Assistive Reproductive Technologies
By Gareth Lewis
Page of Contents
1. Title page
2. Page of contents
3. Information summary of report
4. Natural pregnancy cycle
4.1 Risks of Natural pregnancy for Mother and child
5. Methods of ART
6. Implications of ART
7. Data analysis
10. Annotated bibliography
General Information summary- Introduction
Reproduction is the process on which a two different sex cell combine to create an offspring. Defined as “combining the genetic information from two individuals of different sexes. The genetic information is carried on chromosomes within the nucleus of specialized sex cells called gametes. In males, these gametes are called sperm and in females the gametes are called eggs. During sexual reproduction the two gametes join together in a fusion process known as fertilization” (Biology Dictionary,2014). If a couple is unable to reproduce naturally there are other methods to overcome fertility such as ART (assisted reproductive technologies) is an area of assistive technologies’ as a variety of specialised methods to conceive a child over an orientated problem of infertility from natural causes, see natural pregnancy. And is defined as “to overcome infertility; encompasses drug treatments to stimulate ovulation, surgical methods for removing oocytes (for example, laparoscopy and ultrasound-guided transvaginal aspiration) and for implanting embryos (for example, zygote intrafallopian transfer or ZIFT), in vitro and in vivo fertilization (for example, artificial insemination and gamete intrafallopian transfer or GIFT), ex utero and in utero fetal surgery, and laboratory regimes for freezing and screening sperm and embryos”(Farlex Medical Dictionary,2012). An issue to the change of modern society with women “Family sizes are smaller, and women are bearing children later. In 2008 the median age of mothers at birth was 30.7 years. 257 In 2007 women aged 30–34 experienced the highest fertility of all Australian women, with 126.6 babies per 1,000 women” (Australian Department of health,2011). A 12.6% live delivery rate for the highest bracket of fertility for women.
Steps of Natural Pregnancy
In afterwards to the process of ART and conception, the natural pregnancy will take place and be put forth in certain steps outlined in this information summary. In this circumstance it will be applied to the couple to understand the steps of pregnancy and the natural risks for the mother and during and post-birth periods. The section of pregnancy is placed in accordance to a time of 9 months which are split into sub sections. These sections include. First trimester, second trimester, third trimester, and Labour comprising of 9 months (40 weeks). The first trimester is a section going from contraception and is comprised of 3 months or 12-14 weeks of fertilisation and basic growth and development of the fetus, during this time the basic functions of the child is made such as the heart and spinal column are created and may experience a number of factors such as” Nausea, Morning sickness, fatigue, mood swings, constipation, Appetite fluctuations, implantation bleeding”.(Azma,2017). The second trimester is stage of development leading into another 3 months of development, with first amounts of movement inside and development of with “leg cramps and heart burn” (Healthline,2016). The 3rd trimester is the final 3 months of development into natural pregnancy which involves only growth, no more factors are in place till labour.
Risks Involved in natural pregnancy
Risks during the stage of natural pregnancy are outlined in this section. These risks that could affect the pregnancy included for mother and child are in a summary of categories such as age, weight, diabetes, sexually transmitted diseases, Multiple pregnancies/births, previous pregnancy complications and other pre-existing medical issues. Age is a factor on which can manipulate the amount of fertility and is a main risk for pregnancy such as a miscarriage. “A study found that paternal age can have an effect on miscarriage — if the father is over 40 and the mother is over 35, the risk for miscarriage is much greater than if just the woman is over 35”. (Healthline, 2018). Chromosomal disorders “A woman over 35 has a higher risk of having a child with birth defects due to chromosomal issues. Down syndrome is the most common birth defect related to chromosomes. It causes varying degrees of intellectual disability and physical abnormalities”. (Healthline, 2018).
