BIOETHICS EDUCATION : LIFESTYLE, FERTILITY

AND THE ASSISTED REPRODUCTIVE

TECHNOLOGIES

Irina Pollard, Dept Biological Sciences, Macquarie University,

Sydney, NSW 2109, Australia
e-mail ipollard@rna.bio.mq.edu.au
PART I - THE INFERTILITY PUZZLE

(from ‘Information Brochure’, North Shore Fertility Pty. Ltd.)

 LIFESTYLE AND FERTILITY

OVERALL FITNESS AND THE CAPABILITY

TO BEAR HEALTHY CHILDREN DEPENDS ON:

1. OUR GENES

3. THE CONDITIONS UNDER WHICH WE LIVE

3. THE WAYS IN WHICH WE BEHAVE

INFERTILITY – THE INABILITY TO ACHIEVE PREGNANCY

1. MEDICAL
a) After 12 months of unprotected sexual intercourse or

b) Due to a diagnosed physical abnormality of the

reproductive system; e.g., blocked fallopian tubes
2. SOCIAL Non-engagement in a heterosexual relationship

3. THE INABILITY TO CARRY A PREGNANCY TO LIVE BIRTH

 MEDICAL INFERTILITY
Affects 10-15% of couples attempting pregnancy

DISTRIBUTION OF CAUSE

FEMALE INFERTILITY

(from Ian Pike’s

guest lecture)
MALE INFERTILITY

FERTILITY DECLINES WITH AGE

Female infertility increases from

30 years of age to the menopause

(from Ian Pike’s

guest lecture)
Genetic anomalies in men also increases with age
 MANY CONCEPTUSES DO NOT SURVIVE
Human fecundity rate; i.e., the probability of achieving a clinical recognized
pregnancy within any given menstrual cycle, is about 25% and high levels of
fertilization failures or early developmental death, are the norm at conception

Spontaneous abortion is one of Nature’s ways to counter negative genetic and

environmental factors
 MAXIMIZING FERTILITY AND REPRODUCTIVE OUTCOME:
GENERAL HEALTH ISSUES
THERE ARE SEVERAL THINGS POTENTIAL PARENTS CAN DO TO
SIGNIFICANTLY IMPROVE THEIR REPRODUCTIVE HEALTH AND REDUCE
THE CHANCE FOR ASSISTED REPRODUCTIVE TECHNOLOGY TREATMENT

i) NUTRITION AND REPRODUCTION

All essential nutrients in diet - women who are
significantly overweight or underweight can
have difficulty getting pregnant

ii) EXERCISE AND REPRODUCTION

Regular aerobic exercises but excessive can affect
ovulation and sperm count

iii) SUBSTANCE ABUSE AND REPRODUCTION

Alcohol, nicotine, illicit drugs and some medications
adversely affect the embryo, fetus and newborn

iv) FOLIC ACID AND NEURAL TUBE DEFECTS

Is recommended as daily food supplement
prior to conception
Beans and green leafy vegetables are a rich source of
folic acid (from E. Hyams ‘Plants in the Service of Man’.
Dent & Sons, 1971)
 MAXIMIZING FERTILITY AND REPRODUCTIVE OUTCOME:
GENERAL HEALTH ISSUES CONTINUED
v) TEMPERATURE EFFECTS AND SPERM QUALITY
Optimum spermatogenesis 4-7˚ C below body temperature

vi) PHYSICAL AND PSYCHOLOGICAL STRESS

A relationship between emotion and fertility exists

vii) REGULARITY OF INTERCOURSE

2-3 times per week, particularly around the time of ovulation

viii) SCREENING TESTS

Both partners have blood
tests taken for HIV
antibodies, hepatitis B&C,
and females for immunity to
Rubella (German Measles) –
the virus known to cause
major abnormalities in the
fetus if contracted during
early pregnancy

‘The Stairs of Age’ by Winter Carl

Hansson (1777-1805)
 POVERTY, POPULATION AND DEVELOPMENT

Today in industrialized countries the prospects for pregnant women

and their fetuses is very good. In the US, for example, 80% of all
established pregnancies culminate in the delivery of a live child; and
once a child is born it has 99.3% chance for surviving infancy

However, certain social/ethnic minority groups are significantly

disadvantaged compared with the general population. Indigenous
people in Australia and the United States, for example, experience
various forms of difficulties simultaneously

“Good health is a basic human right, especially among

poor people afflicted with disease who are isolated,
forgotten, ignored, and often without hope. Just to know
that someone cares about them can not only ease their
physical pain but also remove an element of alienation
and anger that can lead to hatred and violence.” Former
U.S. President Jimmy Carter
http://www.cartercenter.org/healthprograms
 PART II : ASSISTED REPRODUCTIVE TECHNOLOGY (ART)

