12 - Assisted reproductive technologies

Summary

Case example

Thirty-year-old Mr. Edward Dawson, an investment manager in a large bank, collapses one afternoon in his office. His assistant immediately calls 911. Emergency medical technicians respond rapidly, recognize that Mr. Dawson is in cardiac arrest, begin cardiopulmonary resuscitation, intubate Mr. Dawson, and transport him to nearby Downtown Medical Center, where he is placed on a ventilator and admitted to the medical intensive care unit. Physical examination and diagnostic imaging reveal that he has suffered a severe anoxic brain injury, and he does not regain consciousness. Eight weeks later, Mr. Dawson's medical condition is unchanged. A consulting neurologist informs his wife that, although he does not satisfy all of the neurologic criteria for the determination of death, his brain injury is extensive and irreversible. The neurologist explains that it is highly unlikely that Mr. Dawson will ever regain consciousness or the ability to breathe on his own.

Mr. Dawson had been married just four months before this accident. Dr. Milam, his attending physician, offers Mrs. Dawson the option that ventilator support be withdrawn and Mr. Dawson be allowed to die. Mrs. Dawson agrees with this treatment plan, but requests that, before the ventilator is withdrawn, her husband's sperm be recovered for artificial insemination at a later date. She reports that they had intended to have children in the course of the marriage, and that she would like to fulfill that goal. How should Dr. Milam respond?

Overcoming infertility

Reproduction is, of course, a natural process essential for the survival of any biological species, but not all individual organisms have the ability or the opportunity to reproduce. For most human beings, reproduction is also a life-changing event with great personal and moral significance. People who desire children and who experience difficulty reproducing may therefore seek medical assistance in achieving that goal. Human infertility is, in fact, a relatively common condition. According to a US National Survey of Family Growth conducted between 2006 and 2010, 6 percent of all married women aged 15–44 (1.5 million women) were infertile, where infertility was defined as having been sexually active without using contraceptive measures over the past twelve months and not having become pregnant. In the same survey, 11.5 percent of all men aged 25–44 who were not surgically sterile reported inability or difficulty fathering a child.