Science and Babies Private Decisions, Public Dilemmas (1990) / Chapter Skim
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2. Infertility
2. Infertility
Pages 14-40
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From page 14... ...
The issue of using frozen semen in artificial insemination by donor in order to protect the recipient and her offspring from sexually transmitted diseases and from AIDS is also outlined. The chapter focuses particularly on IVF and GIE-l; how they are performed and for what reasons.
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From page 15... ...
Many observers believe that the increase is due primarily to the prevalence of sexually transmitted diseases, such as gonorrhea and chlamydia, in this very sexually active segment of the population. Infertility among such young couples is significant because women at this age have one-third of the babies born in the United States.
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From page 16... ...
· F E R T I L I Z A T I O N can be blocked by birth control pills and 1UDs that change cervical mucus, barriers such as condoms, dlaphrams and cervical caps, and In theory by prior Immunization with anti-egg and anti-sperm vaccines, · I M P L A N T A T I O N - can be blocked by changing the hormonal environment with birth control pills, lUDs, prior immunization with HOG vaccine, RU-486 or multidose oral contraceptives used as "morning after" pills. · POST-IMPLANTATION -nonsurgical abortion can be induced by RU-486 and drugs such as Cytotec that contain prostaglandins, though Cytotec has limited effectiveness and Is not approved for this use.
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From page 17... ...
Although each ejaculation usually contains millions of spermatozoa, only a few hundred enter the uterus and make their way into the fallopian tubes. Human eggs, like those of other mammals, are covered with a thick translucent layer called the zone pellucida, which the sperm must penetrate to reach the egg.
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From page 18... ...
lathe entire process is orchestrated according to cycles of interaction between the hypothalamus and pituitary gland in the brain and the ovaries. SEEKING THE CAUSE When a couple has been unable to conceive after months of trying, they usually look to their family physician or the woman's gynecologist for help, since women visit their gynecologists more often than their male partners visit their physicians.
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From page 19... ...
DA`IAGE TO THE REPRODUCTIVE TRACT Increasingly common as causes of infertility are blockages and adhesions that interfere with the normal role of the ovaries and fallopian tubes. Even minor adhesions can prevent the delicate functioning of the reproductive tract and are difficult, often impossible, to repair.
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From page 20... ...
ENDOMETRIOSIS The ability to conceive can be negatively affected by endometriosis, a disorder in which cells that ordinarily line the uterus grow in other areas of the body, such as in the ovaries, fallopian tubes, or the membranes that line the pelvis. One theory supposes that some blood and endometrial cells occasionally back up through the fallopian tubes and escape into the abdomen, from where they spread.
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From page 21... ...
MEDICAL THERAPIES FOR WOMEN AND MEN Medical treatments for female and male infertility can range from advice from a physician or nurse on how to pinpoint the time of ovulation to sophisticated drug regimens. A number of compounds are available to treat ovulatory dysfunctions and to improve semen quality in men who are infertile or subfertile.
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From page 22... ...
Hormone drugs such as clomiphene citrate and tamoxifen citrate can enhance the body's own production of the gonadotropins, which in turn act on the testes to generate spenn. If the hypothalamus is not secreting the rhythmic pulses of GnEH necessary to trigger sperm development, the treatment is a continuous administration of pulses of GnRH via a portable infusion pump.
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From page 23... ...
The OTA found in 1987 that 172,000 women underwent at least one cycle clef artificial insemination from 1986 to 1987. Me survey data suggest that live bits were achieved in about one-third of the women who received this form of infertility therapy.
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From page 24... ...
Drs. Mascola and Guinan warned that the use of fresh semen "is clearly hazardous and should be discouraged, especially because of the risk of AIDS." Although observers believe that most reputable fertility clinics and private physicians using artificial insemination are following the CDC guidelines, a number of practitioners may be still be using fresh sperm.
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From page 25... ...
Most donors are single and under age 35, the age group with the highest reported incidence of STDs, a fact that underscores the importance of using only frozen sperm from carefully screened donors. NEW FERTILIZATION PROCEDURES In Vitro Fertilization In 1978 a normal baby was born in England after fertilization in a test tube.
