Reproduction and Reproduction and Fetal TechnologyFetal Technology

Annabel BarajasAnnabel BarajasTamari ZeiglerTamari Zeigler

Thomas JiThomas JiJared SalisburyJared Salisbury

Nathan VasquezNathan Vasquez

Genetic Engineering and Genetic Engineering and Gene TherapyGene Therapy

Both genetic engineering and gene Both genetic engineering and gene therapy have the same basic therapy have the same basic premise: of having an introduction of premise: of having an introduction of a specific new genetic material into a specific new genetic material into an organism’s genomean organism’s genome

Some General Genetic Some General Genetic FactsFacts

A single chromosome contains about A single chromosome contains about 1000 genes 1000 genes

Humans have approximately 30,000 Humans have approximately 30,000 different kinds of genes spread out over different kinds of genes spread out over the 46 chromosomesthe 46 chromosomes

Humans get one complete set of genes Humans get one complete set of genes from each parentfrom each parent

More General Facts on More General Facts on Genes and Disease Genes and Disease

Relationship’sRelationship’s An abnormal gene is called a mutationAn abnormal gene is called a mutation Abnormal genes can cause disease or , Abnormal genes can cause disease or ,

more commonly, can change your risk of more commonly, can change your risk of developing a diseasedeveloping a disease

Most common diseases are caused by a Most common diseases are caused by a mixture of environmental, dietary and mixture of environmental, dietary and genetic factorsgenetic factors

In a normal cell , it is common for many In a normal cell , it is common for many genes to be “ silent” (not expressed)genes to be “ silent” (not expressed)

So what is genetic So what is genetic engineering?engineering?

Genetic engineering refers to the deliberate Genetic engineering refers to the deliberate design of an entire organism. The process design of an entire organism. The process involves altering the genetic material of a involves altering the genetic material of a single cell in a very small developing single cell in a very small developing embryo, which then develops into an entire embryo, which then develops into an entire organism, with the altered genetic material organism, with the altered genetic material in every cell.in every cell.

The basic strategy is to place the new The basic strategy is to place the new genetic material into the cell, and use the genetic material into the cell, and use the cell’s natural machinery to integrate this cell’s natural machinery to integrate this material into the genomematerial into the genome

There are several ways to There are several ways to conduct the process of genetic conduct the process of genetic

engineeringengineering One way is through horizontal gene transfer. One way is through horizontal gene transfer.

Horizontal gene transfer refers to the transfer of genes Horizontal gene transfer refers to the transfer of genes or genetic material directly from one individual to or genetic material directly from one individual to another by processes similar to infection. another by processes similar to infection.

"Somatic""Somatic" genetic engineering is genetic engineering genetic engineering is genetic engineering that targets the genes in specific organs and tissues of that targets the genes in specific organs and tissues of the body of a single existing person without affecting the body of a single existing person without affecting genes in their eggs or sperm. Somatic gene transfer genes in their eggs or sperm. Somatic gene transfer experiments are currently undergoing clinical trials, experiments are currently undergoing clinical trials, with mixed results to date.with mixed results to date.

"Germline""Germline" genetic engineering is genetic engineering genetic engineering is genetic engineering that targets the genes in eggs, sperm, or very early that targets the genes in eggs, sperm, or very early embryos. The alterations affect every cell in the body embryos. The alterations affect every cell in the body of the resulting individual, and are passed on to all of the resulting individual, and are passed on to all future generations. future generations.

The dangers, moral and ethical The dangers, moral and ethical questions raised by genetic questions raised by genetic

engineeringengineering Genetic engineering is inherently hazardous, Genetic engineering is inherently hazardous,

because it depends on designing artificial vectors because it depends on designing artificial vectors to cross all species barriers, greatly increasing the to cross all species barriers, greatly increasing the potential for generating new viral and bacterial potential for generating new viral and bacterial pathogens by horizontal gene transfer and pathogens by horizontal gene transfer and recombinationrecombination

Genetic engineering poses unprecedented ethical Genetic engineering poses unprecedented ethical and social concerns, as well as serious challenges and social concerns, as well as serious challenges to the environment, human health, animal to the environment, human health, animal welfare, and the future of agriculturewelfare, and the future of agriculture

Also concerns about the consequences of altering Also concerns about the consequences of altering a few select genes, since genes interact in very a few select genes, since genes interact in very complex ways, and we may not be able to predict complex ways, and we may not be able to predict all the consequences of any specific manipulation.all the consequences of any specific manipulation.

