Category: Infertility

Introduction

For the purpose of the following report the author will explore treatments, the influencing Bio-psycho-social factors in addition to wider influences such as legal and ethical issues, and the importance of the promotion in health and education in relation to female infertility. The World Health Organization (WHO) defines infertility as a disease of the reproductive system resulting in the failure to achieve clinical pregnancy after twelve months or more of regular unprotected sexual intercourse (World Health Organization, 2019). Data released in 2016 revealed Ireland as having the third highest fertility rate in Europe (Ec.europa.eu, 2017) which signifies a decline in fertility rate, as in 2012 the Central Statistics Office released data that Ireland had the second highest fertility rate in Europe (The Irish Times, 2014). Furthermore, the decline in infertility is supported by 2017 CSO figures which identify a continuous decline in Irish birth rates over the past decade. Additionally, to the increase in the age of first-time mothers which now stands at 31 years of age there is also a decline in the number of women in younger ages. (CSO, 2017).

Treatments

Treatments for infertility are constantly evolving but can generally be subdivided into three categories consisting of medication and surgical treatment to improve or restore fertility and Assisted Reproductive Technology (ART) such as In Vitro Fertilization (IVF). The type of treatment is dependent on the cause of infertility. Updated NICE guidelines recommend infertility treatments in instances of unexplained infertility and mild endometrioses and IVF treatment for those who have not conceived after two years of vaginal intercourse. For the first-time guidelines are inclusive of women over the age of 39 (40-42 years), same-sex couples, those carrying an infectious disease or those unable to have intercourse due to disability and patients about to undergo cancer treatment that wish to preserve their eggs (NICE, 2013).

Fertility restoration drugs are typically used to treat ovulation disorders affecting fertility. Clomiphene citrate is an oral medication which mechanism of action is to stimulate the pituitary gland to increase the level of the follicle stimulating hormone (FSH) and the Luteinizing Hormone (LH) to fortify the growth of an ovarian follicle containing an egg. Alternatively, gonadotropins are injected to encourage the production of multiple eggs or to mature the eggs and trigger their release at ovulation. Metformin is another pharmacological treatment which may be used when insulin is considered as a contributing factor in women with a diagnosis of polycystic ovary syndrome (PCOS) to improve insulin resistance and thus increasing the chances of ovulation. Aromatase inhibiters or dopamine antagonist may be administered to induce ovulation in a similar manner to clomiphene, when excess production of prolactin by the pituitary gland interrupts ovulation (mayoclinic.org, 2019).

Due to the effectiveness of alternative treatments surgical interventions are rare. Laporscopic and hysteropic surgery can correct or remove abnormalities affecting fertility as a result of endometrial polyps, uterine or pelvic adhesions, fibroids or correcting the abnormal shape of the uterus. Surgery can also create a tubal opening in fallopian tubes that are blocked (Mayoclinic.org, 2019).

There are many variants of Assisted Reproduction Technology (ART) but, the two most common methods are Intrauterine insemination (IUI) and IVF. IUI involves the process of placing millions of healthy sperm inside the uterus at the time of ovulation to facilitate fertilization through the increase in the number of spermatozoa that reach the fallopian tubes. IVF consists of retrieving a mature egg from the woman and fertilizing them in a petri dish in a laboratory with sperm, once fertilization has been established the fertilized embryo is transferred into the uterus. IVF is the most effective form of ART of which the cycle takes several weeks requiring frequent Full Blood Counts (FBC) and hormone injections (Mayoclinic.org, 2019). Although a successful form of treatment, in Ireland it is currently only available privately meaning undergoing IVF can be expensive, even with the tax relief for medical expenses scheme and the drugs payment scheme, average costs are estimated in the region of €4000 (National Infertility and Support Group, 2019). In 2018 the Irish Government announced that plans to allocate funding to IVF treatment had been set aside and legislation delayed for regulatory measures, and that couples seeking treatment would have to meet certain criteria and be means tested, prioritizing those who are childless over existing parents (The Irish Times, 2019).

Legal, social, ethical, psychological issues and sexual behavior.

From a legal perspective the “Children and Family Relationship Act 2015” includes laws on assisted human reproduction (AHR) following on from the commission of AHR in 2005 to establish regulations but have not yet come into force. Additionally, fertility services are generally only available to those who are in a “stable” relationship i.e. married heterosexual couples (HSE.ie, 2018). However, demand for the treatment is expected to rise due in part to the marriage referendum in 2015 and the “Equal Status Act” 2000 to prevent against discrimination on the grounds of preferred sexual orientation, however the “Childrens and Family Relationships Act” must first be amended to clarify parentage as a result of donor-assisted human reproduction (Oireachtas.ie, 2018). Recently ethical issues have surfaced surrounding the advancements in IVF treatment in regard to genetic selection, IVF clinics can already identify which embryos are predisposed to developing certain disease and illness such as cystic fibrosis due to genetic data that has been collected, however controversially the same methods can be used to predict the eventual height, skin tone and even intelligence of an embryo (Regalado, 2018). However, IVF is not alone, as legal issues are increasingly being identified in alternative options for having children through a surrogacy and donor assisted human reproduction retrospectively in recognition of parenthood. Issues surrounding statutory requirements related to maternity leave and maternity benefit was emphasized by the courts in the case of “G v. The Department of Social Protection” where the claimant was neither entitled to parental leave or adoption leave as she did not come within the confinements of the statutory requirements, requiring the necessity for legislation and amending what constitutes “motherhood” in the Irish constitution to address the lacuna in the law (Healy 2017). Also, for consideration is the topic of secondary infertility whereby a woman is unable to bear a child through an inability to conceive or an inability to carry a pregnancy to a live birth or who repeatedly spontaneously miscarry or pregnancy that results in stillbirth following previous pregnancies (World Health organization, 2019). We should also consider societal expectations or pressures surrounding fertility. Research carried out by VHI in conjunction with the “Let’s talk about Fertility” campaign identified that 47% of surveyed women feel there is stigma associated to infertility and one in four linking that to lack of open dialogue surrounding the issue. An additional 20% believed that women are stereotyped in that they should want children (Ring, 2016). Is it expected that all women naturally want more children, or want children at all? And what is it like for those women who decide to go against the norm or lack maternal instincts? Would addressing these societal and cultural notions linking women’s identity with procreation ease the burden on those experiencing difficulties with fertility? (infertility and its treatments, 2009). As a result of this it is important to consider the psychological impact on those faced with infertility. Infertile women experience more depression and anxiety and reduced marital satisfaction than those of their fertile counterparts as well as lower confidence in their parenting abilities post IVF. Due to the cyclical nature of infertility feelings of hope, loss and despair are recurrent, in 1980 Barbara Eck Menning examined these emotional stages categorising them into: “surprise, denial, anger, isolation, guilt, grief and resolution” likening the stages to Kubler-Ross’s stages of grief (Allan and Mounce, 2015). This highlights the need for psychological and emotional support for women and their partners as they journey through infertility and its treatments. It is evident that women are delaying pregnancy into their thirty’s, perhaps in order to establish careers, women aware that pregnancy and child rearing can negatively impact career progression and wrongly rely on reproductive technologies like IVF as a “cure” for fertility issues (Fauser et al, 2019)

