Is a process by which egg cells are fertilized by sperm outside the body. In vitro.

. PROCESSES: hormonally controlling the ovulatory process, removing ova (eggs) from the womans ovaries letting sperm fertilize them in a fluid medium. The fertilized egg (zygote) is then transferred to the patients uterus.

 The term in vitro, from the Latin root meaning within the glass. Artificial insemination, or AI, is a fertilization procedure in which sperm is artificially placed into a womans cervix (intracervical insemination) or uterus (intrauterine insemination).

 The womans menstrual cycle is closely monitored using ovarian kits, ultrasounds, and blood tests. The semen to be implanted is washed in a laboratory, which increases the chances of fertilization while removing unnecessary potentially harmful chemicals. The semen is inserted into woman, and if the procedure is successful, she conceives.

 Infertility of Female related to advance maternal age. Damaged or blocked fallopian tubes (can caused by pelvic inflammatory disease or reproductive surgery). Endometriosis. Infertility of Male including decreased sperm count or blockage.

 Health Ova. Sperm that can fertilized. Uterus that ca maintain a pregnancy.

OVARIAN STIMULATION

1.OVARIAN STIMULATION
Treatment cycles are started on the 3rd day of menstruation Fertility medications are prescribed to control the timing of the egg ripening and to increase the chance of collecting multiple eggs during one of the woman's cycles. (GnRH, LH and hCG). Egg development is monitored using ultrasound to examine the ovaries and urine or blood test samples to check hormone levels. Approximately 10 days of injections will be necessary.

EGG RETRIEVAL

2.EGG RETRIEVAL EGG

When maturation is adequate, hCG is given. The eggs are retrieve from the patient using a transvaginal technique, a minor surgery which also called FOLLICULAR ASPIRATION. This uses ultrasound imaging to guide a hollow needle through the pelvic cavity. Through this needle follicles can be aspirated. The follicular fluid is handed to the IVF laboratory to identify ova. It is common to remove between 10 and 30 eggs. The procedure takes about 20 minutes and sedation and local anaesthesia are provided to remove any discomfort that the patient might experience.

EGG AND SPERM PREPARATION

3.EGG AND SPERM PREPARATION

In the laboratory, the identified eggs are prepared for fertilization. Oocyte selection may be performed. Sperm washing is done. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined and it will be thawed for use.

FERTILIZATION

4.FERTILIZATION
The sperm and egg is incubated together at a ratio of about 75,000:1 in the culture media for about 18 hours which enables fertilization to occur. Fertilized egg will show 2 pronuclei. The fertilized egg is passed to a special growth medium and leave for about 48 hours until the egg consists of 6-8 cells. In some cases where fertilization is suspected to be low, intracytoplasmic sperm injection (ICSI) may be used.

EMBRYO CULTURE

5. EMBRYO CULTURE
Embryos are cultured until having reached the 6-8 cells stage 3 days after the retrieval. Laboratory staff will regularly check the embryo to make sure it is growing properly. Within about 5 days, a normal embryo has several cells that are actively dividing. Blastocyst stage transfers have been shown to result in high pregnancy rates.

EMBRYO SELECTION

6.EMBRYO SELECTION
Laboratories have developed grading methods to judge oocyte and embryo quality. Morphological scoring system is the best strategy for the selection of the embryos. PREIMLANTATION GENETIC DIAGNOSIS (PGD) or screening may be performed prior to transfer in order to avoid inheritable diseases. PGD, diagnosis the specific molecular defect of the inherited disease while PGS screens for numeral chromosomal abnormalities.

EMBRYO TRANSFER

7.EMBRYO TRANSFER
Embryos are graded by the embryologist based on the number of cells, evenness of growth and degree of fragmentation. The number to be transferred depends on the number available, the age of the woman and other health diagnostic factors. The embryos judge to be the best are transferred to the patients uterus through a thin, plastic catheter, which goes through her vagina and cervix. Several embryos may be passed into the uterus to improve chances of implantation and pregnancy.

 These steps are followed by rest and watching for early pregnancy symptoms. A blood test and potentially an ultrasound will be used to determine if implantation and pregnancy has occurred.

 CRYOPRESERVATION if multiple embryos are generated, patients may choose to freeze embryos that are not transferred. Those embryos are slow frozen and then placed in liquid nitrogen and can be preserved for a long time.

Are there variations of in vitro fertilization?

