IN VITRO FERTILIZATION: GIFT OF THE GODS OR PANDORA'S BOX

Sherry Yarema
1992 Woodrow Wilson Biology Institute

Rationale:

Rapid developments in reproductive technologies compel science teachers to introduce their high school students to techniques which show great promise and yet hold many ethical dilemmas.

Intended Audience:

Objective:

1. Familiarize students with powerful new tools, techniques, and dilemmas presented by in vitro fertilization.

2. Students should be able to recognize 5 dilemmas presented by IVF.

3. Students should be able to analyze the positions of the individuals involved and recommend possible courses of action.

4. Students will be gaining valuable development in critical thinking skills.

Materials:

Case study: In Vitro Fertilization

1 copy per student-"Making Babies," Time, September 30, 1991. (optional-excellent for higher level students)

Video, "Hi-tech Babies," NOVA, (1st 30 min-IVF; 2nd half addresses surrogacy) (optional, but excellent)

Procedures:

1. Students will read case study before class.

2. Students will be arranged into groups of 6 with the following roles:

   A. Doctor specializing in infertility
   B. Mr. Davis
   C. Mrs. Davis
   D. Pro-life citizen
   E. Equal Opportunities citizen(s)
   F. Moderator, (time-keeper, etc.)

3. In the groups, the students will do the following things:

   A. Find 5 ethical problems in the case study. (Allow about 5 min.)

   B. What facts are important to the dilemma?

   C. Identify who have stakes in the decision.

   D. What values are at stake in the decision?

   E. What options (solutions) are available to a judge in this case?

   F. What criteria should the judge use in coming to a decision?

   G. Have students in each group share with the class after each section.

   H. Have students write their personal reactions to the dilemma to provide closure to the activity.

   I. For homework have the students analyze Case Study 2.

CASE STUDY 1:

Betty and Junior Davis were married in 1980. After trying for six years to have a child, they went to an infertility clinic. Previous damage to Betty's Fallopian tubes made her a candidate for Zygote in vitro fertilization transfer (ZIFT), a form of in vitro fertilization where Joe's sperm were mixed with about 4-8 of Betty's eggs and fertilized in a Petri dish. 4 of the pre- embryos were returned to Betty's lower Fallopian tubes in hope that the pre- embryo would implant in the uterus - the start of pregnancy. The remaining zygotes now called "pre-embryos" are frozen at -90¡C for additional IVF procedures if needed.

No pregnancy resulted and subsequently the Davises decided to divorce. Betty requested the custody of the extra fertilized pre-embryo stage cells which had been frozen to use at a later date. Mr. Davis insisted that the infertility clinic not release the embryos as he no longer wished to become a parent. Since no laws have been developed regarding the dispersal of pre- embryos in the event of divorce or death of genetic parent, the case went to the courts for settlement.

Your role will be to act as a panel of judges to settle the dispute.

1. As the judge in this case, what do you see as 5 ethical problems present here?

2. What facts are relevant to making your decisions?

3. Who has stakes in the decision? (Remember that previous legal decisions establish precedent in deciding other legal issues for which no legislation exists.)

4. What values are involved in the decision?

5. What options are available to the judge?

6. What criteria should the judge consider in coming to a decision?

Background Materials:

In 1978 Louise Brown was born in England, the first test tube baby ever. Since then over 10,000 babies have been born using the technique of " in vitro fertilization." Some of the fertilized eggs (now called pre- embryos) are transferred to the woman's Fallopian tubes for the trip to the uterus, where pregnancy will start if the fertilized egg successfully implants in the uterine wall about 14 days after conception. Usually four to eight eggs are harvested from the ovary. Only two to four eggs of the fertilized eggs are returned to the woman's body. The remaining embryos are frozen (quickly at -90¡C) for future IVF procedure in case the first one doesn't result in a pregnancy. Pregnancy occurs if the pre-embryo implants in the uterus which then begins the production of those hormones which will direct and support the development and sustenance of the embryo by the development of the placenta, umbilical cord, etc. system which connects the mother's blood stream to the embryo's. Only when that implantation and hormone production begin is the woman pregnant. (It is the hormone human chorionic gonadotropin which the new home pregnancy tests are detecting.) Also it is only on implantation that differentiation begins and only then can one technically call the cell mass an embryo. Only about 1/4 of the procedures result in a pregnancy which goes to full term with the delivery of a healthy baby. Incidentally, scientific evidence indicates that in normal situations only 1/3 to 2/3 of all fertilized eggs ever succeed in implanting.