Due to the complexities and personalized responses to infertility it is difficult to conduct comparative studies to establish the effects, thus highlighting the importance of health promotion and education on fertility, causes and symptoms of infertility (Appendix 1) and the limitations of Assisted reproductive Technology. In order to achieve pregnancy, the steps of the human reproduction process must happen correctly. Ovulation must occur where the egg is released from the ovary into the fallopian tube where it meets the spermatozoa and is fertilized. The fertilized egg then travels down to the uterus where it implants into the endometrial lining and grows in the uterus (Mayo Clinic, 2019). According to Tsevat et al. Untreated sexually transmitted infections (STI’s) such as Chlamydia trachomatis and Neisseria gonorrhea are attributed to tubal factor infertility which causes inflammation, scarring and damage as well as Pelvic Inflammatory Disease (Tsevat et al, 2017). In the first six weeks in Ireland in 2019 there were 216 cases of Chlamydia and 73 cases of gonorrhea reported (HPSC, 2019). A survey conducted by Durex in 2017 exposed the attitude towards sex in Ireland revealing that 59% of women surveyed had never had an STI check with 53% (ironically) reporting that they were more concerned about getting pregnant than contracting an STI that may result in infertility (Irishexaminer.com, 2017). Weight also has an impact on fertility with the Healthy Ireland report identifying that 31% of women are overweight and 22% obese, subsequently half of all women are overweight or obese at pregnancy booking visit (HSE.ie, 2019). Overweight women have an increased risk of infertility, miscarriage and pregnancy complications and have poorer outcomes in terms of natural and ART (Ozcan and Dilbaz 2015). One out of seven Irish couples will have difficulty conceiving with a third of those attributed to female infertility with age being the biggest contributing factor. Other influencers include athletic training, stress, alcohol and tobacco (women’s health clinic, 2019). One should also consider the influence media has on women’s perceptions of age-related infertility through misleading media reports about older celebrities being able to conceive without considering that they may need assisted reproductive technology (Mac Dougal et al. 2012).National fertility awareness week is held annually from the 17th – 24th of July to raise awareness and educate people on the growing issue of infertility (Celebration of National Fertility Awareness Week 2018).

Conclusion

As depicted in the above document the effects associated with infertility are as emotionally, socially and legally complex as the causes and treatments of infertility itself. Due to the rising global prevalence and incidences of female infertility it is evident that there needs to be more of an emphasise on education in order to combat the deficit on knowledge on the impact of fertility issues. Education and open dialogue may help decrease the perception of social stigmatisation felt by infertile women, as well as enabling women to make better lifestyle choices that may impact their fertility. The lack of legislation surrounding AHR in Ireland needs to be addressed to better facilitate those who are faced with no other option than surrogacy to help ease the emotional and psychological burden associated with infertility. Additionally, there is also a need to address the lack of funding in relation to assisted reproductive technology to ensure those who are involuntarily childless have better access to treatments, inclusive of amending current legislation as to not discriminate against those in same sex relationships.

References

1. Allan, H. and Mounce, G. (2015). Managing infertility in primary care. Practice Nursing, 26(9), pp.440-443.
2. Ec.europa.eu. (2017). Visualisations – Eurostat. [online] Available at: https://ec.europa.eu/eurostat/web/population-demography-migration-projections/visualisations [Accessed 18 Feb. 2019]
3. Eurohealth. (2018). National Fertility Awareness Week 2018. [online] Available at: https://eurohealth.ie/national-fertility-awareness-week-2018/ [Accessed 20 Feb. 2019].
4. Fauser, B. C. J. M. et al. (2019) ‘Beliefs, attitudes and funding of assisted reproductive technology: Public perception of over 6,000 respondents from 6 European countries’, PLoS ONE, 14(1), pp. 1–15. doi:10.1371/journal.pone.0211150.
5. Healy, C. (2017) ‘Once more with “sympathy” but no resolution for intended mothers: the EU, Ireland and the surrogacy dilemma’, Journal of Social Welfare and Family Law, (4), p. 504. Available at: http://ezproxy.ait.ie/login?url=http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=edswst&AN=edswst.2410172&site=eds-live (Accessed: 6 February 2019).
6. HSE.ie. (2018). Introduction – HSE.ie. [online] Available at: https://www.hse.ie/eng/health/az/i/ivf/ [Accessed 16 Feb. 2019].
7. HSE.ie. (2019). Key Facts – HSE.ie. [online] Available at: https://www.hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/heal/key-facts/ [Accessed 14 Feb. 2019].
8. https://www.cso.ie/en/releasesandpublications/ep/p-plfp/populationandlabourforceprojections2017-2051/fertilityassumptions/ [Accessed 18 Feb. 2019].
9. Hpsc.ie. (2019). [online] Available at: http://www.hpsc.ie/a-z/hivstis/sexuallytransmittedinfections/publications/stireports/stiweeklyreports/Weekly%20HIV%20&%20STI%20report%20Week6.pdf [Accessed 14 Feb. 2019].
10. infertility and its treatments. (2009). A review of psycho-social issues. [online] the womens health council. Available at: https://health.gov.ie/wp-content/uploads/2014/03/infertPsychosocial.pdf [Accessed 15 Feb. 2019].
11. Irishexaminer.com. (2017). Survey reveals attitudes to STIs among young people in Ireland. [online] Available at: https://www.irishexaminer.com/breakingnews/ireland/survey-reveals-attitudes-to-stis-among-young-people-in-ireland-819080.html [Accessed 14 Feb. 2019].
12. Mac Dougall, K., Beyene, Y. and Nachtigall, R. (2012). Age shock: misperceptions of the impact of age on fertility before and after IVF in women who conceived after age 40. Human Reproduction, 28(2), pp.350-356.
13. Mayoclinic.org. (2019). Female infertility – Diagnosis and treatment – Mayo Clinic. [online] Available at: https://www.mayoclinic.org/diseases-conditions/female-infertility/diagnosis-treatment/drc-20354313 [Accessed 18 Feb. 2019].
14. Mayo Clinic. (2019). Female infertility – Symptoms and causes. [online] Available at: https://www.mayoclinic.org/diseases-conditions/female-infertility/symptoms-causes/syc-20354308 [Accessed 15 Feb. 2019].
15. National Infertility and Support Group. (2019). Fertility Treatments Explained. [online] Available at: http://nisig.com/about-infertility/treatments-part-2/ [Accessed 16 Feb. 2019].
16. ‘NICE updates infertility guidelines’ (2013) PharmacoEconomics & Outcomes News, (673), p. 3. doi: 10.1007/s40274-013-0195-y
17. Oireachtas.ie. (2019). Seanad Éireann debate – Tuesday, 17 Jul 2018. [online] Available at: https://www.oireachtas.ie/en/debates/debate/seanad/2018-07-17/8/ [Accessed 18 Feb. 2019].
18. Özcan Dağ, Z. and Dilbaz, B. (2015) ‘Impact of obesity on infertility in women’, Journal of the Turkish-German Gynecological Association, 16(2), p. 111. Available at: http://ezproxy.ait.ie/login?url=http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=edb&AN=103375815&site=eds-live [Accessed: 14 February 2019].
19. Regalado, A. (2018) ‘Will You Be Among the First to Pick Your Kids’ Genes?’, MIT Technology Review, 121(1), p. 16. Available at: http://ezproxy.ait.ie/login?url=http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=edb&AN=126789251&site=eds-live [Accessed: 6 February 2019].
20. The Irish Times. (2014). Ireland records second highest fertility rate in EU. [online] Available at: https://www.irishtimes.com/news/social-affairs/ireland-records-second-highest-fertility-rate-in-eu-1.2018943 [Accessed 20 Feb. 2019].
21. The Irish Times. (2019). Public funding for IVF treatment set aside, says Varadkar. [online] Available at: https://www.irishtimes.com/news/ireland/irish-news/public-funding-for-ivf-treatment-set-aside-says-varadkar-1.3744352 [Accessed 15 Feb. 2019].
22. Tsevat, D., Wiesenfeld, H., Parks, C. and Peipert, J. (2017). Sexually transmitted diseases and infertility. American Journal of Obstetrics and Gynecology, 216(1), pp.1-9.
23. Womens Health Clinic. (2019). Female Infertility and Conception – Womens Health Clinic. [online] Available at: https://www.womenshealthclinic.ie/female-infertility-and-conception.html [Accessed 14 Feb. 2019].
24. World Health Organization. (2019). Infertility definitions and terminology. [online] Available at: https://www.who.int/reproductivehealth/topics/infertility/definitions/en/ [Accessed 20 Feb. 2019].

