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Assisted Reproductive Technology (ART)

Assisted reproductive technology (ART) is a general term for methods used to treat infertility. Generally, methods manipulate both the egg and sperm with the goal of the creation of an embryo. In vitro fertilization is the most effective and common type of ART.

Types of Assistive Reproductive Technologies

Step by step process of IVF.

In vitro fertilization (IVF)

In vitro fertilization is a method of ART that involves the fertilization of an egg outside the woman’s body. During the IVF cycle, the eggs are retrieved from a woman, which are then fertilized with sperm. This egg grows in a petri dish for several days until it develops into an embryo. The best fertilized eggs are selected and implanted back into the woman’s uterus. This process is one of the most effective, with a success rate of about 15-20% per cycle. This method is used if:

• A woman's fallopian tubes are missing or blocked.
• A woman has severe endometriosis.
• A man has low sperm counts.
• Artificial or intrauterine insemination has not been successful.
• Unexplained infertility has continued for a long time. How long a couple chooses to wait is influenced by the female partner's age and other personal factors.
• A couple wants to test for inherited disorders before embryos are transferred.

Preimplantation genetic diagnosis (PGD)

PGD is often used alongside in vitro fertilization. This procedure is used with the objective to reduce the risk of passing on inherited conditions such as cystic fibrosis and sickle cell anemia, or structural changes in a parent’s chromosomes. In the IVF process, PGD is used after the eggs are retrieved from the woman’s body. They are then evaluated for the particular genetic condition. Those without the condition are reinserted into the woman’s uterus. Two techniques are used during PGD: polymerase chain reaction, and fluorescent in situ hybridization.

Intrauterine insemination

This method fertilizes an egg existing inside a woman’s uterus. It works best for women without a partner, those with unexplained infertility, issues with the movement of a man’s sperm (ie. low mobility or chemical mismatch). It is a brief process that involves sperm being implanted into a woman. Intrauterine insemination is more affordable, yet less effective.

Intrafallopian transfer

Intrafallopian transfer involves the fertilization of a woman’s egg whilst inside the fallopian tube. This process works for women with unexplained infertility, issues with the movement of a man’s sperm, or issues with the woman’s fallopian tubes. Methods are similar to IVF and intrauterine insemination, although taking place inside the fallopian tubes.

Intracytoplasmic sperm injection

Intracytoplasmic sperm injection (ISI) is similar to IVF, such that one or more eggs are removed from a woman's body. One healthy sperm is injected into a mature egg and put back into a woman’s body. This works best when serious sperm issues exist.

Controversies

High Costs

IVF services can be expensive. This is heavily dependent on the general regulation of healthcare services and attitudes towards women’s health in the country . In the U.S., the average cost of one IVF cycle is $12 400. In some countries, infertility treatment cycles are publicly funded such as New Zealand. It also takes many cycles to achieve pregnancy. This leaves poorer women and those without health insurance at a disadvantage. These conditions raise the question as to whether insurance companies should cover reproductive assistance, or if it should be considered a luxury.

Abuse of PGD

The primary function of reimplantation genetic diagnosis (PGD) technology allows for the detection of genetic defects, however more recent uses extend beyond this. As opposed to selecting embryos based on the absence of malicious traits, there are instances where embryos were selected based on 'desirable' traits. This ties to the broader controversy of eugenics. Many question as to whether procreative liberty extends to choosing the genetic characteristics of offspring. One may consider it to be improving the life of a child. The lines have been blurring between "negative and positive eugenics". It is believed by some that procreative liberty should only be restricted when negative outcomes are found. Some directly oppose this, and think unrestricted access to reproductive manipulation to individuals is dangerous as "bad eugenic choices" may be made.

The disability rights community have also raised the discussion on the consequences of PGD on the population of people with characteristics already deemed "undesirable". This argument states that as we continue to strive for our perseption of perfection, our tolerance for diversity will become narrow. As per William Roth, a professor at the State University of New York at Albany, apparent differences in our populations may be deemed as "dysfunctional, inferior, or deficient".

Feminist Critiques

Some criticize ART as it removes the value of life-giving from women and places it in the hands of men and the medical profession. Even in situations where the issue lies in the man's reproductive systems, the burden lies on the woman to undergo the procedures (ie. IVF). The general criticism that comes from the feminist perspective is that the ATP industry objectifies and instrumentalises the female body.

