In Vitro Fertilization

In-Vitro Fertilization
Should it be implemented in society today?

Introduction
“Infertility, also known as primary infertility, is the inability of a couple to become pregnant (regardless of cause) after one year of unprotected sexual intercourse using no birth control methods. Similarly, secondary infertility refers to the inability to maintain pregnancy until birth” (Emedicinehealth, 2012). Statistics have shown that within Australia a staggering one in six couples is infertile. With 40% of cases resting with the male, 40% with the female, 10% with both partners, and in a further 10% the cause is unknown (ABC Health and Wellbeing, 2007). For one discovering that themselves or their partner is infertile can be an extremely traumatic experience, but there are a number of treatments that can be used to increase chances of a successful pregnancy. Some of these include the following; ovulation induction, artificial insemination, In-Vitro Fertilization (IVF), GIFT (Gamete intrafallopian transfer), Donor Eggs and Sperm, and Freezing of Sperm and Embryos etc.

In-Vitro Fertilization or IVF is one of the most effective and well-known methods within Australia at this time. It is used to treat infertility that arises from blockages of the fallopian tubes, endometriosis, abnormal sperm, and some cases of unexplained infertility. The treatment involves the woman being treated with hormones to stimulate growth of eggs within the ovaries. The eggs are then removed and put into a dish with the partners (or donors) sperm. The fertilized eggs are then grown in a laboratory and placed back into the woman’s uterus (ABC Health and Wellbeing, 2007). The first IVF baby in Australia (and the world’s third) was born in 1980, under the supervision of doctors at Monash University. Shortly after this, the accessibility of IVF in Australia increased rapidly as did research concerning the treatment. IVF clinics were established in Sydney, Brisbane, Adelaide and Perth in the early 1980’s. Australian scientists took the leading role (that they now still hold) in the development of IVF technology (Virtual Medical Centre, 2012). Since then there have been numerous social and legal issues and considerations that have evolved from the perspectives of many different cultural groups and individuals within society. Some of these issues include the cost of the procedure and who has to pay; does the physician have an ethical if not a legal obligation to provide a couple with IVF; rights of the embryo (personhood); possible wrong doing to offspring; and transmitting serious disorders.

Technology and Application
The vital parts that are needed in IVF include the Uterus, Cervix, Fallopian Tubes, Ovaries, and Eggs. These are all parts of the female reproductive system as seen in the diagram below.

The eggs are what can be seen as one of the most important parts of the IVF process. Eggs are produced in the ovaries, but they are not yet true eggs and will not complete meiosis until a sperm fertilizes them. A human female has about 40,000 potential eggs formed before birth, but only several hundred of these will ever be released during reproductive years. After the beginning of puberty, due to the stimulation of follicle-stimulating hormone (FSH) one egg matures and is released from the ovary. (Biology.clc.edu, 2004)
The Uterus has thick, muscular walls and is small being about 7 centimeters long by 4 to 5 centimeters wide but can expand to hold a 4-kilogram baby. The lining of the uterus is called the endometrium, and has a rich capillary supply to bring food to embryos that might be implanted there. (Biology.clc.edu, 2004)
In Vitro Fertilization Present
The process of In Vitro Fertilization involves the process of fertilizing eggs with sperm outside of the body, and once fertilized the resulting embryos are placed into the woman’s uterus to hopefully end up in a successful pregnancy. (Better Health, 2011)
The IVF treatment is a six-step method that must be followed. The explanations of each step are seen in the following explanations.
1. Stimulation of the Ovaries: A number of injections are needed of a hormone called FSH because it stimulates the ovaries to produce more than one egg per cycle.
2. Prevention of Premature Ovulation: To prevent premature ovulation the communication between the brain and the ovaries must be shut down in order to control the ovulation day so they can be collected.
3. Triggering Ovulation: An injection is given to trigger the ovulation process.
4. Collection: The eggs and sperm are collected to start the fertilization process outside of the human body.
5. Culturing: The eggs are sorted in the laboratory and the mature ones are chosen and placed with the sperm in a dish. If more embryos are created than what is needed, they will be put into cryo-storage for transfer at a later date if required.
6. Transfer: The embryos get transferred through the cervix into the uterus in hope of a successful pregnancy. (Health Topics, 2012)

A simpler diagram to understand is seen to the left.

In Vitro Fertilization Past
Many different types of tests and methods were attempted to help those who were infertile to have a child. The main aspects of the IVF method have stayed the same as it is only a fairly new concept that has been around for a bit over 30 years. The concept of fertilizing an egg outside the human body was only seriously considered until the 1960’s (Monash IVF, 2012). In Australia at this period the number of children up for adoption was dwindling as government grants of social service benefits came into place. Abortion was also an alternative for unwanted children. So at this time, it was patient demand that IVF was another method for treatment of infertility. (Monash IVF, 2012)

After the demand from infertile individuals was known research had begun and different methods were trialed and failed until they found the correct one. The time line below describes these.

