Medically Assisted Procreation
Assisted reproductive technology or PMA, also called medically assisted procreation (AMP) and medically assisted procreation (MAP) is a set of practices where clinical and laboratory medicine more or less directly involved in reproduction to allow couples infertile to have a child. Although confusion is common, the PMA is not limited to in vitro fertilization (IVF or IVF for "in vitro fertilization and embryo transfer), which is only one method. The human cloning is not legally considered part of MAP techniques.
The GPA is framed in France by the law of bioethics of 6 August 2004 .
Summary |
History
Originally, the first MAP techniques (artificial insemination) were developed to enable infertile couples to bear children. Subsequently, these techniques have been used in other cases, including to prevent transmission of genetic diseases.
- Late eighteenth century: the first artificial insemination intraconjugal takes place in Scotland.
- Early nineteenth century: the first artificial insemination intraconjugal are made in France.
- Late nineteenth century: the first artificial insemination with donor sperm is produced in the United States.
- 1968: Frozen sperm banks are emerging in the United States. It was in those same years that hormones may stimulate the ovary (gonadotropins) are used.
- 1969: first pregnancy was obtained after injection of gonadotropins in Israel.
- 1973: the technique of freezing sperm arrives in France, and with it appear CECOS (Centers for Study and Preservation of human eggs and sperm). These centers organize the donation of sperm according to their ethical rules of anonymity and gratuity.
- 1978: Louise Brown was born in Great Britain. It is the first child born after in vitro fertilization, a new technique developed to overcome the damage of the fallopian tubes that surgery can not repair.
- 1982: birth of Amandine French first baby born after in vitro fertilization. In subsequent years, the successive advances allow better control of hormonal treatments and increased success rate.
- 1984: frozen embryo transfer success for the first time in Australia with the birth of Zoe.
- 1988: towards the development of techniques of medically assisted procreation and following the thoughts of the professionals involved, governments are creating centers approved as the National Commission on Medicine and Reproductive Biology.
- 1992: direct injection of sperm into the cytoplasm of the oocyte (ICSI) is being developed in Brussels and revolutionized the management of male infertility.
- 1994: Birth of Audrey, the first French baby conceived through ICSI. That same year, the first bioethics laws are passed in France. They define medically assisted procreation, "Biological and clinical practice for in vitro conception, embryo transfer and artificial insemination as well as any technical effect equivalent to procreation outside of the natural process." They reserve these practices couples male / female, live, of childbearing age, married or can prove two years of cohabitation. During the following years, treatment fertility drugs appear easier to use. The number of embryos transferred is decreased to reduce multiple pregnancies, quality standards necessary for clinicians and laboratories. The risks are better assessed as well as prognostic factors.
- 2004: although the 1994 Act provides for the host embryo, it was not until 2004 that this technique gives birth to a child in France. That same year, the bioethics laws are revised, maintaining the principles set out in 1994 and providing for the creation of the Agency for Biomedicine. Public body under the Ministry of Health together for the first time under a single authority, the activities of medically assisted procreation, prenatal diagnostics and genetics. She also supports the donation and transplantation of organs, tissues and cells, previously assigned to the property since 1994 French Transplant. Its mission is to accredit the practitioners involved, to authorize certain activities, to evaluate these practices and to monitor compliance with legal provisions.
Statistics
In 2002, the number of babies born by medically assisted procreation would be between 219,000 and 246,000, with an increase in time. The success rate, according to the procedure, between 15% (frozen embryo transfer) and 22% (IVF) .
In Europe
The results of 30 countries of Europe are reported each year in the European registry for IVF. For 2005, 923 centers reported to 418 111 cycles of in vitro fertilization and 128 908 cycles of insemination with husband's sperm and 20 568 with donor sperm. Each participating country is described by more or less complete data on the activity and performance of LDCs but also with demographic data type, number of embryos transferred and the age of women at the PMA .
France
In France , every year, "nearly 200 000 children born through assisted reproductive technology techniques (PMA), a congenital malformation rate of over 4%" (cons 2 to 3% in the general population) . Children conceived using procedures LDCs in 2007, who have 20 657 thank you for bringing your expertise and to specify, represent approximately 2.5% of children born that year. In 2007, there were 122,056 attempts procedures LDCs (insemination, in vitro fertilization, frozen embryo transfer). In 6% of cases, they rely on sperm, eggs or embryos from donation .
