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Bioethics Door Mind Map: Bioethics

1. Assisted Reproductive Technologies (ART)

1.1. In Vitro Fertlization (IVF)

1.1.1. Process

1.1.1.1. 1. Eggs are surgically removed from the female patient and placed in a petri dish.

1.1.1.2. 2. Sperm from the male patient is taken and placed in the petri dish with the eggs. The eggs are then monitored for fertilization.

1.1.1.3. 3. The fertilized eggs are relocated into another petri dish where lab technicians oversee the progression of the cells' development. The cells are given 5 days to become blastocysts and are then implanted into the female patient's uterus.

1.1.2. History

1.1.2.1. The first "test tube baby" was Louise Brown and was born in England in 1978.

1.1.2.2. IVF success rates have doubled within the past couple of decades

1.1.2.3. IVF Livebirths

1.1.3. Controversy

1.1.3.1. Catholics believe that reproductive procedures that involve removing gametes from the female and/or male taint the purity of a marriage. Catholics view reproduction as a natural process that occurs between a man and a woman. It is God's will if a couple should or shouldn't have a child. ART is referred to as "illicit" in the Catholic code for Bioethics. There are still grey areas as to what is and isn't reproductive interference in the Catholic community-- these are just the opinions expressed by the bishops in charge.

1.2. Intrauterine Insemination/Artificial Insemination (IUI)

1.2.1. Process

1.2.1.1. This procedure is favorable for many couples as it is fairly inexpensive (when compared to other ART procedures) and it does not involve as much medical intervention.

1.2.1.2. Sperm is obtained from the male patient or donor and is then directly injected into the female patient's fallopian tubes. This process promotes the fertilization of the eggs by creating the correct environment for fertilization to occur naturally.

1.2.2. Controversy

1.2.2.1. Although this procedure is not as controversial as other ART procedures, there is still some resistance from various religious communities- specifically from the Catholic church. By removing the male gametes from the husband/male partner and injecting them into the woman, it is believed that a spiritual barricade is put up between the husband and wife.

1.3. Gamete Intrafallopian Transfer (GIFT)

1.3.1. Process

1.3.1.1. This is very similar to IUI except it is more specific. The gamete is transplanted into the fallopian tubes versus the uterus to increase chances of conception.

1.3.2. Controversy

1.3.2.1. Catholics believe that reproductive procedures that involve removing gametes from the female and/or male taint the purity of a marriage. Catholics view reproduction as a natural process that occurs between a man and a woman. It is God's will if a couple should or shouldn't have a child. ART is referred to as "illicit" in the Catholic code for Bioethics. There are still grey areas as to what is and isn't reproductive interference in the Catholic community-- these are just the opinions expressed by the bishops in charge.

1.4. Zygote Intrafallopian Transfer (ZIFT)

1.4.1. Process

1.4.1.1. A zygote is transplanted into the fallopian tube. This is a subset of IVF.

1.4.2. Controversy

1.4.2.1. Catholics believe that reproductive procedures that involve removing gametes from the female and/or male taint the purity of a marriage. Catholics view reproduction as a natural process that occurs between a man and a woman. It is God's will if a couple should or shouldn't have a child. ART is referred to as "illicit" in the Catholic code for Bioethics. There are still grey areas as to what is and isn't reproductive interference in the Catholic community-- these are just the opinions expressed by the bishops in charge.

1.5. Intracytoplasmic Sperm Injections

1.5.1. Process

1.5.1.1. This procedure also falls under the category of IVF. To ensure fertilization, the sperm is directly injected into the egg. This procedure is especially popular among men with low sperm count.

1.5.2. Controversy

1.5.2.1. Catholics believe that reproductive procedures that involve removing gametes from the female and/or male taint the purity of a marriage. Catholics view reproduction as a natural process that occurs between a man and a woman. It is God's will if a couple should or shouldn't have a child. ART is referred to as "illicit" in the Catholic code for Bioethics. There are still grey areas as to what is and isn't reproductive interference in the Catholic community-- these are just the opinions expressed by the bishops in charge.

1.6. Gamete Donation

1.6.1. Process

1.6.1.1. This procedure involves taking sperm of eggs from a donor and storing it until it is needed. Most gametes are frozen via cryopreservation. These gametes are then used in place of one of the couple's gametes or as a donation for a single person.

