In Vitro Fertilization (IVF)

1. In Vitro Fertilization (IVF) Rels 300 / Nurs 330 16 January 2014 300/330 - appleby

2. 25 July 1978:1st “test tube” Baby On left: Physiologist Robert Edwards Middle: baby Louise Joy Brown (Middle woman, unidentified) Right: Gynecologist Patrick Steptoe Parents: Lesley & John Brown – after 9 years of infertility After 80 embryo transfer failures, 1st successful pregnancy and birth 300/330 - appleby

3. Currently, over 4 million test tube Babies have been born • Robert Edwards received the 2010 Nobel prize for medicine. • the world's first "test tube baby" was born in July 1978. • IVF technology allowed Lesley & John Brown to experience pregnancy & birth, in spite of Lesley’s blocked fallopian tubes 300/330 - appleby

4. In response, the Vatican protested the awarding of the prize, saying that: • Conception occurs separate from the couple’s conjugal union • Embryos that are fertilized but not implanted are destroyed The President of the Pontifical Academy for Life said that “without Edwards there would not be freezers full of embryos waiting to be transferred to a uterus, or, more likely, used for research or left to die, abandoned and forgotten by all.” http://catholic.org/hf/family/story.php?id=39343 300/330 - appleby

5. James Watson, co-discoverer with Crick of the structure of DNA, and fellow Nobel Laureate from 1953, had this to say about IVF: “All hell will break loose, politically and morally, all over the world.” The Atlantic, June 2012 300/330 - appleby

6. What is IVF? IVF is a process whereby ova and sperm are placed together in a glass dish (in vitro = in glass) in a laboratory setting • If fertilization occurs, and the early embryos successfully begin to grow in the dish, then the embryos are transferred into the woman’s uterus • If one or more embryos are successful in achieving implantation, then a pregnancy has begun 300/330 - appleby

7. 5 Steps • Ovulation induction: fertility drugs are used to cause production of multiple ova (usually 3 or more, up to 15 or 20) and to control the exact timing of the ovulation • Follicular aspiration: ripe ova within their follicles are surgically removed from the woman’s ovaries using a hollow catheter • Ova and sperm are combined in a glass dish in a nutrient-rich medium (ratio of 50,000 to 1) 300/330 - appleby

8. Dish containing ova and sperm is placed in an incubator to provide a temperature-controlled environment; eggs are monitored for fertilization and cell division (“Spare” embryos may be discarded, frozen, or donated) After 17 days, a pregnancy test will be done, followed by an ultrasound if pregnancy has been confirmed • Healthy fertilized zygotes are transferred to the woman’s uterus through the cervix using a catheter; generally 1 to 3 embryos per transfer 300/330 - appleby

9. Medical Risks associated with IVF Hormonal stimulation of woman’s ovaries to produce multiple ova → risk of ovarian hyperstimulation • Severe abdominal pain • Nausea or vomiting • Decreased urination • Shortness of breath • Up to 10 lb. weight gain within 3 to 5 days • Risks associated with anesthesia • Risks of bleeding, infection • Risks of damage to the bowel, bladder or blood vessels • Potential for a multiple pregnancy with risk of premature delivery • Potential risks from donor sperm or ova 300/330 - appleby

10. Variations of IVF • ICSI – intracytoplasmic sperm injection – if sperm are few or inactive – a single sperm is inserted into the ovum with a catheter • GIFT – gamete intrafallopian transfer – ova and sperm are collected and then transferred to the fallopian tubes so that fertilization takes place within the woman’s body 300/330 - appleby

11. IVF with donors • EMBRYO • Excess frozen fertilized embryos from previous IVF cycles; http://www.mountsinai.on.ca/care/fertility/services/embryo-freezing • Purchase from an IVF clinic’s excess inventory • Prenatal adoption of “spare” embryos OVA • Donation of healthy ova no longer needed by another IVF woman • Purchase of ova from a “donor” catalogue • Altruistic donation from a family member or friend; http://www.mountsinai.on.ca/care/fertility/services/egg-donation SPERM • Donation of sperm no longer needed for AI or IVF • Purchase of sperm from a “donor” catalogue • Altruistic donation from a family member or friend • Purchase online 300/330 - appleby

12. IVF fee schedule http://www.mountsinai.on.ca/care/fertility/CFRH%20Fee%20Schedule.pdf 250 Dundas Street West, Suite 700 · Toronto, ON · M5T 2Z5 · (416) 586-4748 300/330 - appleby

13. http://www.eggdonation.com/index.php 300/330 - appleby

14. https://www.eggdonation.com/becoming-an-egg-donor/Donor-compensation.phphttps://www.eggdonation.com/becoming-an-egg-donor/Donor-compensation.php 300/330 - appleby

15. http://www.eggdonation.com/egg-donor-bank.php • Frozen Eggs Available from egg donor 1019 only. We have had a 100% success rate with transfers from • this donor cycle, both fresh and frozen. • The advantages for Intended Parents are tremendous: • The cost for a thawed egg cycle is less than half of the cost • There is one clear cost which eliminates possible extra costs with traditional egg donation such as extra medications, blood tests, travel, monitoring, lost wages. 300/330 - appleby

16. https://www.eggdonor.com/egg-donor-database/ Our on-line egg donor catalog 300/330 - appleby

17. 300/330 - appleby

18. Rotunda-The Center for Human Reproduction MUMBAI, India Rotunda Clinic offers comprehensive IVF services: IUI, IVF, ICSI Donor Egg IVF, Embryo Adoption, Surrogacy Embryo Retrieval through Puncture/ Aspiration, Overseas IVF Patient Program, Gestational Surrogacy & Gestational Carrier ART Program 300/330 - appleby

19. Why choose Egg and/or Embryo Storage? • When fertility is at risk due to illness or surgery. • To delay childbearing until a later date. • Egg/Embryo storage gives women who have completed IVF treatment the option to preserve the unused embryos for potential use in the future. • Your IVF center has limited storage space. • Your IVF center is closing. 300/330 - appleby

20. http://www.embryoadoption.org/sitemap/index.cfm Adopters • Adopters • Embryo Adoption 101 • Terminology Defined • Videos • Personal Stories • Adopter FAQs • News Articles • Embryo Adoption Agencies • Home Study Providers • Clinics with Donation Donors • Donors • Embryo Adoption 101 • Terminology Defined • Videos • Personal Stories • Donor FAQs • Counselor Support Network • News Articles • Where to Donate • Webinar Registration • Glossary 300/330 - appleby

21. Evaluating reproductive technologies • Whose personal dignity and autonomy are promoted or harmed? • What are the potential benefits of reproductive technologies? • Who are the beneficiaries? • What are the potential risks and harms of reproductive technologies? • Who is most likely to be harmed? • Are there justice issues in the provision of reproductive services? • Issues of fairness, equality, equitable access? 300/330 - appleby

22. Procreative Liberty and Harms According to Robertson, “those who would limit procreative choice have the burden of showing that [one’s] reproductive actions” would result in tangible & substantial harms • What sorts of potential harms might there be in artificial insemination? Or IVF? • Who might be vulnerable to being harmed by artificial insemination technologies? Or IVF? 300/330 - appleby