Infertility and Solutions to Infertility - Essay Example

In Vitro Fertilization In Vitro Fertilization The responsibility of watching children grow, develop and nurturing them alters the appreciation of health and life. This results into long term effects on the individual families and the society at large. This proves that the combination of sperm and oocyte in embryo creation with the potential to develop into a unique person or individual cannot be taken easily like any other form of medical technology. It must be treated with the responsibility and respect regarding the most fundamental areas of human life. In the armory of medical technology existing for disease alleviation and quality of life improvement, there is no match for the contributions made by assisted reproductive technology. There is no other life experience matching the birth of a baby in importance and significance. It is usually a devastating experience when couples wishing to start a family realize that they have to contend with fertility problems. For many such couples, in vitro fertilization has been a preferred solution as it gives them hopes of having their own child (Anderson, Haimovici, Ginsburg, Schust &Wayne, 2007). The first in vitro procedure that was successful was carried out in 1977 and thousands of happy and healthy children have been born each year since then. Infertility and Solutions to Infertility Infertility is a couples’ inability to have a kid or become pregnant with regardless of the cause after the duration of one year of having unprotected sex using no birth control methods. Infertility affects about six million people in the United States of America which accumulates to about ten percent of men and women of reproductive age. New and advanced technologies that help women become pregnant are in vitro fertilization (IVF), gamete intrafallopian transfer, zygote intrafallopian transfer, subzonal sperm injection, partial zona dissection, embryo cryopreservation and intracytoplasmic sperm injection among others. Assisted reproductive technology is generally accepted treatment for infertile women suffering from endometriosis. Presence of an ovarian endometrial cyst works towards the reduction of the quality of oocytes. The surgical resection of endometrioma reduces the ovarian reserve for ovarian stimulation by exogenous gonadotropins. In Vitro Fertilization Process In vitro fertilization is a process whereby the ova is removed from a woman’s body, fertilized in the laboratory with her partner’s sperm and returned to her uterus with hopes of fostering pregnancy. Some practitioners use in vitro fertility combined with pre implantation genetic diagnosis as a treatment for recurring miscarriages due to abnormalities of chromosomes (Estevesa, Schneidera & Verza, 2009). The fertilization process may also be used for mothers with infertile ova who wish to use donor ova because of ovarian failure or pregnancy losses. It is an expensive and invasive procedure that may carry greater miscarriage risks in the resulting pregnancy. There is also high likelihood of multiple gestations with in vitro fertility. Successful IVF involves careful coordination of both scientific and medical approaches to each couple undertaking a treatment cycle. It demands close collaboration between nurses, doctors, scientists and counselors. Only meticulous attention to detail at each and every stage of the patient’s treatment can ensure optimum chances of delivering a healthy baby (Boivin, Christensen, Holstein & Schmidt, 2005). Appropriate ovarian stimulation, patient selection, monitoring and timing of oocyte retrieval provide the IVF laboratory with viable and appropriate gametes capable of producing healthy embryos. The IVF laboratory should ensure a stable, non-toxic pathogen free environment with optimum conditions and parameters for oocyte fertilization and development of the embryo. Human IVF must involve systems of at least equal complexity. The clinical biologist should bear in mind that control mechanisms exist which are particularly sensitive to slight changes in the environments of gametes and embryos like temperature and PH and other factors potentially affecting cells at the molecular level according to Araki, Kanto, Kumagai, Kyono, Nakajo and Uto (2007). In IVF, multiple variables exist. Therefore, the basic scientific processes at each stage have to be carefully controlled while at the same time allowing for individual variation between the patients and treatment cycles. Diagnosis The IVF diagnosis and treatment cycle includes the following steps: Consultation: history, counseling, examination and investigation Pituitary down regulation with GnRH agonist Assessment of the baseline Gonadotrophin stimulation Follicular phase monitoring Ultrasound and endocrinology HCG administration to induce ovulation Oocyte retrieval (OCR) Invitro fertilization Embryo transfer Supernumerary embryo cryopreservation Luteal phase support Day fifteen pregnancy test Follow up pregnancy test: day twenty, twenty five and thirty Day thirty five ultrasound assessment Signs and Symptoms The first week of IVF pregnancy is hectic to the couple. The early indications of IVF pregnancy are just like the signs of a normal pregnancy. Usually the IVF patient injects hormones into her body and supplements to help in the sustenance of the pregnancy should it occur. Despite the necessity of the hormones, they may produce some pregnancy symptoms when no conception has taken place. It should be noted that a woman may experience pregnancy symptoms and signs while others may not. The early indications of IVF pregnancy is elevated basal temperature (Adamson, Chambers, Chapman, Ishihara & Sullivan, 2009). The woman feels cramps like she is about to get monthly periods. The breasts become tender and sore, and the woman may feel tired and dizzy. A missed menstrual period is an indication of conception. Even if the woman is undergoing an in vitro fertility cycle, the woman’s menstrual period should arrive approximately fourteen days after the embryos are transferred to the uterus. If more than fourteen days elapse without a period, then it may be a sign of pregnancy. More often than not, a woman may have lighter or shorter menstrual period than normal, this