Methods of ART
What is involved with IVF
IVF is a method of ART that includes the method of both sperm and egg are artificially fused together outside the bodies in a laboratory and injected to conceive a child by the means of reproduction. “The fertilised egg (embryo) is allowed to grow in a protected environment for some days before being transferred into the woman’s uterus increasing the chance that a pregnancy will occur” (IVF Australia, 2018). Stages involved in IVF include Initial treatment of injection for increased embryo growth to succeed in producing more eggs. Continuing over normal ovulation and period cycle with monitored attention to keep track of the amount of eggs produced, with blood tests, and an ultra sound. Once amount of sizeable eggs are produced a trigger injection will be required of hcg (human chorionic gonatropin) to stimulate ovulation. Egg collection is then due, the patient is put into surgery for a total period of time (4 hours). Eggs are placed in a culture medium for further process of IVF. The eggs are placed in a petri dish and are observed and picked to be fertilised. Fertilised eggs are placed in an incubator of 37’C, being examined. The embryo is induced by surgery through the female reproductive organ into the cervix via a catheter, after 5 days of incubation period. two weeks after surgery there is a pregnancy test, blood test and ultra-scan to determine if positive. The cycle continues to a regular pregnancy cycle. See Natural pregnancy.
What is involved with ICSI
ICSI is a specialised method of ART which is a section of IVF. Recommended for couple’s who have been diagnosed with male fertility issues such as low sperm count, low sperm morphology or motility, anti-sperm antibodies or have previously had a vasectomy or unsuccessful vasectomy reversal. A procedure is defined “Intracytoplasmic Sperm Injection (ICSI) is performed as an additional part of an IVF treatment cycle where a single sperm is injected into each egg to assist fertilisation using very fine micro-manipulation equipment” (IVF Australia,2018)
What is involved with ZIFT/GIFT
GIFT/ZIFT is an alternative method of ART which is a section of IVF. Recommended for couples who have problems with having sexual intercourse but both sperm and embryo are able to be used. The procedure is defined “involving removing a women’s eggs, mixing them with sperm, and immediately placing them in the fallopian tube” (American Pregnancy, 2018).
Implications of ART
Implications on a natural scale to the success of methods on ART vary. Depending on the age of the male and female, the body composition of the male and female partner and other biological issues pre to post-pregnancy. Implications of using method include many symptoms of pregnancy. See natural pregnancy. But other complications toward child birth to mother and child such as after effect of ART and the hormonal drugs for embryos. “Fertility drugs are extremely powerful. Their side effects can be severe and overwhelming. Commonly, users of hormone fertility drugs report elevated emotional levels, increased irritability and possibly some weight gain or loss. Other side effects can include increased frequency and length of menstrual cycles and exhaustion” (MH, 2018).
Religious implication varies on which religion the people applying for ART. The summary of religion is to the methods of ART which may not be able to apply by said couple or individual’s belonging. For many religions it is the issue of scientific creation of an offspring rather than natural reproduction. Jewish values toward ART “Be Fruitful and multiply” (Schenkler, 2016). With other religions it is restricted or denied such as in Muslim ideology, “the oocyte and spermatozoon originate from the wife and husband respectively” (Schenkler, 2016).
Economic implications on ART are varied depending on the recipients an amount of money to sustain a successful live delivery of an offspring. The cost of an ART cycle is generated from the amount of assistance is required and the amount of time. Factors of cost will also include the age of the recipients, see data analysis. Costs of ART “all ART treatment is eligible for partial re-imbursement by Medicare, without limitations on the number of cycles or the woman’s age. The cost of fresh stimulated ART cycles is estimated to be about $10 000, of which $6000–7000 is reimbursed by Medicare”(Chambers, 2017).
Legal implications on ART include the summary of what is restricted to the means of methods of infertility in certain countries. Some certain parts of ART such as in certain countries ART is only allowed to “such as Turkey, China and Indonesia, will only permit IVF treatment for married couples, and New Zealand insists on a stable nuclear family to raise the child”. (Fertility Treatment Abroad, 2018)
Figure :1 generated statistic involved in successful cycles to deliveries for age of ART following Australian and New Zealand (2016)
Age group (Years)
18-30 30-34 35-39 40-44 45+ Total
Initiated cycles 3,154 9,671 10,084 5,079 375 28,083
Embryo transfer 3,085 9,352 10,037 4,819 355 27,918
Clinical pregnancies 1,215 3,675 3,685 1,279 67 9,921
Live deliveries 1,028 3,040 2,924 896 42 7,930
Deliveries per cycle (%) 32.6% 31.4% 27.1% 17.6% 11.2% 27.3%
Embryos per transfer cycle (%) 33.3% 32.5% 28.4% 18.6% 11.8% 28.4%
Live deliveries per clinical pregnancy (%) 84.6% 82.7% 79.3% 70.1% 62.7% 79.9%
Figure 1 displays patterns of success rates of ART as compared to the age of the recipient, as of fertility. In this table it creates a pattern from the highest delivery rate in column 30-34. Afterward the percentages of deliveries, embryos and live deliveries decrease slowly until 44-45+ which substantially decreased in percentile success rates.