1968: In this year the first method was trialed by replacing a damaged fallopian tube with an artificial one. As this was unsuccessful the next trials began were they sought to fertilize an isolated egg from sperm, beginning the process of the IVF technology that is around today.
1973: In 1973 it was the first attempt to fertilize an egg outside the body. This test was also unsuccessful as the embryo did not implant into the wall of the uterus, which ended in an embryo death.
1978: In July of this year the world’s first baby to be conceived out of the human body was born in Britain. The scientists there used the natural ovulation cycle as the center of their work.
1979 and 1980: In Melbourne at this time, the scientists investigated the use of artificial hormones to control the ovulation cycle of women on IVF treatment. This was then known as the Fertility Drug Schedule. With this followed the births of many IVF babies throughout the world.
(Monash IVF, 2012)

Since then Australian fertility clinics achieve amongst the highest success rates in IVF in the world. However, an individual couple's chance of success depends on a number of factors such as the cause of infertility, age and lifestyle.

Moral and Ethical Implications and Issues to both Individuals and Society
A number of ethical and moral issues arise from the use of IVF and some of the procedures used. The following issues will be discussed and analyzed upon to come to a conclusion on whether IVF and its procedures etc. are acceptable in society.

Cost of Procedure and who must pay for the procedure
For one full IVF cycle the estimated payment is $7,765 as seen below in the table. If one has Medicare they are able to get rebates on the initial costs and only pay about $3,049. This is for only 1 IVF cycle, and some couples can go through several before becoming successfully pregnant.

It has been estimate that there is about a 50% change of conception per IVF treatment if aged fewer than 30, and this goes down to a 20% chance for ones first IVF treatment over the age of 40 (Woman’s Day, 2010). Although it may seem a high chance, the cost of countless IVF treatments is extremely costly, but there aren’t many other options besides the government or receivers of the procedure that would be able to pay the costs. It seems unfair though that someone who is infertile has to pay to have a baby as they are physically unable.

At this time in Australia’s financial debt, it would be impossible to provide free IVF procedures to all patients, when there are many other sick and disabled individuals in the country at this time. Some of whom might say it was also unfair if the government paid full costs for those who were infertile when they are suffering. In the future this may be a potential goal. IVF is an expensive method for infertile individuals, but as for a solution for right now it should be possible for people to pay off this money for the procedure in a determined amount of time, as they would also have to provide for the child.

Rights of Embryo
The following statement is Australia’s take on the rights of the embryo and how they will be treated after an individual of couple undergoes the IVF procedure where embryos are not used.

“The Human Reproductive Technology Act provides each person on whose behalf an embryo has been developed, the right to decide how that embryo will be dealt with or disposed of, including the right to withdraw or vary the terms of their consent while storage continues. In the event of a disagreement, s 26(2)(c) of the Act requires the parties to obtain a court order to resolve their dispute.”(Find Law, 2007)

This statement gives the ability of the individual persons to decide how their embryos will be disposed or used. The decision to give fertilized embryos to the cause of surrogacy or another woman who cannot conceive is a big one and should be made by the couple themselves.

Many though, based on their own moral values and beliefs, would say that life had started as soon as the egg was fertilized with the sperm and this is a matter of personhood. This would effect their own decisions and actions towards people who chose otherwise. “Personhood is the status of being a person” (Wikipedia, 2012). Some believe that personhood begins at a very early stage in the development of the egg and sperm, yet some believe life starts at the birth of the child itself.

The law that couples can make their own decision on what to do with their fertilized embryos is very sensible and some may argue that all should not be disposed of, but that is from their own moral values and not an ethical one that effects society. It is considered ethical within Australia to have an abortion up to 24 weeks of pregnancy, so it is definitely ethical to dispose of embryos if that is what is wanted.

Transmitting Serious Disorders
If someone wished to try IVF and it was possible they would transmit a genetic disorder a number of ethical issues would arise concerning the child if it could have been perfectly healthy. There are tests that can be conducted to find out whether these disorders exist in the embryo before they are inseminated into the uterus, and they should be conducted before every implantation in IVF as well as in normal pregnancies as a number of benefits arise.

