The twin stories of Hanumanth Rao and Moses Ezekiel: the impact of reproductive health technologies on individual lives.
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Anti-Infective Agents↗
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The new technologies in reproduction: new ethical problems.
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Ethics, Medical↗
[New technologies in reproduction (NTR)].
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Female↗
Desperately seeking donors: the 'saviour sibling' decision in Quintavalle v Human Fertilisation and Embryology Authority (UK).
The recent House of Lords decision in Quintavalle v Human Fertilisation and Embryology Authority has raised difficult and complex issues regarding the extent to which embryo selection and reproductive technology can be used as a means of rectifying genetic disorders and treating critically ill children. This comment outlines the facts of Quintavalle and explores how the House of Lords approached the legal, ethical and policy issues that arose out of the Human Fertilisation and Embryology Authority's (UK) decision to allow reproductive and embryo technology to be used to produce a 'saviour sibling' whose tissue could be used to save the life of a critically ill child. Particular attention will be given to the implications of the decision in Quintavalle for Australian family and medical law and policy. As part of this focus, the comment explores the current Australian legislative and policy framework regarding the use of genetic and reproductive technology as a mechanism through which to assist critically ill siblings. It is argued that the present Australian framework would appear to impose significant limits on the medical uses of genetic technology and, in this context, would seem to reflect many of the principles that were articulated by the House of Lords in Quintavalle.
Australia↗
Reproductive techniques in sheep.
This article reviews current methods of evaluating reproductive performance in the sheep industry. The reproductive technologies of breeding soundness examination, reproductive ultrasonography, estrus manipulation, artificial insemination, and embryo transfer are also extensively discussed. The veterinarian's current and future role in the application of these technologies is discussed.
Animals↗
[Professional and ethical challenges in reproductive biology and genetics at the beginning of the ne millennium].
About 15 to 20 percent of couples are infertile. Developments in reproductive biology have enabled treatment of these couples by means of assisted reproduction. In a broader sense, assisted reproductive technologies involve all methods aiming to restore impaired reproductive function. Preimplantation genetic testing, a new form of prenatal diagnosis, is a result of convergency in the development of assisted reproduction and genetics, and allows couples at risk of transferring hereditary diseases to their offspring to diagnose such abnormalities as early as immediately before or after conception. This article describes technologies of assisted reproduction and preimplantation genetic diagnosis, and discusses ethical as well as legal issues in reproductive medicine.
Bioethics↗
Perception of risks and benefits of in vitro fertilization, genetic engineering and biotechnology.
The use of new biotechnology in medicine has become an everyday experience, but many people still express concern about biotechnology. Concerns are evoked particularly by the phrases genetic engineering and in vitro fertilization (IVF), and these concerns persist despite more than a decade of their use in medicine. Mailed nationwide opinion surveys on attitudes to biotechnology were conducted in Japan, among samples of the public (N = 551), high school biology teachers (N = 228), scientists (N = 555) and nurses (N = 301). People do see more benefits coming from science than harm when balanced against the risks. There were especially mixed perceptions of benefit and risk about IVF and genetic engineering, and a relatively high degree of worry compared to other developments of science and technology. A discussion of assisted reproductive technologies and surrogacy in Japan is also made. The opinions of people in Japan were compared to the results of previous surveys conducted in Japan, and international surveys conducted in Australia, China, Europe, New Zealand, U.K. and U.S.A. Japanese have a very high awareness of biotechnology, 97% saying that they had heard of the word. They also have a high level of awareness of IVF and genetic engineering. Genetic engineering was said to be a worthwhile research area for Japan by 76%, while 58% perceived research on IVF as being worthwhile, however 61% were worried about research on IVF or genetic engineering. Japanese expressed more concern about IVF and genetic engineering than New Zealanders. The major reason cited for rejection of genetic manipulation research in Japan and New Zealand was that it was seen as interfering with nature, playing God or as unethical. The emotions concerning these technologies are complex, and we should avoid using simplistic public opinion data as measures of public perceptions. The level of concern expressed by scientists and teachers in Japan suggest that public education "technology promotion campaigns" will not reduce concern about science and technology. Such concern should be valued as discretion that is basic to increasing the bioethical maturity of a society, rather than being feared.
Adult↗
Conservation of sperms: current status and new trends.