(High school students don't particularly like teacher-picked groups. Self-selecting groups tend to lack significant diversity of ideas and easily get off task because of social dynamics. Having students draw playing cards from a deck as they come to class works well. For this particular activity, use as many suits as there will be groups and as many number values as numbers of students that will be in the group. So in a class of 24 students, the deck would hold all four suits with cards from the ace to the six. If you have 27 students, then use the "7s" from three of the suits. For many group activities, three to four students work best. So have all the " threes" be a group and so on.)

Glossary:

embryo:

fertilized egg embedded in uterine tissue in the process of differentiating into tissues and systems

fetus:

developing human from 12 weeks after conception until birth.

frozen embryo:

pre-embryo cells which are quick frozen in case the IVF procedure does not result in pregnancy

gamete intra-fallopian transfer (GIFT):

a variation of in vitro fertilization sperm and the unfertilized egg are placed in the recipient's Fallopian tubes.

implantation:

when the pre-embryo imbeds in the uterine wall, starting the hormonal changes allowing the uterus to nourish the pre-embryo. When this implantation occurs, the zygote will now be nourished by the uterine blood supply and the cells will begin to differentiate. Thus implantation signals the beginning of the embryo stage and the pregnancy begins.

in vitro fertilization (IVF):

a procedure in which the genetic parents' egg and sperm are mixed in a Petri dish to fertilize. Variations include AID (artificial insemination by donor sperm) and AIH (artificial insemination by the husband).

micro-injection:

a technique in which a very thin needle is used to insert a single sperm cell through the egg's outer membrane to improve chances of fertilization.

pre-embryo:

a fertilized egg which is in the process of early cell division up to the 16 cell stage (up to about day 14 for humans). During these early divisions no differentiation of cells has occurred. Each of these cells has the potential to become a separate individual if the cell becomes separated from the zygotic cell mass. (Identical twins, identical triplets, etc. are formed in this way.)

pregnancy:

a state when an embryo implanted in the uterus stimulates the hormone changes which will nourish the embryo/fetus until birth. Scientifically, pregnancy begins when the hormone HCG is produced by the uterine lining upon implantation of the zygote. Interestingly, recent medical studies indicate that 2/3 of all fertilized eggs never implant probably because of some genetic or developmental defect.

zygote intra-fallopian transfer (ZIFT):

a procedure where a pre-embryo is placed in the Fallopian tube of the recipient to improve chances of the pre-embryo settling in the uterus.

FACT SHEET

1. Currently 2 million American couples per year seek treatment for infertility at 20 U.S. in vitro fertilization clinics.

2. The average birth rate in IVF procedures varies from about 12-20% of IVF pregnancies, with the ZIFT procedures having the highest rates.

3. The IVF procedures cost from about $5000 to $10,000 per treatment. The total medical costs range from $10,000 to $50,000 In most states insurance companies do not cover cost of IVF procedures.

4. Infertility affects men and women about equality.

5. The ZFT procedure involves "harvesting 4 to 8 eggs from the prospective mother with all the eggs being fertilized at one time, then 4 zygotes used for the procedure and 4 others frozen for future use."

References:

Berlfein, Judy. "Earliest Warning," Discover, Feb., 1992 p.14.

Conkling, Winfred. "From Fertility to Fatherhood", American Health p. 10-11.

Elmer-Dewitt, Philip. "Making Babies", Time, Sept, 30, 1991, pp. 56-63.

Hall, Elizabeth. "When Does Life Begin", Psychology Today , Sept. 89.

Hopkins, Ellen. "Tales from the Baby Factory", New York Times Magazine, Mar. 24, 1992, pp.38 ff.

Ozar, David. "The Case Against Thawing Unused Frozen Embryos", Hastings Center Report, Aug. '85, pp.-12.

Robertson, John A., "Resolving Disputes over Frozen Embryos", Hastings Center Report, No/Dec. 1989.

Sanders, Alain, "Whose Lives are These:?" Time Oct. 2, 1989, p. 19.

Singer, Peter, "Making Laws on Making Babies", Hastings Center Report, pp.-6.

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