Counseling the underserved: when an old reproductive technology becomes a new reproductive technology.
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Adolescent↗
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Current trends in human IVF and other assisted reproductive technologies.
The new reproductive technologies such as IVF, GIFT, ZIFT, and micromanipulation have had a profound influence on the therapeutic and diagnostic management of infertility, and in turn have resulted in better understanding of human fertilization and embryo development. While the clinical pregnancy rates in GIFT and ZIFT procedures are comparable to the natural fecundity in the population at large, pregnancy rates in IVF have been generally lower. Further investigations should be directed to improve the implantation rates, and to develop better controlled methods of multiple follicle development. Although more studies are needed, a recent report of potential utilization of nonstimulated oocytes for donor programs as well as IVF-cryopreservation was a promising new development (Cha et al. 1989). Other exciting prospects on the horizon are the possibilities of gene transfer for the treatment of certain genetic diseases and diagnostic applications of embryonal biopsy. These new technologies have also generated serious ethical and legal issues. Any ethical or legal guidelines affecting new reproductive technologies should be developed to protect all participants only when the need for regulation is clear. Ethical guidelines and appropriate legislations with contributions from the medical and scientific community are gradually being established worldwide.
Cryopreservation↗
Creating brave new families with advanced reproductive technologies.
The advanced reproductive technologies such as in vitro fertilization, gamete intrafallopian transfer, and donor gametes have created "brave new families," which can no longer be described by traditional definitions based on genetics and gestation. Understanding the particular stresses and issues that these families face can be particularly helpful to the clinician working with these couples and their children. The potential long-term effects also are explored.
Adoption↗
Application of reproductive technology to the Australian livestock industries.
Current use of reproductive technology in the Australian livestock industries is limited, though it increased in line with higher prices for beef and wool through the 1980s. The required techniques, many of which were developed in Australia, are available and the level of expertise is comparable to the best in the world. However, the extensive pastoral industries do not readily lend themselves to these procedures. Only in the dairy industry is artificial insemination used to a significant degree. On the other hand, application of the technology in the pastoral industries is confined largely to studs and breeding cooperatives which provide breeding animals for producer flocks and herds. Hence the impact of applied technology may be more widespread than first appears. Until recently, little regard was paid to application of the technology along sound breeding principles. Artificial insemination and multiple ovulation and embryo transfer (MOET) have not been used so much in planned breeding programmes aimed at local improvement of stock, but more to proliferate genes of reputedly superior stock, imported either from overseas or elsewhere in Australia. This is particularly true of MOET, where the incentive to use it is commonly a short term cash gain made from proliferating breeding stock of a particularly valuable and usually novel strain or breed. Recent technological improvements which render the use of reproductive technology cheaper and more effective will lead to its more widespread use in commercial practice. Techniques for embryo freezing and splitting have been greatly simplified and quickly put into practice. The novel livestock technologies of in vitro oocyte maturation and fertilization have already found commercial application overseas. Fecundity-enhancing products have also been adopted by the livestock industries. There is potential value for greater use of reproductive technology in the livestock industries provided it is implemented according to sound breeding principles and provided associated management practices are applied simultaneously.
Animals↗
Assisted reproductive technology.
Several aspects of reproductive technology are discussed. In tubal infertility, the choice between surgery or in vitro fertilization and embryo transfer (IVF-ET) is addressed. In cases with bilateral distal occlusion or otherwise bad prognosis, IVF is probably more successful and less expensive. IVF in unstimulated cycles has given promising results, with pregnancy rates comparable to the results from the National IVF-ET Registry. If these results can be confirmed by more studies they will probably have a great impact on the choice of treatment in tubal infertility. The results obtained with various transfer procedures in nontubal infertility have still to prove tubal transfer to be a more effective procedure than IVF. Finally, studies on microinsemination in male infertility or unexplained infertility with previous fertilization failure in IVF show promising results with the subzonal insemination and partial zona dissection procedures.
Embryo Transfer↗
Moral pioneers: women, men and fetuses on a frontier of reproductive technology.
As one of the new reproductive technologies, amniocentesis is rapidly becoming routinized, especially for pregnant women in their mid-thirties and older. Prenatal diagnosis has been evaluated medically, economically, and bioethically. But we know very little about how pregnant women and their families who use, or might use, this new technology respond to its benefits and burdens. This article reports on a two-year field study in New York City. Responses of genetic counselors, a multicultural patient population using and refusing amniocentesis, women who had received "positive" diagnoses, and families with children who have the conditions that can now be diagnosed prenatally were all elicited through participant-observation. My goal in this study is to assess the social impact and cultural meaning of one new reproductive technology.