Preserving genetic resources for next millennium is of great importance, whereas the major contribution of conserving sperms has the potential in many applications such as agriculture, biotechnology, species conservation and clinical medicine. Two major systems (liquid and frozen) of storage technologies have been developed for sperm conservation until the 20th century. The combinations of storage temperature, the cooling rate, chemical composition of extender, cryoprotectant concentration and the hygienic control are the key factors that affect the life span of spermatozoa. In the past decades, a slow progress have been made in improvement of storage technology, however, the recent advancement in reproduction technology and well understanding of the reproductive physiology have opened the door to a new era in conservation of sperm. This paper focuses on current sperm conservation systems as well as alternative strategies that would be effective for preserving genetic resources in future.
Animals↗
Embryo transfer and related technologies in sheep reproduction.
This paper reviews the status of embryo transfer and the major technologies applied to preimplantation of embryos in sheep. Embryo production from superovulated ewes is hindered by an unpredictable response to hormonal treatment. Progress in this area should be expected by an appropriated control of follicular development with gonadotropin-releasing hormone (GnRH) agonist or antagonist prior to gonadotrophin administration. Simple protocols for the cryopreservation of sheep embryos by vitrification are already available and the development of frozen-thawed blastocysts to term is close to the fresh ones. Further research is required to identify factors able to promote the maturation in vitro of oocytes, namely those obtained from prepubertal animals. Semen and embryo sexing procedures are available in cattle although much less attention was paid to their application to sheep. Among all the reproductive technologies, cloning with embryonic and foetal cells has progressed dramatically in sheep and nuclear transfer has been used to produce transgenic animals as an alternative to pronuclear injection. The production of the first lamb cloned from a somatic cell opened new opportunities in animal breeding as well as exciting lines of basic research. The overall conclusions are that, apart from superovulation, the application of in vitro technologies is likely to evolve rapidly and once applied, a great impact on traditional and new animal productions should be expected. However, a better understanding of the changes in gene expression, induced in embryos by different in vitro manipulation procedures, is necessary to prevent abnormal foetal development.
Animals↗
Surgical intervention in infertility management.
Despite improvement in the success of IVF, reproductive surgery will remain an important option and complement to assisted reproductive technologies (ART) for many couples. Reproductive surgery should be considered as the first-line treatment when the correction of infertility pathologies is simple and a good result is expected once corrected, when the pathology is causing symptoms such as pain or abnormal bleeding, or if uncorrected will compromise the results or increase the risks of ART. The success of surgical infertility treatment depends on the careful selection of cases using appropriate investigative techniques, with procedures performed in centres with sufficient expertise. For both specialized reproductive and general gynaecological surgery it is crucial to follow microsurgical principles to avoid adhesion formation and conserve normal tissues, especially tubal and ovarian. These aspects of reproductive surgery, and different surgical techniques used for various tubal, peritoneal, uterine and ovarian conditions to achieve the optimal reproductive outcome are discussed in this article.
Adolescent↗
Ethical considerations in the treatment of cystic fibrosis.
Over the last several decades, rapid medical advancement in the treatment of persons with cystic fibrosis (CF) has brought with it a number of ethical concerns. The increasing life expectancy of persons with CF has made transitions in care increasingly common. This change in life expectancy along with advances in assisted reproductive technologies has focused attention on reproductive decision making in CF. Living lobar lung transplantation, although technically developed, remains ethically problematic. The understanding of ethical issues arising in the treatment of CF is crucial to providing optimal care.
Cystic Fibrosis↗
Female gamete preservation.
The use of multiple agent chemotherapy and combined modality treatment of childhood and adolescent cancers has markedly increased survival rates. Thus, the majority of young cancer patients survive into adulthood and the potential long-term consequences of the therapies are of ongoing concern. Alkylating agents have proven to be the most toxic to the ovaries; however radiation is also extremely gonadotoxic. In addition, combination of these modalities will produce additive effects in terms of ovarian damage (follicle depletion). As a result, there are increasing numbers of young cancer survivors with impaired or absent gonadal function. Advances in the field of assisted reproductive technology (ART) provide hope that the reproductive impact of cancer therapy can be reduced. Those technologies that may be applicable prior to gonadotoxic therapy are pretreatment ovarian protection with oral contraceptives or gonadotropin releasing hormone agonist; ART using pretreatment cryopreservation of embryos or gametes; posttreatment ART with donor gametes or embryos; or adoption. However, ovarian protection is not of proven benefit and oocyte/ovary cryopreservation has had only limited success to date. Information regarding cancer treatment's possible effects on fertility and ways to potentially circumvent these should be part of routine counseling to allow the patient to make an informed decision.