Disposal of Embryos

In cases of death or divorce, it raises the concern about the disposal of embryos. Unused embryos can be donated, but there are many psychological and legal burdens in this process. If not donated to scientific research, embryos are disposed of. There is a lot of sensitivity in today's culture regarding the loss of an underdeveloped life, as seen in discussions about abortion.

Women Past Menopause

Maria Bousada was a 66 year old woman and a single mother who died 3 years after undergoing the IVF process, leaving behind her 2-year old orphaned twins. She had lied about her age prior to the IVF treatment. In an interview, she said "I think everyone should become a mother at the right time for them". This situation has raised controversy surrounding the best interests of a child versus the older mother. IVF allows women who have past menopause able to be fertile, but this may come at a cost . Statistically speaking, older mothers will die much sooner than younger mothers after giving birth, leaving children to their own. There also comes a physical risk with older women and pregnancy.

Social attitudes also play a role in this discussion. There exists a double standard where older mothers are looked down upon for being "selfish", while older fathers are praised.

Legal Barriers

The Assisted Human Reproduction Act (AHRA)

The AHRA is one of the most significant pieces of legislation regarding ART. On March 11, 2004, the Canadian Senate approved this act and it would later become law after approved by the House of Commons. This legislation unblurs the lines surrounding applications of genetic and reproductive technologies, while permitting socially acceptable applications to proceed with regulation. The act distinguishes applications that are approved but regulated, and prohibited. Prohibited practices include:

• The creation of human embryos solely for research;
• germline engineering (i.e., inheritable genetic modification);
• the creation of human/non-human hybrids and chimeras;
• all use of somatic cell nuclear transfer (cloning), whether for research or reproduction;
• sex selection except to prevent, diagnose or treat a sex-linked disorder or disease;
• commercial surrogate motherhood contracts and the sale of sperm, eggs and embryos.

References section

1. U.S. National Library of Medicine. (2021, October 18). Assisted Reproductive Technology. Medline Plus. https://medlineplus.gov/assistedreproductivetechnology.html
2. Centre of Reproductive Medicine. (n.d.). What are the Different Types of Assisted Reproductive Technology (ART)? Infertility Texas. https://infertilitytexas.com/blog/what-are-the-different-types-of-assisted-reproductive-technology-art/
3. Healthwise Staff. (2020, February 11). In Vitro Fertilization for Infertility. HealthLinkBC. https://www.healthlinkbc.ca/health-topics/hw227379
4. University of California San Francisco. (n.d.). Pre-Implantation Genetic Diagnosis. USCF Health. https://www.ucsfhealth.org/treatments/pre-implantation-genetic-diagnosis
5. Asch, A., & Marmor, R. (2015, September 17). Assisted Reproduction. The Hastings Center. https://www.thehastingscenter.org/briefingbook/assisted-reproduction/
6. Shaw, R. (2006). Life in a Petri-Dish: Procreative Liberty, Choice, and the Governance of Women’s Bodies. Hecate, 32(2), 141–154.
7. Shean, R. (2015). The Principle of Procreative Beneficence: Objections and Provisions. Penn Bioethics Journal, 11(1), 20–22.
8. Rebar, Robert. (n.d.). Assisted Reproductive Techniques - Women's Health Issues. Merck Manuals Consumer Version.
9. Gurevich, Rachel. (n.d.). Options for What to Do With Extra Frozen Embryos After IVF. Verywell Family.
10. Banh, David; Havemann, Dara L.; Phelps, John Y. (2010, July). Reproduction beyond menopause: how old is too old for assisted reproductive technology?. Journal of Assisted Reproduction and Genetics. 27 (7): 365–370. doi:10.1007/s10815-010-9418-3.
11. Associated Press. (2009, July 15). Woman who had twins at 66 dies. The Guardian. https://www.theguardian.com/lifeandstyle/2009/jul/15/bousada-oldest-new-mother-dies#:~:text=A%20Spanish%20woman%20believed%20to,died%20on%20Saturday%20aged%2069.
12. Starza-Allen, Antony. (n.d.). 'Older Mothers': a report on the '21st century motherhood' conference held at UCL. BioNews. https://www.bionews.org.uk/page_91924
13. Center for Genetics and Society. (n.d.). Canada: The Assisted Human Reproduction Act. Center for Genetics and Society. https://www.geneticsandsociety.org/internal-content/canada-assisted-human-reproduction-act.

External links section

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