In whose interest? Policy and politics in assisted reproduction

This paper interprets the British legislative process that initiated the first comprehensive national regulation of embryo research and fertility services and examines subsequent efforts to restrain the assisted reproduction industry. After describing and evaluating British regulatory measures, I consider successive failures to control the assisted reproduction industry in the US. I discuss disparities between UK and US regulatory initiatives and their bearing on regulation in other countries. Then I turn to the political and social structures in which the assisted reproduction industry is embedded. I argue that regulatory bodies are seldom neutral arbiters. They tend to respond most readily to special interests and neglect strategies that could more effectively meet the health needs of the people they represent. Neither national nor international bodies have aggressively pursued policies to harness the industry, reduce infertility rates, or meet the needs of people whose fertility is threatened by substandard healthcare and environmental neglect. In conclusion, I consider recent initiatives by activist groups to mount an alternative response to the industry's current practices and build a transnational reproductive justice movement.     

Microfluidic technology for assisted reproduction.

The physical tools used in assisted reproduction have changed little over several decades. Microfluidics is an emerging technology that allows a fresh examination of the way assisted reproduction is performed. Here we review our work to develop microfluidic devices to perform the functions required in assisted reproduction. These functions include loading/unloading, culture, chemical manipulation, and mechanical manipulation of embryos and oocytes. Basic microfluidic theory and microfluidic device design and operation are discussed. Results are presented for mechanical removal of cumulus cells and for embryo culture. Results suggest that microfluidic systems will lead to improved efficiencies in assisted reproduction.     

Health of human and livestock conceived by assisted reproduction.

Assisted reproduction is used to resolve infertility problems in human and in breeding programs to generate livestock. Except for gestation length and birth weight, perinatal outcome of children conceived by In Vitro Fertilization is similar to that of spontaneously conceived children. However, large offspring syndrome observed after In Vitro Production in livestock is quite alarming. The distinct parts of assisted reproduction (oocyte maturation, fertilization and culture) have been found to contribute to abnormal fetal growth and development. Genomic imprinting is suggested to be involved in the induction of the aberrant phenotypes observed after assisted reproduction. Furthermore, current knowledge on postnatal health of offspring conceived by assisted reproduction and speculations on potential longterm effects of In Vitro Fertilization will be described.     

Manipulating the human embryo: cell cycle checkpoint controls

Micromanipulation techniques are widely used in assisted human reproduction and it is logical to assume that successes with recent animal cloning will invariably raise the question of human cloning along with its related ethical problems. However, it is often overlooked that even in animals many complications are still associated with this technique. The purpose of our article is to highlight and discuss some of these problems in the context of the eventual use of nuclear and/or cytoplasmic transfer techniques in assisted human reproduction.     

Assisted existence: an ethnography of being in Ecuador

In Ecuador, reproductive assistance, whether from God, extended family, or medical technologies, is emphasized and desirable in a precarious and unequal world with a minimal social safety net and chronic economic insecurity. Assistance is the very grounds of being. In better‐resourced realities like parts of the United States, assisted reproductive technologies can trouble the biological and social autonomy of individual heterosexual couples. Juxtaposing assisted reproduction in these divergent sites demonstrates that resources can make autonomy easier to establish and assistance between people and things difficult to perceive. Through an insistence on the material specificity of assisted reproduction itself, this ethnographic contrast contributes to anthropological approaches to ontological questions of being. In particular, ethnographic observation of the material realities of reproductive treatments in Ecuador demonstrates that medical care is one means to instantiate race. Private assisted reproduction makes whiter babies and patients in the face of a crumbling public health care infrastructure whose patients are by definition poor and Indian. The framework of assistance might serve then as a means to ethnographically trace the constitution of racial being in better‐resourced nations, as well as allow for a more comprehensive recognition of the interdependence of existence.     

Challenges to biology education from new reproductive technologies

Teaching students about human reproduction is becoming increasingly daunting as assisted reproduction technologies challenge scientific, social and legal perceptions of parenthood. Mitochondrial replacement in particular forces us to re-examine established paradigms not only in the context of human reproduction but also with regard to the way in which we teach students about genetic modification, the nature of the eukaryotic cell, and eukaryote evolution.     

Extended culture up to the blastocyst stage: a strategy to avoid multiple pregnancies in assisted reproductive technologies

The aim of this study was to review the experience and outcomes of assisted reproduction cycles with embryos grown up to day 5 of development, comparing different parameters according to the ages of the patients. We retrospectively studied 1,874 assisted reproduction cycles where embryo culture was extended up to the fifth or sixth day of development. All IVF and ICSI cycles were included, comparing, according to patient age, the following rates: blastocyst formation, pregnancy, implantation and abortion. As control, we analyzed cycles with donated oocytes from young donors (OD). The number of embryos reaching the blastocyst stage is similar in all groups of patients. Only the OD group was different in terms of blastocyst formation, pregnancy and implantation rates. Patients over 39 years of age had an abortion rate of 59.1 %, which is significantly higher than the other groups. Extended embryo culture up to the blastocyst stage can be implemented in programs of assisted reproduction in order to increase the pregnancy rate. The potential of blastocyst implantation is high, allowing us to transfer fewer embryos and reduce the probability of multiple pregnancies.     