Choosing an apt fertility treatment is vital for achieving positive results. Luckily, several treatment solutions are there for your infertility problems. IVF and ICSI appear as effective options for your needs. In IVF method, tons of sperms will be added on every egg for egg fertilization. It is utilized for several years to produce human eggs in a body. A key variation between conventional IVF and ICSI is a way egg is fertilized in a lab.

IVF

Eggs will be collected from women in IVF procedure. And these collected eggs will be left in Petri dishes with millions of sperm. This method is considered for natural fertilization to happen. In reality, this procedure involves a procedure of combining sperms and eggs in a lab instead of human body. Typically, this IVF is a complicated process, with only 5% of couples having infertility choose this procedure. Consulting with Best IVF Doctor in Delhi for a safe cure is helpful to get the higher successive rate. Based on a report, women below 35 years of age undergone IVF cycle have a live birth IVF success rate as 40%. Women above 42 years have a success rate of 4%.

IVF works with an excellent blend of surgical procedures as well as medicines. They aid sperms in fertilizing eggs. The next step is that these fertilized eggs are implanted inside human uterus. Best IVF & Infertility Specialist in Delhi is dedicated to offering complete assistance throughout the treatment from retrieving ovaries and fertilizes sperm in a lab.

ICSI

In the ICSI treatment, embryologist mainly utilizes latest equipment as well as a microscope to pick single sperm to inject in an egg. Embryologists not only offer Best ICSI Treatment in Delhi but also check every egg to be fertilized. After that, they are converted into embryos. Once embryos discovered, they are placed in uterus directly. Remaining embryos will immediately be frozen for further usage. A head of every sperm needs to be attached outside egg even before sperms fertilize an egg. When it is attached, sperm will push through an exterior layer inside an egg, also called cytoplasm, so that fertilization would take place.

Usually, there are two different ways eggs are fertilized through the IVF and ICSI. ICSI process involves a tiny needle or micropipette are injected the sperm into an egg. A primary goal of this process is to ensure that traditional fertilization will occur. The fertilized eggs grow in a lab. Within 2 to 5 days, these eggs would be transferred in a woman’s uterus or womb. As per a report, ICSI procedure fertilizes from 60% to 80% of eggs. Scientist reports revealed that ICSI has a success rate of 24% for pregnancy. Another report states that IVF without ICSI has a higher success rate of 27% for pregnancy. These are mainly assisted with various methods for reproductive technology.

Conclusion

The use of ICSI is estimated as a highly advanced procedure for a male with infertility problems. Recently, there is a more successive rate for techniques involved using non-male factor infertility. Mechanical damage to oocytes after ICSI also results in causing detrimental effects along with a declining chance for fertilization. In short, IVF is helpful for fertilization, production of an embryo, and also implantation to increase a possibility for women to get pregnant. This kind of cure is chosen based on your condition.

Introduction

IVF refers to in vitro fertilization, a method of creating a new life outside the human body. Within this process, eggs and sperm are mixed in the laboratory, for which they are removed and placed in an incubator. Among the formed zygotes, the strongest are selected and implanted into the mother’s body for further natural gestation.

Discussion

This technology provides a high level of efficiency in terms of fertilization: the embryos successfully take root, and women diagnosed with infertility become mothers of healthy children. In case of male infertility, the IVF method is complemented by intracytoplasmic sperm injection (ICSI): fertilization is carried out with only one sperm cell not in a natural way, but with the help of special tools. This method has allowed many men to become parents even with severe pathologies of sperm formation.

The pros and cons of IVF fertilization are much talked about in the press, and this technology is often discussed in religious and scientific circles. There is no doubt about the benefits: it opens the possibility of childbearing to infertile people who have lost hope. Practice has shown that children born through IVF are no different from “natural” babies, they develop normally and live a full life. Since the entire process of conception and gestation is controlled by specialists, the risk of serious genetic pathologies is minimal. Thus, it can be concluded that, indeed, IVF should be an option for women struggling with infertility.

Conclusion

In the historical aspect, IVF is a relatively new concept that arose in the last part of the XX century. Since then, heated discussions were held over the nature and religious appropriateness of the method. Some scholars, while not doubting the value of the IVF, even express the fear that conducting research and experiments on human embryos can lead to a new form of eugenic selection and human cloning. Orthodox theologists express differentiated attitudes towards IVF and other methods of “abnormal” childbearing techniques available today. Meanwhile, the position of the Roman Catholic Church is more simple and unambiguous: it evaluates all such methods negatively, based on the concept of the traditional for the Catholic moral theology inviolability of the natural law. However, theological arguments can be easily refuted by scientific facts that emphasize IVF’s benefits not only for infertile women but for the humanity as a whole.

There is still some substantial controversy over the practice of contraception in Pakistan. Although Pakistan’s total fertility rate, 5 births per woman or more in 2000, has declined in this decade, Pakistan still remains among the most fertile countries in the world (Sathar 1).

National programs designed to reduce fertility levels have seen minimal success and Pakistan needs a closer look at the facts about its fertility rates and the methods it can use to reduce its fertility. If it fails to implement good fertility control programs, it is projected that by the year 2050, it will be among the most populated three countries in the world.

Pakistan is expected to have more population than Brazil by the year 2025 based on the trends in its population and fertility in the past. With a population of 145.5 million in the year 2000, Pakistan is expected to have a population of about 246.3 million in the year 2025 (Sathar 19). It is expected to be among the top three most populated countries in the world by the middle of this century.

In spite of these predictions, the growth rate of Pakistan’s population is expected to decrease in the five-year period between 2025 and 2030. In the same period, total fertility rate, infant mortality rate, crude death rate and crude birth rate are expected to decline to 2.7, 42.2, 5.6 and 21.4 respectively. The population growth rate is expected to be 1.52 during this five-year period. Additionally, the life expectancy will increase to an approximate of 72 years (Sathar 29).

The rates of the use of contraceptives in Pakistan were, essentially, stagnant between the year 1975 and 1991 (Sathar 21). This can be attributed to the low level of government involvement in family planning matters. The decade between 1990 and 2000 was, however, characterized by an exponential rise in the prevalence of contraception.

In a survey conducted in 1994 and 1995, evidence showed that contraception prevalence among married women changed from 12 % in 1990 to 18 %. A second survey conducted in 1996/1997 showed an increase in contraception rates to 24 %. The projected prevalence rate for contraception in the year 2000 was 38 % (Sathar 16). The contraception rates were thus the ones responsible for the fall of the total fertility rate of Pakistan in the 1990’s (Fruchtbaum 1).