Since the first ‘test-tube’ baby Louise Brown was born in Britain in 1978,
more than a million children have been born through assisted reproduction

Social Impacts of Assisted Reproductive Technology

MAJOR ASSISTED REPRODUCTIVE TECHNOLOGIES (ART)
_ Artificial insemination by donor or by husband (AID; AIH)
_ In vitro fertilization and embryo transfer (IVF-ET)
_ Direct intra-peritoneal insemination (DIPI)
_ Gamete intra-fallopian transfer (GIFT)
_ Zygote intra-fallopian transfer (ZIFT)
_ Intracytoplasmic sperm injection (ICSI)
_ Sperm collection by way of microsurgery
_ Embryo and sperm cryopreservation and storage
_ Cytoplasmic transfer
_ Preimplantation genetic diagnosis (PGD)
_ Karyotyping and genetic manipulation
_Tissue banking
_ Ovulation induction
_ Laparoscopy and hysteroscopy
_ Laser laparoscopy
_ Hystero-sonography
_ Ultrasound scanning
_ Egg and embryo donation
_ Posthumous gamete donation
 MALE-FACTOR INFERTILITY:
STANDARD SEMEN PARAMETERS

SPERM PARAMETER FERTILE RESULT

1. COUNT >20 MILLION/ML Drawing by Barbara

Duckworth

2. MOTILITY >50% GOOD FORWARD PROGRESS

3. MORPHOLOGY >30% NORMAL

4. FERTILIZABILITY
(from Ian
Pike’s guest
lecture) ARTIFICIAL INSEMINATION BY HUSBAND OR BY DONOR

Donor insemination is more successful than partner insemination,

does not carry an increased risk of spontaneous abortion or congenital
anomalies, and has advantages over adoption in that the child is
genetically related to the mother and the couple can experience
conception, pregnancy and delivery
 INTRACYTOPLASMIC SPERM INJECTION (ICSI)

ICSI, in conjunction with IVF technology, has given

hope to men with sever infertility problems

Even immature spermatids (sperm precursor cells)

can be harvested and used to fertilize the egg

FEMALE-FACTOR INFERTILITY: IN VITRO FERTILIZATION (IVF) TECHNOLOGY

AIM OF TREATMENT
1. Menstrual Cycle Management

2. Control Ovaries by Drugs

a) Drug 1 – block usual control mechanism

from brain X ovary

b) Drug 2 – Direct stimulation to the ovary

c) Develop a batch of eggs

IN VITRO FERTILIZATION (IVF) TECHNOLOGY CONTINUED

3. Prepare Eggs for Fertilization

4. Drug 3 – induce ovulation

5. Harvest eggs

6. In vitro fertilization
 PROTOCOL - IVF TREATMENT CYCLE

Key
U/S Ultrasound Scan
* FSH daily injections
Blood hormone test
(E = estradiol 17β)
a GnRH analogue – daily (from N.S. Fertility)
injection
 TECHNOLOGIES IN COMBINATION WITH IVF TECHNOLOGY

PREIMPLANTATION GENETIC DIAGNOSIS (PGD)

Alternative to ultrasound, amniocentesis or chorionic villus sampling

STORAGE FOR FROZEN EMBRYO TRANSFER

SPERM, EGG AND EMBRYO DONATION

1. Female Infertility
Premature Menopause
Genetic Disease Carrier Donor Egg
Age Factor & Chronic IVF Failure

Lack of / Unsuitable Uterus Surrogacy

2. Male Infertility
Abnormal Semen Donor Sperm

3. Couple Infertility
Chronic IVF Failure Donor Embryo
TECHNOLOGIES IN COMBINATION WITH IVF TECHNOLOGY CONTINUED
SEX SELECTION AND DESIGNER CHILDREN

ASSISTED REPRODUCTION : RISKS AND UNCERTAINTIES

Some researchers are questioning the safety of technologies such as ICSI
and other invasive techniques, claiming that they may be linked to increased
rates of birth defects and rare genetic imprinting disorders

Dolly the sheep – the world’s first cloned mammal was euthanized 14th February, 2003
(The Japan Times, February 16, 2003)
BALANCING RISKS AND
UNCERTAINTIES

Research into cell and tissue

differentiation using cultured
embryonic stem cells from
humans, and other species,
may enable the control of
differentiation and
dedifferentiation in somatic
cells. This could allow the
production of tissues with
enhanced stem cell
components that may be
used as universal donor cells
for transplantation
(To-day’s Life Sciences, March/April 1999)