Assisted reproductive technologies
Indications and Procedures (Magill’s Medical Guide, Sixth Edition)
Although most couples experience little or no difficulty conceiving and carrying a child to term, about 15 percent experience infertility. Infertility is defined as an inability to conceive after a year of having regular, unprotected intercourse. Not all couples can be helped, but an increasing number of reproductive technologies are available, from in vitro fertilization (IVF) and artificial insemination to drug therapies and surgical repair.
Typically, the first step is to determine whether the man’s sperm is fertile by performing a simple sperm count. If sperm counts are low or the sperm are abnormal, then the primary treatment is artificial insemination, also called intrauterine insemination (IUI). Cryopreserved sperm are obtained from a sperm bank, which collects ejaculate from healthy, fertile men. The donors of the sperm remain anonymous, and the samples are usually a mixture of sperm from two or more men. This method maintains even greater anonymity and increases the amount of sperm available, thus increasing the chances of conception.
To ensure the highest probability of success, IUI should be performed when the woman is ovulating and is most fertile. Most women experience a slight rise in their basal body temperature when they ovulate, and monitoring daily body temperature upon waking can be used in some cases. A more reliable method is detection of a surge in luteinizing hormone (LH) in the...
(The entire section is 1168 words.)
Uses and Complications (Magill’s Medical Guide, Sixth Edition)
Assisted reproductive technologies are best suited to couples in which one or the other is infertile but otherwise in good health. Age may also be an important factor for the woman, as fertility, implantation, and normal development of the fetus are all affected as a woman ages, especially beyond thirty-five. Although these technologies can be successful in older women, the risks involved need to be assessed carefully with a doctor. They can also be more costly in older women, because more attempts using IUI and IVF are often required.
Hysteroscopy and hysterosalpingography are the most commonly used procedures for diagnosing infertility, once the more obvious causes have been ruled out. Although both can cause mild to moderate discomfort, they have very few associated risks and can be performed in most obstetrics/gynecology (OB/GYN) offices. If a clear diagnosis is obtained, then a number of problems may require surgery. Blockage, abnormalities of the Fallopian tubes or other reproductive organs, ectopic pregnancies, and abnormal growths (cysts or tumors) can be treated or repaired surgically. In most cases, laparoscopic surgery is used, as it is less invasive than traditional abdominal surgery. Laparoscopic surgery is performed in the same way as diagnostic laparoscopy and may be done at the same time if a problem is discovered in the process.
Diagnostic laparoscopy is typically the method of last resort, as...
(The entire section is 945 words.)
Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
Assisted reproductive technologies arose during the latter half of the twentieth century. Prior to this period, infertility was poorly understood and treatments were essentially nonexistent. The first attempt at treating infertility involved artificial insemination in 1785 by the Scottish surgeon John Hunter. A child was born that same year, apparently as a result of his attempts. The next documented attempt at IUI was by Robert Dickinson in 1890. His attempts were highly secretive because the Anglican Church condemned such procedures. The first comprehensive guidelines for determining male infertility based on sperm count and quality were published in 1934.
In 1945, a report of early IUI experiments was published in the British Medical Journal. As a result, in 1948 the archbishop of Canterbury proposed making IUI a criminal offense. Although the British government did not follow his advice, it did discourage the use of IUI. During the 1950’s, the public demand for solutions to infertility far exceeded medical solutions. By 1955, there had been four successful pregnancies using frozen donor sperm. In spite of these successes, IUI was not to become an acceptable and widely used procedure until the 1970’s.
The first fertility drug was developed in 1949, but it took until 1962 for this discovery to be applied successfully, resulting in ovulation and a successful birth. Throughout the 1960’s and...
(The entire section is 752 words.)
For Further Information: (Magill’s Medical Guide, Sixth Edition)
American Society for Reproductive Medicine. Guidelines on Number of Embryos Transferred: A Practice Committee Report—A Committee Opinion. Birmingham, Ala.: Author, 1999. Recommendations for in vitro fertilization to prevent problems of prematurity due to multiple births.
Blackley, Michelle. “’EGGS FOR SALE’: The Latest Controversy in Reproductive Technology.” USA Today 132, no. 2698 (July, 2003): 56-58. Discusses one of the ethical dilemmas facing application of the new technologies.
De Jonge, Christopher J., and Christopher L. R. Barratt, eds. Assisted Reproductive Technology: Current Accomplishments and New Horizons. New York: Cambridge University Press, 2002. An in-depth overview of the current technologies, written by professionals from medical and biological disciplines.
Henig, Robin Marantz. “Pandora’s Baby.” Scientific American 288, no. 6 (June, 2003): 62-67. A comparison between the controversy surrounding IVF when it was first introduced and the more recent controversy over human cloning.
Khamsi, F., et al. “Recent Advances in Assisted Reproductive Technologies.” Endocrine 9, no. 1 (August, 1998): 15-25. An overview of the many new technologies that have arisen and a call for more careful assessment of the causes of infertility and the application of the procedures.
Powledge, Tabitha M. “Looking at ART.”...
(The entire section is 369 words.)