The transition of the fertility of Pakistan over the years is mainly attributable to the increase of marriage age of females since the year 1961. It is also partly caused by the highlighted moderate increase of the prevalence of contraceptives. The fertility transition can also be, arguably, explained by the high female mortality evident in this country (Hagen 1). There are also other socio-economic factors that can be used to explain the fertility patterns. An example of the aforementioned is urbanization which has greatly affected fertility rates.

Given the fertility problem in Pakistan, programs aimed at reducing fertility rates should be improved to ensure effective implementation. For instance, policies should be formulated to ensure that the rate of contraception is satisfactory. The government should also provide facilities for proper maternity care to ensure that the high rate of mortality among women in the country is checked (Fruchtbaum 1). Other factors leading to increased fertility like development of poor urban settlements should also be controlled to contain the problem.

Works Cited

Fruchtbaum, Harold. “Women Status and Fertility in Pakistan.” 1994. Web.

Hagen, Catherine. “Fertility and Family Planning Trends in Karachi, Pakistan”. 1999 . Web.

Sathar, Zeba. “Fertility in Pakistan: Past, Present and Future.” 2001. Web.

Research question

An individual is likely to live for at least 80 years in a country where the maximum number of children per woman is two. However, an individual is likely to die before the age of 60 in a country where the number of children per woman is more than six.

Background

The research question is interesting because an increase in population has both positive and negative effects on economic growth and development. Most developed countries such as the US have already exceeded their bio-capacity. Thus, their natural resources will not be able to support production of adequate food and disposal of wastes if their populations continue to rise (Shaw, Horrace and Vogel 768-783).

However, low fertility rates in developed countries have already caused high labor costs, which threaten the sustainability of economic activities. Thus, the argument that a low fertility rate (maximum of two children per woman) leads to a long life expectancy is counterintuitive. Specifically, life expectancy will reduce if economic activities that produce the necessities of life become unsustainable due to the high labor costs that result from low fertility rates (Kabir 185-204).

Source of the Data

The dataset was downloaded from www.google.com/publicdata/. The dataset consisted of three variables namely, population size, life expectancy, and fertility rate. The data was collected from 200 countries in various parts of the world.

Hypothesis

Countries with high life expectancy (at least 80 years) prefer to have less than two children per woman. However, countries where the life expectancy at birth is less than 60 years prefer to have at least four children per woman.

Predictors

From the sample of 200 countries, life expectancy at birth is expected to increase as the number of children per woman reduces. Thus, people live longer in countries with low fertility rates than those with high fertility rates.

Analysis

The data was used to determine the correlation between fertility rate and life expectancy as shown in figure 1. The colored bubbles in figure 1 represent various countries. The size of each bubble was determined by the size of the population of the country that it represents. The data was also used to compare the fertility rate and life expectancy in select countries as shown in figure 2.

Findings

Figure 1 shows that an individual can only live for a maximum of 55 years in a country where the average number of children per woman is six. However, life expectancy increases to 82 years in countries where the maximum number of children per woman is two. According to the figure 1, majority of the countries with more than four children per woman had a life expectancy of 60 years. Figure 2 clearly shows that life expectancy is high in countries with low fertility rate and vice versa.

Conclusions

The findings indicate that an individual is likely to die before his or her 60^th birthday in a country where women have at least six children in their lifetime. Moreover, an individual can live for at least 80 years in a country where women have very few children.

How the Data Supports the Findings/ Conclusions

The analysis shows that fertility rate has an inverse relationship with life expectancy in various countries. Specifically, the data indicates that life expectancy is increasing as the number of children per woman reduces. This means that it is possible to live for 80 years in a country with a low fertility rate. It also indicates that a person is likely to die before the age of 60 years in a country with a high fertility rate.

Works Cited

Kabir, Mahfuz. “Determinants of Life Expectancy in Developing Countries.” Journal of Developing Areas 41.2 (2008): 185-204. Print.

Shaw, James, William Horrace and Ronald Vogel. “The Determinants of Life Expectancy: An Analysis of OECD Health Data.” Southern Economic Journal 71.4 (2005 ): 768–783. Print.

Fertility Issues Are Not Resolved Through Sexual Positions

One of the more prevalent articles seen in magazine oriented towards a female readership are articles specifically dealing with the topic of fertility and pregnancy. It is often the case that these articles give recommendations related to proper sexual positions as a means of addressing fertility issues or to bring about a greater likelihood of getting pregnant. The problem with this perspective is that fertility issues are not resolved through sexual positions.

Biology versus Positioning

People seem to assume that sexual intercourse is all that is needed when it comes to getting pregnant and that difficulties experienced in conceiving are likely due to a lack of sufficient sexual interaction or improper positioning to ensure that sperm reaches the ovum. The problem with this way of thinking is that it neglects to take into consideration the biological factors that can cause issues when it comes to conception (Peng 175).

For instance, vaginal acidity levels are something that most people do not even consider or even know about, yet it plays a crucial role in determining how likely a person is in getting pregnant. The higher the levels of acidity in the vaginal canal, the lower the likelihood someone has in getting pregnant (Glover, McLellan, and Weaver 402). This is due to sperm not being able to survive in a highly acidic environment.

There are also issues with a woman’s hormones to take into consideration. Even if a woman is menstruating, which is indicative of their potential to get pregnant, abnormal hormone levels within a woman’s body can cause issues when it comes to the density of the uterine wall or even the viability of the eggs that are released (Brown and Guinnane 513). Aside from this, there also potential issues when it comes to a man’s fertility that need to be taken into consideration (Barry 606).

There is always the possibility that the sperm a man produces is abnormal (i.e. slow swimmers) which causes them to not reach the female ovum at all. Male infertility is often one of the primary reasons why some couples cannot get pregnant (Kemnitz and Thum 225). These are only a few of the plethora of biological factors that can influence the potential for pregnancy and, as such, shows that proper sexual positioning cannot help someone if biological factors are the primary cause behind their fertility issues.

Potential Harm Caused by these Articles

The problem with these articles is that they are written from a woefully unscientific perspective. They imply that proper positioning, the regularity of intercourse, and the performance of the parties involved are all that is needed to get pregnant. A lot of the articles fail even to mention the potential for biological irregularities being the primary source of the problem. This can be the origin of a considerable amount of conflict between couples who are trying the recommended positions of the articles and are getting nothing out of it (Kjaer 271). As such, this shows the need for proper article investigation.

Works Cited

Barry, Jane. “Prolactin And Aggression In Women With Fertility Problems.” Journal Of Obstetrics & Gynaecology 34.7 (2014): 605-610. Print.

Brown, John C., and Timothy W. Guinnane. “Regions And Time In The European Fertility Transition: Problems In The Princeton Project’S Statistical Methodology.” Economic History Review 60.3 (2007): 513-544. Print.

Glover, Lesley, Ashleigh McLellan, and Susan M. Weaver. “What Does Having A Fertility Problem Mean To Couples?.” Journal Of Reproductive & Infant Psychology 27.4 (2009): 401-418. Print.

Kemnitz, Alexander, and Marcel Thum. “Gender Power, Fertility, And Family Policy.” Scandinavian Journal Of Economics 117.1 (2015): 220-247. Print.