So what is gene therapy? So what is gene therapy? And how does it work?And how does it work?

Gene therapy is an experimental technique Gene therapy is an experimental technique that uses genes to treat or prevent diseasethat uses genes to treat or prevent disease

In the future, this technique may allow doctors In the future, this technique may allow doctors to treat a disorder by inserting a gene into a to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgerypatient's cells instead of using drugs or surgery

Gene therapy is designed to introduce genetic Gene therapy is designed to introduce genetic material into cells to compensate for abnormal material into cells to compensate for abnormal genes or to make a beneficial proteingenes or to make a beneficial protein

If a mutated gene causes a necessary protein If a mutated gene causes a necessary protein to be faulty or missing, gene therapy may be to be faulty or missing, gene therapy may be able to introduce a normal copy of the gene to able to introduce a normal copy of the gene to restore the function of the protein.restore the function of the protein.

A Diagram showing the A Diagram showing the

processprocess

A A genome-genome- is the totality of the genetic is the totality of the genetic material of a cell or organismmaterial of a cell or organism

VectorVector - A vector is a small piece of DNA used - A vector is a small piece of DNA used to carry a gene of interest. Besides the gene to carry a gene of interest. Besides the gene being studied, a vector may contain elements being studied, a vector may contain elements which are used to help the gene integrate into which are used to help the gene integrate into a genomea genome

RecombinationRecombination - The process in which - The process in which strands of DNA are cut open and rejoined. This strands of DNA are cut open and rejoined. This is done by a complex of proteins called DNA is done by a complex of proteins called DNA recombinase. Recombination can be used to recombinase. Recombination can be used to integrate the DNA from a vector into an integrate the DNA from a vector into an organism's genomeorganism's genome

Is gene therapy safe?Is gene therapy safe?

Gene therapy is under study to determine Gene therapy is under study to determine whether it could be used to treat diseasewhether it could be used to treat disease

Current research is evaluating the safety of Current research is evaluating the safety of gene therapy; future studies will test whether it gene therapy; future studies will test whether it is an effective treatment option. Several is an effective treatment option. Several studies have already shown that this approach studies have already shown that this approach can have very serious health risks, such as can have very serious health risks, such as toxicity, inflammation, and cancertoxicity, inflammation, and cancer

Because the techniques are relatively new, Because the techniques are relatively new, some of the risks may be unpredictable; some of the risks may be unpredictable; however, medical researchers, institutions, and however, medical researchers, institutions, and regulatory agencies are working to ensure that regulatory agencies are working to ensure that gene therapy research is as safe as possible.gene therapy research is as safe as possible.

What are the ethical issues What are the ethical issues surrounding gene therapy?surrounding gene therapy?

How can "good" and "bad" uses of gene therapy be distinguished? How can "good" and "bad" uses of gene therapy be distinguished? Who decides which traits are normal and which constitute a disability Who decides which traits are normal and which constitute a disability

or disorder? or disorder? Will the high costs of gene therapy make it available only to the Will the high costs of gene therapy make it available only to the

wealthy? wealthy? Could the widespread use of gene therapy make society less accepting Could the widespread use of gene therapy make society less accepting

of people who are different?of people who are different? Should people be allowed to use gene therapy to enhance basic human Should people be allowed to use gene therapy to enhance basic human

traits such as height, intelligence, or athletic ability?traits such as height, intelligence, or athletic ability? The idea of germline gene therapy is controversial. While it could spare The idea of germline gene therapy is controversial. While it could spare

future generations in a family from having a particular genetic future generations in a family from having a particular genetic disorder, it might affect the development of a fetus in unexpected ways disorder, it might affect the development of a fetus in unexpected ways or have long-term side effects that are not yet known.or have long-term side effects that are not yet known.

