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PubMed2001

Clones, controversy, and criminal law: a comment on the proposal for legislation governing assisted human reproduction.

In the past few years there has been a tremendous amount of regulatory conflict and social controversy in the area of reproductive genetics. The Canadian government has recently released a proposal for legislating in this complex arena. Although the proposed Bill contains many positive elements, it is argued that the use of the criminal law as a regulatory mechanism is neither warranted nor appropriate. The author suggests a more flexible and responsive system of moratoriums and licenses that would enable review and adjustment to the realities of emerging reproductive technologies is a better approach.

Canada↗
PubMed1996

Current and future issues in assisted reproduction.

The last quarter of the twentieth century has given rise to reproductive technologies and arrangements that in the earlier part of the century could only be dreamed of by the authors of science fiction. We stand in the middle of this reproductive revolution, trying to cope with the developments that have already occurred but with an uneasy sense that the future may be even more complicated ethically than the past and the present. In this brief essay, I will survey recent ethical and public-policy discussions of two reproductive techniques (assisted insemination and in vitro fertilization) and one reproductive arrangement (surrogate motherhood). After distinguishing three phases in the normative debate, I will briefly comment on some of the characteristics of, and continuing ambiguities in, the ethical debate of the past 25 years. At the conclusion of the essay, I will attempt to anticipate three future issues in ethics and reproduction.

Advisory Committees↗
PubMed1997

The micro-robotic laboratory: optical trapping and scissing for the biologist.

With the addition of tightly focused laser beams, microscopes have been turned into elaborate preparative tools that permit not only allow detailed observation of a specimen but also the capture, displacement, and microdissection of biological samples in vitro with astonishing ease and accuracy. Laser-Tweezers are used to capture and manipulate cells and organelles. LaserScissors are used to perform microdissections at the submicrometer level. After a short technical description of the instrumentation and its principles of operation, several examples of applications are given relevant to the field of clinical research that could only be achieved using such modern technology. For instance, LaserTweezers and LaserScissors offer a unprecedented means to study the immune response to cancer, to control the growth of nerve cells, or expand the significance of assisted reproductive technologies. It is suggested that newly developing procedures and assays using laser-assisted technologies will prove beneficial for future clinical laboratory testing.

Animals↗
PubMed2003

Emplotting children's lives: developmental delay vs. disability.

While it is increasingly possible to envision "perfect" babies, it is not always the case that reproduction actually proceeds according to individual will; for example, there has been no recent reduction in rates of childhood disability. Nevertheless, in most studies of new reproductive technologies, the birth of those children whom few would actively choose-"defective" or disabled infants-is presented only in hypothetical terms. This paper argues for expanding the domain of reproduction to include research on the parenting of children with disabilities. Based on a qualitative research project carried out at a hospital-based newborn follow-up program that serves as an evaluation site determining eligibility for early intervention services for infants and young children with disabilities, this paper focuses on a particular part of women's experience of acquiring new knowledge about personhood and disability, that is, on the period of time when a woman has recently had confirmed that reproduction has, in her case, gone awry. Disability in many cultures, including the United States, diminishes personhood. I suggest that American mothers' narratives, by utilizing the concept of developmental delay, can assert personhood, or rather, the potential for its future attainment; in doing so, they justify ongoing nurturance of a disabled child in spite of negative attitudes about disability. A particular case of one mother's emplotment of her child's life within a story of developmental delay, in competition with the physician's story of disability, is analyzed. The paper concludes with reflections on how stories of developmental delay told by mothers just encountering a diagnosis of disability may differ from the stories told by those who have experienced mothering a disabled child over time, and on the implications of these differences for the cultural construction of personhood in the United States.

Adaptation, Psychological↗
PubMed1996

The European study of assisted reproduction families: family functioning and child development.

Findings are presented of a European study (conducted in the UK, Italy, Spain and The Netherlands) of family relationships and the social and emotional development of children in families created as a result of the two most widely used reproductive technologies, in-vitro fertilization (IVF) and donor insemination (DI), in comparison with control groups of families with naturally conceived child and adoptive families. Mothers of children conceived by assisted reproduction expressed greater warmth towards their child, were more emotionally involved with their child, interacted more with their child and reported less stress associated with parenting than mothers who conceived their child naturally. Similarly, assisted reproduction fathers were found to interact more with their child and to contribute more to parenting than fathers with a naturally conceived child. With respect to the children themselves, no group differences were found for either the presence of psychological disorder or for children's perceptions of the quality of family relationships. The findings relating to the quality of parenting and the socio-emotional development of the children were similar in each of the four countries studied.