Kjaer, Trille. “Divorce Or End Of Cohabitation Among Danish Women Evaluated For Fertility Problems.” Acta Obstetricia Et Gynecologica Scandinavica 93.3 (2014): 269-276. Print.

Peng, Tao. “Testing The Psychometric Properties Of Mandarin Version Of The Fertility Problem Inventory (M-FPI) In An Infertile Chinese Sample.” Journal Of Psychosomatic Obstetrics & Gynecology 32.4 (2011): 173-181. Print.

Introduction

The process of fertilization is an inevitable one as it the main contributing factor to procreation. The outcomes of fertilization are the offspring who grow up and repeat the process thus coming up with other offspring. It is therefore the cycle that leads to the existence of living things. Fertilization is a process that essentially entails the fusion of two gametes thus producing a new organism.

This process can either take place inside or outside the body of the organism depending on the species. In mammals, fertilization mostly takes place inside the body of the female animal whereby the gamete from the male animal known as the sperm fuses with the female gamete (egg) in the oviduct forming a zygote.

The zygote undergoes development and after the gestation period, it is released to the environment as a mature organism. For a long period, the process of fertilization had been a mystery until recently when the process was extensively investigated to unveil the mystery behind it. This paper is therefore an exploration of the process of fertilization in mammals by looking at what initiates it, how it takes place and the scientific explanation behind the process.

The process of fertilization in mammals

The process of fertilization begins with coitus whereby the mammalian sperm is released into the vagina of the female mammal. Once inside, the sperm finds its way into the egg by swimming. The egg is normally placed in the oviduct. On reaching the egg, the sperm fights to get in through fusion.

The mammalian oocyte or egg comprises of three layers that encloses it. These layers include; the cumulus layer, zona pelllucida and the plasma membrane (Evans 297). For the process of fertilization to be successful, the mammalian sperm ought to penetrate through the three layers. The interaction of the mammalian sperm with the membranes of the oocyte involves several interactions.

The membrane interactions of the sperm and oocyte

To find out on the sperm-oocyte interactions, microscopic analyses were conducted. The study indicated that the plasma membrane of the mammalian oocyte is covered with microvilli (Evans 298). Therefore, once the acrosome reactions take place, the posterior end of the sperm is attached to the membrane of the oocyte thus fusing.

After the fusion, the sperm’s motion is inactivated. The study also indicated that the sperm with the highest motility is the one that penetrates the oocyte membranes. Those with low motility get lost into the body of the female mammal. However, once a sperm has fused with the oocyte the membrane prevents other sperms from fusing with the oocyte again.

It was also found out that the gamete membrane interactions are mediated by various molecules. Some of these molecules include a protein known as DE, CRISPI, ARP and AEG-1 for the sperm. The oocyte contains molecules such as integrins, which play a great role of adhesion. Other components that assist in the reaction are Ca^2+, phospholipase, and IP3 receptors just to mention a few. Essentially, the process of fertilization in mammals takes place in the five steps discussed below.

The five steps of fertilization

The first step is that of attachment of the sperm to the egg. This is species-specific as eggs and sperm will only bind if they are from the same mammalian species (Wassarman et al 1). For instance, it is not possible for the sperm of a rabbit bind and fuse with the egg from a dog, since they are not of the same species. However, recent developments have indicated that fusion of gametes from different species would only fuse if the zona pellucida is removed from the egg using buffers or proteases.

The second step occurs after the sperm binds to the zona pellucida of the egg therefore undergoing an acrosome reaction referred to as cellular exocytosis. In this reaction, multiple fusions are bound to occur between the plasma membrane and the external membrane. Thereafter, the contents of the interior part (acrosome) are exposed thus enabling fusion to take place. The sperm that manages to fuse with the acrosome contents is the one that has fully completed the acrosome reaction to penetrate the zona pellucida.

Penetration of the sperm into the egg zona pellucida is the third step. The sperm that has undergone the acrosome reaction now binds to the zona pellucida for penetration. This step is facilitated by sperm motility as well as enzymatic hydrolysis. The catalyst in action is known as acrosin, which helps the sperm to penetrate the zona pellucida of the egg successfully.

The fourth step is the fusion step whereby the successful sperm fuses with the contents of the egg. This process is partly mediated ADAM proteins and the integrins, which are adhesive compounds (Primakoff and Myles 84). Others are fertilin-α and fertilin-β which support the binding process of the sperm to the egg contents.

The last step in the fertilization process is a continuation of the latter stage whereby the fusion process goes on. The only difference is that the facilitating proteins are now called CD9. These act with the combination of β1 integrins to complete the fusion process (Wassarman et al 3).

Once the process is completely done, it leads to the establishment of the zygote, which is a diploid cell (Bruce). The zygote then slowly develops to form a blastocyst, which then comes down from the oviduct to the uterus (Bruce). Once in the uterus, implantation occurs, marking the beginning of pregnancy.

In a situation where implantation occurs in a different location other than the uterus, ectopic pregnancy is evidenced. Because, pregnancy cannot take place to term in any other place other than the uterus, such a pregnancy is terminated.

Conclusion

From the above discussion, it is evident that the process of fertilization is one of the complicated processes in the body of mammals. This is because it encompasses a series of subsequent reactions and steps that take place inside the body of the female mammal. It is also clear that the process of fertilization occurs in five major steps. Each of these steps requires different compounds and substrates to complete every step. Despite the fact that the process is a series of reactions, the time taken to complete them is very short.

However, this depends on the species of the animal just like the differences in the gestation period. It has also been seen that penetration of the egg zona pellucida by the sperm is species specific, such that penetration only occurs in mammals of the same species. In case of inter-specie penetration, the zona pellucida is removed so that the sperm only penetrates the plasma membrane.

References

Bruce, Carlson. Patten’s Foundations of Embryology -6th Edition. (1996). McGraw-Hill, Inc., New York. Print.

Evans, Janice. “The molecular basis of sperm-oocyte membrane interactions during mammalian fertilization.” Human Reproduction 8.4 (2002): 297-311. Print.

Primakoff, Paul and Myles, Diana. “The ADAM gene family: surface proteins with adhesion and protease activity. Trends Generation. 16.1 (2000): 83-87. Print.

Wassarman, Paul, Jovine, Luca and Litscher, Eveline. A profile of fertilization in mammals. 2001. Web.

Hermaphroditism can only occur as a result of having both female and male reproductive organs. Reproduction can happen through self-fertilization where diploid offspring can be created. This process can be commonly observed in organisms such as snails and earthworms. On the other hand, pathogenesis refers to reproduction that happens in an unfertilized ovum. Haploid offspring are produced and this process is usually observed among lower plants and insects. Internal fertilization requires gametes to be fertilized within the female organism during sexual reproduction. It is characterized by fewer gamete production, and higher survival rates of the embryos, and is common among mammals, reptiles, certain fish, and birds. External fertilization requires gametes to fuse outside the female organism during sexual reproduction and therefore happens in an external environment. It produces a large number of gametes, and greater genetic diversity and is often observed in algae, frogs, fish, mollusks, and crustaceans.

