Discuss about the In Vitro Fertilization for Intracytoplasmic Sperm Injection.
In vitro fertilization (IVF) is medical procedure also referred as test-tube conception. It is a technology or ART that involves removing mature eggs cells from a female and then fertilized with male sperms outside the body. After the fertilization occurs outside the body, everything is put inside the uterus of a different or same woman to enable normal gestation.The ART is presently an ordinary technology that has effectively helped millions of infertile couples all over the world. However, the IVF technology explosion has presented a number of new ethical, social and legal challenges. The aim of this people is to give an overview of IVF procedure as well as discuss its relevance in the society. Besides, the paper will discuss a number of legal, social and most importantly ethical concerns related to this technology.
In vitro fertilization usually takes place after a thorough infertility evaluation has been carried out. Some couples may have been suffering from unexplained fertility or rather the male spouse has the little sperm count. In most cases, women are the victims since they mainly suffer from absent or blocked fallopian tubes. As a result, the fertilization cannot take place thus leading to infertility (Chart et al., n.d )IVF first requires the involvement of health team unlike in vivo fertilization. The intervention at this time starts by noting down couple’s history. The next step that follows intervention involves laboratory and physical examinations that includes testing the sperm count of the man as well as a pelvic inspection. Besides, there is also need for cervical culturing and bruising of cervical discharges for the existence of Chlamydia for the woman. After all these tests have been carried out, fertility medicines are directed to the female partner to kindle her ovarian sacs to generate the required number of healthy eggs. The process is essential since a single fertilized pre-embryo or egg has low chances of survival. The eggs are then retrieved after 27 to 36 hours using a particular stimulation method such as laparoscopy or the ultra-son graphically steered aspiration (Wright et al., 2015). Ideally, so many eggs are obtained in every single retrieval attempt.
The obtained eggs are fertilized by a sample of semen containing male sperm of high quality whereby the preparation is done by washing to prompt capacitation.Infact, every egg that was obtained has approximately 60% to 70% chances of being fertilized. Once the cleavage takes place, the pre-embryos are inserted in the uterus of the woman. At this time, the female partner has to receive the progesterone that prepares her uterine lining to enable embryo implantation(GARCIA et al., 2016). The embryo at this point is termed as blastocyst which is led through the cervix towards the uterus. The blastocyst also seems to float freely for around three hours. In case the process is fruitful, the embryo embeds itself within the uterine wall hence, resulting to pregnancy. However, poor quality sperm reduces the probabilities for the partners to have enough embryos obtainable for aided fertilization (Wintner et al.,2017). Therefore, such problem has been discussed with intracytoplasmic sperm inoculation, whereby every captured sperm is inserted straight away into the egg.
IVF failure is led is generally led by miscarriage or unsuccessful implantation. On the other hand, unsuccessful implantation could be due to the rejection of immune by the female spouse. An embryo with a thick outer membrane may also prevent the hatching of the embryo while inside the uterine hollow (Groenewoud et al., 2018). In addition, the endometrial development and embryonic stage may fail to synchronize during the introduction of the embryo into the uterus leading to unsuccessful IVF. On the other hand, Aneuploidy is realized as the major reason for miscarriage in IVF. Aneuploidy is an abnormal number of chromosomes that lead to IVF failure.
Preimplantation genetic diagnosis (PGD) is the approach used to help improve the achievement of IVF in women who are beyond 38 years old or who have experienced frequent IVF failures (Webster et al., 2017). The method is used to identify the existence of embryonic genomic abnormalities having high chances of causing miscarriage or implantation failure. In PGD only one cell is removed from the embryo immediately the embryo has separated to allow production extra five egg cells. This step could be risky since it may end up damaging the embryo while extracting a single cell. The second step involves analyzing the cell using fluorescence in situ hybridization (FISH) (Wilson, 2017). The method is meant to detect any structural abnormalities within the chromosomes which other normal tests, for instance, karyotyping may not detect. In some instances, DNA is separated from the egg cell and examined using polymerase chain reaction (PCR) that detects gene mutations. The gene mutations can result in different disorders such as cystic fibrosis or Tay-Sachs disease. Comparative genomic hybridization (CGH) is another technique that can be used while combined with PGD to spot certain abnormalities in chromosomes(Gardner et al,2017).CGH is extra sensitive compared with FISH since it can detect a number of small chromosomal deletions, rearrangements as well as duplications. The technique may as well be helpful towards reducing the likelihoods of multiple births by detecting a single embryo, having the best opportunity for effective implantation. The IVF effectiveness may be boosted through supported hatching, an approach used to thin the outer tissue of a particular embryo to allow implantation.