Because people who would be affected by germline gene therapy are Because people who would be affected by germline gene therapy are not yet born, they can't choose whether to have the treatment. not yet born, they can't choose whether to have the treatment. Because of these ethical concerns, the U.S. Government does not allow Because of these ethical concerns, the U.S. Government does not allow federal funds to be used for research on germline gene therapy in federal funds to be used for research on germline gene therapy in peoplepeople

Artificial Insemination-Artificial Insemination-Intrauterine Insemination (IUI)Intrauterine Insemination (IUI)

““Granddaddy” of fertility treatments. It dates Granddaddy” of fertility treatments. It dates back to the early 1900’s.back to the early 1900’s.

““First Line” treatment used before any other First Line” treatment used before any other Assisted Reproductive Technologies (ART’s) are Assisted Reproductive Technologies (ART’s) are used.used.

It is used when an unexplained fertility problem is It is used when an unexplained fertility problem is present.present.

Very simple procedure: only healthy sperm, and Very simple procedure: only healthy sperm, and delivery device, and a female to receive the delivery device, and a female to receive the sperm are needed.sperm are needed.

Much less invasive than other ART procedures Much less invasive than other ART procedures

Process Process

Female usually undergoes a cycle Female usually undergoes a cycle (at least one week) of Clomid or (at least one week) of Clomid or FSH to stimulate development of FSH to stimulate development of eggs.eggs.

Once ovulation occurs a sample of Once ovulation occurs a sample of sperm is collected either from sperm is collected either from father or from a sperm bank.father or from a sperm bank.

The sperm is then “washed.” The sperm is then “washed.” Which concentrates the hardiest Which concentrates the hardiest sperm and removes any potential sperm and removes any potential antigens that may cause allergic antigens that may cause allergic reactions in the female.reactions in the female.

The “washed” sperm in delivered The “washed” sperm in delivered directly to the uterus using a directly to the uterus using a catheter.catheter.

Two weeks later a simple over the Two weeks later a simple over the counter pregnancy test will counter pregnancy test will determine if the female is determine if the female is pregnant or not.pregnant or not.

AdvantagesAdvantages

-If the female has a sperm allergy-If the female has a sperm allergy -If the male has a low sperm count or poor sperm -If the male has a low sperm count or poor sperm

mobilitymobility -It allows fertilization to occur naturally inside the -It allows fertilization to occur naturally inside the

body unlike other ART’sbody unlike other ART’s -If antisperm anti bodies are present in vagina -If antisperm anti bodies are present in vagina

they are bypassed using catheterthey are bypassed using catheter -No father is needed, can acquire sperm from -No father is needed, can acquire sperm from

sperm banks.sperm banks. -Cost: average ranges between $300-$700 per -Cost: average ranges between $300-$700 per

cyclecycle

DisadvantagesDisadvantages

-Most couples only have a 5%-25% -Most couples only have a 5%-25% success rate using IUIsuccess rate using IUI

-May have to repeat process several -May have to repeat process several times to achieve pregnancytimes to achieve pregnancy

-Weak children may be a result due to -Weak children may be a result due to the fact that weaker sperm have a the fact that weaker sperm have a chance to chance to

reach the egg.reach the egg.

Human Cloning Human Cloning

Cloning is the Cloning is the reproduction of an reproduction of an individual single individual single cell taken from a cell taken from a donor or parent.donor or parent.

Somatic Cell Nuclear Transfer Somatic Cell Nuclear Transfer (Therapeutic Cloning) (Therapeutic Cloning)

Egg from female donor is Egg from female donor is taken and the nucleus is taken and the nucleus is removed creating an removed creating an enucleated egg.enucleated egg.

A somatic cell (non-A somatic cell (non-reproductive cell) is then reproductive cell) is then fused together with the fused together with the enucleated egg producing enucleated egg producing an embryo.an embryo.

The embryo is implanted The embryo is implanted into the surrogate mother into the surrogate mother using in vitro fertilization.using in vitro fertilization.

If it is a success, nine If it is a success, nine months later an exact months later an exact clone of the somatic cell clone of the somatic cell donor is created.donor is created.

After hundreds of After hundreds of attempts Dolly the attempts Dolly the sheep was created. sheep was created. After a short life of After a short life of 6 years she was 6 years she was put to sleep after put to sleep after suffering from a suffering from a progressive lung progressive lung disease. disease.

