BIOETHICS

Unless we give the emotional response to an ethical question, we make our

decision based upon the principle or foundation belief. We often to this without the
benefit of realization. From the principles that ground the way we think to the way we
live, we reach conclusions based upon fundamental facts and truths that we hold dear.

Bible - the sourcebook of faith.

Saint Paul - constantly refers to the triad of faith, hope and love in reference to
Christian behavior and also applicable to Christian ethics.

 Faith - according to the Scripture, is being able to see Life from a different
perspective.

- It is recognizing that our greatest joy comes from God through our
relationship with Him.

- It demonstrate that we are willing to root our lives in Him-to play the
game, as it were, by His rules and to give up any claim to run our
lives our ourselves.

- It opens up to us the potential for fulfillment that can come only

from God and frees us the disappointment of living life within the
limit of our own resources.

- is rooted in the past-in who God is and has been for all eternity and
in what He did for us 2000 years ago when Jesus died and
rose again.

 Love - The life we live today is to be lived by giving ourselves to God and
to others.

- Recognizing the importance of fellowmen and to give ourselves sacrificially to

them.

- This love for God and for others is to be one of the driving motivations of all that
we do.

 Hope - the hope that I have in His provision of strength and grace for each
day that we live.
 - We are able to make plans for the future, trusting that He will be there to give
grace sufficient to carry out those plans.

- We can extend our self now beyond our ordinary limits of strength for we know
that eternal rest awaits us when we will be totally fulfilled in His presence.

- These three truths are at the core of all behavior as a Christian.

 By faith, we know that God’s way is right, even when it may

seem to lead to insurmountable difficulties.

 Our hope is that the injustices in this world that we are unable to
address will be taken care of in the proper time and place. We are able to truly
love others and put their needs above those of ourselves.

 We do not live exclusively for comfort in the here and now, but
are able to extend ourselves beyond our comfort level with the expectation that
God will provide grace for each day and a future eternal rest.

Historical Perspective

The Hasting Center - first bioethics study institute

- was established in June 1969 and is now located in Briarcliff Manor,

New York.

Rose and Kennedy Institute of Ethics – opened by the Georgetown University in

Washington D.C. in 1971, which created a
Center for Bioethics (4 volumes).

The rise of bioethics as a distinct field is traceable to several events:

 First, the large-scale introduction of biomedical and other

technology in the second half of the 20th Century intensified
age old problems and added new ones such as issues over
the definition of death and withdrawal of life-sustaining
medical treatment, prenatal diagnosis and abortion, organ
transplantation, storage of frozen human embryo, use of
human, animal and fetal tissues in scientific research, stem
 cell research and cloning, screening of persons for the AIDS
virus and other infections, disposition of toxic waste,
expansion of genetic engineering and allocation of scarce
health resources.

 Second, awareness of bioethics and other moral issues has

been dramatically raised, professionals and students now
routinely refer to ethical questions, such as bioethics has
affected philosophy, pushing it to pay more attention to
practical problem.

 Finally, the growth of multi-disciplinary work in academic

institutions has facilitated dealing concurrently with biological
research and moral and social issues of human behavior.

The Ethics of Bioethics

Fr. Richard McCormick and lawyer Wesley Smith - bioethics pioneers, arguing that
the field as conducted today too often has done moral harm
to medicine and society.

- McCormick wonders whether

bioethics has become a “moral vacuum”.

- Smith complains that in main

stream bioethics, human beings per se have no special
rights or moral values.

Bioethics

- refers to a social institution, a convergence of people from diverse

professional groups which comprises a community in which bioethics is
done.

- a process and a product

  The process of bioethics consists of critical reflection on the
moral dimensions of health care and medical science.

 The product encompasses the literature and resources

amassed in journals, books, conference, programs and other
places. In addition to these familiar distinctions, bioethics
also refers to the social structures in which discussion takes
place and in which the product of the enterprise are
displayed.

BIOETHICS

IN THE NEW MILLENIUM

21st century - “The Biotech Century.”, according to Jeremv Rifkin

- Prof. Richard Oliver of the Vandebilt University has announced that “The
Bioterials Age will complete the triumph of economics over politics, which
began during the Information Age.

- Oliver’s characterization of these new age sound extraordinarily

“Technopian” and the list of technologies which are of concern is daunting
namely:

 The ability to clone humans.

 Pre-determination of the sex of children and their genetic

makeup.