IVF has had different views from the society whereby some people have perceived the technology as bad and others as good. In fact, it has been the reason behind ethical, religious and moral controversy since it emerged. However, all people involved in religious groups are on both sides involving the issues of IVF(Rao, 2015). The most leading opposition emerged from a Roman Catholic Church. The church delivered a doctrinal statement in 1987 differing with In vitro fertilization on three bases. The Roman Catholics held that the human embryos destruction not used during the implantation, the possibility of IVF by a donor other than the male partner, hence eliminating reproduction from the spousal context. Lastly, it held that the act severed a crucial connection between the procreation and conjugal act.
Other ethical concern raised as a result of IVF technology involves the unusual increment of multiple births such as triplets and twins. The issue is currently being sorted out through the advancements of better methods meant to use fewer fertilized egg cells to attain pregnancy. For instance, during the 1990s and 1980s, at least four fertilized egg cells or embryos were inserted into the uterus of a woman to enhance the likelihood of pregnancy and implantation (Orr et al., 2017). However, during the early 2000s, the implementation of advanced methods involved the transfer of only two embryos. In fact, the similar rate of achievement while using four embryos was upheld. The method of only one embryo transfer is also available although, a few women opt for it since it has low chances of IVF success compared to many embryos transfer. Many women go for multiple embryo transfers as much as they may not be willing to have multiple births. The idea has therefore led to many multiple births in different countries such as the U.S since the 1980s (Phalen, 2017). The IVF has as well raised many unresolved moral issues in regards to the freezing of sperms, eggs, ovaries or embryos for the upcoming pregnancies.
In addition, the transfer multiple eggs to facilitate faster conception has resulted in high chances of more than one fetus development. This has however increased the risks of baby health problems, premature birth as well as low birth weight (Malhotra et al.,2015). On the other hand, when the female spouse undergoes aided conception, the health center she visits may decide to freeze the extra fertilized eggs without her consent. This is wrong because the couple should be alerted and more so given the permission to decide what they would want to be done with their egg cells during the event of divorce or death. They need to be sure of what they require by giving written instructions that deliberate their desires. Individuals should also reflect on what they would want to happen to their eggs in case the health system cannot contact them. Lastly, a couple might opt to use the sperm or eggs from the sperm donor or rather have the surrogate female carry their baby. In such a case, couples need to discuss with the lawyer or the clinic concerning the contract being undertaken (Inhorn et al., 2018). The contract should define the responsibilities and rights to the future family and child of every party. Once, the contract is defined, there will be no conflict between the surrogate mother and the couple
Legal, as well as ethical concerns, differ between religious beliefs and with countries. Ideally, each person has his or her own view which further obscures the whole thing. As much as the couple may decide to use their own eggs and sperms, the fact remains that, the creation of life externally or outside human body is a crucial act that evokes strong sentiments and opinion. By involving the surrogate mother or the sperm donor to the mix, the situation becomes even more complex. Ethical issues can even be more complex that legal ones hence it is upon the involved parties to settle on what they are contented with (Liu et al., 2018). For many persons, the conception act is viewed as sacrosanct and holy, hence, must not be troubled in any way. On the other hand, some people view the idea of IVF as the best since having a child is the key thing and are not worried about the methods involved (Tal et al.,2017). Therefore, a whole spectrum of opinions is involved hence; it’s upon an individual to consider her stance, before start looking for fertility treatment in other countries.
A number of ethical concerns regarding fertility treatment involve everyone’s opinions on when the life of a human being begins. For instance, the Catholic Church believes that life starts immediately after conception. They only accept the fertilization of sperm and egg cells ready to be used while insisting on the embedding of all feasible embryos and dumping the rest. Therefore, the most important thing to understand is that there exists no wrong or right answers concerning the IVF art (Hamilton, 2015). The beliefs are personal and in fact, there are different other methods of fertility cure one can engage in without compromising his or her ethics and religious standards.
