1. In Vitro Fertilization by Ms. Mann

2. Assessment Statements 6.6.5 Outline the process of in vitro fertilization (IVF) 6.6.6 Discuss the ethical issues associated with IVF 6.6.5 Outline the process of in vitro fertilization (IVF) 6.6.6 Discuss the ethical issues associated with IVF

3. What is In Vitro Fertilization? In vitro is Latin, meaning “in glass” –Eggs are processed, fertilized, and stored in petri dishes (inside a controlled environment in incubators) –Sperm is processed in test tubes -Fertilization happens OUTSIDE the body! –NO BABIES ARE ACTUALLY MADE OR GROWN IN TEST TUBES! In vitro is Latin, meaning “in glass” –Eggs are processed, fertilized, and stored in petri dishes (inside a controlled environment in incubators) –Sperm is processed in test tubes -Fertilization happens OUTSIDE the body! –NO BABIES ARE ACTUALLY MADE OR GROWN IN TEST TUBES!

4. The IVF Process 1.Drugs - to regulate/ stop the natural menstrual cycle (GnRH, gonadotropin releasing hormone, analogs – prevent natural release of FSH (follicle stimulating hormone)/ LH (luteinizing hormone) from the pituitary gland) 2. FSH - Follicle stimulating hormone administered through a series of injections (stimulates follicle development/ egg production) 3.HCG - Human chorionic gonadotropin administered through a series of injections (matures follicles/ eggs) 4. Retrieval of Eggs - ultrasound to observe and eventually remove/ retrieve mature eggs through follicular aspiration (involves an outpatient operation and a VERY long needle - about as long as your arm!) mature human oocyte 1.Drugs - to regulate/ stop the natural menstrual cycle (GnRH, gonadotropin releasing hormone, analogs – prevent natural release of FSH (follicle stimulating hormone)/ LH (luteinizing hormone) from the pituitary gland) 2. FSH - Follicle stimulating hormone administered through a series of injections (stimulates follicle development/ egg production) 3.HCG - Human chorionic gonadotropin administered through a series of injections (matures follicles/ eggs) 4. Retrieval of Eggs - ultrasound to observe and eventually remove/ retrieve mature eggs through follicular aspiration (involves an outpatient operation and a VERY long needle - about as long as your arm!) mature human oocyte

5. 5. Sperm collection and processing a.male provides sample while woman is undergoing retrieval b.Sperm is washed (removes debris, white blood cells, seminal proteins) c.Sperm is processed (removes dead/ degenerate/ immotile sperm - provides the best sperm for fertilization process) 6. Fertilization of Eggs (in one of two ways) a. In vitro fertilization 1. Sperm is mixed with eggs in a petri dish and allowed to fertilize the eggs “naturally” (sperm and eggs are incubated together for 24h before fertilization success is assessed) 5. Sperm collection and processing a.male provides sample while woman is undergoing retrieval b.Sperm is washed (removes debris, white blood cells, seminal proteins) c.Sperm is processed (removes dead/ degenerate/ immotile sperm - provides the best sperm for fertilization process) 6. Fertilization of Eggs (in one of two ways) a. In vitro fertilization 1. Sperm is mixed with eggs in a petri dish and allowed to fertilize the eggs “naturally” (sperm and eggs are incubated together for 24h before fertilization success is assessed)

6. b. ICSI - Intracytoplasmic Sperm Injection 1. One sperm is injected into each retrieved egg using microscopic equipment. Fertilized eggs are incubated for 24h before fertilization success is assessed. b. ICSI - Intracytoplasmic Sperm Injection 1. One sperm is injected into each retrieved egg using microscopic equipment. Fertilized eggs are incubated for 24h before fertilization success is assessed.

7. 7. Embryo growth and development - fertilized eggs remain in petri dishes in an incubator for 3-5 days while they grow and develop (days 1-3 = cleavage-stage/ compacting embryo, days 4 -5 = blastocyst) 7. Embryo growth and development - fertilized eggs remain in petri dishes in an incubator for 3-5 days while they grow and develop (days 1-3 = cleavage-stage/ compacting embryo, days 4 -5 = blastocyst) Cleavage-stage embryo Blastocyst Cleavage-stage embryo Blastocyst

8. 8. Embryo transfer 1-3 of the “best” embryos are transferred back into the woman’s uterus (another outpatient procedure) 9. Pregnancy Test 14 days to one month after embryo transfer a pregnancy test is administered to determine if embryo implantation in the uterine wall has occurred (does NOT guarantee a viable pregnancy, however) Implantation 8. Embryo transfer 1-3 of the “best” embryos are transferred back into the woman’s uterus (another outpatient procedure) 9. Pregnancy Test 14 days to one month after embryo transfer a pregnancy test is administered to determine if embryo implantation in the uterine wall has occurred (does NOT guarantee a viable pregnancy, however) Implantation

9. Ethical Issues Pros of IVFCons of IVF Helps infertile couplesMultiple embryos produced but not all used – are ALL individuals? Fate of extra embryos? Allows for (SOME) genetic screeningLong-term storage of eggs/ embryos (embryo health concerns/ financials) Allows for surrogate mothersALL embryos have the potential for life Allows for continued fertility after radiation treatments (cancer) Multiple-embryo pregnancies more common (stress on babies, mother, families) Inequitable – high cost so not available to all couples STEM CELLS?!?