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Taking in vitro out of fertilization.

In vitro fertilization has offered infertile couples new hope for giving birth to a child. Despite acceptance of IVF as a procedure, personal and religious objections have been raised concerning its "extracorporeal" aspect A new method of fertilization, intravaginal culture (IVC), allows fertilization to occur in vivo, with normal sexual activity occurring concurrently, if desired. In IVC, following ovulation induction and oocyte retrieval, the oocytes are identified and consolidated into a tiny tube filled completely with culture medium. After the oocytes sink to the bottom of the tube, a sample of 30,000 to 60,000 motile spermatozoa are added to the top of the tube, and the tube is then hermetically sealed. It is then wrapped tightly in a special envelope to prevent vaginal contamination, and inserted into the vagina where it is kept in place next to the cervix by a diaphragm. Everyday activities can proceed unimpeded, and at the same time fertilization occurs within the woman's body (in vivo).

Two days later, the tube is removed and the contents poured into a petri dish. Up to four fertilized embryos can then be transferred into the uterus. Over 500 cases using this technique have been performed, with results comparable to IVF, i.e. a birth rate per oocyte of 13.5 percent (Claude Ranoux et aL, "A New In Vitro Fertilization Technique: Intravaginal Culture," Fertility and Sterility 49 [1988]], 654). Experience with this process has furnished several significant results. From a biological perspective, since sperm concentrations in IVF are usually much higher than those in IVC, the IVC technique proves that a relatively low volume of motile sperm are capable of achieving fertilization. IVC also clearly demonstrates that fertilization is possible without previously incubating the oocytes. These observations require biologists to rethink current dogma concerning the fertilization process.

From a psychological perspective, the introduction of the IVC technique has revealed concerns that were rarely discussed. For example, some patients have admitted, tacit anxiety about potential laboratory error or congenital anomalies that they feared might result from in vitro gamete manipulation.

From a religious and ethical perspective, the implications are even more far-reaching. A widespread objection to IVF has been that with it conception occurs without a conjugal act and fertilization takes place outside of the body. It is possible that IVC, coupled with other available techniques, may resolve these concerns. A special perforated sheath could be used to collect semen daring intercourse so that neither contraception nor masturbation is involved. Moreover, preparation and insertion of the IVC tube can take place in less than fifteen minutes, ensuring that all fertilization occurs within the woman's body, rather than externally. By using IVC, it is possible that couples with religious or other objections to more standard techniques could nonetheless benefit from advances in infertility treatment-by taking the in vitro out of fertilization.
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Author:Ranoux, Claude; Seibel, Machelle M.
Publication:The Hastings Center Report
Date:Sep 1, 1989
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