🧬 Assisted Reproductive Technologies (ARTs)

Question 1

What is infertility?

Answer 1

Being unable to achieve pregnancy despite frequent unprotected sex over the period of at least a year.
- In Australia, affects ~ 1/6 couples.

Question 2

What are the causes of infertility?

Answer 2

1. ~ 40% of infertility is due to problems with sperm.
2. ~ 40% is due to problems in female reproductive system
3. ~ 20% is due to a combination of male and female factors.

Question 3

What is needed for sperm to fertilise an egg?

Answer 3

1. Produced in sufficient quantities
2. Able to move in a forward direction
3. Able to penetrate the corona radiata and zona pellucida.

Question 4

Why is the number/structure of sperm important for fertility?

Answer 4

Needs to be a high number of sperm produced with a correct structure. Problems with these qualities will greatly reduce chance of a pregnancy

Question 5

What are other factors affecting male fertility?

Answer 5

1. Semen, and sperm it contains, may flow into bladder, rather than out urethra.
2. Blockages may occur in male’s reproductive tract, especially in vas deferens, which may stop sperm leaving testes.
3. Hormonal imbalances can affect sex drive and sperm production

Question 6

What are some factors affecting female fertility?

Answer 6

1. Age
2. Polycystic Ovarian Syndrome (PCOS)
3. Hyperprolactinemia
4. Menopause
5. Cancer Treatments

Question 7

What happens as females get older?

Answer 7

The number of healthy eggs remaining decreases - greatly reduces chance of pregnancy, especially after age of 36.

Question 8

What is Polycystic Ovarian Syndrome and how does it affect female fertility?

Answer 8

1. A hormonal condition that causes changes to menstrual cycle as well as cysts on ovaries.
2. Means that eggs are not released and cannot be fertilised.

Question 9

What is Hyperprolactinemia and how does it affect female fertility?

Answer 9

1. Means high levels of the hormone prolactin, may occur in people with pituitary tumours, hypothyroidism and PCOS.
2. High level of prolactin results in intermittent or a lack of ovulation.

Question 10

How does menopause affect female fertility?

Answer 10

1. Once a female has gone through menopause, she will no longer be ovulating.
2. Some females experience menopause before 40 and will be unable to get pregnant from this time = early menopause, or primary ovarian insufficiency.

Question 11

How do cancer treatments affect female fertility?

Answer 11

1. May cause primary ovarian insufficiency, and hence infertility.
2. Women younger than 30 - may be temporary, and they may become fertile again after treatment.
3. The older a woman is, the less likely it is that her fertility will return.

Question 12

What are other factors affecting female fertility?

Answer 12

1. Endometriosis
2. Fibroids
3. Blockages of the Uterine Tubes
4. Menstrual Cycle Problems

Question 13

What is endometriosis and how does it affect female fertility?

Answer 13

1. A painful condition where endometrium cells grow outside uterus
2. Resulting scar tissue or distortion of uterine tubes affects fertility by blocking egg’s release or pathway through to uterus.

Question 14

What are fibroids and how does it affect female fertility?

Answer 14

1. Benign growths in muscular part of uterus
2. Stops egg passing through to uterus.
3. Can occur infections; gonorrhoea/chlamydia or damage - e.g due to ectopic pregnancies

Question 15

How do blockages of the uterine tubes affect fertility?

Answer 15

1. Influences implantation of blastocyst
2. Hormonal imbalances can reduce development of endometrium and its maintenance

Question 16

What are assisted reproductive technologies?

Answer 16

Methods developed to assist couples to have a child, including in vitro fertilisation and intrafallopian transfer

Question 17

What are examples of assisted fertilisation?

Answer 17

1. Gamete intrafallopian transfer (GIFT)
2. In vitro fertilisation (IVF)
3. Intracytoplasmic sperm injection (ICSI)

Question 18

What is Gamete Intrafallopian Transfer (GIFT)?

Answer 18

A method of assisted reproductive technology; a variation of IVF where sperm and eggs are mixed immediately after collecting the eggs

Question 19

What are the steps of GIFT?

Answer 19

1. Hormonal treatment used to stimulate female to produce more than one egg.
2. Sperm and egg are collected and analysed.
3. Sperm and egg are mixed together in lab.
4. Sperm/egg mixture injected into woman’s uterine tubes during laparoscopic surgery.

Question 20

What is supposed to happen after the sperm/egg mixture is injected into the women’s uterine tubes?

Answer 20

It’s hoped that sperm will fertilise egg naturally and move down uterine tube before implanting in uterus.

Question 21

Why has the frequency of GIFT procedures decreased?