R-Models: A mathematical framework for capturing notions of abstraction and assistance in reproductive systems

R-Models are an approach to capturing notions of assistance and abstraction in reproductive systems, based on labelled transition systems and Gibson's theory of affordances. R-Models incorporate a labelled transition system that describes how a reproductive system changes over the course of reproduction. The actors in the system are represented by a set of entities together with a relation describing the states in which those entities are present, and an affordance-modelling function mapping actions to sets of entities which enable those actions to be performed. We show how R-models can be classified based on whether the reproducer is assisted or unassisted in reproduction, and whether or not the reproducer is active during reproduction. We prove that all assisted and unassisted R-models have a related R-model which has the opposite classification. We discuss the relevance to the field of artificial life, give a potential application to the fields of computer virology, and demonstrate reproduction modelling and classification in action using examples.     

Mammalian oocyte therapies

In assisted human reproduction, the cytoplasm of oocytes recovered from follicles is often abnormal. Its lower quality, especially in older patients, may be responsible for certain chromosomal abnormalities or developmental arrest. Thus, the deficiency of some vital molecules, which are necessary for oocyte maturation, can be the cause of infertility in women. Moreover, mutated mitochondrial DNA (mtDNA) that is located in the oocyte cytoplasm might be transmitted to offspring. With the advance of new micromanipulation techniques like the oocyte nucleus replacement or cytoplasmic transfer, some of these abnormalities could be theoretically eliminated. In this review, we briefly discuss some of these approaches and their potential use in assisted human reproduction.     

Techniques developed for the control of estrus, ovulation and parturition in the East German pig industry: a review

Centralized administration of the nationalized pig industry in the former German Democratic Republic (East Germany), promoted wide-scale use of assisted reproduction of pigs. The objective was to synchronize reproductive events such as estrus, ovulation, breeding and parturition in a way that would allow for quick penetration of desirable genetic information by timed artificial insemination and the routine use of hygienic measures. Methods developed to control these events were based on extensive basic and applied research, but the resulting pool of unique scientific information was heretofore not published in refereed journals in the English language. We present here a comprehensive review of biotechnological procedures and physiological insights gained by basic and applied research and by their application at the large pig production units.     

The student and the ovum: The lack of autonomy and informed consent in trading genes for tuition

Rising tuition costs have forced university students to become creative in finding ways to fund their education. Some female university students have decided that ova donation may be an acceptable alternative in which to pay for their tuition. This alternative presents itself because of the insufficient number of ova available for assisted reproduction and emerging stem cell technologies. Young female university students are encouraged by Internet sources and respectable electronic and print media to donate their ova in the cause of assisted reproduction for monetary compensation. While university students generally exhibit autonomy, the constraining influence of their financial predicament compromises the elements of informed consent (voluntariness, competence, capacity, understanding, and disclosure) as to their making an autonomous decision in regard to egg donation. Thus, any moral possibility of giving informed consent is negated. Informed consent can only occur through autonomy. A female university student in need of financial resources to pay for her education cannot make an autonomous choice to trade her genes for tuition. Donated ova are not only needed for assisted reproduction, but for stem cell technologies. While the long-term health of women who donate their ova is of concern (a potential risk of cancer after long term use of ovulation induction), of equal concern is the possibility of a growth in the trade of ova targeting third world and Eastern European women where the precedence for autonomy and informed consent is not well established.     

Neuroendocrinology and ovarian aging

The ovarian aging, a dynamic process that precedes the clinical manifestations of menopause, can be assessed using ovarian reserve biomarkers. It is well-known that reproduction during the later years of reproductive life has known limitations that challenge the success of assisted reproduction. Therefore, a review of the neuroendocrine modifications during this critical period of reproductive life may help to elucidate the ovarian aging process and its impact on reproduction. In this review, we aim to further the discussion of neuroendocrine changes taking place during the ovarian aging process that may impact reproductive function.     