Questions raised:Questions raised:

Scientists are concerned that the clone Scientists are concerned that the clone will have cells that are the same age as will have cells that are the same age as the donor cells.the donor cells.

Will parents try to live the life they Will parents try to live the life they weren’t able to through their exact weren’t able to through their exact clone?clone?

Will knowing that they are not only a Will knowing that they are not only a child but also a sister/brother of child but also a sister/brother of parents emotionally damage the clone?parents emotionally damage the clone?

Assisted Reproductive Assisted Reproductive Technology (ART)Technology (ART)

Most ART procedures are recommended in cases of Most ART procedures are recommended in cases of ovulation problems, blocked fallopian tubes, low sperm ovulation problems, blocked fallopian tubes, low sperm count in partner, and if other treatment method are count in partner, and if other treatment method are unsuccessful.unsuccessful.

Doctor prescribes fertility drugs prior to ART procedures to Doctor prescribes fertility drugs prior to ART procedures to stimulate ovaries to develop several mature eggs for stimulate ovaries to develop several mature eggs for fertilization. The doctor will then monitor blood hormone fertilization. The doctor will then monitor blood hormone levels to detect when the eggs are mature.levels to detect when the eggs are mature.

Since the sperm is put in the direct vicinity of the eggs in a Since the sperm is put in the direct vicinity of the eggs in a dish it is possible to achieve fertilization with a lower than dish it is possible to achieve fertilization with a lower than average sperm count.average sperm count.

Since more than one embryo may be implanted there is a Since more than one embryo may be implanted there is a higher possibility of multiple birth pregnancies than with higher possibility of multiple birth pregnancies than with natural child birth.natural child birth.

In Vitro Fertilization In Vitro Fertilization (IVF)(IVF)

A procedure in which a sperm and oocyte are combined A procedure in which a sperm and oocyte are combined in a laboratory dish and implanted in the uterus.in a laboratory dish and implanted in the uterus. IVF is the most common ART procedure used, accounting for IVF is the most common ART procedure used, accounting for

more than 70% of ART procedures.more than 70% of ART procedures. In the past eggs were retrieved using a laparoscopy procedure; In the past eggs were retrieved using a laparoscopy procedure;

however, due to advancements in technology eggs are now however, due to advancements in technology eggs are now retrieved vaginally with the use of an ultrasound to determine the retrieved vaginally with the use of an ultrasound to determine the location of the eggs.location of the eggs.

After about 2-5 days the fertilized eggs form an embryo and are After about 2-5 days the fertilized eggs form an embryo and are then implanted in the uterus, using a catheter, to develop then implanted in the uterus, using a catheter, to develop naturally.naturally.

Treatment takes about six weeks to complete.Treatment takes about six weeks to complete.

Gamete Intrafallopian Transfer Gamete Intrafallopian Transfer (GIFT)(GIFT)

A procedure similar to IVF but in GIFT the eggs A procedure similar to IVF but in GIFT the eggs and sperm are transferred into the fallopian tubes and sperm are transferred into the fallopian tubes immediately after the two are mixed. There is no immediately after the two are mixed. There is no time given for the eggs to be fertilized before the time given for the eggs to be fertilized before the transfer.transfer. GIFT accounts for about 2 percent of ART procedures.GIFT accounts for about 2 percent of ART procedures. The egg and sperm mixture are implanted in the The egg and sperm mixture are implanted in the

fallopian tubes using a laparoscopy procedure.fallopian tubes using a laparoscopy procedure. One cycle of GIFT takes about six weeks.One cycle of GIFT takes about six weeks. GIFT is the closest ART procedure to natural childbirth.GIFT is the closest ART procedure to natural childbirth.

Zygote Intrafallopian Transfer Zygote Intrafallopian Transfer (ZIFT)(ZIFT)

Similar to GIFT except the egg is fertilized Similar to GIFT except the egg is fertilized before it is placed in the fallopian tubes.before it is placed in the fallopian tubes. ZIFT also referred to as tubal embryo transfer (TET).ZIFT also referred to as tubal embryo transfer (TET). It is different from IVF since the embryo is placed in It is different from IVF since the embryo is placed in

the fallopian tubes instead of the uterus.the fallopian tubes instead of the uterus. Only accounts for one percent of ART procedures.Only accounts for one percent of ART procedures. Zygotes are transplanted about one day after Zygotes are transplanted about one day after

fertilization.fertilization. If the treatment is successful the zygote will travel to If the treatment is successful the zygote will travel to

the uterus and implant itself, where it will develop.the uterus and implant itself, where it will develop.