Adult↗
Moral traditions, ethical language, and reproductive technologies.
The Vatican Instruction on reproductive technologies and the OTA report, Infertility, both use "rights" language to advance quite different views of the same subject matter. The former focuses on the rights and welfare of the embryo, and the protection of the family, while the latter stresses the freedom and rights of couples. This essay uses the work of Alasdair MacIntyre and Jeffrey Stout to consider the different traditions grounding these definitions of rights. It is proposed that a potentially effective mediating language could be that of "human nature", and argued that donor methods raise more serious moral objections than homologous ones.
Catholicism↗
Reproductive technologies and the bottom line.
Reproductive technologies have turned out to be creatures of the marketplace, a fact we did not foresee. Because of this commercialization, women must be as careful in selecting a clinic as in buying a used car. Where initially it appeared that government would impose test-tube babies and genetic engineering on society, the great irony is that we now look to government to protect us from the Brave New World.
Commerce↗
Integration of clinical genetics into assisted reproductive technologies: implications for nursing practice.
Assisted reproductive technologies (ART) have moved from the experimental periphery of clinical treatment to the center of routine practice in the field of reproductive endocrinology. With advances in technology, reduced operative risks, increasing third party reimbursement and increased accessibility to ART programs, a more heterogeneous group of couples is seeking these services. The traditional ART couple has been joined by a growing number of couples who are at risk for or affected by a genetic disorder. These individuals seek alternative methods of conception to minimize the risk of conceiving a child with a significant birth defect. Programs offering donor gamete, donor embryo, gestational carrier, and in the future, preimplantation genetic testing must be prepared for the unique needs of the "traditional" infertile and "nontraditional" fertile couple.
Chromosome Aberrations↗
A case of conflicting paradigms: nursing and reproductive technology.
This article addresses the paradigm conflict between nursing and reproductive technology. This technology is discussed as a conceptual system emphasizing fragmentation and distance, in contrast to the philosophical foundation of nursing, which aspires to holism and connection. The sensory modalities of sight, the paradigmatic sense of distance, and touch, the paradigmatic sense of connection, are considered as they highlight the conflict between nursing and reproductive technology. Particular attention is given to the techniques of ultrasonography and amniocentesis.
Amniocentesis↗
Ethical considerations of the new reproductive technologies. Ethics Committee of The American Fertility Society.
In September 1986, The American Fertility Society issued a report, Ethical Considerations of the New Reproductive Technologies, setting forth the then-held ethical position of the Society on the various new reproductive technologies. In 1987, the Congregation for the Doctrine of the Faith issued the Instruction on the Respect for Human Life and Its Origin and on the Dignity of Procreation. While both documents state that very similar moral criteria were used to derive ethical positions with respect to various reproductive procedures, the conclusions as to the ethical acceptability of the various procedures differ sharply in the two documents. The question can be raised about the procedure used by the Congregation of the Faith to derive its conclusions from the stated premises. Thus, while stating that "the individual integrally and adequately considered" is to be the basis of the moral judgment, the fact is that most conclusions are based on and referenced to past Catholic statements. While the difference in conclusion from similar premises may be troubling to society, it can be especially paralyzing to four groups: (1) those who face problems that might be solved by one or another of the new reproductive technologies; (2) those who are involved in applying them; (3) those who are responsible for institutional policies where such techniques may be applied; and (4) those who are in a position to influence public policy in a legislative or regulatory way. Because of the conflicting conclusions of the two documents, the present Ethics Committee (1986-87) of The American Fertility Society was convened and considered these guidelines in the light of the Instruction. For reasons set forth previously, the Committee reaffirmed the finding of the 1985-86 Committee that basic in vitro fertilization with homologous gametes is ethically acceptable. The Committee reaffirmed the finding that the use of heterologous gametes is also ethically acceptable, provided that various precautions and guidelines are observed, as outlined in its previous report. The Committee recognized and re-evaluated the long-debated and very complex issue of the moral status of the gamete, zygote, pre-embryo, embryo, and fetus. The reasons for believing that progressive degrees of respect are due with progressive development were set forth here and in the previous document. The Committee reaffirmed the position that experimentation on the pre-embryo in conformity with the policies and guidelines, as previously expressed, can be ethically justifiable and, indeed, necessary, if the human condition is to be improved.(ABSTRACT TRUNCATED AT 400 WORDS)
Endocrinology↗
Infertility and bioethical issues of the new reproductive technologies.
