Assisted medical procreation

The assisted medical procreation or LDC, also called medical help with procreation (AMP) and procreation assisted médicalement (WFP), is a whole of clinical and biological practices where medicine intervenes more or less directly in procreation.

Although confusion is current (and maintained by the media), the LDC is not reduced to the FIV which is only one of the methods.

Because of its specific ethical weight the Human cloning will be treated in a separate page.

Techniques

Various techniques exist in the field:
  1. the techniques of programmed Rapports
  2. *Une hormonal monitoring (generally by urinary test) makes it possible to detect the imminence of ovulation and makes it possible the couple to have reports/ratios at the time of maximum fruitfulness.
  3. the techniques of caused Ovulation
  4. *Un processing of hormonal stimulation light and the release forced by a specific injection of hormone (for example HCG) make it possible to obtain an ovulation of better quality of many ovocytes and to place the reports/ratios at the time of maximum fruitfulness.
  5. the techniques of Artificial insemination (IA)
  6. *Cela consists in artificially injecting the sperm more or less prepared at the time of ovulation. Except in the case of insemination with sperm " frais" carried out " with the maison" , using the urinary tests to detect the period of ovulation, It was shown that the coupling of artificial insemination with caused ovulation is the only method of this type significantly improving the chances of pregnancy.
    1. with fresh sperm
    2. *Cette method is primarily practiced " with the maison" by the women wishing to be pregnant without having sexual relation with the male parent of their baby. The reason can be classically an abstract sperm donation for an heterosexual couple from which the man suffers from infertility, or a desire of child at a couple lesbian, or a desire of child for an unmarried woman not wishing to have sexual relation.
    3. with sperm prepared
    4. *Cette méhode is frequently used for the LDC of the couples whose infertility is not monocausale (what is the general case). She is often preferred in these cases in first intention with a FIV from the start for her less aggressive character for the woman.
    5. with sperm frozen
    6. *C' is the method generally used for the Sperm donation.
    7. *Plus seldom the congelation of sperm is used for the safeguarding of the sperm of a man having to undergo a treatment bringing into play its fruitfulness.
  7. the techniques of In vitro fertilization
    1. the traditional FIVETE (FIV)
    2. *Après an important stimulation and a dense monitoring of the follicular development, ovulation is started.
    3. *Les ovocytes is taken in the follicules a few hours before their natural release, generally by puncture under echography, and by celioscopy in the difficult cases.
    4. *Les ovocytes thus collected is put in the presence of selected spermatozoa. The fertilized ovocytes are cultivated (generally two days, sometimes more) in order to evaluate their quality. The best of them is established in the uterus ( transfer) and the others are still cultivated a few days before being frozen if they have a significant chance of survival.
    5. the intracytoplasmic microinjection of spermatozoon: (ICSI) Intra Cytoplasmic Sperm Injection .
    6. *Les process is the same one as for the FIV, except that the setting in the presence of the ovule and of the spermatozoa is replaced by the direct injection of only one spermatozoon selected in each ovule.
    7. the intracytoplasmic microinjection of selected with high magnification spermatozoon: (IMSI) Intra Cytoplasmic Morphologically Selected Sperm Injection .
    8. *Les process St the same ones as for the FIV, except that the setting in the presence of the ovule and of the spermatozoa is replaced by the direct injection of only one spermatozoon preselected under high-power microscope in each ovule.
  8. the Transferts of embryos
  9. *Des let us embyons supernumerary previously frozen obtained by the method of the FIV or of ICSI are defrosted and established.
  10. *On can also freeze embryos obntenus by FIV at a couple whose woman will have to undergo a treatment potentially sterilizing.
  11. the Congelation of ovaries
  12. *En preliminary to a treatment potentially sterilizing for a woman without spouse, of the samples of ovaries are taken in order to produce later on in vitro follicules and ovules.
  13. the gifts
    1. Gift of ovule
    2. Sperm donation
    3. Gift of embryo
    4. the surrogate mothers (illegal in France)

One recognizes several functions with assisted medical procreation, each one having his aspects psychological, ethical, social and legal.

