it right? activity (page 4) to highlight ethical issues associated with IVF

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1 IN VITRO FERTILIZATION I V F In some cases, a sperm is directly injected into an egg IVF: THE MEETING OF SPERM AND EGG IN GLASS Louise Brown, the first test tube baby was born in Since then, there have been thousands of babies born every year using IVF. Scientists estimate that infertility affects 1 in 6 couples at some point. Images courtesy of the Wellcome Library SPECIFICATION CONTENT Old: explain some of the recent developments in the research into fertility problems: the causes of infertility; the use of hormone treatment to produce multiple ova; in vitro fertilization; the transfer of several ova into the uterus. New: explain some of the causes of infertility and developments in fertility treatment: the use of hormones to produce multiple ova; in vitro fertilisation; and the transfer of several embryos into the uterus; and understand some of the controversy associated with these techniques and their ethical implications. STARTER Play fertility traffic lights (see page 2 for suggested questions). STIMULUS Talk through the fertility photo album (on screen or printed out) which is a picture guide to infertility and fertility treatments. Use the is it right? activity (page 4) to highlight ethical issues associated with IVF QUESTIONS After allowing thinking time to create an individual question, ask students to work in groups to select one question to put forward for enquiry on A4 paper and place in the centre of the circle. Read each question and place in a different corner of the room. Ask children to vote with their feet. ENQUIRY Questions that the teacher can use to provoke thought are provided on the COSE guidance page. EVALUATION PMI (Plus Minus Interesting). Give each student 3 colours of post-it note. On one colour, they must write something positive about the enquiry, on another they must write something negative about the enquiry and on a third they must write something interesting about the enquiry. An embryo made during IVF ready for transfer to a womb NEXT STEPS Ask students to create a flow chart showing the sequence of stages in in-vitro fertilization. New and related technologies such as preimplantation genetic diagnosis can be included in these flow diagrams. Ask students to highlight the stages which raise ethical issues, and to identify what these issues are. [ 1 ] Resource for Teachers

2 Traffic Lights The aim of this game is to find out what students know about infertility. Give every student 3 cards: one red, one orange and one green. Variation 1 Formulate questions based on the lesson objectives and ask children to hold up their Green card if they think the answer is true. Orange card if they don t know. Red card if they think the statement is false. Variation 2 Formulate questions based on the lesson objectives and ask children to hold up their Green card if they understand well. Orange card if they are not sure. Red card if the idea needs to be explained again. The examples below are to be used in Variation 1. Correct answers are shown by coloured circles. You can t get pregnant when you have sexual intercourse for the first time. You can get pregnant without having sexual intercourse. Using IVF FALSE Sexually transmitted diseases can cause infertility. e.g. chlamydia Some men have no sperm in their semen. Anyone conceived using donor sperm cannot be told their donor s identity. Since 1995, donor conceived people have been allowed this information when they turn 18. The biggest health risk associated with fertility treatment to women is a reaction to fertility drugs. It is having multiple births You are allowed to select the sex of your baby if you undergo IVF. Only for medical reasons - to avoid giving birth to a baby with a sex inked genetic disorder Eggs, sperm and embryos can be frozen for future use. I DON t KNOW TRUE [ 2 ] Resource for Teachers

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4 RIGHT to screen embryos made during IVF for genetic diseases to allow a woman to become pregnant using IVF to do research on embryos left over from IVF Split the room up the middle with a length of string. One side represents what is ethically right, the other side what is ethically wrong. Read out one statement at a time and ask students to move to the side of the room that represents their opinion. Suggested questions are provided to encourage students to think more about their opinions. Is this always right/wrong? Are there any special cases? to destroy embryos left over from IVF How can you justify your opinion? Why? to reveal the identity of a sperm/egg donor to the child What alternatives are there? to implant more than one embryo in a woman at a time What would make you change your mind? What might people who disagreed with you say? WRONG [ 4 ] Resource for Teachers

5 the information In fertility Infertility Infertility is when a couple are unable to have a baby despite frequent unprotected sex. Infertility may be due to problems with the female or with the male. egg surrounded by sperm Causes of infertility About one third of fertility problems are due to problems with the male, one third are due to problems with the man, and the cause of the remaining third is not known. Common causes of infertility in women include age (fertility drops sharply over 35 for a woman), problems ovulating (releasing an egg): some women don t release eggs at all, and others do so irregularly; damaged or blocked fallopian tubes (this is where fertilisation happens), or a damaged womb (where the fertilised egg implants and grows). Other factors that affect fertility are the use of medicines such as chemotherapy, long term or high doses of ibuprofen or aspirin, and the use of illegal drugs such as marijuana and cocaine. Infertility in men is caused by abnormal semen: that with a low sperm count, low sperm mobility, abnormal sperm (e.g. with poor tails); damaged testicles due to infection, cancer, surgery or trauma; or sterilization, i.e. having had a vasectomy. Use of medicines and drugs such as chemotherapy, steroids and alcohol also adversely affect fertility. Factors that affect men and women include being overweight or underweight, smoking, having a sexually transmitted infection such as chlamydia, or stress. In Vitro Fertilisation (IVF) In vitro fertilisation can be used to treat infertility. During IVF, fertilisation takes place in a petri dish, in a lab. The sperm and egg may come from the couple concerned, or they may be donated by another man and/or woman. To obtain the eggs, the woman has to be encouraged to produce several eggs at once, and to do this she is given hormones. The fertilised eggs are incubated and allowed to grow into embryos. When they are a few days old, they are placed into the woman s uterus where implantation occurs. Where the woman is not able to carry the baby, a surrogate may be used. Although several embryos are created during IVF, a maximum of 3 can be implanted at one time to reduce the risks to the health of mother and children associated with multiple births. The left over embryos may be destroyed, used for research, or donated to other infertile couples who are unable to create their own embryos. The destruction of embryos, and the use of embryos for research is controversial. Some people have religious objections to this happening. Genetic screening Screening can be used to select an embryo free from inherited conditions. Preimplantation genetic diagnosis is used following IVF: when the embryo consists of 8 cells, one cell is removed and tested to see if it contains a faulty gene (e.g. the BRCA1 gene for breast cancer). Only embryos that do not contain the unwanted gene are implanted. This 6 day old embryo implanting in womb stops genetic diseases being passed on to children. Diseases that can be diagnosed at the embryo stage include cystic fibrosis, Downs syndrome and haemophilia. Embryos affected by genetic diseases are allowed to perish. [ 5 ] Resource for Teachers