1.6.2. Controversy

1.6.2.1. Catholics believe that reproductive procedures that involve removing gametes from the female and/or male taint the purity of a marriage. Catholics view reproduction as a natural process that occurs between a man and a woman. It is God's will if a couple should or shouldn't have a child. ART is referred to as "illicit" in the Catholic code for Bioethics. There are still grey areas as to what is and isn't reproductive interference in the Catholic community-- these are just the opinions expressed by the bishops in charge.

1.6.2.2. As reproduction is viewed as an intimate experience shared between a married couple, the Catholic church responds negatively to using another person's gametes that are not from the marriage.

1.7. Surrogacy

1.7.1. Process

1.7.1.1. Surrogacy involves another woman carrying someone else's child. Surrogacy suggests that the child has no biological connection to the surrogate. Surrogacy is great for women who have polycystic ovarian syndrome or another issue with implantation to the uterine wall.

1.7.2. Controversy

1.7.2.1. Catholics believe that reproductive procedures that involve removing gametes from the female and/or male taint the purity of a marriage. Catholics view reproduction as a natural process that occurs between a man and a woman. It is God's will if a couple should or shouldn't have a child. ART is referred to as "illicit" in the Catholic code for Bioethics. There are still grey areas as to what is and isn't reproductive interference in the Catholic community-- these are just the opinions expressed by the bishops in charge.

1.7.2.2. Just like with gamete donation, surrogacy involves a third party which goes against the Catholic view of marriage.

1.7.2.3. Some skeptics believe that surrogacy is wrong as it exploits the female body. Often, women in poverty become surrogates to earn money.

1.8. Preimplantation Genetic Diagnosis (PGD)

1.8.1. Process

1.8.1.1. PGD is the process of analyzing the genome of an embryo before implantation to test for potentially harmful or fatal genetic disorders. The process is not extremely invasive; some of the cytoplasm from the blastocyst is analyzed and little harm is done to the blastocyst.

1.8.2. Controversy

1.8.2.1. Catholics believe that reproductive procedures that involve removing gametes from the female and/or male taint the purity of a marriage. Catholics view reproduction as a natural process that occurs between a man and a woman. It is God's will if a couple should or shouldn't have a child. ART is referred to as "illicit" in the Catholic code for Bioethics. There are still grey areas as to what is and isn't reproductive interference in the Catholic community-- these are just the opinions expressed by the bishops in charge.

1.8.2.2. There is pushback from nonreligious groups, as well, with PGD. Some people view PGD as a tool for creating the perfect child, free of disease. There are fears that PGD will later progress to allow parents to choose their children's traits.

1.9. Cryopreservation

1.9.1. Process

1.9.1.1. Donated gametes are often frozen in this process to use for later. Viability varies between gametes due to age of the donor and the facility that holds the frozen gametes. Sperm is almost always viable after freezing; ova, on the other hand, have difficulty successfully thawing without implications. Technology has gotten more precise, though, so recovering frozen eggs has been more successful than it used to be.

1.9.2. Controversy

1.9.2.1. Catholics believe that reproductive procedures that involve removing gametes from the female and/or male taint the purity of a marriage. Catholics view reproduction as a natural process that occurs between a man and a woman. It is God's will if a couple should or shouldn't have a child. ART is referred to as "illicit" in the Catholic code for Bioethics. There are still grey areas as to what is and isn't reproductive interference in the Catholic community-- these are just the opinions expressed by the bishops in charge.

1.10. Posthumous Reproduction

1.10.1. Process

1.10.1.1. Posthumous reproduction is a specific type of cryopreservation. This procedure is most commonly used with cancer patients. Individuals who are terminally ill have the option of freezing their gametes to use in the case that they pass away but their partner still wants to have a child with them.

1.10.2. Controversy

1.10.2.1. Catholics believe that reproductive procedures that involve removing gametes from the female and/or male taint the purity of a marriage. Catholics view reproduction as a natural process that occurs between a man and a woman. It is God's will if a couple should or shouldn't have a child. ART is referred to as "illicit" in the Catholic code for Bioethics. There are still grey areas as to what is and isn't reproductive interference in the Catholic community-- these are just the opinions expressed by the bishops in charge.

1.10.2.2. This is commonly viewed as taboo as the gametes are from a dead person. Some people view this process as resurrecting the dead.

2. The Fertility Center in York

2.1. Interview with Michele Munch, CRNP

2.1.1. 11/22/2016 at 1:15 PM

2.1.2. 1. What procedures does the Fertility Center perform? What is the most common procedure?