may also indicate pregnancy. After conception, there is increase in estrogen and progesterone which can cause the breasts to swell or become extremely tender to touch. This can make it uncomfortable for a woman even by putting on a bra or rolling in bed. Some of the breast nipples become sore or tingly or there is darkening of their areolas. This can be noticeable even before the woman misses her periods. However it should be noted that women using hormone injections and supplements may observe tenderness of the breasts even if they are not pregnant. IVF pregnancy may result to fatigue caused generally by a surge in progesterone hormone. A woman only few weeks pregnant may feel the need for a rest or take rest after undertaking a small and easy task. From the fact that IVF patients take progesterone as supplements after transferring the embryos to the uterus, they may feel fatigued; the hormone’s effects are usually felt even if the patient does not get pregnant. The woman may suffer from implantation bleeding. Sometimes when the fertilized embryo implants itself to the uterine wall, she may experience slight amount of brown or pink spotting and bleeding. This will usually occur between 6-12 days after ovulation. In the case of an IVF patient, the bleeding may occur a week or so after the ova are retrieved from the ovaries. The IVF patient may suffer from nausea which is usually caused by surges and changes in the hormonal levels of the woman. The nausea can begin as early as seven days after conception. For most IVF patients this may happen within a few days of the fertilized eggs transfer to the uterus. However, it should be noted that not all women will suffer from nausea (Riley & Wood 1994). Some may suffer from morning sickness and feel queasy. It is a common occurrence for some to suffer from nausea later in the day or when they go without taking food. Further still, a patient may suffer from nausea food aversions for the better part of the day. Medications Used Previously, infertile patients were subjected to surgery for egg recovery in IVF procedures but this has changed over the years. The physicians nowadays retrieve ova using sonographically guided needle through a procedure called trans-vaginal oocyte retrieval. The procedure does not require general anesthesia or hospitalization. To create an environment within a woman allowing retrieval of many healthy and mature ova, the patient is kept in two weeks intensive preparation. This includes hormonal therapy with blood tests, fertility drugs and ultrasound scans of the ovary. This is to determine the optimal time usually just before menstruation for retrieving the ova. When the procedure is carried out at the proper time under local anesthesia, the ova can be visualized by ultrasound. It can be retrieved from the ovary by use of a needle placed through the vaginal wall (Dyson, 1995). After removal the eggs are stored in the laboratory under physiological conditions equivocal to those in a woman’s body. The embryologist places a sperm with the ova when ready for fertilization. The eggs are maintained in dishes inside a nutrient mixture that imitates the environment of the fallopian tubes. The couple’s pre embryos are later passed through the vagina into the uterus using a special catheter (Gardner & Weissman, 2004). The pre embryos are inserted back to the woman’s body at the same time that they would have reached the uterus - that is two or more days after retrieval. Hopefully the pre embryos attach to the woman’s uterine walls and mature normally. Usually the pre embryos are more than two and each attempt to attach to the uterine wall is called a cycle. Nursing Care and Diagnosis There are two types of transfers that can occur in the IVF procedure; the blastocyst transfer and the three day transfer. While the embryos are still in the laboratory, a number of techniques can be applied to improve the embryos’ health. The commonly used technique is assisted hatching which greatly improves the embryos’ ability to attach to the uterine wall (Ludwig, 2002). The embryos’ may receive a pre-implantation genetic diagnosis before being transferred back to the woman’s body. The remainders of the embryos are preserved to be used in the future IVF cycles if necessary. Conclusion Couples suffering from sperm count or endometriosis can now raise their own kids when they accept in vitro fertilization as a solution to their problem. Although the procedure is expensive and relatively complex, the treatment has brought hope to many couples with fertility problems. The procedure, although making it possible for infertile couples to bear children, raises the chances of miscarriages. References Adamson G. Chambers G., Chapman M., Ishihara O. & Sullivan E. (2009) "The economic impact of assisted reproductive technology: A review of selected developed countries". Fertil. Steril 91 (6): 2281–94. Anderson B., Haimovici F., Ginsburg E, Schust D. &Wayne P. (2007) "In vitro fertilisation and acupuncture: Clinical efficacy and mechanistic basis". Altern Ther Health Med 13 (3): 38–48. Araki Y, Kanto S. Kumagai S., Kyono K., Nakajo Y. & Uto H. (2007) "Seven pregnancies and deliveries from non-mosaic Klinefelter syndrome patients using fresh and frozen testicular sperm". Assist. Reprod. Genet. 24 (1): 47–51. Boivin J., Christensen U., Holstein BE & Schmidt L. (2005) “Communication and coping as predictors of fertility problem stress: cohort study of 816 participants who did not achieve a delivery after 12 months of fertility treatment”. Hum Reproduction 20: 3248–56. Dyson A. (1995) The ethics of IVF, London, Continuum International Publishing Group. Estevesa S.C, D.T. Schneidera, S. & Verza Jr. (2009) “Single or sequential medium are equally effective for the culture of human embryos to the blastocyst stage”, Fertility and Sterility 92(3), Supplement 1: S231-S232. Gardner D. & Weissman A.(2004) Textbook of assisted reproductive techniques: laboratory and clinical perspectives (2nd ed., illustrated), London, Informa Health Care. Ludwig M. (2002) Pregnancy and birth after assisted reproductive technologies (illustrated), Springer, Springer. Riley R., & Wood C., (1994) IVF: In Vitro Fertilization (3rd edition, illustrated), Melbourne, Hill of Content. Read More