Data in the analysis displayed the means of age into the median age of success of ART methods. For it included percentile ranges of what was the best age for infertility assistance without much cost. The data in the table presents deliveries per cycle indicating how many cycles were required for possible live deliveries to occur. In such the age recommended for the couple for maximum results and less economic cost is around the median 30-34 for both partners. See Biological Implications. And that for the number of embryos used per cycle is to be a recommended 3 for ages 18-30 while the amount for a 45+ maybe 10 healthy embryos for successful IVF or ICSI treatments resulting in a live delivery which may require more as 1:3 transfers did not result in a pregnancy (From lowest age bracket).
In conclusion, it is a recommended feature to be prepared for an investment into a method of ICSI as due to the male and female being able to use both gametes in production of a zygote using ART. As with the following methods of IVF, a subsection surgery for ICSI is all required to a start to successful live delivery. Several factors of religious not specified will not be into account as it was not specified so procedure can go unrestricted. However economic pricing on the amount of money required is unsure as the couple depending on the age of recipients can go through multiple cycles without clear natural pregnancy during IVF treatment as In 1:3 embryos from the lowest age bracket are live deliveries following data analysis and results. For other methods of ART, GIFT is an option however is unsure on whether the option is viable due to missing data in sources. Therefore, the method of choice for to proceed would be ICSI due to its sufficient usage toward the main problem of infertility in the certain circumstance.
what is reproduction – Biology Dictionary
Biology Dictionary(2014) https://biologydictionary.net/sexual-reproduction/ Last accessed 22/11/18
what is ART-
Farlex Partner Medical dictionary (2012)
https://medical-dictionary.thefreedictionary.com/assisted+reproductive+technology Retrieved 30/10/18
statistics of fertility
Australian institute of health (2011) http://www.health.gov.au/internet/publications/publishing.nsf/Content/womens-health-policy-toc~womens-health-policy-experiences~womens-health-policy-experiences-reproductive~womens-health-policy-experiences-reproductive-maternal~womens-health-policy-experiences-reproductive-maternal-fert Last accessed 22/11/18
Stages of natural pregnancy-
Healthline (2016) https://www.healthline.com/health/pregnancy/calendar#due-date
Azma (2017) https://www.pregnanteve.com/stages-of-pregnancy/ Last accessed 22/11/18
Risks of Natural pregnancy
Healthline (2018) https://www.healthline.com/health/pregnancy/risk-factors#age-over-
Last accessed 18/11/18
what is IVF/ICSI
IVF Australia (2018) https://www.ivf.com.au/fertility-treatment/ivf-treatment Last accessed 18/11/18
what is involved with GIFT
American pregnancy association (2018) http://americanpregnancy.org/infertility/
gamete-intrafallopian-transfer/ Last accessed 18/11/18
what is involved with ZIFT
Infertilityhr (2011) http://infertilityihr.com/zift.html Last accessed 18/11/18
Data in analysis
The National Perinatal Epidemiology and Statistics Unit (2016) https://npesu.unsw.edu.au/data-collection/australian-new-zealand-assisted-reproduction-database-anzard
Biological implications of ART
MH Sub (2018)https://www.fertilityproregistry.com/article/fertility-basics/assisted-reproductive-technology-art-fertility-drugs Last accessed 22/11/18
Religious implications of ART
Schenker, J (2016) https://www.rbmojournal.com/article/S1472-6483(10)61789-0/pdf Last Accessed 2/11/18
Chambers, M, Georgina (2017) https://www.mja.com.au/journal/2017/207/3/assisted-reproductive-technology-australia-and-new-zealand-cumulative-live-birth#18 Last accessed 22/11/18
Fertility treatment abroad (2018) https://fertility.treatmentabroad.com/going-abroad-for-treatment/ethical-and-legal-issues