Frozen Embryo Transfer Frozen Embryo Transfer (FET)(FET)

Frozen embryos can be frozen after 24-72 Frozen embryos can be frozen after 24-72 hours in a culture.hours in a culture.

Frozen embryos can be stored for several Frozen embryos can be stored for several years.years.

Embryos will be thawed and replaced in the Embryos will be thawed and replaced in the uterus once ovulation is identified by a doctor uterus once ovulation is identified by a doctor or when the endometrium is thick enough.or when the endometrium is thick enough.

Not all embryos survive the freezing, storage, Not all embryos survive the freezing, storage, and thawing processes.and thawing processes.

Thawed embryos are implanted in the uterus Thawed embryos are implanted in the uterus using a catheter.using a catheter.

Intracytoplasmic Sperm Intracytoplasmic Sperm Injection (ICSI)Injection (ICSI)

This procedure was introduced in 1982, and This procedure was introduced in 1982, and continues to be a popular treatment in treating continues to be a popular treatment in treating male infertility.male infertility. ICSI is prescribed in cases of low sperm count, missing ICSI is prescribed in cases of low sperm count, missing

vas deferens, or irreversible vasectomy.vas deferens, or irreversible vasectomy. The male provides the doctor with a sperm sample by The male provides the doctor with a sperm sample by

ejaculation. However, if there is not enough sperm in ejaculation. However, if there is not enough sperm in ejaculate the doctor may remove sperm from the ejaculate the doctor may remove sperm from the testicles using a needle or perform a biopsy of the testicles using a needle or perform a biopsy of the testicular tissue.testicular tissue.

There is concern for the long term health and There is concern for the long term health and development of children conceived by ICSI since it development of children conceived by ICSI since it enables weaker sperm to fertilize eggs.enables weaker sperm to fertilize eggs.

Surrogate MotherhoodSurrogate Motherhood

Surrogate mothers are women who carry a child for a Surrogate mothers are women who carry a child for a mother who is unable to conceive with the intention of mother who is unable to conceive with the intention of giving the child up once it is born.giving the child up once it is born. Also known as ersatz mothersAlso known as ersatz mothers Surrogate pregnancies are conceived through artificial Surrogate pregnancies are conceived through artificial

insemination.insemination. In gestational surrogacy the surrogate mother is implanted In gestational surrogacy the surrogate mother is implanted

with the real parent’s embryo using an IVF procedure.with the real parent’s embryo using an IVF procedure. Some gay male couples use surrogate mothers to have Some gay male couples use surrogate mothers to have

children that are biologically related to at least one of the children that are biologically related to at least one of the partners.partners.

Surrogate mothers usually receive compensation for carrying Surrogate mothers usually receive compensation for carrying the child.the child.

There are many ethical and legal concerned with this process There are many ethical and legal concerned with this process since some surrogate mothers grow attached to the fetus and since some surrogate mothers grow attached to the fetus and sue for custody of the child they carried. The most publicized sue for custody of the child they carried. The most publicized case is that of Baby M.case is that of Baby M.

Storage of gametes and Storage of gametes and embryos – Sperm embryos – Sperm

cryopreservation & cryopreservation & embryo cryopreservation embryo cryopreservation Gamete is a sex cell containing the Gamete is a sex cell containing the

genetic material necessary for genetic material necessary for reproductionreproduction

Embryo is the early form of life in the Embryo is the early form of life in the uterus between the stages of uterus between the stages of blastocyst and fetusblastocyst and fetus

Cryopreservation is a process to Cryopreservation is a process to store gametes or embryos by store gametes or embryos by freezing them at low temperaturesfreezing them at low temperatures

Sperm cryopreservation & Sperm cryopreservation & Embryo cryopreservationEmbryo cryopreservation

Collect semen from self-masturbationCollect semen from self-masturbation More portions of semen can be More portions of semen can be

cryopreserved. This so-called “test cryopreserved. This so-called “test thaws” will be warmed up to verify thaws” will be warmed up to verify successsuccess