Pre-Implantation Genetic Diagnosis and Pre-Implantation Genetic Screening are treatment options for couples at increased risk of passing a chromosome abnormality or specific genetic disease to their child. They involve screening the IVF made embryos for the conditions prior to insemination and then only transferring unaffected embryos to the uterus. (Monash IVF, 2012)

These scans are optional, but if they were done it is potential that elimination of genetic diseases could occur. These scans could not only be conducted on women on IVF but all women. There are some disabled rights activists who say they would gladly have a child with a genetic disorder of their own, but giving birth to a child who is disabled would not only be hard on the parent, but especially the child itself. “Rights are not infinite; the rights of adults to become parents does not take precedence over a child’s right to identity, optimal family environment or safety.” (The Age, 2005)

If all these tests were done on all IVF women the results could be transferred back to them, and if they wished they could inseminate the embryo containing the genetic disorder, or they could choose another without it. But by at least doing the tests, couples and individuals would have more knowledge about the babies disability before they are thrown in the deep end, so they would know what to expect so they can care for their child in the best way.

One Parent IVF
There have been many controversial issues that have arisen about the wrong doing to offspring if only one parent has raised the IVF conceived child. Children also have a right to know who their biological parents are if they wish and in the laws it states that “once a child conceived using donated gamete or through surrogacy turns 18, they will be able to access certain information on the register if they wish”(IVF Australia, 2012). This means that throughout their whole child life they would not know their biological father even if they wanted to. This could be a very traumatic experience for some children. It is true however that children in history have been raised well by single parents, as well as the fact that in these times many parents are divorced and force the mother to raise the children by themselves or the other way around. In fact, in 2010 within Australia a staggering 50, 200 divorces were allowed (ABS, 2011). This shows that single parents are perfectly capable of raising a child as there are many single parents throughout Australia.

Up until January of 2010 women had to prove they were medically rather than “socially” infertile. This is another issue that arose in society not too long ago. Infertile married women were getting access to sperm that had been screened for HIV while unmarried women were unable to get this same access to have a baby of their own, which is clearly discriminatory. This also may have been the cause of women resorting to unsafe sperm, and there for open to a wide range of genetic diseases that could have effected their child (Essential Baby, 2010).

Older Women using IVF
The average at which the Australian woman is giving birth to their first child is increasing. A woman’s fertility declines with age, and declines after the age of 35. Infertility and the need for treatment then increases, as the age of childbirth increases (Woman’s Day, 2010). The reason why the age of women giving birth is increasing is not because it just happened that way, but because they want to succeed in life and have a career before they take the step to motherhood so they can successfully and happily provide for their child.

In Australia, laws are in place so that IVF cannot be provided to women over the age of 51 (the average age of menopause in Australia (Wikipedia, 2012)), or to someone whose health could be compromised by a pregnancy (IVF Australia, 2012) or have possible wrong doing to offspring. This does have benefits as the child should be growing up with a parent who can take care of them in a correct manner, and a woman shouldn’t go through a difficult pregnancy which risks their own life as well as the babies. But saying this, there are many healthy and successful 51-year-old women within Australia who could provide to a child.

The life expectancy in Australia is rising and is currently 81.7 years (Google, 2012). As technology grows this number will only increase. At the age of 51, women can still be successful at getting pregnant and having a successful birth if they are healthy. If a woman at 51 wants to have a baby and is successful with IVF they should have the right to be a mother.

If any woman feels the need to have a child using IVF or other procedures, tests should be conducted to ensure no harm is in way for both the parent and the child. If the woman if over 51 and is perfectly healthy to provide for the child then she should be able to do it. If a woman is under 51 and endangers the life of her child then more problems arise and depending on the problem it may be able to be solved by methods such as gene therapy.

Justification and Conclusion
Within this report a number of issues have been discussed and analyzed to do with In Vitro Fertilization and its technologies. In Vitro Fertilization helps thousands of couples each year with infertility and enables them to have a child. But along with this many ethical and moral issues arise that have to be dealt with. The cost of the procedure is half provided by the government and Medicare and half out of someone’s own pocket, and although this is fairly expensive, Australia is lucky that the government provides this service, and perhaps in the future it will fully be provided for. Couples who are successful in IVF make their own decisions to do with the left over embryos and how they are taken care of. This decision will be made from their own moral values and perspectives, which is a good way to do things in Australia as it is multicultural country with a population of many different opinions and beliefs. Transmitting disorders when undergoing IVF is a serious issue, and all embryos should be tested to see if they contain any genes that could effect the baby’s life, and if they do the parents should be told to prepare or they inseminate different embryos that do not carry the gene. It was then decided that a woman who is either infertile or fertile should be able to undergo IVF if they wish as they are perfectly capable to caring for their children on their own as many single parents in Australia do. Lastly, women over the age of 51 should be able to have children using IVF if they are physically and mentally fit to do so. All women should have tests before IVF to ensure they are capable and if a woman under the age of 51 is not different methods could be trialed such as genetic therapy to ensure their baby is not in any physical danger. Overall, IVF is a fantastic method that provides happiness to thousands of families and will continue to do so in the future.

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Date Accessed: 17/10/2012

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