Transcript Infertility and its Treatments

Infertility and Its Treatments
By: Jaimie Studenski, Jessi Ackerman and Melanie Dettmer
Infertility-what is it?
• When a woman fails to get pregnant after a year of unprotected sexual
intercourse, or after 6 months if the woman is over 35. This also includes
being unable to carry a pregnancy to live birth.
• There are two types of infertility:
1. Primary Infertility-difficulty conceiving when the couple has no previous children
2. Secondary Infertility-difficulty conceiving when at least one partner has previous
children
• 10.2% of women and 12.9% of married women have fertility issues
• 40% has been traced back to problems on the male’s part, 40% has been
traced back to problems on the female’s part, 10% is linked to both
partners, and 10% remains unknown
Infertility-Female Causes
1. Failure to Ovulate
•
•
•
•
Hormonal Problems
Scarred Ovaries
Premature Menopause
Follicle Problems
2. Poorly Functioning Fallopian
Tubes
•
•
•
•
•
Infection
Abdominal Diseases
Previous Surgeries
Ectopic Pregnancy
Congenital Defects
3. Endometriosis
4. Additional Factors
• Other Variables
 Abnormal uterus
 Congenital abnormalities, such as septate uterus
 Abnormal cervical mucous
• Behavioral Factors
 Diet and Exercise
 Smoking
 Alcohol
 Drugs
• Environmental Factors
 Lead
 Medical Treatments and Materials such as
radiation
 Ethylene Oxide
 Dibromochloropropane (DBCP)
Infertility-Male Causes
3.
1. Hormonal Problems
•
•
•
•
•
Hyperprolactinemia
Hypothyroidism
Congenital Adrenal Hyperplasia
Hypogonadotropic Hypopituitarism
Panhypopituitafism
2. Psychological/Physical/ Behavioral
Problems
• Erectile Dysfunction (ED)
• Premature Ejaculation
• Ejaculatory Incompetence
4.
Physical Problems
•
•
•
•
•
•
Varicocele
Damaged Sperm Ducts
Torsion
Infection and Disease
Klinefelter’s Syndrome
Retrograde Ejaculation
Environmental Factors
•
•
•
•
•
•
•
•
Smoking/Alcohol/Drug Use
Steroid use
Overly intensive exercise
Tight underwear
Exposure to environmental hazards
Malnutrition and anemia
Inadequate Vitamin C and Zinc
Excessive stress
Infertility Treatment for Women and Men
Women
• Women who have problem with ovulation can try medicine such as
clomiphene and metformin.
• If a woman has unexplained infertility they can take Clomiphene,
receive hormone injections, or insemination.
• If fallopian tubes are blocked, treatment may include tubal surgery.
• If a woman has mild endometriosis, they could have laparoscopic
surgery. It might not be an option for severe endometriosis
Men
• Suggested to try insemination
Assisted Reproductive Technology
• In vitro fertilization (IVF)- fertilized eggs or eggs inserted in woman’s
uterus through cervix
• Intracytoplasmic sperm injection(ICSI)-Injects one sperm into one egg
in the lab. If fertilization occurs-it is implanted into the women’s
uterus
Natural Treatments
• Nutrition
• Remove carbohydrates from grains, processed foods, sugars and starches and instead get them
from vegetables, fruits, sweet potatoes and squash.
• Increase healthy fats
• Get enough protein
• Eat a lot of vegetables
• Avoid processed dairy and instead have organic dairy such as butter, ghee, and heavy cream
• Drink lots of water
• Control insulin levels
• Lifestyle Factors
• •Lack of sleep, exposure to toxins, lack of exercise or too much exercise, high stress levels, and
certain medications or supplements
• Supplements
• Vitamin D, Vitamin C, Folic Acid, Zinc, Selenium, B-vitamins
• Red Raspberry Leaf, Nettle Leaf, Dandelion, Alfalfa, Red Clover, Maca, Vitex/Chaste Tree Berry,
Natural Progesterone Cream
Social Issues
• Negative impact on self-esteem and increased risk of depression
• Feel as if having a child is important art of life plan, infertility is a major life problem
• People who have children from past relationships feel desperate to conceive with
current partner
• Life has been put on hold, body is failing
• Infertility in Western World
• Studies show involuntary childlessness has multiple psychological and psychosomatic
effects-especially women
• Distress, depression, anxiety, reduced self esteem, somatic issues, reduced sex drive, sense of
blame and guilt
• Studies show elderly people with no children have less social support and framework
for independent living
• Impact communication with family and friends that have children
• Coping strategy is participating in care of others children, 10% of couple adopt this strategy
Social Issues
• Infertility in Developing Countries
• Not as many psychological effect as in the Western World, main issues are
social and cultural effects
• Women view lives as hopeless if childless
• Face discrimination in many cultures
• Ostracism and stigma if childless
• Viewed as “non-human” or cursed
• Little to no availability for infertility services and IVF is often unaffordable
• Lack of support emotionally and financially
• Sub-Saharan Africa women are not encourage by male partners to get modern fertility
treatments, so women seeking fertility help often have unavailability of these services
and no support from their significant other
Ethical Issues
• Multiple Pregnancy
• IVF increases the chance of two or more fetuses developing, thus increasing
the risk of premature babies, infant health problems and low birth weight
• Embryos
• Clinics freeze additional fertilized eggs that are not implanted for future
attempts. People need to consider what do with eggs in case of death,
divorce, or if the clinic isn’t able to contact them.
