1. IN VITRO FERTILIZATION (IVF) Rels 300 / Nurs 330 12 November 2014 300/330 - appleby1

2. 25 July 1978: 1 st “test tube” Baby On left: Physiologist Robert Edwards Middle: baby Louise Joy Brown (Middle woman, unidentified) Right: Gynecologist Patrick Steptoe Parents: Lesley & John Brown – after 9 years of infertility After 80 embryo transfer failures, 1 st successful pregnancy and birth 300/330 - appleby2

3. Currently, over 4 million test tube Babies have been born Robert Edwards received the 2010 Nobel prize for medicine. the world's first "test tube baby" was born in July 1978. IVF technology allowed Lesley & John Brown to experience pregnancy & birth, in spite of Lesley’s blocked fallopian tubes 300/330 - appleby3

4. In response, the Vatican protested the awarding of the prize, saying that: Conception occurs separate from the couple’s conjugal union Embryos that are fertilized but not implanted are destroyed 300/330 - appleby4 The President of the Pontifical Academy for Life said that “without Edwards there would not be freezers full of embryos waiting to be transferred to a uterus, or, more likely, used for research or left to die, abandoned and forgotten by all.” http://catholic.org/hf/family/story.php?id=39343

5. James Watson, co-discoverer with Crick of the structure of DNA, and fellow Nobel Laureate from 1953, had this to say about IVF: “All hell will break loose, politically and morally, all over the world.” The Atlantic, June 2012 300/330 - appleby5

6. What is IVF? IVF is a process whereby ova and sperm are placed together in a glass dish (in vitro = in glass) in a laboratory setting If fertilization occurs, and the early embryos successfully begin to grow in the dish, then the embryos are transferred into the woman’s uterus If one or more embryos are successful in achieving implantation, then a pregnancy has begun 300/330 - appleby6

7. 5 Steps 1.Ovulation induction: fertility drugs are used to cause production of multiple ova (usually 3 or more, up to 15 or 20) and to control the exact timing of the ovulation 2.Follicular aspiration: ripe ova within their follicles are surgically removed from the woman’s ovaries using a hollow catheter 3.Ova and sperm are combined in a glass dish in a nutrient-rich medium (ratio of 50,000 to 1) 300/330 - appleby7

8. 4.Dish containing ova and sperm is placed in an incubator to provide a temperature-controlled environment; eggs are monitored for fertilization and cell division (“Spare” embryos may be discarded, frozen, or donated) After 17 days, a pregnancy test will be done, followed by an ultrasound if pregnancy has been confirmed 5.Healthy fertilized zygotes are transferred to the woman’s uterus through the cervix using a catheter; generally 1 to 3 embryos per transfer 300/330 - appleby8

9. Medical Risks associated with IVF Hormonal stimulation of woman’s ovaries to produce multiple ova → risk of ovarian hyperstimulation Severe abdominal pain Nausea or vomiting Decreased urination Shortness of breath Up to 10 lb. weight gain within 3 to 5 days Risks associated with anesthesia Risks of bleeding, infection Risks of damage to the bowel, bladder or blood vessels Potential for a multiple pregnancy with risk of premature delivery Potential risks from donor sperm or ova 300/330 - appleby9

10. Variations of IVF ICSI – intracytoplasmic sperm injection – if sperm are few or inactive – a single sperm is inserted into the ovum with a catheter GIFT – gamete intrafallopian transfer – ova and sperm are collected and then transferred to the fallopian tubes so that fertilization takes place within the woman’s body 300/330 - appleby10

11. IVF with donors OVA Donation of healthy ova no longer needed by another IVF woman Purchase of ova from a “donor” catalogue Altruistic donation from a family member or friend; http://www.mountsinai. on.ca/care/fertility/serv ices/egg-donation http://www.mountsinai. on.ca/care/fertility/serv ices/egg-donation SPERM Donation of sperm no longer needed for AI or IVF Purchase of sperm from a “donor” catalogue Altruistic donation from a family member or friend Purchase online; http://www.mountsinai. on.ca/care/fertility/serv ices/donor- insemination http://www.mountsinai. on.ca/care/fertility/serv ices/donor- insemination 300/330 - appleby11 EMBRYO Excess frozen fertilized embryos from previous IVF cycles; http://www.mountsina i.on.ca/care/fertility/se rvices/embryo- freezing http://www.mountsina i.on.ca/care/fertility/se rvices/embryo- freezing Purchase from an IVF clinic’s excess inventory Prenatal adoption of “spare” embryos