Techniques
Before resorting to the techniques of LDCs themselves, different methods may allow couples to maximize their fertility:
- Detection of the fertile period
- Hormonal monitoring (usually by urine test) can detect imminent ovulation and allows the couple to have intercourse at the time of maximum fertility.
- The techniques of ovulation induction
- The gynecologist may suggest a slight hormonal stimulation treatment and forced activation by a hormone injection point (eg hCG). The treatment gives a better ovulation in number of oocytes limited to one or two and put the reports at the time of maximum fertility, the date of ovulation is known.
Techniques LDCs themselves:
- The techniques of artificial insemination (AI)
- This involves injecting the sperm artificially prepared more or less at the time of ovulation, except in the case of insemination with semen "fresh" done "at home", using urine tests to detect ovulation. It was shown that the coupling of artificial insemination with ovulation induction significantly improves the chances of pregnancy.
- with fresh semen
- This method is primarily used "home" for women wishing to become pregnant without having sex with the male parent of their future baby. The pattern can be conventionally informal donated sperm for a heterosexual couple where the man is suffering from infertility, or a desire for a child with a lesbian couple, or a desire for a child to an unmarried woman does not wish to be a connection sexual, or finally a desire for a child for a woman carrying the HIV virus when their illness is well controlled.
- with prepared sperm
- This method is frequently used for the PMA couples whose infertility is not mono-causal (which is the general case). Whenever possible, it is preferred in these cases of unexplained infertility in an IVF first-line immediately to its less restrictive for women.
- with frozen semen
- This is the method generally used for sperm donation.
- More rarely, the freezing of sperm is used to preserve the sperm of a man undergoing a process involving its fertility.
- techniques of in vitro fertilization
- IVF
- After ovarian stimulation and monitoring the development of follicles in the ovaries (ultrasound, blood ...),
- The oocytes were collected from the follicles a few hours before natural release, mostly through vaginal puncture under ultrasound or, more rarely, by laparoscopy in difficult cases.
- The oocytes collected are placed in the presence of sperm prepared. The fertilized oocytes are cultured (usually two days, sometimes longer, up to 6 days) to assess their morphology. 1-2 are implanted in the uterus (transfer) and others can be frozen if they have a significant chance of survival.
- The number of embryos is limited to 2, less often 3. To reduce the risk obstetric or medical, embryonic reductions may be proposed in case of triplets or more, if the couple wishes. Embryo reduction is much less used today than in the 1980s, the number of embryos implanted today are rarely more than three.
- micro-intracytoplasmic sperm injection ( ICSI ) Intra Cytoplasmic Sperm Injection.
- Processes are the same as for IVF, except that the bringing together of the ovum and sperm is replaced by the direct injection of a single sperm is selected in each egg.
- microinjection and intracytoplasmic sperm selected high magnification (IMSI) Intra Cytoplasmic Sperm Injection Morphologically Selected.
- Processes are the same as for IVF, except that the bringing together of the ovum and sperm is replaced by the direct injection of a single sperm screened under high-power microscope in each egg.
- IVF
- the frozen embryo transfer ( FET )
- Of previously frozen embryos obtained by the method of IVF or ICSI were thawed and transferred into the uterus.
- We can also freeze embryos obtained by IVF in couples where the woman has to undergo potentially sterilizing treatment.
- the freezing of ovaries
- As a prerequisite to a potentially sterilizing treatment for a woman or a child, samples of ovaries are removed to preserve future fertility. There are two techniques to restore reproductive function: in vitro maturation of follicles and eggs (currently at the research stage) and autograft (a dozen births were reported in the world).
- Donations
- egg donation (not for example in Italy, Norway, Germany, Austria and Switzerland)
- sperm donation (illegal in Italy, for example)
- Embryo donation for couples where both partners are infertile or at risk of spreading disease (illegal in Portugal, Sweden, Israel, Slovenia and Italy, for example)
- the surrogates (eg illegal in France, Italy, Spain, Norway and Switzerland)
It recognizes several functions at the assisted reproductive technology, each with its psychological, ethical, social and legal.
- the fight against infertility or sterility is the most common case
- compensation caused sterility,
- prevent transmission to a child from a serious illness, see: preimplantation diagnosis , sperm donation
- the desires of unconventional parenting
- offset the effect of menopause.
