Bioethics by Bonnie Steinbock

Author:Bonnie Steinbock
Language: eng
Format: epub
Publisher: Oxford University Press
Published: 2022-06-15T00:00:00+00:00

What medical procedures are used to treat infertility?

Treatment begins with a work-up to determine the cause of infertility. The problem could lie with the male partner, the female partner, or both. If the man does not produce sufficient sperm, or if his sperm do not swim fast or long enough to reach and fertilize the egg, he cannot biologically reproduce. The couple may then decide to use a sperm donor.

Infertility may be due to the failure of the woman to ovulate (i.e., produce eggs). This can be treated with drugs to promote ovulation. Sometimes the problem is not ovulation, but blocked fallopian tubes, where the released egg is prevented from traveling through the fallopian tubes where fertilization occurs. Surgical repair may then be indicated.

These approaches to infertility, known as conventional therapies, are used to treat eighty to ninety percent of cases. If they do not work, the next step is in vitro fertilization (IVF), a reproductive technology in which sperm fertilize eggs outside the body, in a petrie dish. IVF may also be used by women who do not have trouble getting pregnant but whose pregnancies end in miscarriage caused by chromosomal abnormalities in her eggs due to age.

To remove eggs from a woman’s body requires considerable preparation. The woman must be injected or, increasingly, inject herself, every day for two weeks with drugs that cause her to super-ovulate (i.e., produce many eggs, not just the one or two she would naturally produce). When the eggs are ripe, they are retrieved in a transvaginal surgical procedure. Afterward, most women experience cramping, which can range from mild to severe.

It is much easier to retrieve sperm from a man than to retrieve eggs from a woman. All the man has to do is masturbate into a cup. A high concentration of his sperm is placed around each egg in a growth medium in a petrie dish. If all goes well, fertilization will occur within two to six hours. The fertilized egg then begins to divide until, in about five days, it reaches 100 cells and is then technically known as a blastocyst, though commonly called an embryo. At this point, the blastocyst is usually tested for any chromosomal abnormalities that might prevent implantation or normal development. Typically, the blastocysts are frozen until they are transplanted into the woman’s uterus.

The first IVF baby, Louise Brown, was born in the United Kingdom in 1978. Her parents knew that the procedure was experimental, but they did not know that it had never before resulted in a human baby. Critics said that this prevented them from giving genuinely informed consent to the procedure. At first the success rates of IVF were very low, resulting in the birth of a live baby in only about ten percent of cases. Clinics varied tremendously in their success rates, and no reliable data were available on how successful individual clinics were. Concern about the exploitation of “desperate” couples led to calls for more accurate data collection and regulation of ART.

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