 Pharmacogenomics, which directs and tailors drugs to the

genetic makeup of the individual.

 Genetically-derived therapist for the prevention and cure of

most cancers, heart disease, AIDS and other diseases,
including new strains of vaccine-resistant ones like malaria.

 The ability to “Program” out of human genes the propensities

to contract various diseases and illnesses.
  Repair of damaged brain cells, spinal cords and other
damaged or diseased human tissues.

 Animals that grow replacement organs for the 50% of

humans who die before getting a transplant organ from a
human donor.

 A “smart mouse” that points the way to eliminating aging in

humans.

Benefits of biotechnologies:

 genetic engineering

 cloning

 cybernetics

 nanotechnology

 a litany of their neologisms yet to be invented;

What biotechnologies affect:

 portend human tragedy

 a loss of human

 a world which is increasingly hostile to concerns which

transcend the world of contemporary scientific research.

Sober questions for Christians who are witnesses to the dawn of the biotech age.

1. Are Christians ever aware of these issues? Certainly some are.

2. Does the Church have anything to say to biotechnology? If so, what? If not, why
not?

3. Can we afford not to speak to these issues? Can we afford to misspeak on these
issues?
 One of the challenges which we will increasingly face us new technologies arise is
the determination of what it means to be human.

Katherine Hayles - argues that mortal human beings are rapidly becoming an
endangered species.

- How We Became Posthuman,

Han’s Morevec’s - vision of the future is realized, human beings as we know them
will have to fight for their own survival, but with an unlikely
enemy.

- Quoted,

- “Humans can be enhanced by both

biological and hard robotic technologies,
as present day examples as hormonal and
genetic tuning of body growth and
function, pacemakers, artificial hearts,
powered artificial limbs, hearing aids and
night vision devices are faint hints of
future possibilities. Mind Children
speculated on ways to preserve a person
while replacing every part of the body and
brain with superior artificial substitutes. A
biological human … could grow into
something seriously dangerous once
transformed into an unbounded super
intelligent robot.”
- founder of the world’s largest robotics program at
Carnegie Mellon University.

Bill Joy - w co-founder and chief scientist at Sun Microsystems, does not think these
are ludicrous ideas.

- with the world’s largest erector set would be formidable power.

Bioethical issues

The Xenotransplantation Debate

In theory, xenotransplantation could be viewed as a life-saving answer for many
awaiting organ transplants, and for doctors dealing with organ shortages. However, the
use of animal organs for human transplants has been under scrutiny since the inception
of the idea, due to the many risks involved, not only to the patient but the general public,
and bioethics issues pertaining to the use of animals for human advancement.

Latest Developments

Several years ago it appeared the main roadblock to using pig organs for
xenotransplantation was the presence of galactosyl (GAL) moeties linked to the cell
surfaces of animal tissues, and produced by the enzyme alpha-galactosyl transferase.
Primates, including humans, do not have GAL-linkages on their cell surfaces and
produce antibodies against them, causing the rejection of transplanted animal organs. It
has since been established that the causes for organ rejection are more complicated
than that, and additional antigens have been implicated in the human immune system
response. However, immunological issues remain the main roadblocks to
xenotransplantation, according to Dr. Muhammad Mohiuddin of the NIH Cardiothoracic
Surgery Research Program, National Heart, Lung, and Blood Institute.

In addition to the immunological issues, there are safety concerns for whole
populations, due to the possibility of infection of an organ recipient by an animal virus,
and animal rights issues, that result in ethical debate over the topic of
xenotransplantation. As a result, there are also many regulatory hurdles to overcome,
before xenotransplantation becomes everyday practice.
What's at Stake?

Transplants of animal organs to humans are obviously performed at the expense of the
animal in question. Animal rights advocates believe that it is not morally acceptable to
sacrifice animals for the benefit of human lives, whether for the use of their organs or for
research necessary to study the immunological factors causing organ rejection.

Humans are not without risk in this issue either. The effects latent animal viruses will
have on human organ recipients are still unknown. Opponents of xenotransplantation
fear that these viruses, when introduced into a human system might cause epidemics of
diseases for which we have no immunity and no cure. Pigs, for example, currently the
best candidate animal species for culturing organs for humans, carry a retrovirus called
PERV (Porcine Enogenous Retrovirus). This virus has been shown to infect human
cells and the consequences of infection have not yet been determined.

