Ethics of Reproduction

1. Ethics of Reproduction Implications in Nursing Practice Sara McCormick Fall 2013 NURS 450

2. Introduction • What is reproduction? • The act of sexual reproduction is a process to create offspring, for the survival of a species, that will pass on traits to the next generation. • Both male and female reproductive systems are needed for the process of fertilization (sperm fusing with ovum), then the female organs assume responsibility for the developing human. • ("Human biology: human," 2013).

3. Infertility • According to the Mayo Clinic, ten to fifteen percent of couples in the United States are infertile. • Infertility may be caused by a single factor affecting the male or female partner, or may be a combination of factors. • There are now many options to treat infertility. • ("Infertility," 2013).

4. Assisted Reproduction Technology (ART) • What is assisted reproduction? • Assisted reproduction technology (ART) “includes all fertility treatments in which both eggs and sperm are handled. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman. They do NOT include treatments in which only sperm are handled (i.e., intrauterine—or artificial—insemination) or procedures in which a woman takes medicine only to stimulate egg production without the intention of having eggs retrieved,” ("Assisted Reproductive Technology").

5. History • 1947 Educational video about reproduction: • http://www.youtube.com/watch?v=xFpVy9OCI4o, (Diehl, 1947). • We have come a long way from 1947 in the means of reproduction and technology used to achieve reproduction. • England and Australia got it right first, 14 times before the United States. • “More than eight years had passed since America’s first attempt at a test tube baby. Amid controversy and limitations on federal funding, the United States had languished behind while 14 other children were born in England and Australia using the new technique,” ("The us' first," 2010).

6. History cont. • The failed Del-Zio attempt: • In 1973 a family from Florida were a part of the first attempt at IVF. One physician surgically removed the egg from the female, Doris, and another physician attempted to fertilize the egg. Their experiment was halted by hospital administration. The physician’s involved encouraged the couple to seek damages and sue the hospital. Several years later they were awarded minimal damages, thus paving the way for more IVF attempts in America, ("The del-zio lawsuit," 2010). • After Del-Zio • IVF then moved into the periphery of American science and into places outside of the medical mainstream. Two retired John’s Hopkins’ doctors opened an IVF clinic in 1980 at Eastern Virginia Medical School. The two physician’s watched as a British doctor brought the first test tube baby into the world in 1978. They began implanting fertilized eggs into patients only at night, and didn’t use fertility drugs. The first year was unsuccessful, so they changed their techniques, (“The us’ first, 2010”).

7. History Cont. • The US’ first test tube baby: • Judy Carr was the perfect candidate for IVF, as she had no fallopian tubes and no chance of getting pregnant the old fashioned way. • Teacher Judy Carr received injections 3 times daily for 3 weeks of the fertility drug Pergonal. • On April 17, 1981 Judy’s uterus was implanted with a fertilized egg. • There were concerns about how a test tube baby would turn out, so the pregnancy and all details were kept under wraps, so that media couldn’t get a hold of any problems. The doctors were concerned if something went wrong it would give ammunition to those who thought IVF was immoral and wrong. • America’s first test tube baby was born on December 28, 1981. Although there had been concerns about her health prior to delivery, the baby was perfectly healthy. • (“The us’ first,” 2010)

8. Techniques of ART • In Vitro Fertilization (IVF) • Involves taking a woman’s eggs and fertilizing them with sperm inside a laboratory. • Most commonly used and most effective form of ART available today. • Resulting embryos are cultured in the lab for several days and monitored closely. • The best embryos are placed into the woman’s uterus. • In the past several embryos would be placed into the woman’s uterus, with advances now just a single embryo can be implanted, reducing the risk of a multiples pregnancy. (Jensen, 2013)

9. Techniques cont. • Intracytoplasmic sperm injection (ICSI): Used to treat male infertility, IVF procedure involving microinjection of a single sperm into the egg cytoplasm. • Assisted hatching: The application of lasers, chemicals, or mechanic means to create an opening in the zona pellucida to assist implantation of the embryo after IVF. • Pre-implantation genetic testing: an experimental technique used to test embryos created by IVF prior to transferring to the uterus to detect any genetic anomalies. • Post-menopause pregnancy: pregnancy achieved through IVF using a donor egg and sperm for a woman who is post menopausal. • Immature oocyte cryopreservation and maturation: The retrieval of unstimulated and immature oocytes from a fertile woman for freezing and subsequent IVF at a later date. • Reconstructed oocytes: Involving either the transfer of normal cytoplasm from an egg donor into the egg of an infertile woman or the transplantation of the nucleus of an egg from a woman who’s infertile into an enucleated donor egg. These techniques allow genetic link to the woman’s offspring. • Embryo splitting: Does not involve substitution of the entire genome, unlike cloning. Separating of blastomeres of an early preimplantion embryo to produce two or more embryos with the same genome, to reduce the number of IVF treatment cycles. • (Reame 331-38).

10. The Nurse’s Role • “Nurses are actively involved in planning and providing nursing care to infertile individuals and couples in a variety of healthcare settings. Infertility is a health problem with ethical and physical, psychological, and social dimensions,” (White, 1992. • Because of the huge ethicolegal controversies that surround ART in the US, the most important role for nurses may be helping families and third party participants obtain fully informed consent. Due to high compensation fees for egg donors, they may be at high risk for exploitation, (Reame 331-38). • In regards to HIV positive patients, the role of the nurse is to listen, clarify, and support. The decision for HIV patients to procreate is fraught with controversy, but the decision lies with the patient and family, not the healthcare provider, ((Wayson Locher 465-69). • For same sex couples the nurse will need to identify where services could be more inclusive and push for improvements, (Wykes 871-75).