Technical specifications
Artificial insemination (AI) overcomes the problems associated with the ejaculation , the mucus , which prevents any sperm to flow readily, but also some unexplained infertility.
The in vitro fertilization (IVF) bypasses the problems associated with lack of contact between egg and sperm. Problems with tubal , among others.
The ICSI (introduction of a medical sperm into the egg ) overcomes the problems of fertilization, and infertility in humans.
The AI and IVF can also be made through a donation of gametes , to circumvent the lack or poor quality of gametes. Donation of sperm or egg for IVF. Donate sperm for AI.
Disadvantages of PMA
Context of infertility, many failures, "requirements" to have sex at certain times, medication for women, many appointments, many cases of twins, triplets ... feeling of a body and denigrated for machinis women, feelings of worthlessness narcissistic ...
Disadvantages physical
The ovarian hyperstimulation of women's body fatigue. The AI is less tiring for the woman with IVF.
During a medically assisted procreation, incidents of varying severity can occur at every stage of care, because of the treatments, gestures of aspiration and anesthesia.
Like any surgery, ovarian puncture may cause anesthetic complications, bleeding, infectious, may require treatment, hospitalization, surgery, and have exceptionally serious consequences for your health.
Frequently, an excessive response to ovarian stimulation called ovarian hyperstimulation syndrome can occur, causing symptoms of varying severity. Most often, overstimulation manifested by discomfort or abdominal pain, nausea, vomiting, diarrhea, increased the size of the ovaries. More rarely, it causes a sudden weight gain, fluid accumulation in the peritoneum (ascites), respiratory disorders. Exceptionally, ovarian hyperstimulation may have severe consequences (blood clots). In all cases, the appearance of signs, however small, requires an urgent consultation to assess the severity and consider hospitalization if necessary.
Disadvantages of the fetus
In general, pregnancies after IVF seem to be slightly more complicated than natural pregnancies. Published studies show an increased risk of prematurity and low birth weight, primarily due to the higher incidence of multiple pregnancies, but perhaps not so much the technique of IVF itself, as infertile parents.
The child, born of assisted reproductive technology, has a slightly increased risk of being a carrier of birth defects (6.7% instead of 6% for couples conceiving naturally subfertile and 5% for a couple with no problem experienced infertility), often less serious defects. These figures should not hide the fact that the vast majority of children are strictly normal. It is unclear whether this risk is attributable to the treatment of infertility, or to infertility itself or the characteristics of couples in IVF (advanced age, parity) or the high frequency of multiple pregnancies .
Position of religions
Judaism
More permissive than Catholicism, it permits artificial insemination (with sperm from the husband only, the opposite being considered adultery), in vitro fertilization (IVF), embryo freezing and pre-implantation diagnosis. These techniques should be reserved for heterosexual couples, except in Judaism.
Catholicism
The Catholic Church is not opposed to assisted reproductive technology (see moral theology ). The Vatican considers that the child should be considered a "gift" from God and advises rather sterile couples adopt a child / children (s) or to serve children . For the Church, a child should only be the result of the sexual relationship of a married couple. In some specific cases, artificial insemination is allowed . The official position of the Roman Catholic Church was expressed in 1987 in the instruction Donum Vitae , then in 2008 in investigating Dignitas Personae.
Islam
Artificial insemination and IVF are allowed, but only if the couple is married, and that the sperm and egg come even though the couple wanting a child. Sex selection of babies is prohibited, except by some scholars, in case a genetic disease affects only one sex. The pre-implantation diagnosis is allowed only if it is therapeutic. Positions sometimes differ between the highest authorities in Sunni and Shia, for example.
Protestantism
It's obviously all denominations as open as regards the LDCs. Most techniques are allowed. Indeed, the use of assisted reproduction techniques is permitted. The only restrictions are made that these techniques should be used only to heterosexual couples (which excludes homosexuals and widowed / ves, except in certain communities Anglican / Episcopalian) and it should not be any other interest (for eg financial) that give life to a child.
The LDCs in France
See also demography in France.
In France there in 2006 , 119,649 attempts per year AMP , including artificial insemination and 54 179 65 413 cycles of in vitro fertilization ( IVF , ICSI and FET ) per year . 3% of these in vitro fertilizations were performed with donated gametes . 238 000 embryos per year are designed as part of the GPA, they are then either implanted or frozen or destroyed. They give rise to 17 350 deliveries.