In conclusion, the IVF has emerged has been considered as the most widely successful and adopted medical technologies till to date. It has given hope to many married spouses suffering from infertility. However, the technology has also presented social and ethical issues that the society should address. A number of countries have decided to regulate various aspects of the technology. For instance, they have taken various steps towards regulation of different aspects such as what laws and regulations must be considered in IVF reporting as well as social inequities that may emerge from financial challenges affecting IVF success. Besides, individuals’ right towards their embryo or gamete donation is an aspect of IVF technology that may become controversial and questioned in the nearer future. However, the legal and ethical concerns involving the technology are yet to be settled. The government should understand how to fund IVF technology in an equitable and responsible manner to boost access to care. Other unresolved issues concerning embryo and gamete donation, should also be addressed comprehensively in future legal and social dialogues. The IVF is a technology that is ever-changing hence very dynamic. In the fields of ART such as preimplantation genetics, the advancements of novel technologies persist on changing the abilities of IVF.As a result of rapidly growing technologies, the government finds it difficult to align with it pace as well as address all legal and ethical issues that are emerging every day in the field. Therefore, it is upon the physicians to constantly to keep an eye on these issues and make sure that the technologies are delivered and offered in the appropriate manner that balances both moral responsibility and patient care.
References
Chart, M. M., Give, W. T., & Risk, F. In vitro fertilization (IVF).
GARCIA, D. M., NERA, A., BRIAND, L., TOPIE, E., BENCHARIF, D., & TAINTURIER, D. (2016).In Vitro Fertilization (IVF).
Gardner, D. K., &Simón, C. (Eds.). (2017). Handbook of in vitro fertilization.CRC press.
Groenewoud, E. R., Cohlen, B. J., Al?Oraiby, A., Brinkhuis, E. A., Broekmans, F. J., de Bruin, J. P., … &Hoek, A. (2018). The influence of endometrial thickness on pregnancy rates in modified natural cycle frozen?thawed embryo transfer. ActaobstetriciaetgynecologicaScandinavica.
Hamilton, J. (2015). The Ethical Viability of In Vitro Fertilization. Dialogue & Nexus, 2(1), 8.
Inhorn, M. C., &Patrizio, P. (2018). Is Lower Quality Clinical Care Ethically Justifiable for Patients Residing in Areas with Infrastructure Deficits?. AMA journal of ethics, 20(3), 226.
Liu, H., Zhao, H., Yu, G., Li, M., Ma, S., Zhang, H., & Wu, K. (2018). Conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI): which is preferred for advanced age patients with five or fewer oocytes retrieved?. Archives of gynecology and obstetrics, 1-6.
Malhotra, N., &Vignarajan, C. P. (2015). Does the mode of surgery for hydrosalpinges affect the outcome in in-vitro-fertilization (IVF) cycles? A randomized trial comparing laparoscopic salpingectomy and proximal tubal occlusion (PTO). Journal of minimally invasive gynecology, 22(6), S14-S15.
Orr, E., Jack, S. M., Sword, W., Ireland, S., &Ostolosky, L. (2017). Understanding the Blogging Practices of Women Undergoing In Vitro Fertilization (IVF): A Discourse Analysis of Women’s IVF Blogs. The Qualitative Report, 22(8), 2206-2230.
Phalen, R. F. (2017). Unsolved Problems: Our Brave New World. In Core Ethics for Health Professionals (pp. 115-131).Springer, Cham.
Rao, R. (2015). How (Not) to Regulate Assisted Reproductive Technology: Lessons from” Octomom”. Family Law Quarterly, 49(1), 135.
Tal, R., Talarczyk-Desole, J., Bentov, Y., Lin, Y. J., Fujiwara, T., &Tiboni, G. M. (2017).Advances in In Vitro Fertilization. Advances in In Vitro Fertilization, 327.
Webster, A., &Schuh, M. (2017).Mechanisms of aneuploidy in human eggs. Trends in cell biology, 27(1), 55-68.
Wilson, D. (2017). In Vitro Fertilization, Infertility, and the ‘Right to a Child’in 1970s and 1980s Britain. In The Palgrave Handbook of Infertility in History (pp. 565-586). Palgrave Macmillan, London.
Wintner, E. M., Hershko-Klement, A., Tzadikevitch, K., Ghetler, Y., Gonen, O., Wintner, O., …& Wiser, A. (2017). Does the transfer of a poor quality embryo together with a good quality embryo affect the In Vitro Fertilization (IVF) outcome?. Journal of ovarian research, 10(1), 2.
Wright, D. L., Afeiche, M. C., Ehrlich, S., Smith, K., Williams, P. L., Chavarro, J. E., …& Hauser, R. (2015). Hair mercury concentrations and in vitro fertilization (IVF) outcomes among women from a fertility clinic. Reproductive Toxicology, 51, 125-132.
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