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From page 26... ...
Gamete Intrafallopian Transfer If at least one fallopian tube in an infertile woman is functioning, a variation of the IVF technique can be used. Gamete intrafallopian transfer (GIFT)
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From page 27... ...
A survey of the nation's IVF clinics and procedures by the congressional Subcommittee on Regulation, Business Opportunities, and Energy found that in 1988 the rate of live births per stimulated ovarian cycle was measurably higher for GIFT than for IVF. The overall success rate for IVF was 9 percent per stimulated cycle; for GIFT it was 16 percent.
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From page 28... ...
test tube baby was born in December 1981; In January 1984 the American Fertility Society published a one-page description of qualifications for the personnel, facilities, and ancillary support involved with in vitro fertilization. In July 1988 the society published standards for GIFT.
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From page 29... ...
On one hand, some physicians or clinics are encouraging patients to undergo IVF or GIFT before less invasive treatments have been attempted; on the other, many centers are still not using the most advanced forms of infertility techniques, including the use of frozen donor sperm. The OTA estimates that the time lag for the dissemination of new technology may be as long as two years.
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From page 30... ...
The testimony led the subcommittee to launch its survey of this country's IVF clinics, their procedures, and their results. With a questionnaire developed with the help of the American Fertility Society, 224 clinics were polled in late 1988 by the subcommittee staff.
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From page 31... ...
Credit: National Institute of Child Health and Human Development subcommittee discovered that a newly formed branch of an internationally known IVF center was advertising as its own successes the many births achieved by its parent organization. Representative Wyden observed: The subcommittee's investigation turned up instances of questionable advertising practices.
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From page 32... ...
Blackwell and his colleagues cautioned fertility professionals that it is misleading to claim a high pregnancy rate based on a small number of patients and on pregnancies determined by a blood test. It also is deceptive, they said, for a clinic to quote a high pregnancy rate based solely on its experience with young patients who have only tubal disease or to use as its overall success rate the pregnancies that occurred in a period when results were unusually good.
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From page 33... ...
After the Wyden subcommittee survey revealed that success rates were actually much lower, the industry agreed to publish its clinic-by-clinic figures. IVF clinic spokespersons cautioned, however, that an individual clinic's overall success rate is affected by the types of infertility it treats and the age of its patients.
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From page 34... ...
As the OTA noted in its report, conferences have been sponsored by professional societies, government agencies, and insurance companies in an effort to develop protocols for medical care in order to safeguard research subjects and patients. A logical goal for such a meeting, the OTA suggested, would be the development of a protocol to determine which infertility treatment is the best approach for a given patient.
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From page 35... ...
Additional costs can be substantial in time spent away from work and, if the treatment center is located some distance away, travel and hotel expenses. The OTA estimates that a couple experiencing severe female infertility could easily spend over $20,000 for four embryo transfers, which might give the couple a 50 percent chance of taking home a baby.
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From page 36... ...
Current costs for infertility treatment are so substantial that they place infertility care beyond the reach of low-income couples, and they represent a sizable investment for middle-income couples. For couples with before-tax annual incomes under $20,000, the cost per stage of treatment would range from 6 to 62 percent of their annual income.
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From page 37... ...
· To improve chances of conception using frozen sperm, more must be known about cryopreservation, the true effectiveness of frozen semen, and methods for improving that effectiveness. · Sperm deficiencies are evident in 30 to 40 percent of infertile couples, yet few methods exist for determining healthy sperm, and not enough is known about the basic process of sperm movement through the female reproductive tract.
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From page 38... ...
1988. Testimony at the Hearing on Consumer Protection Issues Involving In Vitro Fertilization Clinics, before House Subcommittee on Regulation and Business Opportunities.
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From page 39... ...
1988. Testimony at the Hearing on Consumer Protection Issues Involving In Vitro Fertilization Clinics, before the House Subcommittee on Regulation and Business Opportunities, Washington, D.C.
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From page 40... ...
1989. Opening remarks and testimony at the Hearing on Consumer Protection Issues Involving In Vitro Fertilization Clinics, before the House Subcommittee on Regulation, Business Opportunities, and Energy, Washington, D.C.
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