The embryos are retained by AMP centers, where they are frozen as the couple wishes . Without the new couple for 5 years, the center may terminate the storage of embryos. In 2006, 176,523 embryos were well preserved, as regards 49 618 couples, an increase of 25% compared to 2005 . In 2006, 83,407 embryos have been "abandoned" by their parents, almost as much as those who continue to be a "parental project" . The parents decided to donate either to science (9319 ), offer them to other infertile couples (10 239 ) or destroy (17,877 ). 26% of those embryos "left" or 45,972 embryos have been no requests by parents who want to appear, leaving the centers with the responsibility for making decisions about these embryos redundant .
Regulation
France
Medically assisted procreation is governed by the law of bioethics No. 2004-800 of 6 August 2004 .
The main legal principles of medical assistance to procreation are:
1 / Implementation of medically assisted procreation is indicated when the couple faces infertility medically or to avoid transmission of serious illness to the child or any member of the couple. It is practiced in licensed establishments and practitioners approved for these activities. The couple (man and woman) must be of childbearing age, married or able to have at least two years together. In France it is forbidden to use a "surrogate mother" and resorting to a double donation of gametes. The anonymous, free and voluntary service are the main principles underlying the gamete and embryo donation.
2 / Regarding the storage of embryos, with the prior written consent of the couple, it is possible to fertilize an egg number as the couple can get good quality embryos, which will be frozen for later transfer. The couple is then consulted annually in writing on the fate of their embryos frozen (continued storage for a subsequent transfer, receiving their embryos to another couple, research, conservation or stop). Consent is obtained and confirmed in writing after a cooling-off period of three months. Moreover, stopping the storage of embryos is possible under very specific conditions. She is, for example, if the couple consulted several times, does not consider the fate of their embryos preserved for at least five years.
3 / In a reproductive intraconjugal, rules of descent are those that govern every birth.
4 / Regarding gamete donation, the recipient couple must first give its consent to the judge or notary, which prohibits all subsequent actions to establish or challenge paternity, unless it is demonstrated that the child is not born of medically assisted procreation or if the consent is invalid.
5 / As for the donation of gametes, during a welcoming embyons, the recipient couple consents to the judge, who also has a monitoring of reception conditions that the couple is likely to offer the unborn child at the family, educational and psychological. The host embryo is subject to judicial authorization given for three years recipient couple.
References
- Law No. 2004-800 of 6 August 2004 concerning bioethics
- "Medically assisted procreation refers to clinical and biological design for in vitro embryo transfer and artificial insemination, and any technical effect equivalent to procreation outside the process natural. " The MPA and the codes of French law
- International Committee for Monitoring Assisted Reproductive Technology, World Collaborative Report on Assisted Reproductive Technology, 2002 , Human Reproduction, 2009, doi: 10.1093/humrep/dep098
- Assisted reproductive technology in Europe and intrauterine inseminations, 2005: results generated from European registers by ESHRE The European IVF Monitoring Programme (EIM) For the European Society of Human Reproduction and Embryology (ESHRE) Andersen AN, Goossens V, S Bhattacharya, AP Ferraretti, MS Kupka, J de Mouzon, KG Nygren, and The European IVFmonitoring (EIM) Consortium, for The European Society of Human Reproduction and Embryology (ESHRE) Human Reproduction, 24, from 6.1267 to 1287, 2009
- from the largest study ever conducted on the subject in 33 hexagonal (source: The risk of AHR, Sciences et Avenir , August 2010 , page 29.)
- Annual Report 2008 Agency of Biomedicine
- (en) Infertility, Infertility Treatment, and congenital malformations: Danish national birth cohort , Zhu J, Basso O, Obel C, Bille C, Olsen J, BMJ 2006; 333:679
- "Infertile couples should not forget that even when procreation is not possible, conjugal life does not lose its value. Physical sterility may be an opportunity for spouses to make other important services to human existence, such as for example adoption, various forms of educational work, assistance to other families, the poor and disabled children. " Donum Vitae II 8.
- If the technical means facilitates the conjugal act or assist in achieving its objectives natural, it can be morally accepted Donum Vitae II 6.
- a , b , c , d , e , f , g , h , i and j key figures, framed additional frozen embryos: the delicate choice of parents , Le Figaro , May 12, 2009, p. 12.
- Law No. 2004-800 of 6 August 2004 concerning bioethics
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