Infertility And New Reproductive Technologies 2

Infertility and New Reproductive Technologies ARTIFICIAL INSEMINATION (therapeutic option) By: Honeylette M. Brotonel

Conjugal Love   

Procreative Unitive Child is conceived  out of love  for love  To “create” a child outside conjugal love is considered immoral.

Artificial Insemination  Sperm is placed in a woman’s reproductive tract by means other than sexual intercourse  Sperm  From spouse: Artificial Insemination by Husband (AIH)  From a donor: Artificial Insemination by Donor (AID)

History  ???? - First artificial insemination attempt on Juana, wife of King Henry         

IV of Castile. 1677 - Anton Von Leeuwenhoek visualized spermatozoa under the microscope. 1780 - Spallanzani’s experiment proved that physical contact between the male and female gamete is required for successful embryo development. 1899 - Russia works towards development of Artificial Insemination methods. 1922 - Reports of successful insemination experiments in horses published. 1939 - G. W. Salisbury pioneers research in animal breeding and artificial insemination. 1940 - Technical improvement in freezing and thawing of sperm preparations. 1950’s - Cornell suggests idea of adding anti-biotic to the sperm preparation media. 1953 - The first successful artificial insemination with frozen human semen was achieved. 1970, 1980’s - Enhancement in the sperm collection techniques.

Commonly Used for Infertility Associated with:

 Endrometriosis  Disease state in which the endometrial tissue has spread elsewhere (ovaries)

Commonly Used for Infertility Associated with:  The hormones that stimulate egg

development must be made in the brain and pituitary and be released properly  The egg must be of sufficient quality and be chromosomally normalThe egg must develop to maturity  The brain must release a sufficient surge of the LH hormone to stimulate final maturation of the eggThe follicle (eggs develop in structures called follicles in the ovaries) must rupture and release the follicular fluid and the egg  The tube must "pick up" the eggThe sperm must survive their brief visit to the vagina, enter the cervical mucous, swim to the fallopian tube and "find" the egg shell (zona pellucida) of the egg

 Unexplained Fertility

 Idiopathic infertility  Cases are those in

which standard infertility testing has not found a cause for failure to conceive

 A weak link anywhere

in this chain can cause failure to conceive

Commonly Used for Infertility Associated with:  Anovulatory Infertility  Women who do not properly develop and release egg every month  Polycystic ovarian syndrome (common cause)

Commonly Used for Infertility Associated with:  Mild degree of male factor infertility  Picture of human sperm in a counting chamber (hemocytometer); tool used in determination of sperm counts

Commonly Used for Infertility Associated with:  Cervical Infertility  Immunologic Abnormalities

Donor Variation  Indication for artificial insemination with husband’s sperm (AIH) include:

 Male problems that prevent normal deposition of sperm into the vagina  Premature ejaculation  Impotence  Retrograde ejaculation

Donor Variation  Problems with the woman that prevent normal deposition of sperm into the vagina.  painful intercourse  physical deformities  Cervical factors.  narrowed cervix  absent, abnormally thick or acidic cervical mucus

Donor Variation  Suboptimal semen quality.  Artificial insemination can ensure that most of the sperm in an ejaculate of low volume will get past the vagina into the upper reproductive tract of the woman

 Use of frozen husband's sperm.

Donor Variation  Indication for artificial insemination with donor’s sperm (AID) include:  Azoospermia - the absence of sperm  Oligo-astheno-teratospermia - sperm that are of low supply, having poor quality motion and/or abnormally shaped  Avoidance of transmission of genetic abnormalities.  Reproduction by single or lesbian women.

Selection and Screening of the Donor  21-35 years old  Excluded:  sexually transmitted disease  Hepatitis or acquired immune deficiency syndrome  Genetically transmittable disease in the donor’s family  Use of recreational drugs  Excessive alcohol

Site of Insemination  Depends on the type of infertility Intracervical Insemination Intrautrauterine Insemination

Technique 1. Woman is stimulated with medication. 2. Semen specimen is produced. Abstinence from ejaculation (2-5 days)

3. The semen is “washed” in the laboratory. 

20-60 minutes

4. The specimen is placed above the level of vagina using a catheter.

Technique  Single insemination is planned for the expected day of ovulation each cycle.

 The day of insemination(s) may be determined

by several means. Some woman will utilize a kit that detects the LH surge in her urine. Ovulation is most likely to occur on the day after the LH surge is first appreciated.  Ultrasound evaluation of follicle growth  Blood testing

Technique  There is also the administration of an injection of human chorionic gonadotropin (hCG) to some patients (who are usually receiving other fertility drugs) in order to "trigger" ovulation.  artificial insemination will usually be scheduled for 3644 hours after the hCG injection when a single insemination is planned or at approximately 24 and 48 hours after the hCG injection when two inseminations are to be done.

Complications  Rare  Infection or allergic reaction to sperm  Fever, chills, and lower abdominal pain

 Multiple pregnancy

Ethical Issues: Heterologous Artificial Insemination  Fusion of gametes of at

least 1 donor other than the spouse  Respect for the unity of marriage and for conjugal fidelity demands that the child be conceived in marriage; the bond existing between husband and wife accords the spouses, in an objective and inalienable manner, the exclusive right to become father and mother solely through each other.

Ethical Issues: Heterologous Artificial Insemination  Heterologous artificial

fertilization violates the rights of the child.  It offends the common vocation of the spouses who are called to fatherhood and motherhood: it objectively deprives conjugal fruitfulness of its unity and integrity; it brings about and manifests a rupture between genetic parenthood, gestational parenthood and responsibility for upbringing.

Ethical Issues: Homologous Artificial Insemination

 Artificial insemination as a substitute for the conjugal act

is prohibited by reason of the voluntarily achieved dissociation of the two meanings of the conjugal act. Masturbation, through which the sperm is normally obtained, is another sign of this dissociation: even when it is done for the purpose of procreation, the act remains deprived of its unitive meaning: "It lacks the sexual relationship called for by the moral order, namely the relationship which realizes 'the full sense of mutual selfgiving and human procreation in the context of true love.

VIRTUES OF A CATHOLIC HEALTH CARE GIVER  FIDELITY  HONESTY  HUMILITY

FIDELITY  Faithfulness to trust and promise  Trust: basis of patient-healthcare professional relationship  Keep the patient’s best interest first in mind

FIDELITY  Providing competent care  Avoid: using the patient as means to advance one’s power or exploiting a patient in research  Respect the dignity of man  Provide the truth  Obtaining the free and informed consent

HONESTY  Truthfulness and integrity

 Convey the truth  Telling the patient the truth about the illness, benefits and burdens of alternative actions

HUMILITY  Recognizing one’s capabilities and limitations

 Recognizing the patient as one who knows and should decide what is best for one