Medical Procedures To Increase Fertility
There are medical procedures which may increase a person's fertility. Although sexually transmitted diseases (STDs, such as gonorrhea, syphilis, and chlamydia) and, for women, pelvic inflammatory diseases (PID), are predominant causes of infertility, preventive actions can decrease the possibility of contracting an STD or PID or suffering adverse environmental and/or occupational effects. Curative procedures include gynecological and urological surgery (e.g., surgery to open blocked fallopian tubes in women, or correct varicose veins in men). There are also infertility-bypassing procedures, which are called assisted reproductive technologies (ARTs), because they do not cure the physiological cause of the infertility. These ARTs include low-tech therapies, such as hormone medications and intrauterine insemination using sperm from the woman's partner or from a donor. High-tech procedures, which include retrieval of oocytes or fertilization of gametes outside the female body, are referred to as in-vitro fertilization (IVF) and related technologies. In IVF, eggs are fertilized outside the female body, and the embryo(s) are cultured in the laboratory; later, fresh or frozen embryo(s) are transferred to the female uterus (Grainger and Tjaden 2000). In IVF, donated gametes and embryos can also be used. When combined with surrogate motherhood, IVF can be used for couples in which the woman is without a womb. Other IVF-related technologies are zygote intrafallopian transfer (ZIFT), in which embryos are transferred to the fallopian tubes, and gamete intrafallopian transfer (GIFT), in which the egg and sperm are placed in a woman's fallopian tubes (Fidler and Bernstein 1999). The most common micromanipulation technique is intracytoplasmic sperm injection (ICSI) where one sperm is inserted into an egg in the laboratory. The access to these high-tech ART procedures depends on the local health care system and insurance coverage. Overall, about half amillion children worldwide have been conceived with the help of IVF; and in the United States it has been estimated that approximately 29,000 IVF children are born annually; in Europe, approximately 40,000 IVF children are born annually (Nygren, Andersen, and the EIM 2001; Use of Assisted Reproductive Technology 1999)
IVF has revolutionized reproduction: IVF can be used to treat fertile couples for concerns unrelated to infertility; IVF may be used for embryo biopsy for purposes of sex selection and genetic diagnosis; IVF may be used to store gametes of cancer patients before starting chemotherapy (Lass, Akagbosu, and Brinsden 2001). Insemination can to be used for single women or lesbian couples (Baetens and Brewaeys 2001). IVF with donated eggs is used for postmenopausal women (Sauer, Paulson, and Lobo 1993). Surrogate motherhood, combined with IVF, can be used for homosexual male couples. Thus, the ARTs have widened the human possibilities to reproduce.