Adoption↗
PubMed1994

Regulatory models for human embryo cloning: the free market, professional guidelines, and government restrictions.

Both experimental and therapeutic uses of the new reproductive technologies have been governed not by the medical ideology of the best interests of patients and their children, but by the market ideology of profit maximization under the guise of "reproductive liberty." Government in our constitutional, democratic society has the authority and obligation to make and enforce reasonable regulations to manage the new reproductive market in order to protect the interests of the public, prospective parents, and their future children. The "cloning" debate provides a useful opportunity to compare and contrast the competing regulatory models of the free market, professional guidelines, and government restrictions.

Advisory Committees↗
PubMed2006

[Infertility: a global perspective].

Infertility has always existed; however, today it has a different meaning because the possibility exists, not only to treat it in some three quarters of all cases, but also, in a number of instances, to prevent it. At the same time, this improved scenario created a number of important new issues concerning public health policies and the social impact of infertility; these issues can be summarized with two words: equity and ethics. Indeed, there are intolerable differences in access to infertility care, depending on the social-economic status, as well as the country in which a couple lives. It is generally believed that, overall, in the general population a persistent form of infertility affects some 7-8% of all couples; in Europe the prevalence of infertility has been estimated at around 14%. There are important regional differences in the incidence and causes of sterility. Whereas the best known factor in western countries is an increase in the age in which women attempt to conceive, in Africa, the most important cause is represented by sexually transmitted infections. Over the last fifty years there have been major break-throws in the diagnosis and treatment of infertility, although it must be stressed that the importance and validity of therapy must be in all cases evaluated against expectant management. This is because in couples without clear signs of functional or organic pathology, conception will occur spontaneously in between 80 and 90% of the cases. At the same time, if attempts to conceive fail over a period of three years, even in women 30 years or younger, the probability of pregnancy decreases to about 40%. Finally, it must be stressed that advances in assisted reproductive technology have created not only important successes, but also significant ethical problems: on the one hand, the debate is open on the limits of artificial interventions in the field of reproduction; on the other the possibility exists that a partner may ''impose'' an infertility on the other.

Female↗
PubMed1997

Unstimulated immature oocyte retrieval: early versus midfollicular endometrial priming.

OBJECTIVE: To assess the ability to retrieve transvaginally unstimulated immature oocytes from assisted reproductive technology (ART) patients and to determine their competency to mature, fertilize, and implant with early versus midfollicular exogenous estrogen endometrial priming. DESIGN: Prospective randomized study. SETTING: In vitro fertilization unit, private reproductive endocrinology and infertility practice. PATIENT(S): Fourteen patients, all had failed at least one IVF cycle. INTERVENTION(S): Early follicular endometrial priming was initiated on cycle day 3 with 2 mg 17 beta-E2 twice per day (group A). Midfollicular endometrial priming was initiated with 1 to 2 mg/d of 17 beta-E2 between cycle days 5 and 7 and gradually increased by 1 to 2 mg/d until the oocyte retrieval (group B). The oocytes were allowed to mature in 0.075 IU FSH or hMG, 0.5 IU of hCG, 1 microgram of 17 beta-E2 in Eagle's or Tissue Culture Media 199, fertilized, and transferred 72 hours later. MAIN OUTCOME MEASURE(S): Maturation, fertilization, and pregnancy rate. RESULT(S): Group A patients had 83 oocytes retrieved (11.8 +/- 6.1) versus 78 oocytes (11.1 +/- 2.7) from group B. The maturation rate in group A was 39.7% (34/83) versus 61.5% (48/78) in group B. The fertilization rate was 75.7% (25/34) in group A versus 75.0% (36/48) in group B. The cleavage arrest rate was significantly higher, 36.0% (9/25) in group A versus 8.3% (3/ 36) in group B. The number of embryos transferred was 1.8 embryos per retrieval in group A versus 4.0 embryos per retrieval in group B. One pregnancy was established in a patient with tubal disease in group B who delivered at 36 weeks gestation. CONCLUSION(S): Unstimulated immature oocyte retrieval can be performed successfully in ART patients. Midfollicular endometrial priming was able to achieve successful maturation (60%), fertilization (75%), and cleavage (92%), with the delivery of a successful pregnancy.

