Date post: | 11-Jan-2016 |
Category: |
Documents |
Upload: | hugh-ferguson |
View: | 216 times |
Download: | 2 times |
2012Marek Vácha
It is not birth, marriage, or death, but gastrulation, which is truly the most important time in your life.
Lewis Wolpert (1986)
citizenship year
AR: Number of cycles
on the whole donors of oocytes women going to the IVF+ET
Czech Rep.
2007
15169 593 14576
European Union 2045 11 2034
Outside EU 528 1 527
On the Whole 17742 605 17137
Czech Rep.
2008
17300 1271 16029
EU 3328 9 3319
Outside EU 721 1 720
On the Whole 21349 1281 20068
Czech Rep.
2009
17299 1243 16056
EU 4453 1 4452
Outside EU 761 0 761
On the Whole 22513 1244 21269
Zdroj dat: Národní registr asistované reprodukce, ÚZIS ČR
Numbers of Sperms
1940 113 millions /ml
1990 66 millions /ml
the number of „normal“ sperm fell from 60 million per mL to 20 mL in the same period(Carlsen, E., Giwercman, A., Keiding, N., Skakkebaek, N., (1992) Evidence of decreasing quality of semen during past 50 years. Brit. Med. J. 305: 609-613)
Man Examination: Spermiogram
Normal spermiogram Pathological Spermiogram
Woman Examintaion Ultrasound
Ovulation cycle Anovulation
First „test tube baby“
July, 25, 1978 – Louise Brown
Louise Brown with her parents, 25-year-oldin 2003
A Delivery. LB. Patrick Steptoe right, Robert Edwards left
They persisted through more than 40 embryo transfers before obtaining their first pregnancy. Unfortunately it was ectopic and had to be aborted. Louise Brown was born from the second pregnancy.
2010: Nearly four million babies have been born using IVF fertility treatment since
1978.
Prof. Edwards and Louise Brown, 2008, in the day of her 30th birthday
1983 = donation of oocyte 1993 = ICSI 2000 = PGD
Czech Rep.
1982 - Brno – first IVF at eastern block, GIFT. But till 1987 at ČR 10 children only
1988 – first twins at ČR 1994 – first triplets at ČR
Useful terms AIH - homologous fertilization = artificial
insemination husband AID - heterologous fertilization = artificial
insemination donor “ (Encyclopedia of Bioethics,4/2219)
IVF + ET
Therapy II. MUDr. Karel Janíček
Stimulation of Ovulation
Therapy III. MUDr. Karel Janíček
Intrauterinne insemination
Therapy IV. MUDr. Karel Janíček
In vitro fertilization (IVF)
Therapy V.MUDr. Karel Janíček
ICSI (intracytoplasmatic sperm injection)
Testicular Biopsy for ICSI e.g. here:http://www.medicalvideos.us/play.php?vid=1363
ICSI e.g. herehttp://www.dnatube.com/video/2716/ICSI--Intracytoplasmic-Sperm-Injection
USA
the average cost per delivery in 1994 was $ 66,667 for couples undergoing their first cycle of oocyte maturation...
...rising to over $ 114,250 for those couples on their sixth attempt this does not include the hospital fees for
multiple births (which often exceeded $ 100 000)
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 77)
USA
Right now, it is strictly a market economy, and there is very little regulation put on any physician who wants to start a clinic.
If a couple knows it might be possible to have a genetically related child if only they were wealthy enough, does it frustrate more people than it helps?
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 77)
USA
In U.S. courts, frozen embryos usually are considered property. This makes them contested items if the coupel divorces.
