The Art of ART: Assisted Reproductive Technology

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The Art of ARTAssisted Reproductive Technology

• Mary L. Davenport, M.D.
• Berkeley Students for Life
• March 4, 2009

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What is ART?

• Assisted Reproductive Technologies
• Fertility therapies where eggs and sperm are
  manipulated
• Involve surgically removing eggs from women and
  combining them with sperm in the laboratory

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ART Assisted Reproductive Technology

• Predominantly IVF In Vitro Fertilization
• Expensive
• Most attempts fail to produce a live birth
• Separates procreation from the marital act
• Large loss of embryos in failure to implant,
  discarding embryos, pre-implantation diagnosis,
  freezing, selective reduction

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IVF
TYPES OF ART
SART 1999
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ASSISTED REPRODUCTIVE TECHNOLOGY

• Major philosophical and ethical shift in
  reproductive medicine
• Emphasis changed from healing and eradicating
  disease to control of procreation

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REPRODUCTIVE CHRONOLOGY

• 1934 Gregory Pincus First animal IVF
• 1944 John Rock First human IVF
• 1960 FDA approves the pill
• 1978 First IVF baby
• 2001 421 U.S. ART clinics with 41,000 live
  births annually

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GREGORY PINCUS

• 1934 First in vitro fertilization of rabbit eggs
• Criticized as mad scientist
• Developed oral contraceptives in 1950s

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Dr. John Rock1890-1984

• 1936 First doctor to open a Rhythm clinic in
  Boston
• 1944 First IVF created four embryos in secret
• 1954 Collaborated with Pincus on U.S. clinical
  trials of the pill

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STEPTOE AND EDWARDSBirth of Louise BrownFirst
IVF Baby, 1978
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Why ART?
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Infertility Extremely Prevalent

• Definition inability to achieve pregnancy in one
  year
• 17-26 of couples worldwide (90 million women)
• 27-47 of infertile couples have impaired male
  fertility decline in semen quality worldwide
  over last 50 years

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Why the increase in infertility?

• Delayed marriage and child-bearing
• Sexually transmitted diseases
• Hormonal contraception
• Abortion
• Obesity
• Environmental Pollution

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FERTILITY CLOCK
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What is IVF?
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IVF (in vitro fertilization) is a method in which
egg cells are fertilized by sperm cells outside
the mothers womb (in vitro). The resulting
embryos are then transferred back into the uterus.
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STEPS IN IVF

• Follicle suppression
• Controlled ovarian hyperstimulation
• Aspiration of eggs from follicles
• Fertilization, incubation and selection of
  embryos
• Embryo transfer
• Pregnancy test

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FOLLICLE SUPPRESSION ANDCONTROLLED OVARIAN
HYPERSTIMULATION
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ASPIRATION OF EGGS
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IVF LAB FOLLICULAR FLUID
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HIGH QUALITY EGG
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LOW QUALITY EGG
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EMBRYOLOGIST MANIPULATING OVA AND SPERM
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ICSI
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INCUBATOR
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HIGH QUALITY THREE DAY OLD EMBRYO
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EMBRYO TRANSFER
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IVFWHY NOT?
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IVF Why not?

• LOSS OF LIFE

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IVF OUTCOMES
SART 1999
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Pregnancy Rates Nondonor Eggs SART,CDC, 2004
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LOW QUALITY EMBRYO
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TANK FOR FREEZING EMBRYOS
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MFPRMULTIFETAL PREGNANCY REDUCTION
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ART Outcomes by Age SART, CDC, 2004
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COMPARISON OF OWN AND DONOR EGGS
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Pregnancy Loss by Age CDC
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IVF why not?IVF permits the use of donor ova and
sperm and cloned embryos

• Violates traditional Judeo-Christian concept of
  marriage
• Legal and biologic confusion
• Commercialization of human lifesale of ova and
  sperm
• Donor ova and sperm illegal in many countries
• Cloned embryos can be used
• Cloning a dangerous technology and makes massive
  abuses possible

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COMPARISON OF OWN AND DONOR EGGS
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Egg donor Characteristics e.g. Hair
color, Weight Ethnicity
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CLONED HUMAN EMBRYO
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PANAYIOTIS ZAVOS, PH.D.

• CURRRENTLY CONDUCTING HUMAN CLONING EXPERIMENTS
  IN UNDISCLOSED COUNTRY WITH DRS. SEVERINO
  ANTORINI AND BEN-ABRAHAM
• GOAL PROVIDING CHILDLESS COUPLES WITH THE
  ABILITY TO CLONE THEMSELVES AS A FORM OF
  REPRODUCTION

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IVF Why not? MULTIPLE BIRTHS
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IVF why not? Multiple births

• Multiple pregnancies with IVF (37.4)
• Triplets or more 8.4 (4.9 of live births)
• Prematurity Average with triplets 33 weeks 85
  survive
• Prematurity Quadruplets average 29 weeks 70
  survive
• Fetal risks mental/physical disabilities such as
  blindness, cerebral palsy 5 in twins, 10 in
  triplets, 50 in quadruplets
• Fetal risks death seven times more likely to
  die in the first year 40x more likely to die in
  infancy
• Maternal risks toxemia, diabetes, hemorrhage
• Family risks depression, social isolation,
  divorce

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IVF Expensive

• Medication 1,500-7,000 per cycle
• Office visits, egg retrieval, fertilization,
  assisted hatching, cryofreezing of embryo (six
  months),ultrasound, lab tests 12,000-18,000
  PER CYCLE
• Egg donation 3,000-50,000

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IVF Additional Costs

• Hospital costs - Singleton 10,000 Twins
  20,000 Triplets 40,000
• Intensive care of baby 100,000-150,000 per
  month
• Work time lost--daily medical visits
• Frequently not covered by insurance

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Benitez v North Coast Womens Medical Group

• Lesbian couple desired pregnancy
• ObGyn group declined to perform IUI (Intrauterine
  insemination) because of marital status (or
  sexual orientation ?) based on physicians
  religious beliefs
• Lower court found in favor of the doctors
• California Supreme Court found in favor of
  Benitez

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R. Alta Charo, J.D.Professor of LawUniversity
of Wisconsin

• The Celestial Fire of Conscience Refusing to
  Deliver Medical Care
• New England Journal of Medicine
• June 16, 2005

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The McCaughey Septuplets 1997
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The Chukwu Octuplets
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Dr, Michael Kamrava
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