Adult↗
PubMed2003

Contextualizing a medical breakthrough: an overview of the case of IVF.

In this article I examine the ways in which the technology of in vitro fertilization (IVF) is embedded in prevailing sociocultural perceptions and power relations in North American and Western European contexts. From this perspective, I look at the efforts involved in developing reproductive technologies and at the particular direction such attempts have taken. I then examine the policies and laws through which IVF is regulated; the technical characteristics of the technology and its implementation; the social implications of IVF for poorer women, women of color, and single and lesbian women; and the media coverage of the subject. Women's responses to IVF and their roles in its shaping are also addressed. I conclude with a reference to the social and cultural repercussions of IVF in the industrialized world. The overview suggests that IVF embodies social continuity while also encapsulating a potential for radical social transformations.

Attitude to Health↗
PubMed1998

Comfort care interventions in a preimplantation genetic testing program.

The fields of human genetics and assisted reproductive technology (ART) have experienced many scientific advances over the past 50 years. The integration of these two clinical specialties has resulted in the ability to perform preimplantation genetic testing (PGT) on an embryo created through ART. This is a technology that can be used by individuals at risk for the transmission of a genetic disorder to prevent occurrence of the disorder in their child. Both the process of PGT and the life experiences that lead to the decision to use PGT stimulate many levels and types of discomfort. Holistic comfort care interventions performed by the nurse are uniquely designed to eliminate or reduce discomfort and to enable those at risk to utilize the available technologies to create healthy families.

Adult↗
PubMed2004

Reflections upon the trends of education and research in small animal reproduction in Europe.

An open questionnaire-based survey was performed among 86 institutions of veterinary education in 32 European countries: 15 within the European Union (EU) and 17 outside the EU, in Central and Eastern Europe and the European Free Trade Association (EFTA). The survey aimed to provide a view of the general status of education and research in small animal reproduction (SAR) in Europe. It further aimed to disclose whether ongoing trends in organization (e.g., from the classical animal reproduction discipline orientation [DO] toward a species-oriented [SO] organization) among veterinary colleges responsible for undergraduate education and research in SAR have affected the provision of clinical services, continuing professional development (CPD), specialization, post-graduate education, and research. Response rates reached 80% among EU institutions and 48.4% in other countries (overall response rate = 68.6%). A clear, significant majority of institutions (> 60%) were DO, with a well-defined comparative subject in the veterinary curriculum. No differences were reported for either orientation in their ability to provide undergraduate education or clinical services in SAR. However, more DO institutions reported active research in SAR than their SO counterparts. Similar (and stronger) differences were seen for post-graduate education, CPD, and participation in specialization programs (national or European). Finally, more DO than SO institutions provided assisted reproductive technologies (ARTs), such as AI with frozen semen, to customers. The analysis of the data emanating from the respondents' perceptions, supports the advantages of the more classical, DO-based approach. The results highlight the need for caution when institutions abandon the comparative benefits of the classical DO animal reproduction subject for a SO approach, which tends to prioritize clinical specialized service rather than research and research education. In the author's opinion, in the absence of the data generated by comparative research and used in research education and the development of new technologies in SAR, there is a risk that sound science-based academic preparation for undergraduates and candidates for post-graduate research education is constrained. To counteract these negative trends, SAR must be recognized as a very important branch of the department of animal reproduction. Access to resources, personnel for teaching and research, and curriculum space should be made available in order to provide the basis for relevant post-graduate training, specialization, and research.

Animals↗
PubMed1995

Ovarian volume: a novel outcome predictor for assisted reproduction.

OBJECTIVE: To determine the potential of ovarian volume as a predictor of assisted reproduction outcomes. DESIGN: Retrospective chart review. SETTING: University-based assisted reproduction program. PATIENTS: One hundred eighty-eight women initiating their first cycle of assisted reproduction. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Pretreatment transvaginal ultrasound ovarian measurements were compared with subsequent ovulation induction parameters (peak E2, numbers of oocytes, and embryos) and cycle outcome (cancellation and pregnancy). RESULT: Total ovarian volume and volume of the smallest ovary were significant variables predicting peak E2 and numbers of oocytes and embryos. Total ovarian volume was a predictor of cycle cancellation and volume of the smallest ovary a predictor of clinical pregnancy. Large ovarian volumes are associated with good assisted reproductive technology outcomes whereas small ovarian volumes are associated with poor outcomes. CONCLUSION: Beyond maternal age, total ovarian volume, and volume of the smallest ovary are significant predictors of the success of assisted reproductive techniques.