Culture, characterization and differentiation of cells from buffalo (Bubalus bubalis) amnion

Stem cells present an important tool in livestock assisted reproduction and veterinary therapeutic field such as tissue engineering. We report for the first time isolation of pluripotent stem cell-like cells expressing pluripotency markers (alkaline phospahatase, OCT-4, NANOG and SOX-2) from the amnion of water buffalo (Bubalus bubalis). The cells showed no apparent abnormalities in their chromosomal profiles before and after cryopreservation. The cytochemical staining revealed that pluripotent cells were capable of undergoing directed differentiation in vitro into osteocytes. It could be inferred that amnion-derived pluripotent stem cell-like cells can be isolated, cultured for many passages and differentiated into mesoderm lineage, and may be an alternative source to mesenchymal stem cells. These cells can have applications in assisted reproduction, developmental biological and regenerative medicine.     

Drawing the line on in vitro gametogenesis

In vitro gametogenesis (IVG) might offer numerous research and clinical benefits. Some potential clinical applications of IVG, such as allowing opposite-sex couples experiencing infertility to have genetically related children, have attracted support. Others, such as enabling same-sex reproduction and solo reproduction, have attracted significantly more criticism. In this paper, we examine how different ethical principles might help us to draw lines and distinguish between ethically desirable and undesirable uses of IVG. We discuss the alleged distinction between therapeutic and non-therapeutic uses of assisted reproduction in the context of IVG, and show how it is both problematic to apply in practice and theoretically dubious. We then discuss how the ethical principles of reproductive justice and beneficence apply to IVG for opposite-sex reproduction, same-sex reproduction, and solo reproduction. We suggest that these principles generate strong reasons for the use of IVG for opposite-sex and same-sex reproduction, but not for solo reproduction.     

Improving ovarian stimulation protocols for IVF in baboons: lessons from humans and rhesus monkeys

The aim of this review paper is to provide a scientific basis for the development of ovarian stimulation (OS) protocols for in vitro fertilization (IVF) in baboons. Firstly, the evidence available regarding OS for assisted reproduction in baboons is reviewed based on available published data, assessed by a Pub Med search of papers published between 1970 and 2008 using the following key words: baboon, assisted reproduction, IVF, embryo, oocyte. Secondly, we discuss how state-of-the-art or potentially new OS protocols used in humans and in rhesus monkeys may offer guidance for the development of standardized and reliable OS protocols for IVF in baboons. Based on this review and discussion, we conclude that more randomized trials are needed to improve standardization of OS protocols for IVF in baboons with respect to gonadotrophin type, dose, duration of stimulation, ultrasound monitoring, and time interval between ovulation trigger and oocyte retrieval.     

人类辅助生殖技术研究的里程碑——2010年诺贝尔生理学或医学奖解读

试管婴儿技术是现代医学治疗不育症的人类辅助生殖技术之一．试管婴儿技术的发展,打破了人类繁衍的自然方式和过程,是生殖医学领域的一场革命,对生命医学的发展产生了重大影响．为此,在试管婴儿技术研究中做出开创性贡献的英国科学家罗伯特·爱德华兹,荣获2010年诺贝尔生理学或医学奖．     

Breeding genetically modified rodents: tips for tracking and troubleshooting reproductive performance

Infertility or reduced fertility in genetically modified mouse strains represents a serious bottleneck for planned research projects. The authors describe simple methods for troubleshooting poor reproductive performance in breeding colonies and introduce various means of assisted reproduction that might be used to 'rescue' infertile lines.     

Global Health Care Justice,Delivery Doctors and Assisted Reproduction: Taking a Note From Catholic Social Teachings

This article will examine the Catholic concept of global justice within a health care framework as it relates to women's needs for delivery doctors in the developing world and women's demands for assisted reproduction in the developed world. I will first discuss justice as a theory, situating it within Catholic social teachings. The Catholic perspective on global justice in health care demands that everyone have access to basic needs before elective treatments are offered to the wealthy. After exploring specific discrepancies in global health care justice, I will point to the need for delivery doctors in the developing world to provide basic assistance to women who hazard many pregnancies as a priority before offering assisted reproduction to women in the developed world. The wide disparities between maternal health in the developing world and elective fertility treatments in the developed world are clearly unjust within Catholic social teachings. I conclude this article by offering policy suggestions for moving closer to health care justice via doctor distribution.     

'The good of the child'

Warnock, chair of Britain's Committee of Inquiry into Human Fertilisation and Embryology, discusses the implications of the "artificial family" for children born through the use of reproductive technologies. She considers both treatment of infertility and the possible use of assisted reproduction to enable persons other than infertile couples, such as single persons and homosexuals, to have children. Warnock has found that emphasis has been placed on the wants and well-being of the adult(s) involved, and that the "good of the child" is a "wide and vague concept, widely invoked, not always plausibly." She is particularly concerned about children born as a result of the delayed implantation of frozen embryos, AID children who are deceived about their origins, and children born of surrogate pregnancies. She recommends that a detailed study of existing "artificial family" children be conducted to aid public policy decisions on assisted reproduction.