1. What is Assisted Reproduction Technology?

2. What is ART (Assisted Reproduction Technology) ? ► Group of high tech treatment methods to improve infertility. ► Techniques include  In Vitro Fertilization  Artificial Insemination  Gamete Intra-Fallopian Transfer  And many more

3. History of ART ► 1978- first successful birth using In Vitro Fertilization ► 1984- first successful birth using Gamete Intra Fallopian Transfer ► 1986-first successful birth using Zygote Intra Fallopian Transfer

4. What is Infertility? ► Inability to conceive a baby after one year of unprotected intercourse. ► Affects the reproductive organs of both men and women. ► Infertility affects about 15% of couples in the United States.

5. Factors Affecting Conception ► Production of healthy sperm ► Healthy eggs by the woman ► Unblocked fallopian tubes ► The ability for the sperm to fertilize the egg ► The ability for the embryo to implant in the uterus

6. Causes of Infertility in Women ► The older a woman is the higher her chances of becoming infertile. ► Ovulation disorder ► Blocked fallopian tubes caused by a pelvic inflammatory disease or endometriosis (a condition that causes adhesions and cysts).

7. Causes of Infertility in Men ► Lack of sperm production ► Inability to ejaculate normally ► Varicocele- veins in the scrotum are enlarged which can heat the inside of the scrotum and can affect sperm production. ► Teratospermia- increased percentage of abnormal shaped sperm

8. Statistics ► Infertility affects more than 15% of the couples in the United States. ► About one-third of infertility cases are caused by male factors. ► In about 20% of infertile couples the cause is unknown. ► The remaining one-third of infertile cases is caused by a combination of factors in both partners. ► The chances of becoming pregnant decreases 3- 5% per year after the age of 30.

9. Most Common Choices of Treatment ► In Vitro Fertilization ► Artificial Insemination ► Frozen Embryos ► Gamete Intra Fallopian Transfer ► Zygote Intra Fallopian Transfer

10. Artificial Insemination ► Sperm is collected and placed into a woman’s vagina, cervical canal or in the uterus. ► Sperm can come from your partner or an anonymous donor.

11. In-Vitro Fertilization ► Procedure that involves retrieving eggs and sperm from the bodies of the male and female partners and placing them together in a laboratory dish to enhance fertilization. ► Fertilized eggs are then transferred several days later into the female partner's uterus where implantation and embryo development will hopefully occur as in a normal pregnancy.

12. Gamete Intra-Fallopian Transfer (GIFT) ► A mixture of a woman’s eggs and sperm are placed into the fallopian tube during a laparoscopy. ► Once inserted, fertilization is allowed to occur.

13. Zygote Intra-Fallopian Transfer (ZIFT) ► Mixture of In Vitro Fertilization and Gamete Intra Fallopian Transfer. ► Fertilization takes place outside the uterus and placed into the fallopian tubes.

14. Intra-Cytoplasmic Sperm Injection ► Sperm is injected directly into the eggs in a laboratory. ► Used if infertility originates from the male such as:  Low numbers of sperm  Severe Teratospermia

16. Frozen Embryos ► Embryos may be taken from an individual and stored for later use. ► Once ready to use, they can be thawed and then placed into the uterus. ► This allows a higher chance of pregnancy.

17. Selecting an ART Program ► Qualifications and experience of the clinic and its personnel. ► Support services available ► Cost ► Success rates of that specific program

18. How Does this Affect Me? ► Knowing your body, as well as taking care of your body increases your chances of becoming pregnant. ► If you are considering having children in the future, the best thing to do is practice safe sex, take care of your body and stay away from harmful contaminants such as smoking and other types of drugs. ► Fertility affects us all, male or female and attending the doctor regularly can increase your chances of becoming pregnant in the future.

