Fertility, infertility, and pregnancy

1
Fertility, infertility, and pregnancy

• The phenomena
• Ethical issues

2
How to become pregnant

• 1. Engage in sexual intercourse repeatedly.
• 2. If not yet pregnant, repeat step 1.
• For most couples, that script works well.
• For some couples, it doesnt Infertility

3
Conception

• Sperm meets ovum Zona pellucida
• Sperm action Enzymes and exocytosis
• Fertilization Chromosome pairing
• Implantation
• Amnion, chorion, and placenta
• Umbilicus
• Zygote-morula-blastocyst-embryo-fetus

4
Infertility

• Inability to conceive
• Identifying the contributing partner

5
Male problems

• Low sperm count
• Defective sperm
• Low motility
• Disease effects diabetes, STIs
• Drug effects, especially alcohol
• Damaged testes cryptorchidism, mumps, trauma
• Autoimmune response to sperm
• Hormonal problems pituitary, thyroid

6
Female problems

• Irregular ovulation, anovulation
• Low body fat
• STI damage to Fallopian tubes PID
• Reproductive system disease
• Endometriosis
• Aging
• Allergic reactions to sperm or semen

7
Methods for dealing with infertility

• Behavioral methods
• Timing methods, male and female
• Calendar method Day 14
• Basal body temperature
• Take oral temperature with an electronic
  thermometer early in the morning, before rising.
• Temperature is 97.8oF a few days before ovulation
• Dips 0.4o to 0.8o the day before ovulation
• Rises to 98.4o after ovulation.
• The woman is fertile for 4 to 20 hours after
  ovulation
• After 3 days of 98.4o, the couple is no longer
  fertile.

8
More behavior methods

• OTC test kits for LH in urine or saliva
• Cervical mucus roll between fingers
• Thin, slippery, and clear around ovulation time
• A mucus plug indicates the end of fertility
• Males should reduce frequency of intercourse to
  increase sperm count

9
More methods

• Control position to recruit gravity
• Readers Digest method Male should penetrate
  deeply, hold position for ejaculation, withdraw
  slowly
• Change of venue
• Change of underwear
• Change of ambient temperature
• Decrease athletic activity
• Relax

10
Artificial enhancement of fertility

• Artificial insemination, husband donor
• Artificial insemination, third party donor
• In vitro fertilization
• Fertility enhancing drugs
• Ovum and oocyte transplants

11
Ethical and social issues

• Whose sperm? Whose eggs?
• What do we do with extra embryos?
• Eugenics
• Selective reduction/abortion
• Use of tissue from aborted babies
• Sex selection
• Surrogate motherhood

12
Contraception

• Why use contraceptive procedures?
• Margaret Sanger and the Comstock laws
• The Pivot of Civilization
• http//onlinebooks.library.upenn.edu/webbin/gutboo
  k/lookup?num1689
• Why not use contraceptive procedures?
• Roman Catholic teaching

13
Choosing contraceptive procedures

• Effectiveness
• Convenience
• Aesthetics
• Equality/sharing
• Availability
• Consequences

14
Contraceptive methods

• Contraception vs. contra-implantation
• Abstinence and calendar methods
• Barrier methods
• Spermicides
• Implantation blockers
• IntraUterine Devices (IUDs)
• Progestasert T
• Copper T 380A

15
Hormonal methods

• Female
• Male
• The pill(s)
• Norplant
• Depo-Provera
• Patch
• Emergency contraception
• Mifepristone (RU-486)

16
Sterilization procedures

• Tubal ligation
• Ovariectomy
• Hysterectomy
• Vasectomy
• Orchidectomy