religious beliefs • Lower court found in favor of the doctors • California Supreme Court found in favor of Benitez

  32. The McCaughey Septuplets 1997

  33. The Chukwu Octuplets

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