ASSISTED REPRODUCTIVE TECHNOLOGIES (ARTs) can be very helpful for certain patients, but ethical concerns have been raised about the inherent nature of specific techniques and the contexts in which many techniques are used. Physicians play important roles in supporting those who wish to become parents and in educating patients about impediments to fertilization and ways to promote conception. We discuss various ethical issues surrounding ARTs, including family relationships, informed choice, gender issues, embryo status and the commercialization of reproduction, as well as legal and policy issues. We examine the empirical evidence of the effectiveness of ARTs and suggest ways to approach ARTs in practice.
What is Assistive Reproductive Technology?
Assisted reproductive technology (ART) is a general term referring to methods used to achieve pregnancy by artificial or partially artificial means. It is reproductive technology used primarily in infertility treatments. Some forms of ART are also used in fertile couples for genetic reasons. ART is also used in couples who are discordant for certain communicable diseases, i.e. AIDS, to reduce the risk of infection when a pregnancy is desired. The term also includes any reproductive technique involving a third party e.g. a sperm donor.
What are Assisted Reproductive Technologies?
Procedures are mainly fertility medication, as well as ART techniques that use more substantial and forceful interventions, of which in vitro fertilization (IVF) and expansions of it (e.g. OCR, AZH, ICSI, ZIFT) are the most prevalent. However, there are also other manual ART, not necessarily dependent on IVF (e.g. PGD, GIFT, SSR).
Most fertility medications are agents that stimulate the development of follicles in the ovary. Examples are gonadotropins and gonadotropin releasing hormone.
In Vitro Fertilization
In vitro fertilization (IVF) is the technique of letting fertilization of the male and female gametes (sperm and egg) occur outside the female body. Embryo transfer is the step in the process whereby one or several embryos are placed into the uterus of the female with the intent to establish a pregnancy.
Expansions of IVF
The following are techniques involved in, or requiring, in vitro fertilization. In vitro fertilization does not necessarily involve each technique. •Transvaginal ovum retrieval (OCR) is the process whereby a small needle is inserted through the back of the vagina and guided via ultrasound into the ovarian follicles to collect the fluid that contains the eggs. •Assisted zona hatching (AZH) is performed shortly before the embryo is transferred to the uterus. A small opening is made in the outer layer surrounding the egg in order to help the embryo hatch out and aid in the implantation process of the growing embryo. •Intracytoplasmic sperm injection (ICSI) is beneficial in the case of male factor infertility where sperm counts are very low or failed fertilization occurred with previous IVF attempt(s). The ICSI procedure involves a single sperm carefully injected into the center of an egg using a micro-needle. This method is also sometimes employed when donor sperm is used. •Autologous endometrial coculture is a possible treatment for patients who have failed previous IVF attempts or who have poor embryo quality. The patient’s fertilized eggs are placed on top of a layer of cells from the patient’s own uterine lining, creating a more natural environment for embryo development. •In zygote intrafallopian transfer (ZIFT), egg cells are removed from the woman's ovaries and fertilized in the laboratory; the resulting zygote is then placed into the fallopian tube. •Cytoplasmic transfer is the technique in which the contents of a fertile egg from a donor are injected into the infertile egg of the patient along with the sperm. •Egg donors are resources for women with no eggs due to...