Reproductive technology

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Reproductive technology encompasses all current and anticipated uses of technology in human and animal reproduction, including assisted reproductive technology, contraception and others.

Assisted reproductive technology

Assisted reproductive technology (ART) is a general term referring to methods used to achieve pregnancy by artificial or partially artificial means. It is reproductive technology used in infertility treatment, which is the only application routinely used today of reproductive technology. However, there is yet no strict definition of the term.

Definitions

While there is no consensus on the definition, generally the process of intercourse is bypassed either by insemination (example IUI) or fertilization of the oocytes in the laboratory environment (i.e. in IVF).

• The Centers for Disease Control and Prevention(CDC) -- which is required as a result of the 1992 Fertility Clinic Success Rate and Certification Act to publish the annual ART success rates at U.S. fertility clinics -- defines ART to include "all fertility treatments in which both eggs and sperm are handled. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman." According to CDC, "they do not include treatments in which only sperm are handled (i.e., intrauterine—or artificial—insemination) or procedures in which a woman takes medicine only to stimulate egg production without the intention of having eggs retrieved."

Examples include in vitro fertilization and its possible expansions.

• Artificial insemination
• Cloning (see human cloning for the special case of human beings)
• Cryopreservation of sperm, oocytes, embryos
• Embryo transfer
• Hormone treatment
• In vitro fertilisation
  • Intracytoplasmic sperm injection
• Preimplantation genetic diagnosis (PGD)
• Surrogacy
• Testicular sperm extraction (TESE)
• Gamete intrafallopian transfer (GIFT)

Risks

The majority of IVF-conceived infants do not have birth defects. However, some studies have suggested that assisted reproductive technology is associated with an increased risk of birth defects. In the largest U.S. study, which used data from a statewide registry of birth defects, 6.2% of IVF-conceived children had major defects, as compared with 4.4% of naturally conceived children matched for maternal age and other factors (odds ratio, 1.3; 95% confidence interval, 1.00 to 1.67).

The main risks are:

• Genetic disorders. DNA damage increases in e.g. IVF and ICSI, which is reflected e.g. by upregulation of the gene expression of HNRNPC in the placenta.
• Low birth weight. In IVF and ICSI, a risk factor is the decreased expression of proteins in energy metabolism; Ferritin light chain and ATP5A1.

Other risk factors are:

• Membrane damage, which is contributed to or reflected by increased expression of the membrane fusion proteins NAPA and Annexin A3.

Costs

United States of America

Not everyone in the U.S. has insurance coverage for fertility investigations and treatments. Many states are starting to mandate coverage, and the rate of utilization is 277% higher in states with complete coverage.

There are some health insurance companies that cover diagnosis of infertility but frequently once diagnosed will not cover any treatment costs.

2005 approximate treatment/diagnosis costs (United States, costs in US$):

• Initial workup: hysteroscopy, hysterosalpingogram, blood tests ~$2,000
• Intrauterine Insemination (IUI) fka Artificial insemination ~ $200- 900 per. trial
• Sonohysterogram (SHG) ~ $600 - 1,000
• Clomiphene citrate cycle ~ $ 200 - 500
• IVF cycle ~ $10,000 -30,000
• Use of a surrogate mother to carry the child - dependent on arrangements

Another way to look at costs is to determine the cost of establishing a pregnancy. Thus if a clomiphene treatment has a chance to establish a pregnancy in 8% of cycles and costs $500, it will cost ~ $6,000 to establish a pregnancy, compared to an IVF cycle (cycle fecundity 40%) with a corresponding cost of ($12,000/40%) $90,000

For the community as a whole, the cost of IVF on average pays back by 700% by tax from future employment by the conceived human being.

United Kingdom

In the UK all patients have the right to preliminary testing, provided free of charge by the National Health Service. However, treatment is not widely available on the NHS and there can be long waiting lists. Many patients therefore pay for immediate treatment within the NHS or seek help from private clinics.

Sweden

In Sweden, official fertility clinics provide most necessary treatments and initial workup, but there are long waiting lists, especially for egg donations, since the donor gets just as low reward as the receiving couple are charged. However, there are private fertility clinics.^{[How to reference and link to summary or text]}

Contraception

Contraception is a form of reproductive technology that enables people to control their fertility.

Controversy

Many issues of reproductive technology have given rise to bioethical issues, since technology often alters the assumptions that lie behind existing systems of sexual and reproductive morality.

Also, ethical issues of human enhancement arise when reproductive technology has evolved to be a potential technology for not only reproductively inhibited people but even for otherwise reproductively healthy people.

See aslo

• Eugenics
• Fertilization
• Genetic engineering
• Genetics
• Prenatal diagnosis
• Selective breeding
• Sexual reproduction