Reproductive Ethics

Reproductive Ethics

Schedule
* Papers
* Understanding the Technology
* Ethical Issues

Reproductive Technology
* Artificial Insemination
* In Vitro Fertilization
* Surrogacy
* Freezing Sperm
* Freezing Embryos
* Freezing Eggs
* (Cloning)

Artificial Insemination
* Essentially, sperm (either from the husband or some other donor) is injected into the reproductive tract of the intended mother.
* Used most commonly when there are concerns about male infertility.
* The sperm can be “washed” first to ensure that there is a high concentration of sperm.
* Actually a general term, not a specific procedure.
* The most common procedure is intrauterine insemination (IUI), where the sperm is inserted directly into the uterus, so as to avoid possible problems with the cervix.
* IUI has a success rate of about 15-20%, and is fairly quick.
* A major disadvantage is that the doctor cannot tell if insemination has been successful because it occurs in the body.
* Another procedure, intracytoplasmic sperm injection (ICSI) involves injecting a single sperm by pipette into an egg.
* ICSI allows men with very low sperm counts to reproduce.
* Can be done in utero, but is becoming more common in vitro.

In Vitro Fertilization
* In these processes, sperm and eggs are combined outside the body, and reinserted after it is clear that insemination has occurred.
* The most common sign that insemination is successful is when the egg has divided into an eight-celled organism. This is the point that the egg(s) are reinserted.
* Depending on the procedure used, can cost between $5,000 and $12,000 an attempt.
* The rate of success for IVF varies from clinic to clinic, and procedure to procedure, but the national average is about 34% (measured in terms of babies per egg retrieval.)

GIFT
* Gamete Intrafallopian Transfer (GIFT) is a hybrid of IVF and AI.
* Eggs and sperm are both retrieved from the potential parents, and screened for problems.
* The sperm and eggs are then placed in a catheter together and inserted directly into one the woman’s fallopian tubes.
* Since the eggs are withdrawn from the body first, GIFT is similar to in vitro, but since the fertilization occurs in the body it is like AI.
* Some find this preferable to traditional IVF, because there is no question about what to do with “excess” embryos.

Surrogacy
* Surrogacy is when the potential parents have someone other than the eventual mother carry the child to term.
* This can be done with AI, or IVF, and can utilize either the eventual mother’s eggs, the surrogate's eggs, or eggs from a donor.
* Surrogates generally fall into two camps: Close relatives or hired surrogates.
* In either case it is routine to sign a contract stating what compensation (if any) will be done, concerns about how the surrogate will handle health issues during pregnancy, and a waiver of the surrogate’s parental rights.

Freezing Sperm
* A.K.A. “Sperm Banks”
* Sperm is collected via masturbation and is stored in a frozen manner. The sperm can be later “thawed,” and used in various reproductive technologies.
* While people who “sell” their sperm gets the most media attention, many men have some sperm frozen if they are going to be undergoing various procedures that could affect future fertility.

Freezing Embryos
* After fertilization, embryos can be frozen for later implantation via IVF.
* Most common with the “excess” embryos from IVF attempts and women who will be undergoing procedures that could effect future fertility.
* A problem with this approach is that embryos require both the egg and the sperm.
* Women who do not know for sure if they want to have children with Father “X,” but wish to save embryos cannot use this procedure.

Freezing Eggs
* Problematic for a long time because in the freezing process ice crystals could form, harming the eggs.
* Involves removing ovarian tissue, and freezing it. After the tissue is “thawed” it is transplanted into a host. Mature eggs are removed, inseminated, and implanted into the birth mother.
* The technology is still evolving, and many caution that there may be lingering side-effects from the freezing of the eggs.
* Allows women who want to preserve fertility, but not commit to having a child with any particular person to do so.

Cloning Technologies
* We will be looking into these next week, but many of the same ethical issues that rise with these technologies are also raised. (But as a bonus, additional ethical issues are raised.)

Ethical Questions
* What concerns do you have about these technologies?
* Has technology outpaced law?

More Questions
* Who has access to these technologies?
* Given problems with overpopulation, should we continue to look into advanced in reproductive technology?
* Is reproduction without sex moral?
* What should happen to eggs/sperm/embryos that have been stored when the donors have died?
* Do you own your genetic material? Can you bequeath it?
The Big Question
* What is to be done with “excess” embryos?

Reproductive Ethics.ppt