Adult↗
PubMed2002

Leptin regulation of reproductive function and fertility.

Leptin, a 16-KD protein secreted primarily by adipose tissue, was first discovered in the search for a satiety signal. When administered into the brain, leptin depresses appetite. Interestingly, hyperphagic, obese, transgenic mice with leptin deficiency were noted to be reproductively incompetent, and administration of leptin restored their fertility. These pivotal observations led to numerous studies on the site of action of leptin within the hypothalamo-hypophyseal-gonadal axis, and a variety of models have been used ranging from the prepubertal condition to fasting suppression of reproductive hormones. The preponderance of studies thus far has focused on how leptin serves as a metabolic signal of energy balance within the neuroendocrine system, particularly as a regulator of GnRH/LH secretion. Less research has been conducted with other components of the reproductive system, but local effects of leptin have been demonstrated in the gonads where hyperleptinemia suppresses steroidogenesis and potentially affects gamete maturation. This presentation will review the major concepts for the role of leptin in the modulation of fertility and will consider the potential use of leptin in assisted reproductive technology and embryo transfer.

Animals↗
PubMed1995

From uncommitted to committed embryonic cells: opportunities for their study and manipulation.

This paper offers a broad review of the methodologies used for the study of embryonic development and for the manipulation of embryonic cells. It was written in the context of the silver anniversary of the Australian Society for Reproductive Biology and places particular emphasis on the achievements of Australian scientists in this field. It has attempted to place recent advancements in some historical perspective, to examine the present "state of the art' in reproductive technologies and to consider future directions.

Animals↗
PubMed2002

Genetically selected baby free of inherited predisposition to early-onset Alzheimer's disease.

The application of preimplantation genetic diagnosis to select against early-onset Alzheimer's has been criticised on several grounds. Some critics think it is wrong to reject an embryo because it may develop a disease later on in middle age and some question whether a woman who will soon become incapacitated and unable to provide for her child should be a candidate for assisted reproductive technology.

Alzheimer Disease↗
PubMed2002

Spinal cord injury and male infertility.

Spinal cord injury (SCI) commonly affects males in their reproductive years. After spinal cord injury, most men experience fertility related problems including erectile and ejaculatory dysfunction, impaired spermatogenesis, abnormal sperm viability, motility, and morphology, genitourinary infection and endocrine abnormalities. In this article we will review the pathophysiology, evaluation and management of infertility in spinal cord injury. The impact of spinal cord injury on seminal plasma and the contribution of seminal oxidative stress to the poor sperm quality of men with spinal cord injury will be presented. Success with sperm retrieval techniques and assisted reproductive technology in SCI men with spinal cord injury will be discussed.

Ejaculation↗
PubMedDate not supplied

Clones, parents, persons and the law in Australia.

Current understanding of cloning and artificial reproductive technology was reviewed. The results show that they are in contradiction with fundamental concepts upon which our society is built, such as person and parenthood. Analyses of some recent British and Australian laws show that attempts to protect the individual by regulating some biological technologies through carefully drafted legislation are bound to fail.

Animals↗
PubMed2006

In vitro maturation of human oocytes for assisted reproduction.

OBJECTIVE: To describe and evaluate the current practice of in vitro maturation of oocytes for assisted reproduction. DESIGN: Review of the available and relevant literature regarding in vitro maturation of oocytes. CONCLUSION(S): In vitro maturation of human oocytes retrieved from antral ovarian follicles is an emerging procedure quickly being incorporated into the realm of assisted reproductive technologies. This new technology has several potential advantages over traditional controlled ovarian hyperstimulation for IVF, such as reduction of costs by minimizing gonadotropin and GnRH analogue use, elimination of ovarian hyperstimulation syndrome, and simplicity of protocol. In vitro maturation of oocytes for assisted reproduction in human beings still is undergoing refinement but currently is providing efficacy and safety outcome comparable to that of traditional IVF in recent selected studies. Implementing in vitro maturation into an established IVF practice is feasible and requires only a few simple adjustments. Crucial to the advancement and optimization of the technology is a better understanding of how to maximize immature oocyte developmental competence and endometrial receptivity.

Cell Culture Techniques↗