  • the fight against the Infertility or the sterility,
  • the compensation of a caused sterility,
  • to avoid the transmission to a child of a grave disease, to see: Diagnosis préimplantatoire,
  • nontraditional desires of parentality,
  • to compensate for the effect of the menopause,

Indications of the techniques

Artificial insemination (IA) makes it possible to circumvent the problems involved in the ejaculation, with the glaire, all that prevents the spermatozoa from circulating well.

The In vitro fertilization (FIV) makes it possible to circumvent the problems involved in the absence of meeting between Ovule and spermatozoa. Problems of horns, in particular.

ICSI (medical introduction of a Spermatozoon into the Ovule) makes it possible to circumvent the problems of fecundation, and sterility of the man.

The IA and the FIV can also be done via a gift of Gamète, to circumvent the absence, or the bad quality of the gamètes. Sperm donation for the IA and the FIV. Sperm donation or of ovules for the FIV.

Disadvantages of the LDC

  • physical Disadvantages

On-ovulation of the woman tires her body. The treatments of pre-menopause put out of order its cycle. The IA is less tiring for the woman than the FIV. An increase in the cancer risk of the ovary due to stimulations is not established but cannot be isolated.

  • psychological Difficulties

The first difficulty comes from the diagnosis of sterility which occurs after testing medical check-up. Many studies highlight depressive and anxious features. It is especially the woman who suffers from it more within sight of her statute of patient, when well even sterility would come from the man.

The medical care of the woman influences her Hormone S, and by there its character. The couple is strongly upset by these changes. The pregnancies obtained are more fragile than normal pregnancies and involve an important anxiety.

Waiting, followed often disappointed hopes, creates an emotional dependence. The desire of child can become a need for child. All the attention of the woman is assigned to the treatments, punctures and transfers during all the duration of the treatments, which can last several years.

  • Disadvantages in love

The couple is very strongly balloté: sexual relations required at certain times inappropriate, or prohibited at the best times. Shift enters the man and the woman: the woman being very solicited by the doctors and the man very little. Dislike of the frequent sexual relations. Rate of separation of the very important couple.

  • social Disadvantages

The punctures and examinations often take place the morning. From where frequent delays with work. Without counting the disadvantages with the work of the effects of the treatments. For that, much of women resign or put themselves in sabbatical year.

  • Disadvantages on the fetus

The child, born from an assisted medical procreation, has a risk slightly raised to be carrying malformations to the birth (6,7% instead of 6% for a naturally conceiving couple hypofertile and 5% for a couple without known problem of infertility. These figures should not hide that the very great majority of the children are strictly normal) often not very serious. It is not clear if this risk is ascribable with the treatment of infertility or infertility itself

Position of the religions

  • Catholicism
The Church is opposed to assisted medical procreation (see moral Théologie). The the Vatican considers that the child must be regarded as a " don" of God and rather advises with the sterile couples to adopt un/des child (S). For the Church, a child is only the fruit of a sexual relationship.

  • Protestantism

It is obviously the most open religion with regard to the LDC. All the techniques are authorized, even the anonymous Sperm donation, rejected into all the other religions. Indeed, the recourse to the techniques of AMP is authorized, even by using a sperm of donor. The only formulated restrictions are that these techniques must only be used for an heterosexual couple (what excludes the homosexual ones and the widowers/ves) and that there should not be of another interest (for example financial) only that to give the life to a child.

  • Judaism

More permissive than Catholicism, it authorizes artificial inseminations (with sperm of the spouse only, opposite being regarded as an adultery), in vitro fertilization (FIV), the congelation of embryos, and the diagnosis pre implantatoire. These techniques must be held for an heterosexual couple.

  • Islam

Artificial insemination and the FIV are allowed, but only if the couple is heterosexual, married and that sperm allowing fecundation comes from the spouse. The diagnosis pre implantatoire is authorized only if it is with therapeutic aiming.

Random links:Parliamentary Parliament of the francophonie | Alfio Ticci | Rhagium inquisitor | List bridges of the English Channel | Picris hieracioides