• Donor Egg/Sperm of surrogacy
• Rights and responsibilities defined for both the surrogate and the couple for
the future child
Ethical Issues
• Embryo Creation, Selection, and Disposition
• Infertility treatments are expensive and often not covered by insurance-this could deter lower income families
from access to these resources
• Since payment is so high, encourages implanting many embryos at one time and creating more than what the
couple will need to reduce cost and extra chance of carrying one to term
• Use of preimplantation genetic diagnosis(PGD) for selecting characteristics of the embryo to implant
• Cost, Coverage, and Access
• Infertility clinics don’t have any regulations for cost, access, or quality of treatments
• Cost of IVF Cycle is $12,400
• Debate on whether insurance should cover infertility treatment-if so does this suggest conceiving a biological
child is preferable to adoption
• Theorists argue that procreation and parenting are important to one’s identity and life goals rather than a
luxury
• Resource Allocation
• Law, policies, and practices of ARTs developed separately from state and the national child welfare systems
• Unregulated infertility treatments result in difficult pregnancies with multiple babies that may have been
avoided if there was more conservative implantation practices to help conditions that cause infertility in the
first place
Ethical Issues-Sperm Donation
• Sperm Donor Rights
• Donor anonymity
• Client Rights
• Can be informed about limitations and complications involved with sperm donation, sperm bank
can’t guarantee disease free or no genetic abnormalities in sperm. The client(s) must also be fully
responsible for any offspring conceived with the donated sperm
• Sperm donor and client rights established through a consent form. The form indicates that the
client understand their rights and rights of sperm donor.
• Choosing Sperm
• All sperm banks are highly selective, but some more than others. California Cyrobank only accepts
graduates from major 4-year university who are also tall, trim, heterosexual, and between 19 and
34 years old. Repository of Germinal Choice only accepted sperm from Nobel prize winners.
• This raises ethical concerns abut eugenics
• How Much Sperm Can Be Donated?
• Sperm banks have a limitation on how many children a donor can produce-a maximum of ten
children
Ethical Issues-Egg Donation
• Autonomy
• Quality of consent-payment and high financial payouts
• Studies show that women who donate eggs for financial reasons suffer more emotional harm and more likely to regret the decision
• With the technical terminology, donors may not fully understand potential risks and treatment options without a background in
biology and medicine
• Justice
• Shortage of egg donors, upper class women can afford more advertising, compensation, and agency fees then lower class women
• Infertility doctors have to do all they can to ensure a successful pregnancy, but with the shortage of eggs, donor recruitment is
necessary. This causes a conflict of interest because they need to encourage donation for their patients but also have to protect the
health of donors who would otherwise not be involved in the risks of the procedure.
• Beneficence and Non-maleficence
• These principles require that egg donation is performed for purpose of improving the health of the patient and preventing harm.
However, there is already maleficence because the donors do not get any clinical benefit. This brings to light on whether to place a
donor at risk for harm is justifiable for the benefit of an infertile patient.
• Side effects for ovulation enhancing drugs is not completely known-may be risk of ovarian cancer, ovarian hyperstimulation
syndrome, lacerations, and ovarian cancer
Ethical Issues In Other Countries
• Anonymity for donors in Greece but not in the UK
• Many countries allow embryo to develop for a certain number of days to pick the healthiest one for
implantation, but some countries only use early embryos
• Paying a surrogate is not allowed in many countries but is legal in India
• Spain and Canada can store embryos for an unlimited time, but in Brazil they can only be stored for 3 years
• Genetic screening before implantation is completely banned in some countries but have strict
regulations(but still can be used) in others
• Many countries there is a limit to only one embryo being implanted, however in other countries it is up to
the doctor
• Iceland has the frozen sperm destroyed if the male dies, but in Belgium sperm can be used for future
treatment if written permission is given
• Catholic Church believes life begins at conception and allows fertilization if all viable embryos are implanted,
others wait a few weeks later and only pick the healthiest embryos and destroy the rest
Infertility Myths
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
It's easy for most women to get pregnant
Men don't have infertility problems
Infertility is a psychological -- not physical -- problem
Couples who "work" hard enough at having a baby will eventually get pregnant
Once a couple adopts a child, the woman will become pregnant
Husbands often leave their wives if they're infertile
You need to orgasm in order to conceive
Lifting your legs in the air for 20 minutes after having sex will help you get pregnant
Doing it missionary style is the only way to conceive
Eating yams while trying to conceive will cause twins
Chugging cough syrup will help you conceive
Being on the Pill for too long will delay pregnancy
Works Cited:
• "7 Myths About Infertility." Parents Magazine. Parents Magazine, 2015. Web. 7 Nov. 2015.
• "10 Crazy Fertility Myths -- Debunked - Getting Pregnant - Myths & Superstitions." 10 Crazy Fertility Myths -Debunked - Getting Pregnant - Myths & Superstitions. The Bump, 2015. Web. 7 Nov. 2015.
• Asch, Adrienne, and Rebecca Marmor. "Assisted Reproduction." The Hastings Center. The Hastings Center,
2015. Web. 7 Nov. 2015.
• "How to Naturally Reverse Infertility & Get Pregnant Naturally." Wellness Mama. Wellness Mama, 2015.
Web. 15 Nov. 2015.
• "Infertility: Ethical and Legal Concerns-Topic Overview." WebMD. WebMD, 30 Sept. 2014. Web. 7 Nov. 2015.
• "Infertility Treatment: An Overview." Infertility Treatment: An Overview. Stanford University, 2015. Web. 7
Nov. 2015.
• Robertson, Sally. "Infertility Ethics." News-Medical. News-Medical, 18 May 2010. Web. 7 Nov. 2015.
• Robertson, Sally. "Infertility Social Impact." News-Medical. News-Medical, 18 May 2010. Web. 7 Nov. 2015.
• "What Are Infertility Treatments? Types, Benefits, Risks, and More." WebMD. WebMD, Jan. 2014. Web. 7
Nov. 2015.