Adolescent↗
Invoking vali: painful technologies of modern birth in south India.
As reproduction becomes increasingly biomedicalized throughout the globe, reproductive technologies are used in unique ways and imbued with different meanings. This article explores why lower-class women in south India in the 1990s were demanding to have childbirth labors induced with oxytocin drugs while rejecting anesthesia. Cultural constructions of women's reproductive power are evoked and reworked in discourses of modernity that explain this preference. Discourses on relationships among gender, pain, and modernity relate to political-economic constraints on hospitals to perpetuate this practice.
Anesthesia, Obstetrical↗
Technology, power and the state.
Technical innovations may produce not only the changes they were intended to effect but also lead to consequences which are unexpected and sometimes destructive. There is an intimate relation between technological innovation and political power. Any great advances in reproductive technology are very likely to be controlled and commandeered by the state with all kinds of unforeseeable consequences.
Government↗
In vitro fertilization. Technology and methods.
The laboratory component of assisted reproductive technologies involves the manipulation and culture of male and female gametes in vitro, with the goal of producing viable embryos for transfer to a woman to enable the establishment of pregnancy. The biology of the gametes and resulting embryos dictates how they should be handled in vitro to maximize their potential at establishing a viable pregnancy. This article examines the biology of gametes and offers some suggestions as how best to proceed with the process of in vitro fertilization, embryo culture, and embryo transfer.
Acrosome↗
Sperm donation in Israel.
Science and technology in the field of human reproduction present new legal, ethical and religious questions which do not always have immediate answers. The first step in the rapidly developed field of reproductive technology was the use of sperm donation (artificial insemination by donor, AID) and the establishment of sperm banks. The state of Israel faced these problems when the regulations for sperm donation were discussed. The fact that the main holy places for the three monotheistic religions are in Israel directly influences the make-up of the population constituents. Therefore, besides a majority of secular people, a high percentage of the population of Israel is very religious: Jews, Moslems and Christians. Thus any resolution relating to AID should take this demographic combination into account. The practice of AID is opposed by the different monotheistic religions. To avoid the conflict between secular and religious people, and between the different religions' perspectives, the legal problem of AID in Israel was solved not by laws but by regulations which were published by the Ministry of Health. The main idea behind this attitude is that the state and its authorities should not and do not deal with ethical or religious questions. Thus, the decision was left to the couples and to the donors. The regulations address technical requirements, health problems and confidential issues concerning the couple, the donor and the child. In this paper we present the different views relating to these problems as perceived by the different religions, and describe the solution that was accepted by the Israeli Ministry of Health.
Government Regulation↗
A renaissance in reproductive endocrinology and infertility.
Assisted reproductive technology (ART) is catalyzing a renaissance in reproductive endocrinology and infertility (REI), manifested by the rapid growth of new technologies, such as intracytoplasmic sperm injection, oocyte cryopreservation, preimplantation genetic manipulation of embryos, and embryonic stem cell biology. Because of advances in ART, REI will be a vibrant and growing discipline, both in academic and independent practice settings, for many decades.
Endocrinology↗
Potential contribution of cryopreserved germ plasm to the preservation of genetic diversity and conservation of endangered species in captivity.
Demographic and genetic objectives of captive propagation programs for endangered species focus on establishing demographically secure populations that maintain adequate levels of genetic diversity. Long-term storage and utilization of cryopreserved germ plasm could extend the population's generation length and allow higher levels of genetic variation to be maintained in smaller populations. Since fewer breeding animals would be needed, more species would be "rescued" from extinction using the cage facilities currently available at existing institutions. Doubling generation lengths for callitrichid primates through use of cryopreservation could almost triple the number of species that could be rescued in world zoos. Additionally, long-term cryopreservation would allow for a third population, that of the frozen zoo. Three-way exchange of germ from germ plasm banks to captive and wild populations would increase genetic diversity at reduced risk and expense. Advances in reproductive technology and better understanding of the reproductive physiology of these animal populations are necessary to permit routine application of artificial insemination and embryo transfer using frozen-stored germ plasm.
Animals↗