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The Art of ART: Assisted Reproductive Technology

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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 ... – PowerPoint PPT presentation

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Title: The Art of ART: Assisted Reproductive Technology


1
The Art of ARTAssisted Reproductive Technology
  • Mary L. Davenport, M.D.
  • Berkeley Students for Life
  • March 4, 2009

2
What is ART?
  • Assisted Reproductive Technologies
  • Fertility therapies where eggs and sperm are
    manipulated
  • Involve surgically removing eggs from women and
    combining them with sperm in the laboratory

3
ART Assisted Reproductive Technology
  • 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, pre-implantation diagnosis,
    freezing, selective reduction

4
IVF
TYPES OF ART
SART 1999
5
ASSISTED REPRODUCTIVE TECHNOLOGY
  • Major philosophical and ethical shift in
    reproductive medicine
  • Emphasis changed from healing and eradicating
    disease to control of procreation

6
REPRODUCTIVE CHRONOLOGY
  • 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

7
GREGORY PINCUS
  • 1934 First in vitro fertilization of rabbit eggs
  • Criticized as mad scientist
  • Developed oral contraceptives in 1950s

8
Dr. John Rock1890-1984
  • 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

9
STEPTOE AND EDWARDSBirth of Louise BrownFirst
IVF Baby, 1978
10
Why ART?
11
Infertility Extremely Prevalent
  • 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

12
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13
Why the increase in infertility?
  • Delayed marriage and child-bearing
  • Sexually transmitted diseases
  • Hormonal contraception
  • Abortion
  • Obesity
  • Environmental Pollution

14
FERTILITY CLOCK
15
What is IVF?
16
IVF (in vitro fertilization) is a method in which
egg cells are fertilized by sperm cells outside
the mothers womb (in vitro). The resulting
embryos are then transferred back into the uterus.
17
STEPS IN IVF
  • Follicle suppression
  • Controlled ovarian hyperstimulation
  • Aspiration of eggs from follicles
  • Fertilization, incubation and selection of
    embryos
  • Embryo transfer
  • Pregnancy test

18
FOLLICLE SUPPRESSION ANDCONTROLLED OVARIAN
HYPERSTIMULATION
19
ASPIRATION OF EGGS
20
IVF LAB FOLLICULAR FLUID
21

HIGH QUALITY EGG
22
LOW QUALITY EGG
23
EMBRYOLOGIST MANIPULATING OVA AND SPERM
24
ICSI
25
INCUBATOR
26
HIGH QUALITY THREE DAY OLD EMBRYO
27
EMBRYO TRANSFER
28
IVFWHY NOT?
29
IVF Why not?
  • LOSS OF LIFE

30
IVF OUTCOMES
SART 1999
31
Pregnancy Rates Nondonor Eggs SART,CDC, 2004
32
LOW QUALITY EMBRYO
33
TANK FOR FREEZING EMBRYOS
34
MFPRMULTIFETAL PREGNANCY REDUCTION
35
ART Outcomes by Age SART, CDC, 2004
36
COMPARISON OF OWN AND DONOR EGGS
37
Pregnancy Loss by Age CDC
38
IVF why not?IVF permits the use of donor ova and
sperm and cloned embryos
  • Violates traditional Judeo-Christian concept of
    marriage
  • Legal and biologic confusion
  • Commercialization of human lifesale 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

39
COMPARISON OF OWN AND DONOR EGGS
40
Egg donor Characteristics e.g. Hair
color, Weight Ethnicity
41
CLONED HUMAN EMBRYO
42
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

43
IVF Why not? MULTIPLE BIRTHS
44
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45
IVF why not? Multiple births
  • 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

46
IVF Expensive
  • 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

47
IVF Additional Costs
  • 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

48
Benitez v North Coast Womens Medical Group
  • 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

49
R. Alta Charo, J.D.Professor of LawUniversity
of Wisconsin
  • The Celestial Fire of Conscience Refusing to
    Deliver Medical Care
  • New England Journal of Medicine
  • June 16, 2005

50
The McCaughey Septuplets 1997
51
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52
The Chukwu Octuplets
53
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54
Dr, Michael Kamrava
55
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56
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57
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