Answer 21

1. Has disadvantages of having a lower pregnancy rate and requiring surgery.
2. As fertilisation occurs naturally, this method is preferred by some couples.

Question 22

What is In vitro fertilisation (IVF)?

Answer 22

Fertilisation outside the female body

Question 23

Why is IVF used?

Answer 23

To overcome fertility issues, such as blocked uterine tubes, ovulation disorders, endometriosis, fibroids, etc.

Question 24

Why is hormonal treatment used during IVF?

Answer 24

1. To stimulate ovaries so that multiple follicles develop
2. Control ovulation
3. Prepare the uterine lining

Question 25

Why are blood tests and ultrasounds used in IVF?

Answer 25

1. To monitor development of follicles. 2. When eggs are mature, they're collected by a needle passing through vagina to ovaries.

Question 26

What happens in IVF once the eggs are retrieved?

Answer 26

The eggs are mixed with sperm in a suitable environment at 37'C to maximise chances of fertilisation and development.

Question 27

When is the embryo inserted into the uterus?

Answer 27

~ 2-6 days after collection, an embryo is inserted into uterus via a catheter passed through cervix.

Question 28

What are the ethical concerns regarding IVF?

Answer 28

1. IVF destroys human lives - create more embryos than parents intend to bring to term 2. Over 1.5 million human embryos created in IVF are being stored in freezers 3. Enables adults to treat children - and sometimes other adults - as commodities

Question 29

What is Intracytoplasmic Sperm Injection (ICSI)?

Answer 29

A process whereby a single sperm is inserted into a single egg

Question 30

Why is ICSI a better option then IVF if the sperm cannot fertilise an egg unassisted?

Answer 30

1. IVF has a low chance of success 2. ICSI is very similar to IVF - Once eggs have been collected, they're examined to ensure they're suitable.

Question 31

How is fertilisation achieved using ICSI?

Answer 31

1. A sperm is then injected into the egg, achieving fertilisation. 2. Resulting cells are monitored - any that are developing normally are able to be inseminated.

Question 32

What is recommended for children born from ICSI and why?

Answer 32

1. Male infertility may be a genetic disorder. 2. It's recommended that children born from ICSI are examined by a paediatrician. 3. Possible for genetic testing to be done prior to undertaking ICSI

Question 33

What is done during ICSI for men who are unable to ejaculate or have low sperm numbers?

Answer 33

1. Sperm may be collected during surgery to be used in IVF and ICSI. 2. Surgery may be performed under local or general anaesthetic. 3. In both cases, needle is used to collect sperm from epididymis/testis.

Question 34

What are other options for pregnancy?

Answer 34

1. Donor gametes or embryos 2. Surrogacy

Question 35

How are donor gametes or embryos used to achieve pregnancy?

Answer 35

1. Donor may be known to couple, or anonymous. 2. In Aus, there are strict regulations regarding donors, incl. counselling for donors and recipients, cooling-off periods and health screening.

Question 36

What is surrogacy?

Answer 36

When a woman bears a child for someone else because the female is unable to conceive/carry a baby

Question 37

What happens during a surrogacy?

Answer 37

Another woman carries child for duration of pregnancy and then gives child to couple to raise as their own. - Very strict surrogacy laws in Aus

Question 38

How are surrogate pregnancies achieved?

Answer 38

1. By artificial insemination of father’s sperm. 2. Gestational surrogacy - IVF used to produce embryo that is then inserted into surrogate

Question 39

What are other considerations regarding fertility treatments?

Answer 39

1. Frozen Embryos 2. Religious Beliefs 3. Costs

Question 40

What are frozen embryos and how do they affect fertility treatments?

Answer 40

1. Embryos produced but not used during IVF cycle are typically frozen. 2. Outcome of embryos no longer needed by couple is a serious ethical/moral consideration. 3. For this reason, there are many legalities and guidelines relating to it.

Question 41

What are religious beliefs and how do they affect fertility treatments?

Answer 41

1. Religions differ in their acceptance of assisted reproduction. 2. Decision whether or not to use ARTs is individual one, with religious beliefs being one factor.

Question 42

What are costs and how do they affect fertility treatments?

Answer 42

1. Assisted reproductive technologies are very expensive. 2. While Medicare rebates are available for many treatments, out-of-pocket expenses per cycle are still very high.

Question 43

What are the ethical concerns of ARTs?

Answer 43

1. Disposal of Surplus Embryos: What is the ethical fate of embryos created through IVF that are no longer needed for intended parents 2. Eligibility: Who should be eligible for ARTs, including single individuals, same-sex couples, and those with certain medical conditions