Retrieve egg under ultrasound guidanceRetrieve egg under ultrasound guidance Embryo can be frozen at any stageEmbryo can be frozen at any stage Both sperm and embryo are stored in Both sperm and embryo are stored in

liquid nitrogen, around -196Cliquid nitrogen, around -196C

Benefits from Sperm & Benefits from Sperm & Embryo cryopreservationEmbryo cryopreservation

People facing surgery, radiation therapy or People facing surgery, radiation therapy or chemotherapy for cancer or other medical chemotherapy for cancer or other medical operations that can make them sterileoperations that can make them sterile

If a male partner is expected to be away, If a male partner is expected to be away, cryopreserved sperm can be used in time for cryopreserved sperm can be used in time for optimal inseminationoptimal insemination

Cryopreservation can help people with internal Cryopreservation can help people with internal problem such as cervical stenosisproblem such as cervical stenosis

Frozen sperm or embryos can be donated to Frozen sperm or embryos can be donated to infertile couplesinfertile couples

Lesbian couples who wants a child from Lesbian couples who wants a child from cryopreservation method if they don’t desire cryopreservation method if they don’t desire sexual relationship with a male partnersexual relationship with a male partner

Problems of Sperm & Problems of Sperm & Embryo CryopreservationEmbryo Cryopreservation

Not all sperms and embryos can survive Not all sperms and embryos can survive the freezing and thawing processthe freezing and thawing process

Pregnancy rate using frozen sperm or Pregnancy rate using frozen sperm or embryo may have lower chance compared embryo may have lower chance compared to using fresh sperm or embryoto using fresh sperm or embryo

No apparent birth defects from using No apparent birth defects from using frozen-thawed sperm but it is not sure frozen-thawed sperm but it is not sure whether problems will not appear in the whether problems will not appear in the futurefuture

Chance of possible infection with a Chance of possible infection with a bacteria or virusbacteria or virus

Choices and Moral IssuesChoices and Moral Issues

Couples have choices to:Couples have choices to: continue to store themcontinue to store them arrange for the transfer treatment cycle before expirationarrange for the transfer treatment cycle before expiration discard them by interfering during the thawing process discard them by interfering during the thawing process donate them to approved research facility or to infertile donate them to approved research facility or to infertile

couple. couple. Most countries have different policies on how long sperm & Most countries have different policies on how long sperm &

embryo can be stored, United Kingdom is 10 yearsembryo can be stored, United Kingdom is 10 years Moral issues surrounding the cryopreservation process:Moral issues surrounding the cryopreservation process:

the fate of cryopreserved sperm or embryo on the death of the fate of cryopreserved sperm or embryo on the death of couple who preserved themcouple who preserved them

ownership of the sperm or embryos if the couple separates, ownership of the sperm or embryos if the couple separates, safety of sperm & embryo cryopreservationsafety of sperm & embryo cryopreservation

a possible detrimental effect on the outcome of cryopreserved a possible detrimental effect on the outcome of cryopreserved sperm & embryo transfer and possible increase in fetal sperm & embryo transfer and possible increase in fetal abnormalities after long period of cryopreservation. abnormalities after long period of cryopreservation.

Fertility Drug Fertility Drug TreatmentsTreatments

WHAT ARE THEY FOR?WHAT ARE THEY FOR?

WomenWomen Treat irregular ovulationTreat irregular ovulation Help those who do not ovulate at allHelp those who do not ovulate at all Polycystic ovarian syndrome (PCOS)Polycystic ovarian syndrome (PCOS) Men with hormonal imbalancesMen with hormonal imbalances Low sperm countLow sperm count Poor sperm quality or motilityPoor sperm quality or motility Primary hypogonadotrophic hypogonadismPrimary hypogonadotrophic hypogonadism

TYPESTYPES

ClomipheneClomiphene Oral PillOral Pill GondotropinsGondotropins ShotShot BromocriptineBromocriptine Oral or Vaginal PillOral or Vaginal Pill

HOW LONG IS THE HOW LONG IS THE TREATMENT?TREATMENT?