12. http://www.mountsinai.on.ca/care/fertility/fee-schedule-august-2014.pdf http://www.mountsinai.on.ca/care/fertility/fee-schedule-august-2014.pdf IVF fee schedule http://www.mountsinai.on.ca/care/fertility/fee-schedule-august-2014.pdf http://www.mountsinai.on.ca/care/fertility/fee-schedule-august-2014.pdf 300/330 - appleby12 250 Dundas Street West, Suite 700 · Toronto, ON · M5T 2Z5 · (416) 586-4748

13. http://www.eggdonation.com/index.php 300/330 - appleby13

14. MISSION 300/330 - appleby14 To locate stunning, well motivate candidates… To accept no more than 5% of our 1,200 + monthly egg donor applications To be instrumental in setting & surpassing industry standards… To provide competitive program costs To provide reliable financial auditing To provide secure and confidential records To provide cycle coordination… To honor the responsibility of creating families Create a username and password to view our Database of Egg Donors Database of Egg Donors ONE OF OUR REAL EGG DONOR ANGELS

15. https://www.eggdonation.com/becoming-an-egg- donor/Donor-compensation.php https://www.eggdonation.com/becoming-an-egg- donor/Donor-compensation.php 300/330 - appleby15

16. Frozen Egg Donor Cycle 5 mature eggs = $16,500 plus transfer fees Fresh Egg Donor Cycle Unknown quantity of eggs = $38,000 - $60,000 300/330 - appleby16 http://www.eggdonation.com/egg-donor-bank.php Frozen Eggs Available from egg donor 1019 only. We have had a 100% success rate with transfers from this donor cycle, both fresh and frozen.

17. https://www.eggdonor.com/egg- donor-database/ https://www.eggdonor.com/egg- donor-database/ Our on-line egg donor catalog HAYLEY (#73010) https://www.eggdonor.com/ donor-profile/?pid=73010 https://www.eggdonor.com/ donor-profile/?pid=73010 HAYLEY (#73010) https://www.eggdonor.com/ donor-profile/?pid=73010 https://www.eggdonor.com/ donor-profile/?pid=73010 300/330 - appleby17 SHAKIRA (#61803) https://www.eggdonor.com/ donor-profile/?pid=61803 SHAKIRA (#61803) https://www.eggdonor.com/ donor-profile/?pid=61803

18. Choose – a – Donor ! http://www.ctfertility.com/ http://www.ctfertility.com/find-egg-donors Sample Profile for egg donor #254, http://www.ctfertility.com/sample-egg- donor-profile http://www.ctfertility.com/sample-egg- donor-profile 300/330 - appleby18

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20. MUMBAI, India Rotunda-The Center for Human Reproduction MUMBAI, India Rotunda Clinic offers comprehensive IVF services: IUI, IVF, ICSI Donor Egg IVF, Embryo Adoption, Surrogacy Embryo Retrieval through Puncture/ Aspiration, Overseas IVF Patient Program, Gestational Surrogacy & Gestational Carrier ART Program 300/330 - appleby20

21. Why choose Egg and/or Embryo Storage? When fertility is at risk due to illness or surgery. To delay childbearing until a later date. Egg/Embryo storage gives women who have completed IVF treatment the option to preserve the unused embryos for potential use in the future. Your IVF center has limited storage space. Your IVF center is closing. 300/330 - appleby21

22. http://www.embryoadoption.org/sitemap/index.cfm Adopters Embryo Adoption 101 Terminology Defined Videos Personal Stories Adopter FAQs News Articles Embryo Adoption Agencies Home Study Providers Clinics with Donation Donors Embryo Adoption 101 Terminology Defined Videos Personal Stories Donor FAQs Counselor Support Network News Articles Where to Donate Webinar Registration Glossary 300/330 - appleby22

23. CASE STUDY 60-YEAR-OLD CALGARY MOTHER WELCOMES TWINS Ranjit Hayer tried for decades to have a child, enduring multiple miscarriages, surgery, even the trauma of being robbed by a fertility doctor. Finally, after a successful IVF treatment, the Calgary woman gave birth to twins — at age 60. She is believed to be among the oldest Canadian women to give birth. http://www.cbc.ca/news/canada/calgary/60-year-old-calgary-mother- welcomes-twins-1.844372 http://www.cbc.ca/news/canada/calgary/60-year-old-calgary-mother- welcomes-twins-1.844372 300/330 - appleby23

24. 60-year-old MOM “We can do so much but the question is, should we do it just because we can do it?” 300/330 - appleby24

25. Evaluating reproductive technologies  Whose personal dignity and autonomy are promoted or harmed?  What are the potential benefits of reproductive technologies?  Who are the beneficiaries?  What are the potential risks and harms of reproductive technologies?  Who is most likely to be harmed?  Are there justice issues in the provision of reproductive services?  Issues of fairness, equality, equitable access? 300/330 - appleby25