Pheromones have a number of roles throughout the reproductive cycle. They can influence the presence of estrus in female organisms and can affect the behaviors of individuals of the opposite sex. Even throughout the pregnancy, pheromones can contribute to the successful development of a fetus. The menstrual cycle can only occur in primates and involves bleeding due to the broken down endometrium in the blood flow. Copulation can occur at any time during the cycle among female primates. On the other hand, the estrous is prevalent in other mammalian species and does not involve bleeding as the broken down endometrium is absorbed. Female individuals only permit copulation when in the estrous cycle. Andrea suspects that her body produced multiple ovulations due to the fact that she had just stopped taking birth control pills, which can be a common side effect in the first month of not taking pills (Powell & Tillman, 2011). As such, she became pregnant from the two or more ovulations she experienced, with sperm from different fathers and two different times of conception.

Reference

Powell, J., & Tillman, E. (2011). Case study: An unusual case of animal reproduction. National Center for Case Study Teaching in Science.

Introduction

As well as land and capital, labor is one of the main factors of production in economics. An organization’s activity and performance directly depend on human capital. Human capital signifies the talent, creativity, productivity, skills, and knowledge of the workforce. What is more, human capital is considered to be one of the most important factors of a country’s competitiveness. Gender equality plays a key role in human capital. Gender equality signifies that no one should be discriminated against due to his or her gender. Gender equality is a basic human right and a common value of the contemporary world. This paper is aimed at the analysis of the evolution of female labor market participation infertility and the detection of the main factors behind these evolutions.

The Evolution of Female Labour Market Participation

Although women started working after the Industrial Revolution that led to the rise of factory work, there was a significant increase in women’s labor force participation only over the last century. In the first half of the 20th century, only unmarried women worked (Leigh 2010). Less than one-third of women were in the labor force in the United States of America after World War II. “Women soon began to participate in greater numbers, and their labor force participation rose rapidly from the 1960s through the 1980s before slowing in the 1990s” (Women in the labor force: a databook 2015). Women in the labor force reached a peak of 60 percent in 1999. Approximately the same statistics can be noticed in the evolution of female labor market participation in other developed countries.

Cipollone, Patacchini, and Valenti (2014, p. 2) state that “the female participation rate in Europe has increased from around 55% in the early 90s to more than 66% in 2008”. Consequently, the female employment rate was increasing gradually during this period from the early 90s to 2008. Cipollone, Patacchini, and Vallanti (2014) underline that these changes led to a dramatic decrease in the gender employment gap, which was almost two times less in 2008 than it was in 1990. Women in the labor force enjoy all the associated benefits nowadays. For instance, Hamermesh and Trejo stress (2000, p. 38) that “for many years, California required that most women receive an overtime premium of time-and-a-half for hours of work beyond eight in a given day”. The evolution of female labor market participation has led to an increase in the supply of woman’s labor.

The Evolution of Fertility

On the contrary, with the establishment of modern economic growth, fertility is moving in a completely different direction. Fertility tends to decline in developed countries. As it is described by Sommer (2016, p. 2), “over the last four decades, the average total fertility rate in OECD countries has fallen dramatically: from 2.9 in the 1960s to 2.0 in 1975, and then further down to 1.6 in 3 4 2000”. There are a lot of factors that influence fertility choices. The most common are changes in income levels (a rise in female wages), earnings risk, education, career, changes in labor market regulations, marriage circumstances, and contraceptive use. It is important to understand the essence of fertility decisions and factors that influence it because fertility is closely connected with population growth and even economic outcomes (Kasarda, Billy & West 2013).

Women’s Labour Supply and Fertility

There are some important connections between women’s labor supply and fertility. Sometimes having a child and taking care of him are considered to be a barrier to participation in the labor market to some extent (Billingsley & Ferrarini 2014). The more children a woman has, the lower the opportunity to find a job. Due to it, some women decide not to have children. They devote as much time and as many resources as possible to their careers. As can be seen from the overall tendency of decreasing fertility rate, more and more women choose jobs.

A lot of European countries have low fertility rates, and there are specific reasons for that. These reasons are education, women in careers, later marriages, and state benefits (Case study: pro-natalist policy in France 2016). People tend to be more aware of the essence of contraception, and they try to avoid an unplanned pregnancy and its consequences that can affect their careers. In her paper, Bailey (2006, p. 306) underlines that “changing career trajectories, resulting from delay in childbearing, constitute the primary mechanism connecting early access to the pill to increases in labor force participation”. Also, European women prefer to follow their career choice rather than give birth (Genre, Salvador & Lamo 2010). Apart from this, some European families do not think about having children anymore because due to a variety of different state benefits, they will not need children to help them in the future.

European Fertility Policies

Some social and fiscal policies are implemented to make child-rearing less difficult for working women and to increase the fertility rate (Siegel 2017). These programs vary from country to country. In 2013, the European Parliament published the document that gathers and describes all the necessary and important factors that should be taken into account when developing fertility policy. This document written by Ron Davies is a kind of guideline for governments.

Firstly, it is important to create financial options. As it is described by Davies (2013, p. 4), “a child bonus is paid out to parents once at the time of birth; a child or family allowance is paid continuingly until the child reaches a given age”. Ongoing tax reductions or credits should be implemented too. Further, Davies (2013, p. 5) states that maternity and paternity leaves are to be provided. What is more, a part of this leave can be transmitted from one parent to another. The next factor is the childcare provision. Davies (2013, p. 6) claims that “the availability and affordability of formal childcare, especially for the youngest children, can make having children easier, particularly where both parents want to continue working”. Some additional options were offered. For instance, it is important to pay enough attention to fathers and encourage them to take care of their children more. Apart from this, social housing programs can contribute to establishing new families. Finally, such options as a part-time job and flexible working hours are also important for parents. This proposed options could have a positive effect on fertility.

It can be said that the Northern European countries offer a mixed variety of childcare programs and part-time opportunities. The policies of northern European countries are aimed at both the labor force participation of women and fertility. These programs allow women to choose if they want to continue working their childbearing years or to take care of their children themselves. In this case, mothers are given long optional maternity leaves (Rechel et al. 2013). However, women tend to use childcare and continue working simultaneously in Northern European countries. There is almost no negative influence on their careers.

In Anglo-Saxon countries, governments developed programs mainly for poor people. Mothers are not given long optional maternity leave. Women have to choose if they work part-time or leave the labor market.

The governments of the Southern European countries implemented programs that are aimed at working mothers. These social programs include employment protection. In regions where public childcare is more available, women can continue working and take care of children without leaving the labor market. Whereas, in regions where childcare availability is low or even absent women can continue working only if they have families who support them. The social policies of the Southern European countries do not offer long maternal leaves and part-time opportunities. Moreover, the availability of childcare is low, and women have to rely on their families.

The French Fertility Policy

France was the first country that implemented an active family support program. Anderson (2016, p. 46) states that the French fertility policy was introduced in 1939 when the French government introduced the ‘Code de la Famille’. The fertility policy was developed by the French government because of the decrease in fertility and the increase in life expectancy. These two factors contributed to such problems as the fall in labor supply and future population decline.

The French policy is the most successful fertility policy at the moment. It is confirmed by the fact that France has one of the highest fertility rates in Europe. Three main characteristics of the policy are the payment of family benefits (housing benefit, family allowance, early childhood benefit); the introduction of specific forms of leave (maternity leave, paternity leave); tax allowances, or specific benefits. For instance, full tax benefits are given to women until their youngest child turns 18 (With 2.01 children per woman, France has one of the highest fertility rates in Europe 2013). Also, large family transport cards are introduced with a fare reduction of 30%. Retirement benefits are given to mothers.