Gamete intrafallopian transfer (GIFT) and Zygote intrafallopian transfer (ZIFT) are two procedures related to IVF. GIFT is similar to IVF, but the gametes (egg and sperm) are transferred to the fallopian tubes rather than the uterus, and fertilization takes place in the tubes rather than in the laboratory. GIFT also involves a laparoscopic surgical procedure to transfer the sperm and egg into the tubes. GIFT accounts for approximately 2% of assisted reproductive technology (ART) procedures in the United States.

 ZIFT differs from GIFT in that the fertilization process still takes place in the laboratory versus the fallopian tubes. It is similar to GIFT in that the fertilized egg is transferred into fallopian tubes, and it involves a laparoscopic surgical procedure. ZIFT accounts for less than 1.5% of assisted reproductive technology (ART) procedures in the United States.

 According to the Society of Assisted Reproductive Technologies (SART) the approximate chance of giving birth to live a baby after IVF as follows: 41 43% for women under age 35. 33 36% for women age 35 37. 23 27% for women age 38 40. 13 18% for women over age 41.

 Potential factors that may influence pregnancy ( and live birth rates of IVF): 1. Stress 2. Accupuncture 3. Level of DNA fragmentation and semen quality 4. Smoking 5. Ideal body mass index is 19 -30 6. Salpingectomy 7. Optimal womans age is 23 39 years at time of treatment 8. Success with previous pregnancy and/or live birth increase chances. 9. Low alcohol/caffeine intake increases success rate.

Benefit for the infertile couple to have a baby. Gives opportunity to those who wanted to be parent/s regarding their status in life. No sexual intercourse done. 30% assurance.

 Costly.  Risk for multiple births and prematurity.  Risk for miscarriage and other complications.  25% of pregnancies results to spontaneous abortion.  Risk for the mothers health.  Side effects of fertility medications.  Multiple required procedures including injection of medications.  Risks of egg retrieval include reactions to anesthesia, bleeding, infection, and damage to structures surrounding the ovaries including the bowel and bladder.

 From the Catholic Church teaching, A human being comes into existence at the moment of fertilization of an Oocyte (ovum) by a sperm. The church teaches that a human being must be respected as a person from the very first instant of his existence as a human being, therefore from that same moment, his rights as a person must be recognized among which in the first place, is the inviolable right of every innocent human being in life.

 Moral point of view a truly responsible procreation in relation to the unborn child, must be the fruit of marriage.

 Government agencies in China passed bans on the use of IVF in 2003 by unmarried women or by couples with certain infectious diseases. Sunni Muslim nations generally allow IVF between married couples when conducted with their own respective sperm and eggs, but not with donor eggs from other couples.

 The nation of Costa Rica has a complete ban on all IVF technology, it having been ruled unconstitutional by the nation's Supreme Court because it "violated life." A Victorian federal court had ruled in 2000 that the existing ban on all single women and lesbians using IVF constituted sex discrimination.

 The US state of Tennesse proposed a bill in 2009 that would have defined donor IVF as adoption. During the same session another bill proposed barring adoption from any unmarried and cohabitating couple, and activist groups stated that passing the first bill would effectively stop unmarried people from using IVF. In Philippines, there is implementation of IVF especially in the area of metro manila on designated hospitals:

Asian Hospital and Medical Center Medical City Manila Doctor s Hospital St. Luke s Medical Center

 In a few cases, laboratory mix-ups (misidentified gametes, transfer of wrong embryos) have occurred, leading to legal action against the IVF provider and complex paternity suits. Pregnancy past menopause Same-sex couples, single and unmarried parents

Example: Carolyn Savage, Ohio Woman Implanted With Wrong Embryo, Gives Birth.

SOCIAL AND PHYSICAL STRESSES ON WOMEN:

Discomfort and inconvience, and one hopes that the technology will be improved with time, but the administration of drugs with unknown long term effects and potential for harm to the women receiving them is a continuing problem.

AVOIDING HARM AND DOING GOOD

The harm principle, which probably is being violated in the use of infertility therapies, is entirely insufficient as a basis for the ethics of health care professionals. Doing good should be the central principle guiding their behavior.

QUESTIONS OF AUTONOMY AND JUSTICE

Respect for autonomy should not be violated in the interest of doing good. This principle includes a very strong requirement for informed consent.

THE TREATMENT OF EMBRYOS AND FETUSES

The technique is effective, but with high rates of miscarriage, early preterm rupture of membrane. Higher rates of preterm birth and growth restriction.

 Whatever the metaphysical status of the pre-embryo, embryo, or fetus, he or she represents a human life. IVF seemed like a good idea at the time. Now we are discarding embryos, freezing them, creating them, fighting over them in lawsuits as property, manipulating them, cloning them, flushing them out for genetic scrutiny. All of this may be legal, but are we sure that it is ethical?