Some opponents of xenotransplantation believe that animals are not the solution but
that biotech companies are just looking to make money from their ability to clone animal
cells and create GMOs, specifically GM pigs (knockouts lacking the alpha-galactosyl
transferase enzyme).

Why It Works

Using animal organs would reduce the length of time many people have to wait for a
suitable organ, and would allow transplants to occur while the recipient is still strong and
somewhat healthy and better able to tolerate surgery. According to statistics quoted by
the Lincoln Journal Star, the current number of 20,000 transplants per year in America
could be increased to over 100,000, if animal organs were used, and 12 out of 73,000
Americans waiting for transplants die each day.

It is hoped that current practices of injecting donor cells into pig embryos, in utero, will
eliminate the need for immunosuppressant drugs as this has been shown to make the
donor and recipient compatible when tested between pigs and other animals. This
means using molecular genetics techniques to create GM animals, specifically altered
to be a match for an individual human recipient. The knockout species would be
conceived and raised for the sole purpose of being sacrificed for medicine.

Pigs are a good choice of organ donor because of their short gestation period, rapid
growth rate and size of organs (matching those of humans). Hyperacute rejection (HAR)
of organs from Gal-knockout pigs transplanted into baboons was prevented due to the
absence of expression of the 1,3-galactosyltransferase gene. Although other immune
responses are present, there is hope that similar genetic alterations will be possible, to
address the issue of HAR in humans.

According to Dr. Muhammad Mohiuddin, ethical issues based on the possibility of a

disease spread from animals to humans seem to hold less water than previously
thought, since PERV has not been found to infect any humans treated with pig tissues
to date, nor have any epidemics arisen from infection of human farm workers involved in
handling pigs. Pigs are very clean and can be raised in exceptionally clean
environments if necessary. Pig farms for research on xenotransplantation contain barns
fitted with filters for keeping out viruses and bacteria. In future, if/when the pigs are
raised for human transplants, even farm workers will wear masks to prevent exposure of
the pigs to human pathogens.

Arguments Against

Ethical issues surrounding the use of animal organs for human transplants appear to be
threefold. There is the issue of animal rights and the breeding of animals simply for
human consumption and medical benefit. Secondly, there are some who believe that
xenotransplant technology is just another way for biotech companies to make money,
and they are not concerned with the welfare of the animals or truly concerned with the
welfare of mankind, due to their perceived disregard for the third issue, which is the
unknown impact on the human race, should a new infection be introduced for which we
have no cure.
Where it stands

Experts involved in xenotransplant research seem to dismiss many of the arguments

against the technology. According to lead researcher Dr. William Beschorner at the
University of Nebraska Medical Center, who has successfully transplanted hearts and
major blood vessels between pigs and sheep, the class action and malpractice lawsuits
that could arise from foolishly jumping the gun, before all the risks have been
addressed, should be enough to deter anyone from risking the safety of consumers just
to make money. Furthermore, one anonymous farmer was quoted by Bob Reeves of the
Lincoln Journal Star as saying the profits to pig farmers would be minuscule.

Ethicist Dr. Andrew Jameton, from the Nebraska Medical Center in Omaha, pointed out
that this issue is no different from research in any medical field. Although the desire for
recognition and compensation for the cost of research is always a temptation, especailly
where venture capitalists are involved, "scientists in all fields must guard against letting
profit get ahead of scientific method and accuracy". That is, the issue of integrity is no
greater in this than in any other field of science and should not necessarily be viewed as
a reason to hold back the technology to save lives.

Scientists involved in xenotransplant research say their research is highly regulated and
that the animals involved are treated with the greatest respect, in addition to being given
any painkillers or anesthetics required making them comfortable. In many experiments,
nerve cells are not connected to transplanted organs, so the animals cannot feel pain
from the organ being rejected. Realistically, it must be acknowledged that none of the
medical advances of mankind could have been accomplished without animal
experimentation. However, the fact remains that xenotransplantation is ethically on a
whole different level, as even after the technology is established, animals’ lives will
continuously need to be sacrificed for the lives of human beneficiaries.

The Science Behind Stem Cell Research

For decades, stem cells have attracted the attention of medical researchers and others
because they have the capacity to develop into specialized cells that make up a variety
of organ and other tissues. These so-called "building blocks of nature" can literally
transform into any other type of cell in the body, making them potentially invaluable in
treating many diseases and injuries.