The Advantages and Disadvantages of the French Policy

There are some advantages and disadvantages that arose from the French policy. This policy contributes greatly to the increasing number of the workforce in France. Moreover, due to this policy, the fertility rate that is important for future cultural stability has increased. It seems that the French fertility policy does not have any limitations. However, there are some disadvantages. Because of the pro-natalist program, the French government has to spend more money on the health care sector. Also, it cannot be denied that the French immigration policy has led to a huge number of refugees and immigrants in the country. There is a popular belief the French fertility rate is increasing due to immigrants. Immigrants tend to have more children than the French, so they contribute a lot to the population growth or fertility in France. The French government spends a lot of money on programs related to immigration issues, and the costs continue to increase due to the fertility policy. Apart from this, the French policy is considered to be more feministic than familistic because women are not to get married and stay at home anymore to have children, and the French government provides strong support to single-parent families.

Recommendations

Immigrants do not associate themselves with the citizens of the country where they live. They do not want to work and accept the new lifestyle; they just want to get benefits. The majority of immigrants living in France get married, give birth to children, and bring them up by their own culture. Although immigrants are the reason for the growth in population to a great extent, it is not appropriate for the future of society. To overcome this immigration problem related to fertility, the one possible solution is establishing a successful immigration policy, which is determined by creating conditions helping immigrants accept new laws and rules and successfully become conscientious citizens. Such a program will help immigrants and refugees to integrate into the local community.

Conclusion

To sum up, gender equality is a fundamental human right and a common value of the contemporary world. Women have come a long way from discrimination. Nowadays, women have access to educational resources, and they can find a job. The evolution of female labor market participation has led to an increase in the supply of woman’s labor. Such terms as female labor market participation and fertility are closely connected. Fertility rates tend to decline in developed countries. Contemporary women prefer to build their careers rather than give birth to children. Some pro-natalist policies are introduced to make child-rearing less difficult for working women and to increase the fertility rate. The brightest and most successful example of such policies is the French fertility program because France has one of the highest fertility rates in Europe. Although there are a lot of advantages to this policy, some disadvantages can be noticed too. The main negative characteristic is the fact that French fertility depends on immigrants to a great extent.

Reference List

Anderson, M 2016, ‘The office de la famille française: familialism and the National Revolution in 1940s Morocco’, French Politics Culture & Society, vol. 34, no. 3, pp 44-62.

Bailey, M 2006, ‘More power to the pill: the impact of contraceptive freedom on women’s life cycle labour supply’, Quarterly Journal of Economics, vol. 121, no. 1, pp.289-320.

Billingsley, S & Ferrarini, T 2014, ‘Family policy and fertility intentions in 21 European countries’, Journal of Marriage and Family, vol. 76, no. 2, pp. 428-445.

Case study: pro-natalist policy in France. 2016. Web.

Cipollone, A, Patacchini, E & Vallanti, G 2014, ‘Female labour market participation in Europe: novel evidence on trends and shaping factors’, IZA Journal of European Labour Studies, vol. 3, no. 1, p.18.

Davies, R 2013, ‘Promoting fertility in the EU. Social policy options for the Member States’, Library of the European Parliament. Web.

Genre, V, Salvador, R, & Lamo, A 2010, ‘European women: why do (not) they work?’, Applied Economics, vol. 42, no. 12, pp. 1499-1514.

Hamermesh, D & Trejo, S 2000, ‘The demand for hours of labour: direct evidence from California’, Review of Economics and Statistics, vol. 82, no. 1, pp.38-47.

Kasarda, J, Billy, J, & West, K 2013, Status enhancement and fertility: reproductive responses to social mobility and educational opportunity, Elsevier, Amsterdam.

Leigh, A 2010, ‘Informal care and labour market participation’, Labour Economics, vol. 17, no. 1, pp. 140-149.

Rechel, B, Grundy, E, Robine, J, Cylus, J, Mackenbach, J, Knai, C, & McKee, M 2013, ‘Ageing in the European Union’, The Lancet, vol. 381, no. 9874, pp. 1312-1322.

Siegel, C 2017, ‘Female relative wages, household specialisation and fertility’, Review of Economic Dynamics, vol. 24, pp.152-174.

Sommer, K 2016, ‘Fertility choice in a life cycle model with idiosyncratic uninsurable earnings risk’, Journal of Monetary Economics, vol. 83, pp. 27-38.

Women in the labour force: a databook. 2015. Web.

With 2.01 children per woman, France has one of the highest fertility rates in Europe. 2013. Web.

Introduction

Fertility preservation refers to the method of enabling cancer patients to maintain their fertility. This is because chemotherapy, radiation and other treatment regimens destroy the reproductive system of the body by attacking reproductive cells such as sperms and ovas.While the loss of the reproductive ability maybe temporary in some patients, some never regain it. Women may experience menopausal symptoms while men display characteristics of andro-pause.

Ovarian destruction depends on the drug, the dose, and the age. As the age of the patient increases lesser doses, increase chances of failure of the ovaries. It may result from radiation of the abdomen, the pelvic, or the whole body. The case is worse for pre-pubertal girls because in addition to the risk of infertility, female survivors of childhood cancer are also at a risk of premature ovarian failure. Statistics from a study indicated that 25% of female childhood survivors had premature menopause before the age of 16 years (Donnez and Kim 74).

Improvement of cancer survival rates among children means doctors have to focus their attention on offering them a wholesome life in future. It is estimated that two-thirds of children with cancer will be cured and most of them will experience fertility deficiency. Fertility is a major aspect of such a life.

Fertility preservation in males, children, or adult are less expensive, less invasive, and more effective because they are a wide range of options available and procedures. For females, the methods are complicated, especially in relation to pre-pubertal children whose eggs are not yet mature.

Methods for preservation range from cryopreservation, protecting gametes during chemotherapy by using the gonadotropin-releasing hormone. Ovarian tissue cyro-preservation is a process in which normal functioning ovarian tissue is excised from the ovary and stored cryogenically and is the only option that can be offered to pre-pubertal girls (Donnez and Kim 77).

This opinion states that embryo cryopreservation after in-vitro fertilization as well as cyro-preservation of mature human oocytes are in most cases unsuitable for minors therefore cryopreservation of ovarian tissue containing small immature ovarian follicles remains almost the only option.

Pre-pubertal males have a gonad maturation process. In contrast, the process of establishing in-vitro maturation process for pre-pubertal females is still in progress.In spite of the fact that the process is still at an experimental level, ovarian tissue removed from pre-pubertal and adolescent cancer patients is being frozen in medical centers around the world.

Paedetriac surgeons use thorascopy and laparoscopy in pre-pubertal females. Lapascropy involves isolation of the fallopian tube from the ovaries to control supply of blood. Through an incision on the abdomen, the ovary is then removed in a special bag. The advantage of this method is that the abdomen is thoroughly explored through an incision and both ovaries can be examined before removal.

Legal and Bioethical Issues

Ethical and legal etiquette demands that any process involving a minor should be done in the best interest of the minor. The society’s obligation to act in the best interest of the child is a paramount feature of bio-ethics. In case of failure of the parent’s or the society, the state should intervene in its capacity as parens patriae i.e. parent of the nation.

Feinberg, a legal scholar proposes existence of special rights in relation to children, which he names as “rights in trust”. Such rights are to be preserved for them until adulthood and fertility is one such right (Weintraub et al 4). The concept of best interest means that fertility preservation procedures should be aimed at enhancing the survival of the child and minimizing risk to that child. This gives rise to myriad legal and bio-ethical issues.

