Transcript The Art of ART: Assisted Reproductive Technology

The Art of ART:
Assisted Reproductive
Technology
Mary L. Davenport, M.D.
Berkeley Students for Life
March 4, 2009
What is ART?
Assisted Reproductive
Technologies:
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Fertility therapies where eggs and sperm
are manipulated
Involve surgically removing eggs from
women and combining them with sperm
in the laboratory
ART: Assisted Reproductive Technology
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Predominantly IVF – In Vitro Fertilization
Expensive
Most attempts fail to produce a live birth
Separates procreation from the marital
act
Large loss of embryos in failure to
implant, discarding embryos, preimplantation diagnosis, freezing,
selective reduction
IVF
TYPES OF ART
SART 1999
ASSISTED REPRODUCTIVE
TECHNOLOGY
Major philosophical and ethical
shift in reproductive medicine
 Emphasis changed from healing
and eradicating disease to control
of procreation
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REPRODUCTIVE CHRONOLOGY
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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
GREGORY PINCUS
1934 First in vitro
fertilization of rabbit
eggs
 Criticized as “mad
scientist”
 Developed oral
contraceptives in
1950’s
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Dr. John Rock
1890-1984
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
STEPTOE AND EDWARDS
Birth of Louise Brown
First IVF Baby, 1978
Why ART?
Infertility: Extremely Prevalent
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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
Why the increase in infertility?
Delayed marriage and child-bearing
 Sexually transmitted diseases
 Hormonal contraception
 Abortion
 Obesity
 Environmental Pollution
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FERTILITY
CLOCK
What is IVF?
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.
STEPS IN IVF
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Follicle suppression
Controlled ovarian hyperstimulation
Aspiration of eggs from follicles
Fertilization, incubation and selection of
embryos
Embryo transfer
Pregnancy test
FOLLICLE SUPPRESSION AND
CONTROLLED OVARIAN HYPERSTIMULATION
ASPIRATION OF EGGS
IVF LAB: FOLLICULAR FLUID
HIGH QUALITY EGG
LOW QUALITY EGG
EMBRYOLOGIST MANIPULATING OVA AND SPERM
ICSI
INCUBATOR
HIGH QUALITY THREE DAY OLD EMBRYO
EMBRYO TRANSFER
IVF:
WHY NOT?
IVF Why not?
LOSS OF LIFE
IVF OUTCOMES
SART 1999
Pregnancy Rates: Nondonor Eggs
SART,CDC, 2004
LOW QUALITY EMBRYO
TANK FOR FREEZING
EMBRYOS
MFPR
MULTIFETAL PREGNANCY REDUCTION
ART Outcomes by Age
CDC, 2004
SART,
COMPARISON OF OWN AND DONOR EGGS
Pregnancy Loss by Age: CDC
IVF why not?
IVF permits the use of donor ova and
sperm and cloned embryos
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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 can be used
Cloning a dangerous technology and makes
massive abuses possible
COMPARISON OF OWN AND DONOR EGGS
Egg donor
Characteristics:
e.g. Hair color,
Weight
Ethnicity…
CLONED HUMAN EMBRYO
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PANAYIOTIS ZAVOS, PH.D.
CURRRENTLY
CONDUCTING
HUMAN CLONING
EXPERIMENTS IN
UNDISCLOSED
COUNTRY WITH
DRS. SEVERINO
ANTORINI AND
BEN-ABRAHAM
GOAL:
PROVIDING
CHILDLESS
COUPLES WITH
THE ABILITY TO
CLONE
THEMSELVES AS
A FORM OF
REPRODUCTION
IVF Why not?
MULTIPLE
BIRTHS
IVF why not? Multiple births
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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
IVF: Expensive
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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
IVF: Additional Costs
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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
Benitez v North Coast Women’s Medical Group
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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
“The Celestial Fire
of Conscience:
Refusing to
Deliver Medical
Care”
R. Alta Charo, J.D.
Professor of Law
University of Wisconsin
New England Journal of
Medicine
June 16, 2005
The McCaughey Septuplets 1997
The Chukwu Octuplets
Dr, Michael Kamrava