There are two basic kinds of stem cells: those found in certain adult tissues and those
found in the cells of three- to five-day-old embryos. Adult stem cells, found in brain,
bone marrow, muscle, skin, blood and liver tissue, can change into a limited number of
cell types. The stem cells found in embryos, on the other hand, are pluripotent, that is,
they have the unique ability to develop into any of the 220 cell types in the human body.

In addition to their versatility, embryonic stem cells are easier to grow in the laboratory
than adult stem cells. Adult stem cell lines proliferate only for a limited time, while
embryonic stem cells potentially can continue dividing forever.

The first and best-known success in adult stem cell research is the bone marrow
transplant, in which stem cells from a donor's bone marrow are used to regenerate
healthy bone marrow in patients with leukemia and other blood diseases. This therapy
is still used today.

Embryonic, or pluripotent, stem cells offer even more dramatic prospects for new
treatments and cures for conditions such as spinal cord injuries, blindness and juvenile
diabetes, as well as Parkinson's disease, Lou Gehrig's disease and Alzheimer's
disease. In addition, some scientists say research using pluripotent cells could
ultimately result in treatments for certain types of cancer, new methods of rapidly testing
drugs and a basic understanding of human development and genetic abnormalities.

Early Research and Controversy

In the early 1980s, scientists began studying embryonic stem cells, first in mice. But
because mouse embryos develop very differently than human embryos, researchers
soon sought a way to isolate human embryonic stem cells. In 1998, a team lead by
James Thomson at the University of Wisconsin was the first to successfully harvest
stem cells from human embryos donated by fertility clinics. Since then, scientists have
developed some 400 stem cell lines using private and public funds.

Embryonic stem cells are harvested in two ways: from existing human embryos and
from embryos that have been created using a cloning process known as somatic cell
nuclear transfer (SCNT). In both cases, the embryo is ultimately destroyed, which
opponents of embryonic stem cell research argue is immoral.

The SCNT process was developed by the Scottish scientist Ian Wilmut, who cloned
Dolly the sheep in 1996. During the process, the nucleus of a human egg cell is
removed and replaced with the nucleus of a donor's adult cell, which contains the
person's DNA. The egg is then stimulated to begin subdividing, eventually growing into
an embryo with stem cells that can be harvested. Many scientists consider SCNT very
promising because it creates an embryo with stem cells that have the same DNA code
as the person who donated the cell nucleus. These stem cells can then be used to
create therapies that potentially would be compatible with that donor's immune system.
In other words, if doctors grew new heart tissue to treat someone with heart disease,
the use of the patient's DNA could greatly reduce the likelihood of the patient's body
rejecting the new tissue.

A Potential Breakthrough

In 2007, Thomson and his team at the University of Wisconsin, along with scientists in
Tokyo, created what appear to be pluripotent cells from adult human skin cells rather
than from embryonic cells. The new technique coaxes skin cells to revert to an
embryonic stem cell state by inserting a tiny DNA-containing virus.

Even though the new skin cell technique begins with an adult cell, the resulting stem
cells appear to have the same makeup and properties as embryonic stem cells,
potentially allowing scientists to create pluripotent cells without destroying embryos. If
perfected, it also could eliminate the need to create embryos using SCNT. Some say
this could eventually end the controversy surrounding stem cell research.
Like SCNT, the new skin cell technique would produce compatible stem cells. Some
scientists say the skin cell technique may be more efficient than using embryos because
it would eliminate the cumbersome process of acquiring donated eggs and embryos.

While the skin cell discovery has been hailed as a major breakthrough, many scientists
caution that these new cells are not yet ready for therapeutic use. For instance, the
virus used to coax regular cells into pluripotent stem cells could lead to cellular
mutations that could, in turn, cause cancer in patients. Furthermore, Thomson and
others contend that this possible breakthrough has by no means eliminated the need for
continued research on embryonic stem cells, at least for now. Adult stem cells that have
been altered to what appear to be pluripotent cells need to be tested in comparison with
human embryonic cells, researchers say, to determine whether they do, indeed, have
the same pluripotent qualities.

Local: Center offers modern assisted pregnancy

Fertility doctors recommend childless couples to seek medical care immediately to

determine the main cause of subfertility. A lot of married couples try to conceive for years yet
remain unsuccessful after engaging in unprotected sex.
 Victory A.R.T Laboratory Philippines, Inc. in Makati is one such facility that offers
high-tech fertility treatment, i.e., in-vitro fertilization (IVF) and embryo transfer (ET). This
center, established for over a year now, is affiliated with a chain of IVF labs in Asia. It
offers a complete range of services and procedures including fertility screening, semen
analysis, sperm preparation for intra-uterine insemination (IUI), hormone tests and
pregnancy test. Also, the lab provides cryopreservation of embryos and sperms.