A pre-pubertal girl is a minor in law and is therefore incapable of consenting to any procedure; he or she cannot understand the complications arising from the preservation procedure. The consent of the parents is therefore required. This is known as at two- test procedure because it involves the parents’ consent and minor’s assent.

Conflicting scenarios may arise whereby the parents consent and the minor does not assent or where the parents decline to consent and the minor requests the preservation. This creates a legal crisis, which is hard to solve considering the sensitive and vulnerable nature of pre-pubertal children (Moorland 78).

The issue of use of experimental procedures is a thorny issue in legal and ethical circles. The earlier discussion has revealed that cyro-preservation of ovarian tissue is the only available option. The process is not thoroughly established and is still at an experimental level.

So far, no baby has been born out of the procedure because the minors are still adolescents and there are no accurate statistics. Questions rise as to whether pre-pubertal females should be subjugated to the level of guinea pigs and what remedies should be available in case such a procedure backfires.

Preservation of ovarian tissue means that in future the pre-pubertal minor may have to rely on a surrogate mother if her reproductive system is destroyed. She may also have to rely on sperm from a donor if she does not have a stable partner. Legal issues arise such as who is to have parental responsibility over such children. Should the secondary parents (surrogate mother and sperm donor) have a right to know the child or should they be completely out of the child’s life as is the case now?

There is a chance that cancer patients may pass the disease to their offspring or that such offspring would stand a high chance of cancer infection. The treatment regime may lead to defects in the chromosome, increase transmission of heritable diseases and other anomalies in the genetic structure of the child.

There are discussions on whether it is ethical to allow cancer patients to preserve fertility if they are going to pass medical conditions to their children. Those against preventing preservation of fertility on such aground argue that other people with heritable genetic conditions such as albinism and hemophilia are allowed to reproduce, and cancer patients should not be prohibited, as it would constitute discrimination.

The other bio-ethical issue stems from the fact that the cancer patient may suffer from a recurrence and die pre-maturely leaving the without one parent or rendering him an orphan if single. While one school of physicians suggests that it is unethical to assist cancer patients with expected short life span to have offspring, the other argues that “to deny cancer patients the right to preserve their fertility amounts to ‘forced sterilization’ which is ethically unacceptable” (Chian, 253).

Those in support of allowing preservation despite a reduced life-span suggest that it’ in the best interest of the pre-pubertal child to have the right to reproduce while those against say they consider the best interest of the pre-pubertal child’s child.

Storage, disposal, and post-humus use of the preserved ovarian tissue or embryo is a delicate ethical issue. If the cancer patient dies before using the preserved tissues, there are concerns as to whether such materials should be destroyed, whether they should be used for research, or whether they should be donated to other infertile couples. All those methods raise moral and religious issue.

Research into fertility preservation methods requires embryo and oocyte donation from humans. Creation of embryos and subsequent destruction in research is considered unethical because at the end of the day the tissues are capable of potential human life. To address these legal and bio-ethical issues, a coherent legal framework needs to be put in place.

How the Policy should be impacted

The cancer patient, particularly a minor is distinct from other fertility patients by virtue of the disease and the age. Every human being has an inherent desire to reproduce and propagate the species. Surveys indicate that cancer patients have a strong desire to preserve their fertility through procedures that involve minimum risk and are beneficial. They should not be deprived of the opportunity but qualified professions under stringent legal conditions, particularly in relation to pre-pubertal minors, should undertake the process.

In developing the fertility preservation policies for pre-pubertal girls, saving the life of the cancer patient must always take precedence over fertility preservation.

It should only be offered where chances of survival are realistic. The costs of fertility preservation for females are currently very high, estimated up to $10,000. The state should reduce the cost for pre-pubertal females in view of their age by establishing a fund for them. Funds should also be availed for research to increase options for them and make surgery procedures less invasive.

Complications related to anesthesia occur more commonly in infants than in adults. Children under 1 year suffer the greatest risk, which decreases when they turn 3 years and equalizes with that of adults at the age of 15 years. Because of the increased risk, ovarian cero-preservation in pre-pubertal females should not be performed before they turn three (Weintraub et al 5). Qualified pediatricians and oncologists should perform the surgery.

A cogent legal and bio-ethical issue that arises is disposal of cyro-stored gametes if patients die before the use them. If the cancer patient does not survive, there should be a framework for disposal of stored gametes or embryos and they should never be applied by the medical center for other purposes such as invitro fertilization of other infertile couples. “A minor child who survives to majority age should take full-control of the disposition of the bio-materials and should become the sole person entitled to consent to their use or disposal” (Chian 254).

Minors should give directions for disposal of such tissue at a time when there are healthy and lucid, preferably through a written agrrement.Such an agreement should be amendable at a future time if they wish to change the terms and proposals. This would give directions in case of death, failure of payment of storage fees or other contingencies.

The patients and their guardians should be approached by clinical professionals in charge of the therapy or by a multi-disciplinary team who will explain the fertility risks resulting from the anti-cancer therapy and the purpose and the potential of cyro-preservation of ovarian tissue (Gwendolyn and Thomas 135). Doctors should avoid exerting undue influence on the vulnerable patient and the anxious parents by issuing statements like “she will suffer later if she does not go through the process” (Gwendolyn and Thomas 135).

The minors and parents should have a right to be informed of the future fertility status of their children and all fertility options. If this is not done promptly or in time, the fertility options for the patient may be lost. In consenting to fertility preservation, parents should only accept established methods. They should never consent to experimental procedures that may increase the risk for their children.

An independent body such as an ethics committee should be established to review the decisions of the parents and the doctor’s decision as the state exercises its responsibility as parens patriae.This would ensure that the decision to preserve fertility is in the best interest of the child, and it is not for selfish motives or profit gains. It would also sort out legal crises where the parents assent, the minor does not consent, or where the parents do not consent, and the minor approves.

Genetic tests should be conducted to evaluate whether the patient has genetic conditions that maybe passed onto the offspring and increase the risks for transmission of cancer infection just for ethical considerations. If the chances are high, and the patient still insists on the procedure the information should be passed to an independent body such as an ethics committee which should vet whether fertility preservation should be allowed for such a patient, and whether the patient can be convinced to accept other options such as adoption.

Conclusion

Counseling services should be offered to the pre-pubertal female, her parents, or legal guardians. Before and after the removal of such tissue.Counselling should be progressive from the day of the removal, to the day the minor is cured, until the day she decides to undergo the reproduction process itself. It should continue to post-reproduction days and be extended to the child delivered if they are chances that the infection will be transmitted to the offspring, or a recurrence will occur to the patient, or the parent will die pre-maturely.

Works Cited

Chian, Ri-Cheng. Fertility Cryopreservation. Cambridge: Cambridge University Press, 2010. Print

Donnez, Jacques, and Kim, Stephen. Principles and Practice of Fertility Preservation. Cambridge, UK: Cambridge University Press, 2011. Print.

Gwendolyn, Quinn, and Thomas, Susan. Reproductive Health and Cancer in Adolescents and Young Adults. Dordrecht: Springer, 2012. Internet resource.

Moorland, Margarite. Cancer in Female Adolescents. New York: Nova Science Publishers, 2008. Print.

Weintraub, Mathew et al. “Should Ovarian Cryopreservation be offered to Girls with Cancer?” Review of Pediatric Blood Cancer 48.1 (2007): 4–9. Print.