2.1.2.1. The center does IVF (in vitro fertilization), IUI (intrauterine insemination), embryo biopsies, artificial insemination, ultrasounds, and blood work.

2.1.2.2. The most common procedure at the clinic is IVF or IUI

2.1.3. 2. What are the expenses for such procedures?

2.1.3.1. One round of IVF costs about $11,000

2.1.3.2. One round of IUI costs about $450

2.1.3.3. The prices vary depending on insurance plans and other financial factors

2.1.4. 3. What is the most satisfying part of your job? What is the most difficult part of your job?

2.1.4.1. "The most satisfying part of my job is helping my patients achieve pregnancy. You get to know the couples very well and being there for them throughout their journey is extremely rewarding when they finally are successful with getting pregnant. It's a beautiful thing."

2.1.4.2. "The most difficult part of my job is when couples are unable to get pregnant. Watching these people invest so much time and money into getting these procedures is heartbreaking when they are still unable to get pregnant. So many people take conception for granted and being in this field definitely emphasizes that."

2.1.5. 4. How do you think ART will progress in the future?

2.1.5.1. Success rates will continue to increase

2.1.5.2. The science of freezing eggs (cyropreservation) will become more accurate/successful, "as more women are delaying childbearing until later in their lives"

2.1.6. 5. What are some reasons as to why people seek out your services?

2.1.6.1. Infertility (trying to get pregnant for over one year without success)

2.1.6.2. Genetic testing

2.1.6.3. Assistance with irregular periods due to unknown causes or polycystic ovarian syndrome

2.1.7. 6. What ethical obstacles (personally or as a team) have had to overcome within your job? This can be in regards to religious beliefs, company policy, etc.

2.1.7.1. Difficult for some Catholic patients to pursue reproductive assistance as there is a lot of pushback from the Catholic community (even IUI, which is fairly natural, is frowned upon)

2.1.7.2. "Now, this wasn't at the clinic that I work at now, but I did work with a woman who ended up leaving her job because of the ethics. Personally, she took no issue in her job; it was her husband who wasn't fond of her work. He took issue with her handling other men's sperm for analysis, and after a few months on the job, she quit."

2.1.7.3. "I imagine that there has been some controversy when same-sex couples come in for certain services and when people come for embryo biopsies, but like I said, the majority of our patients are married couples."

2.1.8. Experience and Credentials

2.1.8.1. Working in the field of fertility for 19-20 years

2.1.8.1.1. 1996-2002: Genetics and IVF Institute in Fairfax, VA

2.1.8.1.2. 2002-present: The Fertility Center in York, PA

2.1.8.2. 1988: Beebe School of Nursing

2.1.8.3. 1991: Bachelor's degree from Wilmington

2.1.8.4. 1994: Master's degree from University of Delaware

2.1.8.5. 1997: completed Post Master's Family Nurse Practitioner program and received certification from American Nurses Credentialing Center

3. Personal Experience

3.1. My Parents

3.1.1. Married in 1991 in Malmo, Sweden

3.1.2. Moved to the U.S. shortly after marriage

3.1.3. Began trying to have kids ~1994/1995

3.1.3.1. According to my grandmother, my mother had always wanted children. She always played with baby dolls and loved babysitting. When my mother was 18, she was an au pair for a family in Florida

3.1.3.2. My uncle (my mom's brother) and aunt weren't married until after they had my cousin. My aunt told me that this deeply hurt my mom; my mom had been trying to get pregnant for a few years without success while my aunt got pregnant without any effort. My aunt teared up speaking about it. She said she was so happy for my parents when finally they had the two of us (my brother and I).

3.1.4. Adoption

3.1.4.1. My parents had looked into the possibility of adoption. The trouble was that they weren't naturalized citizens so the process of adoption would be very strict and time consuming for them compared to U.S. citizens. Adoption was the last option for my parents-- luckily, they never had to use it.

3.1.5. ART

3.1.5.1. As my parents were becoming older, they sought out the opinion of fertility professionals. Before they became too old to naturally conceive, they wanted to look into ART

3.1.5.1.1. Blood work and Testing

3.1.5.1.2. Acupuncture

3.1.5.1.3. Medication

3.1.5.1.4. Intrauterine Insemination

3.1.5.1.5. In Vitro Fertilization

3.2. Life as a "test tube baby"

3.3. My mother's experience teaching Ethics at Pennsylvania College of Health Sciences