At the heart of any fertility treatment is an embryologist, a specialist who helps

childless married couples achieve their long-time goal to conceive a baby. The role of
embryologists in modern assisted conception is very crucial. Working hand-in-hand with
fertility clinicians, embryologists conduct laboratory tests on the female-egg and male
sperm and culture the egg and sperm to achieve fertilization.

Tracy Ong is a scientific IVF consultant chief embryologist at Victory A.R.T

Laboratory Philippines, Inc. in Makati. A Singaporean, Tracy started to specialize in
embryology in 1987 and has undergone training abroad to improve her knowledge on
male and female subfertility.

Tracy also studied In-Vitro Fertilization (IVF) at Kings College Hospital in London
in 1995. In 1997, she underwent training on ICSI (intracytoplasmic sperm injection)
manipulation technology at the Reproductive Medicine Laboratory at Queen Elizabeth
Hospital in Adelaide, Australia; and Brussels, Belgium. Developed in 1992, ICSI is a
new fertility technology that specifically helps improve male fertility.

In 2001, Tracy attended a workshop on the latest assisted conception technology

called pre-implantation genetic diagnosis (PGD) at University College London. PGD is
another technology for people who have repeated failures in conceiving despite
undergoing assisted conception.

The key to helping couples conceive, Tracy related, is positive thinking. Also,
physical and emotional stress brings negative effects on fertility.
 She advises couples who have difficulty getting pregnant after a year of natural
intercourse, to come forward and seek treatment. Tracy provides free counseling to
couples. This way, questions are answered clearly before they decide to undergo any
assisted reproductive technique (A.R.T.).

Victory A.R.T. Lab features state-of-the-art facilities, rivaling those found abroad.
That’s why couples need not travel overseas to seek A.R.T. procedures or IVF
anymore. A core team of specialists provides quality service that patients are treated
with utmost respect and privacy to make them feel comfortable while undergoing the
process.
Intra-Uterine Insemination (IUI)

For IUI, sperm are first washed and placed into a sterile medium. The sperm are then concentrated
in a small volume of medium and are injected directly

Definition

Intra-uterine Insemination (IUI) is the placement of sperm directly into the uterus of the
woman, bypassing the cervix.

Indications

This procedure is performed for patients with a cervical factor (cervicitis, cervical
stenosis, inadequate mucus or hostile mucus), unexplained infertility, male factor
infertility or immunological infertility.

Procedure

The female's ovaries are stimulated hormonally to produce follicles containing the eggs.
An ultrasound scan is performed to determine the number and size of the follicles and
also the thickness of the endometrium, lining the uterus, to see whether it is ready for
implantation. Also, blood hormone levels will be measured. Ovulation will be induced
by an injection of human chorionic gonadotrophin (hCG), and the egg will be released
36-48hr later. The male partner's semen is processed to select the highest quality
sperm. The physician will then inject this sperm via a catheter through the vagina and
cervix, into the uterus.
Therapeutic Insemination with Donor Sperm (TID)

Through the process IUI, sperm are placed high in the female reproductive tract to enhance the
chance of successful fertilization.

Definition

TID is the placement of donor sperm directly into the uterus of the patient.

Indications

In cases of severe male factor infertility, i.e., very low sperm count and/or motility, or no
sperm at all, TID may be indicated. TID may also be used if the male partner carries a
genetic disorder.

Procedure

The procedure is the same as for IUI, but with the use of donor sperm. Donor sperm are
frozen and stored for 6 months, to enable adequate screening and help prevent
communicable diseases from being transmitted. Frozen donor sperm will be thawed
and processed to isolate the highest quality sperm and then placed directly into the
uterus via a catheter.
In-Vitro Fertilization (IVF)

Definition

In-vitro fertilization (IVF) is the process whereby the female partner's ovaries are
stimulated to produce eggs. These are then removed and placed together with her
partner's sperm in a petri dish and allowed to fertilize. The resulting embryos are then
transferred into her uterus after 2-3 days.

Indications

IVF is used in cases of tubal blockage, male factor infertility or previously failed IUI
cycles.