19. Moral Issues ► What is the moral status of the egg, sperm, and the embryo? ► What are the individual moral constraints on trying for reproduction “at any cost”? ► Dehumanizing aspects of procedures ► Social implications of widespread use ► Complexities of surrogacy

20. What is the moral status of the egg, sperm, and the embryo? ► Moral status before sperm and egg come together ► Moral status after sperm and egg come together but before implantation in the uterine wall ► Including frozen fertilized eggs ► Moral status after implantation

21. Left-over Embryos  Typically, during fertility treatments, women may store fertilized eggs, embryos, as part of their treatment.  Kept frozen for unanticipated catastrophe  A kind of immortality  Many major fertility centers have thousands of these--10,000 per year nationally  No federal agency oversees this  Sometimes embryos are donated to infertile couples, but legal issues about parental rights persist.

22. ► Dr. Griffo, at Cornell, stored embryos for a married woman who subsequently died. Before she died, she said she wanted her embryos destroyed, and her husband agreed. But now, Dr. Giffo reports, "her husband has changed his mind and says he wants someone to carry the embryos" so he can have his dead wife's babies. Difficult Cases, 1

23. Difficult Cases, 2 ► Julie Garber of Anaheim, Calif., who, in 1994, was 26, single and dying from leukemia. She knew her only chance of surviving was to have a bone marrow transplant. Realizing that the treatment would leave her sterile, she decided to store some embryos beforehand. She had one month before the transplant to accomplish this, said her mother, Jean Garber. ► Ms. Garber and her father, Dr. Howard Garber, a retired optometrist, selected a sperm donor from a sperm bank to fertilize her eggs. She ended up with 12 embryos, which are stored in Anderson's tanks, but she died last December. Her parents are now deciding between two potential surrogates who have agreed to carry the embryos -- their grandchildren -- to term. ► "This is a love situation," Jean Garber said. The embryos, she added, "are so precious to me." They are a bit of her daughter, she said, "my friend and my business partner and my confidante. I miss her so much."

24. Difficult Cases, 3 ► A more typical situation, according to Dr. Sauer, is that of a couple in their early 30s who had in vitro fertilization and completed their family. Now they have 10 embryos frozen at Columbia-Presbyterian, and they have not replied to letters asking them whether they want to keep the embryos or have them discarded. Dr. Sauer understands. Infertility is a devastating disorder that wreaks havoc on people's lives. The young couple "have a family now," Sauer said. "They don't want to be reminded of that period of their lives." So their embryos remain, frozen in perpetuity. ► Ethical Questions: ► What is the moral status of these embryos? Are they persons? ► Should the embryos be destroyed? Should they be given to couples or individuals who wish to have children? With whose permission?

25. What are the individual moral constraints on trying for reproduction “at any cost”? ► Sex selection ► Genetic screening for so-called “defects” ► Selective abortion with multiple fetuses ► Pregnancies and older women ► Surrogate motherhood ► Cloning

26. Dehumanizing aspects of procedures ► Greater freedom of choice ► Much less natural process ► Conception as a medical event vs. an act of love ► Tacit pressure to use such technologies if they are available

27. Social implications of widespread use  Vast demographic changes ► Shift in male/female ratio ► Shift in age of parents relative to their children ► Possible decline of two parent family ► Possible homogeneity in society

28. Surrogacy Surrogacy occurs when 1 woman agrees to carry to term the fetus for another person.Surrogacy occurs when 1 woman agrees to carry to term the fetus for another person. That fetus may be from the egg and sperm of the couple who want to raise the child or it may b donor eggs or donor sperm.That fetus may be from the egg and sperm of the couple who want to raise the child or it may b donor eggs or donor sperm. What are the rights of the surrogate mother? Of the individuals who ask her to be a surrogate?What are the rights of the surrogate mother? Of the individuals who ask her to be a surrogate?

29. Surrogacy: The Possibilities ► Intentional mother the woman who wants to have the child ► Intentional father the man who wants to have the child ► Genetic mother the woman who supplies the egg for the embryo ► Genetic father the man who supplies the sperm for the embryo ► Gestational mother the woman who carries the embryo to term and gives birth to it ► Nurturing mother the woman who raises and nurtures the child from infancy as her own ► Nurturing father the man who raises and nurtures the child from infancy as his own