Reproductive Ethics

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Reproductive Ethics

• 3/15/04

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Schedule

• Papers
• Understanding the Technology
• Ethical Issues

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Reflection 3
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Reproductive Technology

• Artificial Insemination
• In Vitro Fertilization
• Surrogacy
• Freezing Sperm
• Freezing Embryos
• Freezing Eggs
• (Cloning)

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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.

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Artificial Insemination

• 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.

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Artificial Insemination

• 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.

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Artificial Insemination

• 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.

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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.

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In Vitro Fertilization

• 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.)

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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
  womans fallopian tubes.

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GIFT

• 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.

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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 mothers eggs, the
  surrogate's eggs, or eggs from a donor.

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Surrogacy

• 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 surrogates parental rights.

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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.

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Freezing Sperm

• 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.

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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.

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Freezing Embryos

• 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.

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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.

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Freezing Eggs

• 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.

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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.)

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Ethical Questions

• What concerns do you have about these
  technologies?
• Has technology outpaced law?

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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?

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Even More Questions

• 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?

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The Big Question

• What is to be done with excess embryos?

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For Next Time

• Finkel, David. What Kind of Choice is That?
  Sciences War on Infertility Can Deliver Painful
  Decisions (Progdata)
• Weiss, Rick. Iowa Septuplets Multiply Critics of
  Fertility Therapy. (Progdata)
• Steinbock, Bonnie. The McCaughey Septuplets
  Medical Miracle or Gambling with Fertility
  Drugs?
• Charles, Sonya Shivas, Tricha. Mothers in the
  Media Blamed and Celebrated - An Examination of
  Drug Abuse and Multiple Births.  (Progdata)