Clomiphene- You start 3 to 5 days Clomiphene- You start 3 to 5 days into your cycle and continue for into your cycle and continue for about 5 daysabout 5 days

Gonadotrophins- 7 to 12 days each Gonadotrophins- 7 to 12 days each monthmonth

Bromocriptine- 2 to 3 times a day Bromocriptine- 2 to 3 times a day until you get pregnantuntil you get pregnant

POSSIBLE SIDE EFFECTSPOSSIBLE SIDE EFFECTS

BloatingBloating Fluid retentionFluid retention Weight gainWeight gain NauseaNausea DizzinessDizziness FatigueFatigue DiarrheaDiarrhea headachesheadaches Abdominal tendernessAbdominal tenderness Stomach painStomach pain Brest tendernessBrest tenderness Blurred visionBlurred vision IrritabilityIrritability DepressionDepression

CAN THEY CAUSE CAN THEY CAUSE CANCER?CANCER?

BeliefsBeliefs

1999 & 2000 studies1999 & 2000 studies

SUCCESS RATESSUCCESS RATES

It varies by treatment:It varies by treatment: Clomiphene- 80 percent ovulate of this 40 Clomiphene- 80 percent ovulate of this 40

percent get pregnantpercent get pregnant Gonadotrophins- 20 to 60 percent conceiveGonadotrophins- 20 to 60 percent conceive Bromocriptine- 90 percent ovulate, 65 to 85 Bromocriptine- 90 percent ovulate, 65 to 85

percent get pregnantpercent get pregnant COSTCOST Clomiphene- $50 on one cycle of ClomidClomiphene- $50 on one cycle of Clomid Gonadotrophins- $2,000 to $5,000 per cycleGonadotrophins- $2,000 to $5,000 per cycle Bromocriptine- $75 to $112 on one cycleBromocriptine- $75 to $112 on one cycle

* This is in the United States.* This is in the United States.

SEX SELECTIONSEX SELECTION

QUICK FACTSQUICK FACTS

Males and FemalesMales and Females Carry 23 pairs of chromosomesCarry 23 pairs of chromosomes Difference between males and femalesDifference between males and females Lies in the 23rd chromosomeLies in the 23rd chromosome Girls have two X chromosomesGirls have two X chromosomes Boys have one X and one Y Boys have one X and one Y

chromosomechromosome

IDENTIFYING THE SEXIDENTIFYING THE SEX

Before implanting the embryo into Before implanting the embryo into the mother, a fertility doctor stains the mother, a fertility doctor stains the chromosomes.the chromosomes.

The x chromosome will be a different The x chromosome will be a different color than the Y chromosome.color than the Y chromosome.

Under the microscope, the doctor Under the microscope, the doctor can easily tell whether the embryo is can easily tell whether the embryo is male or female.male or female.

THREE MAIN TECHNIQUESTHREE MAIN TECHNIQUESOF SEX SELECTIONOF SEX SELECTION

Sperm Sorting Before ConceptionSperm Sorting Before Conception

Preimplantation Genetic Diagnosis Preimplantation Genetic Diagnosis (PGD)(PGD)

MicrosortMicrosort

SPERM SORTING BEFORE SPERM SORTING BEFORE CONCEPTIONCONCEPTION

Sperm sorting can be carried out Sperm sorting can be carried out either by putting live sperm in a either by putting live sperm in a dense liquid and spinning it in a dense liquid and spinning it in a centrifuge to separate sperm centrifuge to separate sperm carrying the X chromosome and carrying the X chromosome and those carrying the Y chromosome.those carrying the Y chromosome.

PRE-IMPLANTATION PRE-IMPLANTATION GENETIC DIAGNOSISGENETIC DIAGNOSIS

This procedure is carried out before This procedure is carried out before the embryo is transferred into the the embryo is transferred into the woman.woman.

A cell is removed from the embryo A cell is removed from the embryo for genetic testing to detect X or Y for genetic testing to detect X or Y chromosomes.chromosomes.

It is more controversial technique It is more controversial technique than sperm sorting because it than sperm sorting because it involves embryos.involves embryos.

MICROSORTMICROSORT

This procedures involves using a This procedures involves using a fluorescent dye which binds to DNA fluorescent dye which binds to DNA in chromosomes in the semen in chromosomes in the semen sample, allowing the sperm to be sample, allowing the sperm to be separated using a laser.separated using a laser.