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In Vitro Fertilization (IVF)

Rels 300 / Nurs 330

18 November 2015

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On left: Physiologist Robert Edwards

Middle: baby Louise Joy Brown

(Middle woman, unidentified)

Right: Gynecologist Patrick Steptoe

Parents: Lesley & John Brown – after 9 years of infertilityAfter 80 embryo transfer failures, 1st successful pregnancy and birth

25 July 1978:1st “test tube” Baby

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Robert Edwards received the 2010 Nobel prize for medicine.

the world's first "test tube baby" was born in July 1978.

IVF technology allowed Lesley & John Brown to experience pregnancy & birth, in spite of Lesley’s blocked fallopian tubes

Currently, over 4 million test tube Babies have been born

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In response, the Vatican protested the awarding of the prize, saying that: Conception occurs separate

from the couple’s conjugal union Embryos that are fertilized but

not implanted are destroyed

The President of the Pontifical Academy for Life said that “without Edwards there would not be freezers full of embryos waiting to be transferred to a uterus, or, more likely, used for research or left to die, abandoned and forgotten by all.”

http://catholic.org/hf/family/story.php?id=39343

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“All hell will break loose, politically and morally,all over the world.”The Atlantic, June 2012

James Watson, co-discoverer with Crick of the structure of DNA, and fellow Nobel Laureate from 1953, had this to say about IVF:

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IVF is a process whereby ova and sperm are placed together in a glass dish (in vitro = in glass) in a laboratory setting If fertilization occurs, and the early embryos

successfully begin to grow in the dish, then the embryos are transferred into the woman’s uterus

If one or more embryos are successful in achieving implantation, then a pregnancy has begun

What is IVF?

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5 Steps

1. Ovulation induction: fertility drugs are used to cause production of multiple ova (usually 3 or more, up to 15 or 20) and to control the exact timing of the ovulation

2. Follicular aspiration: ripe ova within their follicles are surgically removed from the woman’s ovaries using a hollow catheter

3. Ova and sperm are combined in a glass dish in a nutrient-rich medium (ratio of 50,000 to 1)

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5. Healthy fertilized zygotes are transferred to the woman’s uterus through the cervix using a catheter; generally 1 to 3 embryos per transfer

4. Dish containing ova and sperm is placed in an incubator to provide a temperature-controlled environment; eggs are monitored for fertilization and cell division

(“Spare” embryos may be discarded, frozen, or donated)

After 17 days, a pregnancy test will be done, followed by an ultrasound if pregnancy has been confirmed

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Risks associated with anesthesia

Risks of bleeding, infection

Risks of damage to the bowel, bladder or blood vessels

Potential for a multiple pregnancy with risk of premature delivery

Potential risks from donor sperm or ova

Hormonal stimulation of woman’s ovaries to produce multiple ova

→ risk of ovarian hyperstimulation

Severe abdominal pain

Nausea or vomiting Decreased urination Shortness of breath Up to 10 lb. weight

gain within 3 to 5 days

Medical Risks associated with IVF

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ICSI – intracytoplasmic sperm injection – if sperm are few or inactive – a single sperm is inserted into the ovum with a catheter

GIFT – gamete intrafallopian transfer – ova and sperm are collected and then transferred to the fallopian tubes so that fertilization takes place within the woman’s body

Variations of IVF

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SPERM Donation of

sperm no longer needed for AI or IVF

Purchase of sperm from a “donor” catalogue

Altruistic donation from a family member or friend

Purchase online; http://www.mountsinai.on.ca/care/fertility/services/donor-insemination

OVA Donation of

healthy ova no longer needed by another IVF woman

Purchase of ova from a “donor” catalogue

Altruistic donation from a family member or friend; http://www.mountsinai.on.ca/care/fertility/services/egg-donation

IVF with donors

EMBRYO• Excess frozen

fertilized embryos from previous IVF cycles; http://www.mountsinai.on.ca/care/fertility/services/embryo-freezing