Procedure

The ovaries will be stimulated to produce eggs. Firstly, a gonadotropin-releasing

hormone (GnRH) analogue is given for about 8-10 days. Secondly, daily injections of
human menopausal gonadotrophin (hMG) are given to stimulate the ovaries to produce
an increased number of follicles containing the eggs. After about 8 days, the number
and size of the follicles will be measured using ultrasound. When 1-2 of the follicles
reach 18mm in diameter, an injection of human chorionic gonadotrophin is given, and
the oocyte retrieval scheduled for 36hrs later.

The oocytes will be retrieved via transvaginal ultrasound. Ultrasound allows the
physician to visualize the follicles and can then push a needle into each of them and
aspirate the fluid inside the follicle containing the oocyte. The follicular fluid is examined
by laboratory personnel for the presence of the egg and if found, is placed in an
incubator. This is done for all the follicles. At the time of oocyte retrieval or immediately
thereafter, the male partner's perm will be processed to isolate the highest quality
sperm. Approximately 5hrs after the oocyte retrieval, the oocytes and sperm are put
together in a petri dish and placed in an incubator.

The next day, the oocytes are observed to see whether normal fertilization has
occurred. The fertilized oocytes are then left in the incubator to develop into embryos.
After 2-3days after oocyte retrieval, the embryos are transferred into the uterus of the
woman using a special catheter. Hormonal treatments are given for the following 3
weeks, after which a pregnancy test is scheduled. Any excess embryos not
transferred may be cryopreserved for later use.

Embryo transfer

Embryo transfer refers to a step in the process of in vitro fertilization (IVF) whereby
one or several embryos are placed into the uterus of the female with the intent to
establish a pregnancy.

8-cell embryo for transfer 3 days after fertilization

Fresh versus frozen

Embryos can be either "fresh" from fertilized egg cells of the same menstrual cycle, or
"frozen", that is they have been generated in a preceding cycle, cryopreserved - see
Controlled-Rate and Slow Freezing in Cryopreservation, - and are thawed just prior to
the transfer. Babies born from frozen IVF embryos are less likely to be born prematurely
or underweight than are those conceived during fresh treatment cycles, three
independent teams of scientists have found. One of the studies also recorded lower
rates of stillbirth and early death among frozen-embryo babies. The results, from
researchers based in the United States, Australia and Finland, suggest that far from
being riskier than conventional IVF, as is generally thought, cycles using frozen
embryos may actually be safer, Mark Henderson of the Times London reported in
November 2008.
Gamete Intra-Fallopian Transfer (GIFT)

Definition

GIFT is the direct placement of eggs and sperm into the fallopian tube.

Indications

GIFT is usually performed in cases of unexplained infertility.

Procedure

The oocytes/eggs are removed from the woman's ovaries and the sperm is processed
in the same manner as for IVF. The difference is that instead of allowing the oocytes to
be fertilized in a petri dish, the sperm and up to 3 eggs are injected directly into the
fallopian tube and allowed to fertilize there. Hormones are given for the next 2 weeks to
help maintain a pregnancy. Any extra eggs may be fertilized in vitro (IVF),
cryopreserved, or donated.

Intra-Cytoplasmic Sperm Injection (ICSI)

Definition

The process whereby a single sperm is injected directly into the cytoplasm of the egg.
Indications

ICSI is the method of choice for patients with severe male factor infertility, and for
patients who have had previously failed or poor fertilization resulting from conventional
IVF.

Procedure

The eggs are retrieved from the woman's ovaries in the same way as for IVF. The eggs
are then stripped of all surrounding cells and placed in a droplet and the male partner's
sperm placed in another droplet. The sperm can be obtained via ejaculation or in severe
cases, directly from the testis or epididymis using microsurgical sperm retrieval
techniques.

The oocyte is held in place by a specialized holding micropipette. With a microinjection

pipette, one sperm is picked up (aspirated) and then carefully injected into the
cytoplasm of the oocyte. This is done for all the eggs. The eggs are then placed in the
incubator, and checked the next morning for fertilization.

The fertilized eggs are then allowed to develop for another 24-48hr, after which they are
transferred into the uterus via a thin catheter. Hormonal treatment to help maintain a
pregnancy is given for the next 2 weeks.