The scientific breakthroughs resulting in the delivery of Louise Brown in 1978 have opened the floodgates for an ongoing bioethical discussion about medically assisted reproduction. The majority in our society has accepted in vitro fertilization as an ethically justifiable procedure for infertile couples. The concern persists, however, that new reproductive technology has started us on the course of a slippery slope with potentially dire consequences for the so-created children, the traditional family, and, indeed, for society as a whole. The moral status of the embryo is the central issue in debates about such reproductive developments as the "spare" embryo, embryo freezing, embryo donation, embryo research and micromanipulation. Conflicts of interests between the adult's desire to become a parent and the welfare of the offspring are at the root of moral objections raised against manipulation of human reproduction. Extracorporal conception with the possibility for various gamete donors has also brought the long-practiced procedure of artificial insemination by donor and the potential consequences for the child into the discussion. Surrogate mothering and surrogate gestational mothering force us to redefine the age old dictum mater certa est and can render the child a helpless pawn in parental, emotional, and legal strife. Over the ages, society has through firmly established values exerted control over reproduction and acceptance of the new member in the community. Sex without reproduction was a severe blow to the highly regarded societal belief in parenting as the epitomy of life goals. Reproduction without sex through various technically feasible collaborative means further jolts fundamental traditional values and mandates their re-evaluation. Ethical belief systems are by nature highly charged and fiercely defended. Thus, in a pluralistic society, a consensus on the question "What ought to be done of all that can be done with new reproductive technologies?" is probably unachievable. Heated controversies between interest groups constitute an additional psychological burden complicating the ethical ambiguities for some infertile couples who have to decide about using noncoital conception. The interdisciplinary group report by the ethics committee of the American Fertility Society published in the "Ethical Considerations of the New Reproductive Technologies" constitutes a wide framework of guidelines for rational consideration. It will, one hopes, help to formulate needed regulations because some segments of our society as well as many scientists and physicians in the field believe that not all that potentially can be done ought to be done.(ABSTRACT TRUNCATED AT 400 WORDS)
Ethics, Medical↗
Assessment the carrier frequency of monogenic diseases in populations requiring assisted reproductive technology.
PURPOSE: The objective of this study is to assess the carrier frequency and pathogenic variation of monogenetic diseases in a population of 114 subjects in Han Chinese from Hebei province who are undergoing assisted reproductive technology through the utilization of Expanded Carrier Screening (ECS). METHODS: The study utilized a panel consisting of 155 severe monogenic recessive genetic diseases for ECS. Next-generation sequencing technology was employed to identify specific variants associated with ECS in a cohort of 114 subjects from 97 couples, comprising 97 females and 17 male spouses. RESULTS: A total of 114 individuals received ECS. The carrier rate of pathogenic genes in the enrolled population was 44.74% (51/114). Among the 97 females, the carrier rate of pathogenic genes was higher in those without assisted reproduction indicators than in those with assisted reproduction indicators (59.09% vs. 41.33%). However, the carrier rate of pathogenic genes in males without assisted reproductive technology was slightly lower than that with assisted reproductive technology (40% vs. 41.67%). Among both female and male participants, the carrier rate of pathogenic genes between individuals without indicators of assisted reproduction and those with such indicators was 55.55% vs. 41.38%. In 51 carriers, 72.55% (37/51) carried one genetic variant, 25.49% (13/51) carried two genetic variants, and 1.96% (1/51) carried three genetic variants. A total of 38 pathogenic genes were detected in this study, and GJB2 and MMACHC were most common. The carrier rates of the two genes were both 5.26% (6/114). A total of 55 variations were detected, and c.235delC was most frequently found. The carrier rate was 3.51% (4/114). The incidence of couples carrying the same pathogenic genes was 1.03% (1/97). CONCLUSIONS: The findings elucidate the carrier rate of pathogenic genes among 155 severe monogenic recessive genetic diseases and underscore the significance of ECS as a preventive measure against congenital anomalies. When both partners carry the same genetic mutation for a monogenic disease, preventive strategies can be taken in offspring through preimplantation genetic testing (PGT), prenatal genetic testing, or the utilization of donor gametes. ECS is instrumental in assessing reproductive risk, guiding fertility-related decisions, and reducing the prevalence of monogenic recessive genetic disorders in subsequent generations.
Humans↗
Ethical considerations of the new reproductive technologies. By the Ethics Committee (1986-87) of The American Fertility Society in light of Instruction on the Respect for Human Life in its Origin and on the Dignity of Procreation issued by the Congregation for the Doctrine of the Faith.
