Question

Which assisted reproductive technologies might help the following couples? (More than one answer may fit some situations.) a. A woman is born without a uterus, but manufactures healthy oocytes. b. A man has cancer treatments that damage his sperm. C. A genetic test reveals that a woman will develop Huntington disease. She wants a child, but does not want to pass on the disease. d. Two women wish to have and raise a child together. e. \(A\) man and woman are carriers of sickle cell disease. They do not want to have an affected child or terminate a pregnancy to avoid the birth of an affected child. f. A woman's uterine tubes are scarred and blocked. g. A young woman must have radiation to treat ovarian cancer, but wishes to have a child.

Short answer

a. IVF and surrogacy, b. Sperm donor or ICSI, c. PGD, d. IVF and donor sperm, e. PGD, f. IVF, g. Fertility preservation and IVF

Step-by-step solution

Situation A

A woman without a uterus but with healthy oocytes can be helped through In Vitro Fertilization (IVF) to create an embryo. This embryo could then be implanted in a surrogate who carries the pregnancy.

Situation B

A man who has damaged sperm due to cancer treatments can either use sperm from a donor, or he can use Intracytoplasmic Sperm Injection (ICSI) where a single sperm can be injected directly into an egg.

Situation C

Preimplantation genetic diagnosis (PGD) can assist the woman with the risk of Huntington's disease. This involves using IVF and then testing the embryos for the disease before implantation.

Situation D

Two women wishing to have a child together can use IVF. One woman's eggs can be used and fertilized with donor sperm, and the resulting embryo can be implanted either in the same woman or the other woman.

Situation E

A couple carrying sickle cell disease can utilize PGD. This would involve screening embryos for the disease prior to implantation.

Situation F

A woman with scarred and blocked uterine tubes can be helped by IVF where the egg can be directly fetched, then fertilized, and the embryo implanted.

Situation G

A young woman needing treatment for ovarian cancer can have her eggs or embryos frozen before treatment starts. This is known as fertility preservation. After her treatment, IVF can be used to implant these preserved embryos.

Key concepts

In Vitro Fertilization (IVF)

In Vitro Fertilization, commonly known as IVF, is a process where eggs are collected from a woman's ovaries and fertilized with sperm in a laboratory. This technique offers hope for many couples facing different fertility challenges. The fertilized egg, known as an embryo, is then carefully observed for a few days before it is transferred to the woman's uterus.

IVF can assist in various situations such as when a woman's uterine tubes are blocked as it allows bypassing the tubes entirely. It's also an option for same-sex couples desiring to have a child together. One partner's eggs can be fertilized with donor sperm, and the embryo can be implanted in the partner or a surrogate.

IVF is crucial for individuals with difficulties in natural conception, and its success hinges on several factors, such as age and the viability of the eggs and sperm.

• The process includes stimulating the ovaries to produce multiple eggs.
• Retrieving mature eggs from the ovaries.
• Fertilizing the eggs with sperm in a lab setting.
• Transferring the embryo to the uterus.

Intracytoplasmic Sperm Injection (ICSI)

ICSI, or Intracytoplasmic Sperm Injection, is a specialized form of IVF that is particularly beneficial when male infertility issues are present. This technique involves the direct injection of a single sperm into an egg to facilitate fertilization, making it an excellent option when sperm count is low or sperm is otherwise compromised.

For couples where the male partner has undergone treatments such as chemotherapy that harm sperm quality, ICSI provides an opportunity to achieve a biological child. This technology also shows promise when prior IVF cycles have had poor fertilization outcomes, suggesting that sperm might be struggling to penetrate the egg.

• ICSI bypasses many natural barriers, cutting directly to the core of fertilization.
• A single healthy sperm is carefully chosen and injected into the egg.
• Once fertilized, the embryo is monitored and eventually transferred to the uterus.

Preimplantation Genetic Diagnosis (PGD)

Preimplantation Genetic Diagnosis, or PGD, is a technique that combines IVF with genetic testing. It's particularly helpful for individuals or couples who have a risk of passing certain genetic diseases to their children. PGD allows genetic testing on embryos created via IVF, ensuring only healthy embryos are implanted.

This technology is of immense value to couples with hereditary conditions like Huntington's disease or sickle cell anemia, as it enables them to select embryos free from these genetic markers, thus avoiding the transmission of the condition to their offspring.

• PGD involves removing one or a few cells from an embryo and testing these cells for specific genetic disorders.
• This process usually takes place in the early stages of embryo development.
• Only embryos that do not carry the conditions are selected for implantation into the uterus.

Fertility Preservation

Fertility preservation is a vital option for individuals who need to undergo treatments, such as chemotherapy or radiation, which can impair fertility. This process secures the possibility of having biological children in the future. It can involve freezing eggs, sperm, or even embryos for later use.

For young women facing ovarian cancer treatment, fertility preservation may include harvesting and freezing their eggs or embryos before starting therapies that potentially damage ovarian function. This proactive step ensures that individuals have reproductive options post-treatment.

• Eggs or sperm are collected and cryogenically frozen for future use.
• Embryos can be created using IVF and then frozen.
• Fertility preservation allows people to focus on their treatment without sacrificing future family-building plans.