In February 2005, a couple undergoing IVF in Chicago found that one of their preserved fertilized eggs had been thrown out by mistake The couple filed a wrongful death lawsuit, and won. The court ruled that this embryo was a human being even
though it had not even been implanted into uterus. Currently (=2005) there are more than 100 000 frozen
embryos in storages, and this number is growing at around 20 000 embryos per year
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 79)
Donation of gamets
up to 85 % IVF+ET is taking place with the help of ICSI Sweden: every citizen 18+ has the right to
know his or her biological parents When Sweden passed a law in 1985 requiring
that the identity of the semen donor should be recorded to enable the child at eighteen years of age to contact the biological father, this resulted in the almost total disappearance of donors in Sweden and frequent referral of couples to other parts of Scandinavia
at ČR is donation anonymous
Australia: A registry identifying donors is open to children at age eighteen, equialent to the law on adoption
American states, however, have uniformly protected the identity of donors and recipients
(Dorff, E.N., (2003) Matters of Life and Death. A Jewish Approach to Modern Medical Ethics. The Jewish Publication Society, Philadelphia, PA, p. 86)
prenatal sex selection
there are 100 million fewer living women than we should expect 44 million fewer in China 37 million fewer in India
(Blackburn, S., (2001) Ethics. A Very Short Introduction. Oxford University Press, Oxford, p. 50)
A study based on 1,1 million Indian household in 1997 showed that although
numbers of boys and girls born were almost equal for the first child
759 girls were born per thousand boys for second children
and only 719 girls per thousand boys for third children
this practice accounted for 10 million fewer indian girls being born over the last 20 years
(Mepham, B., (2008) Bioethics. An Introduction for the Biosciences. Oxford University Press, Oxford, p. 125)
http://www.bbc.co.uk/news/world-south-asia-13264301
preimplantation genetic diagnosis
the American Medical Association has advised physicians that sex selection of this kind in the absence of any accompanying health problems is not something that physicians should do.
(Richards, J.E., Hawley, R.S., (2005) The Human Genome. A User´s Guide. 2nd ed. Elsevier Academic Press, Burlington, MA, USA, p.386)
- if PGD is not permitted, pregnancy and abortion might occur instead
following a public consultation exercise in the UK, the HFEA announced in 2003 that it had decided to ban sex-selection for „family balancing“, although permitting it where a child of one sex would risk inheriting a serious genetic disorder
„Your child will be female, which increases the risk of sexual abuse, domestic violoence and poverty.“
the American Medical Association has advised physicians that sex selection of this kind in the absence of any accompanying health problems is not something that physicians should do.
(Richards, J.E., Hawley, R.S., (2005) The Human Genome. A User´s Guide. 2nd ed. Elsevier Academic Press, Burlington, MA, USA, p.386)
generally, the sex selection in USA is made for the second or third baby, not for the first
Ovum donation
UK
In 2003 in the UK only 20 eggs were donated for research, and in general those that are surplus to requirements in IVF programmes tend to be of poor quality.
this led the HFEA in 2007 to permit researchers to reimburse women up to £250 for their eggs, although the donors will be required to show that they are „acting altruistically“
women donating eggs in this way may also have the fee for their own IVF treatment halved, which would be equivalent to a payment of about £1500
UK
critics suggests that this is likely to result in the exploitation of poorer women, many of whom may be induced to travel to Britain from abroad to sell their eggs.
(Mepham, B., (2008) Bioethics. An Introduction for the Biosciences. Oxford University Press, Oxford, p. 143)
Possible scenarios of the future
Collins, F., (2006) The Language of God. Free Press, New York, p. 269)
notable cases in the UK were the applications to the HFEA from two set of parents (the Hashmi and Whitaker families) for permission to select embryos (=saviour siblings) to treat their existing children, who suffered from beta-thalassaemia and rare non-inherited disease Diamond-Blackfan anaemia respectively
in each case, the proposed strategy was to harvest stem cells from umbilical cord blood following the birth of the younger sibling,with the aim of using stem cells in a bone marrow transplant and subsequently curing the disease in the older child through the production of healthy blood cells
Saviour Siblings
The Hashmis were granted permission by the HFEA in 2001 to create and tissue-type embryos, because it was argued that the use of PGD would be in the interests of both the prospective child and its older sibling
by contrast, the application made to the HFEA in 2002 by Whitakers was refused, on the grounds that the unborn child should not be exposed to the hazards of PGD when there was no direct benefit to the younger sibling – because DBA is not inherited
Saviour Siblings
…consequently, the couple went to the USA to receive PGD treatment,resulting in the birth of a son in 2003.
following a subsequent House of Lords ruling, the HFEA granted a license for use of saviour sibling PGD in the case of the Fletcher family, whose son also suffered from DBA
Saviour Siblings