In September 1986, The American Fertility Society issued a report, Ethical Considerations of the New Reproductive Technologies, setting forth the then-held ethical position of the Society on the various new reproductive technologies. In 1987, the Congregation for the Doctrine of the Faith issued the Instruction on the Respect for Human Life and Its Origin and on the Dignity of Procreation. While both documents state that very similar moral criteria were used to derive ethical positions with respect to various reproductive procedures, the conclusions as to the ethical acceptability of the various procedures differ sharply in the two documents. The question can be raised about the procedure used by the Congregation of the Faith to derive its conclusions from the stated premises. Thus, while stating that "the individual integrally and adequately considered" is to be the basis of the moral judgment, the fact is that most conclusions are based on and referenced to past Catholic statements. While the difference in conclusion from similar premises may be troubling to society, it can be especially paralyzing to four groups: (1) those who face problems that might be solved by one or another of the new reproductive technologies; (2) those who are involved in applying them; (3) those who are responsible for institutional policies where such techniques may be applied; and (4) those who are in a position to influence public policy in a legislative or regulatory way. Because of the conflicting conclusions of the two documents, the present Ethics Committee (1986-87) of The American Fertility Society was convened and considered these guidelines in the light of the Instruction.(ABSTRACT TRUNCATED AT 250 WORDS)
Bioethics↗
Reproductive technology and the law in Canada.
Even leaving aside the question of the impact of reproductive technology on property law, successions, commercial law and the legal qualification to be given to some of the relationships it entails (e.g. 'deposit' of genetic material, 'lease and hire' of wombs, 'gifts' of embryos), there is no doubt that, like the discovery of the atom, no other scientific advance portends such an enormous potential for human benefits or harm. No other scientific advance will so affect the personal, intimate life of the individual person in its public or private aspects. Beginning then with the positive law (Part I), we will attempt to trace, albeit summarily, possible legal approaches to reproductive technology in Canada and to conclude with an overview of proposed reforms (Part II).
Canada↗
Efficacy of assisted reproductive technology during diagnostic and operative infertility laparoscopy.
Women being evaluated for infertility were offered assisted reproductive technology at the time of diagnostic laparoscopy. Oocyte retrieval was performed after ovulation induction in 33 women, of whom 19 had concurrent operative laparoscopy. Gamete intrafallopian transfer (GIFT) or in vitro fertilization (IVF) and embryo transfer were performed subsequently depending on laparoscopic assessment of pelvic architecture, oocyte maturity, and semen parameters. The clinical pregnancy rate was 24% per cycle and 28% per gamete or embryo transfer (four pregnancies after GIFT and four after IVF/embryo transfer). The clinical pregnancy rate per transfer did not differ significantly between the 19 women who had therapeutic operations in conjunction with laparoscopy (lysis of adhesions and/or fulguration of endometriosis) and the 13 who did not (25 versus 30%; P greater than .05). Assisted reproductive technology can be performed successfully during diagnostic infertility laparoscopy. Operative endoscopic manipulation did not adversely influence pregnancy outcome.
Adult↗
The nursing role in assisted reproductive technologies.
The role of the nurse in assisted reproductive technologies (ART) has evolved as the needs of couples and infertility programs have changed. This multidimensional nursing role encompasses skill as a manager, educator, counselor, researcher, and professional. Such skills are combined with a specialized knowledge base of reproductive endocrinology and infertility. This chapter describes the various facets of the role, including the interdependence of other team members.
Adult↗
The spontaneous LH surge in ovarian hyperstimulation for assisted reproductive technology.
Thirty-seven patients who underwent assisted reproductive technology programme, in vitro fertilisation or embryo transfer and gamete intra-fallopian transfer, were randomised into two groups in order to evaluate frequency of premature spontaneous LH surge when stimulated with different type of hMG. An hMG (FSH:LH = 1:1) was administered for eighteen patients (group A) and the different highly purified hMG (FSH:LH = 19:1) was administered for nineteen patients (group B). Blood samples are drawn from day 3 of the cycle until hCG administration, and serum LH level are measured in the frozen samples. There were no statistical difference in the total amount of hMG used before hCG injection, days of hMG injection and the number of oocytes retrieved between two groups. The premature spontaneous LH surge occurred only one patient in group A (5.6%), but more frequent LH surge was observed in group B (42.1%) (p < 0.05). It is suggested that the different FSH/LH ratio may be the reason for the difference of the incidence of premature spontaneous LH surge.
Chorionic Gonadotropin↗