Microsugical Epidiymal Sperm Aspiration

Testiculat Sperm Extraction (TESE)
Round Spermatid Injection (ROSI)

Definition

MESA is the retrieval of sperm from the epididymis by means of aspiration. TESE is the
retrieval of sperm from the testis by means of testicular biopsy. ROSI is the injection of
round spermatid (immature spermatozoa) when no mature sperm can be found in the
testis.
Indications

When sperm are unable to move through the genital tract due to uncorrectable damage,
sperm can be extracted directly from the epididymis or testes via microsurgical
techniques. Congenital absence of the vas deferens (CAVD) or failed sterilization
reversal are other indications.

Procedure

Around the time that the woman has her eggs retrieved, the husband/male partner will
undergo a surgical procedure that will either take a very small piece of testicular tissue
(TESE) or aspirate the fluid from the epididymis (MESA). For TESE/MESA the
testicular tissue/epididymal fluid will be examined for the presence of sperm cells.
These can then be injected into the oocyte via ICSI. In cases where no sperm are seen,
round spermatids (immature sperm seen on right) can be used for ICSI (ROSI).

We at the Kentucky Center for Reproductive Medicine and IVF in cooperation with the
Andrology Institute of America and Dr. Zavos, along with other Scientists and
Physicians from Japan, Greece and France, have been successful in developing and
employing the new ROSI Technique. This method enables the micro-injection of round
spermatids (immature spermatozoa), recovered from the testes or from post-ejaculated
fractions into retrieved oocytes via ICSI techniques and achievement of fertilization and
pregnancies. This technique will assist a great number of azoospermic males with
round "spermatid-type" arrest in their testes and other male infertility patients with other
severe spermatogenic deficiencies to achieve pregnancies, throughout the World.

Sperm Cyropreservation and Thawing

Definition

The process of preserving sperm by means of freezing for use at a later time.

Indications

Sperm can be cryopreserved in cases where the male might have difficulty in producing
a specimen at a given time. If sperm were retrieved microsurgically, excess sperm may
be stored to avoid having to repeat the invasive surgical procedure. Also, for patients
planning to undergo chemotherapy or radiotherapy (for cancer), sperm may be
cryopreserved as the therapy may diminish their sperm production. Sperm can also be
frozen for persons wishing to donate their sperm to infertile couples.

Procedure

Sperm retrieved by masturbation, testicular biopsy or microsurgical epididymal sperm

aspiration are placed together with a cryoprotectant and stored in cryostraws in liquid
nitrogen at a temperature of -196°C. This can be thawed at any time, and the
cryoprotectant can be removed and the sperm used for ART procedures.

Sperm Cyropreservation and Thawing

Definition

The process of preserving sperm by means of freezing for use at a later time.

Indications

Sperm can be cryopreserved in cases where the male might have difficulty in producing
a specimen at a given time. If sperm were retrieved microsurgically, excess sperm may
be stored to avoid having to repeat the invasive surgical procedure. Also, for patients
planning to undergo chemotherapy or radiotherapy (for cancer), sperm may be
cryopreserved as the therapy may diminish their sperm production. Sperm can also be
frozen for persons wishing to donate their sperm to infertile couples.

Procedure

Sperm retrieved by masturbation, testicular biopsy or microsurgical epididymal sperm

aspiration are placed together with a cryoprotectant and stored in cryostraws in liquid
nitrogen at a temperature of -196°C. This can be thawed at any time, and the
cryoprotectant can be removed and the sperm used for ART procedures.

Embryo Cryopreservation and Thawing

Definition

The process of storing embryos by means of freezing in liquid nitrogen for use at a later
time.

Indications

When excess embryos are present after an embryo transfer, these can be frozen and
then transferred in subsequent cycles, if the patient does not become pregnant. This
would save her from undergoing another oocyte retrieval procedure. She may also elect
to have her embryos donated to another infertile couple.

Procedure

Excess embryos are place with a cryoprotectant and aspirated into cryostraws, and then
gradually frozen to a temperature of -196°C, and placed in liquid nitrogen. Storage can
be indefinite but KCRM requires written approval/consent from the parents every 3
years.

When the patient wants to transfer embryos that are in cryostorage, these can be
thawed prior to or on the day of transfer, assessed for survival and development, and
then transferred.

Assisted Hatching

Definition

Assisted hatching is the opening of the zona pellucida , surrounding the embryo, to help
the embryo/blastocyst "hatch" or emerge from the zona and implant in the uterus.

Indications

Assisted hatching is usually indicated in older women, and those with failed implantation
in previous cycles.

Procedure

Prior to embryo transfer, a small opening is made in the zona pellucida using
microdissection tools. The embryos are then transferred normally.