• Purchase from an IVF clinic’s excess inventory

• Prenatal adoption of “spare” embryos

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IVF fee schedule http://

www.mountsinai.on.ca/care/fertility/financing-options/fee-schedule-may-2015.pdf

250 Dundas Street West, Suite 700 · Toronto, ON · M5T 2Z5 · (416)

586-4748

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http://www.eggdonation.com/index.php https://www.eggdonation.com/becoming-an-egg-donor/BecominganEggDonor.php

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MISSION To locate stunning, well motivate candidates…To accept no more than 5% of our 1,200 + monthly egg donor applicationsTo be instrumental in setting & surpassing industry standards…To provide competitive program costsTo provide reliable financial auditing To provide secure and confidential recordsTo provide cycle coordination…To honor the responsibility of creating families

Create a username and password to view ourDatabase of Egg Donors

ONE OF OUR REAL EGG DONOR ANGELS

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https://www.eggdonation.com/becoming-an-egg-donor/Donor-compensation.php

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Frozen Egg Donor Cycle5 mature eggs = $16,500 plus transfer fees

Fresh Egg Donor CycleUnknown quantity of eggs = $38,000 - $60,000

http://www.eggdonation.com/egg-donor-bank.php

Frozen Eggs Available from egg donor 1019 only. We have had a 100% success rate with transfers from

this donor cycle, both fresh and frozen.

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HAYLEY (#73010) https://www.eggdonor.com/donor-profile/?pid=73010

https://www.eggdonor.com/egg-donor-database/

Our on-line egg donor catalog

SHAKIRA (#61803)https

://www.eggdonor.com/donor-profile/?pid=61803

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http://www.ctfertility.com/find-egg-donors

Sample Profile for egg donor #254, http://www.ctfertility.com/sample-egg-donor-profile

What does she think you would want to know about her?

Choose – a – Donor !

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Rotunda Clinic offers comprehensive IVF services:

IUI, IVF, ICSI Donor Egg IVF, Embryo Adoption, Surrogacy Embryo Retrieval through Puncture/ Aspiration, Overseas IVF Patient Program, Gestational Surrogacy & Gestational Carrier ART Program

Rotunda-The Center for Human Reproduction MUMBAI, India

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Why choose Egg and/or Embryo Storage? When fertility is at risk due

to illness or surgery To delay childbearing until a

later date Egg/Embryo storage gives

women who have completed IVF treatment the option to preserve the unused embryos for potential use in the future

Your IVF center has limited storage space

Your IVF center is closing

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Donors Donors Embryo Adoption 101 Terminology Defined Videos Personal Stories Donor FAQs Counselor Support

Network News Articles Where to Donate Webinar Registration Glossary

Adopters Adopters Embryo Adoption 101 Terminology Defined Videos Personal Stories Adopter FAQs News Articles Embryo Adoption

Agencies Home Study Providers Clinics with Donation

http://www.embryoadoption.org/sitemap/index.cfm

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Ranjit Hayer tried for decades to have a child, enduring multiple miscarriages, surgery, even the trauma of being robbed by a fertility doctor. Finally, after a successful IVF treatment, the Calgary woman gave birth to twins — at age 60.

She is believed to be among the oldest Canadian women to give birth.

http://www.cbc.ca/news/canada/calgary/60-year-old-calgary-mother-welcomes-twins-1.844372

CASE STUDY:60-YEAR-OLD CALGARY MOTHER WELCOMES TWINS

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“We can do so much but the question is, should we do it just because we can do it?”

60-year-old MOM

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Whose personal dignity and autonomy are promoted or harmed?

What are the potential benefits of reproductive technologies?

Who are the beneficiaries?What are the potential risks and harms of

reproductive technologies?Who is most likely to be harmed?

Are there justice issues in the provision of reproductive services?

Issues of fairness, equality, equitable access?

Evaluating reproductive technologies