Are manufactured children different?
This year in July and September Tri Service General Hospital and Chang Gung Memorial Hospital independently discovered cases of test-tube babies with Down's Syndrome. This hardly alleviates the suspicions that people have about in vitro fertilization. Many people can not comprehend the cause of these problems: since the embryo has undergone screening beforehand, how can they not perform "quality control"?
Actually, the screening involved in the in vitro fertilization process has nothing to do with the good or bad properties of the genes. Liu Chi-hung explains that the purpose of the screening process is to increase the likelihood of pregnancy. Sperm cells with the soundest forms and the most powerful motion will have the most successful fortunes. In terms of the embryos, those which are round, transparent, uniform, and have no jagged imperfections are most likely to do well. Liu Chi-hung emphasizes, "The success of an embryo doesn't necessarily have any relationship with its genetic makeup."
Therefore, any disease or impairment that a naturally fertilized embryo may fall ill to, an artificially ferilized embryo may, as well. This includes Down's Syndrome, which is brought about by mutation in the chromosomes. Liu Chi-hung believes that test-tube babies with Down's Syndrome should be attributed to inadequate testing during pregnancy; it has no connection to the in vitro fertilization process. According to estimates, the rate of abnormality among test-tube babies is about the same as that among naturally conceived children, approximately 2-3%.
Specially gifted test-tube children?
How test-tube babies grow in body and mind is also the focus of many people's attention. In the past Veteran's General carried out a follow up investigation of some test-tube babies born in the hospital. They discovered that the physiques of test-tube babies are about the same as any other children; in the realm of intelligence, they tend to be slightly higher. Chen Shu-chen, director of pediatrics at Veteran's General, notes that follow up investigation only includes fifty children, so the results can only be used as a reference and are not necessarily representative.
Liu Chi-hung points out that France carried out follow up research on several thousand test-tube children and found them to differ in no way from naturally conceived children. He feels that the reason that some test-tube babies have a higher IQ is that after birth the home environment is better. With the price of one cycle of in vitro fertilization standing at NT$70,000 to NT$80,000, any family that can afford the operation is at least in the upper middle class. In addition, the child was not easily brought into the world, and it is natural that it receive better care and attention.
The first test-tube baby born in Taiwan--a little boy surnamed Chang--is a good example. Master Chang is eight years old this year. Currently in the third grade, he is considered a gifted student. Mrs. Chang believes that today the boy "is pretty good," and this is probably due to the good effects of his home environment. Judging only from the many after-school lessons he is made to take--piano, English, painting, math and logic, natural science--it is not difficult to realize that his family spares no effort in grooming the child.
Furthermore, the education level of the Parents is another factor for reference. According to a survey by Veteran's General Hospital, 70% of parents with test-tube children have educations at a college level or higher, 30% have educations at the high school or junior high level.
Technology's bottleneck:
Although Taiwan's technology has reached a certain level, in vitro fertilization technology is still meeting two kinds of difficulties. The first is the age barrier. The second is that embryos do not easily affix themselves in the womb. These two problems have made the success rate of in vitro fertilization not as high as it could be.
According to estimates, the rate of miscarriages after in vitro fertilization is as high as 25% to 30%, twice as high as natural conception. The crucial matter is the would-be mother's age. Liu Chi-hung observes that the older a woman is, the less effective are her ovaries, and the miscarriage rate is higher. For women 35 years of age, the miscarriage rate is 20%; for those 40 years of age the rate surpasses 30%; for women 45 years of age, the rate of miscarriage is already 50%.
Besides this, when embryos are being cultivated outside the body, their shells ("zona pellucida") tend to harden, which leads to the embryos not easily taking root in the womb after they are implanted. Currently, the medical world uses lasers to pierce the shell, making it easier for the embryo to break out of its shell and escape, thus affixing itself in the womb. Thus, this problem has seen some improvement. For patients who have experienced repeated failures, it can be a great help.
Besides a higher rate of miscarriages, in vitro fertilization also increases problems related to multiple embryos. The rate of multiple embryos is more than ten times higher than natural conception. Liu Chi-hung explains that at the time of embryo implantation, the more embryos implanted, the greater the likelihood of pregnancy. Because of this, most patients request that many embryos be implanted. "It is best to draw the limit at four," says Liu Chi-hung. Multiple embryos can produce complications, such as premature delivery, high blood pressure diabetes, toxemia, and so forth. It is important to cut down the number of embryos to ensure safety.
Finding an heir in a test tube:
Even though Taiwan's in vitro fertilization technology has reached an international standard, Liu Chi-hung feels concern that little attention is paid within the country to basic research. "Everyone is only anxious to study the procedures, without researching the underlying reasons. They just understand the superficial results; when they run into problems, they're lost at sea."
Chang Sheng-ping notes, "Everyone started doing it at once, in a swarm. It's not a good thing." He points out that in vitro fertilization only involves one small part of the reproductive endocrine system. Everyone is at present only increasing clinical accomplishments, not engaging in basic research.
"Those who can bear children can never understand the pain of those who can not," says a barren wife who can not stand the ridicule of her neighbors. Perhaps it is a deeply rooted conviction that one must produce an heir; perhaps it is the unceasing pressure from in-laws. People deeply crave flesh-and-blood offspring, to maintain matrimonial love and to affirm the position of the household. To Chinese people, the advent of testtube babies not only relieves the troubles of women who can not conceive; it also relieves the burden of the spirit.
There is a limit, after all, to the help that science can provide. How it can help people address the failures in the affairs they pursue is perhaps closer to the heart of the question.
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In vitro fertilization technology provides new hope for infertile women.
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"Micromanipulation of Sperm" uses microscopic instruments to guide the sperm into the egg to increase the chances of fertilization. It is a great aid to men with a low sperm count or low virility.
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With the use of "Cryopreservation," multiple embryos can be stored in liquid nitrogen at -196℃, thus avoiding the trouble of extracting eggs from the womb a number of times.
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Using laparoscopy to implant embryos in the uterus takes only about 20 to 30 minutes.
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The Process of Creating Test-tube Babies
1.Ovulation medicine is injected, inducing the production of surplus eggs.
2.Ultrasound is used to extract the eggs after they have matured.
3.The egg undergoes external fertilization, and the embryo is cultivated for about 48 hours. After the fertilized egg divides into two or four cells, it is implanted in the mother's body.
4.Implanting the embryo in the mother's womb can be accomplished via two different channels. Insertion through the vagina is customarily termed "In Vitro Fertilization and Embryonic Transfer (IVF/ET); insertion using laparoscopy is termed "Tubal Embryo Transfer" (TET).
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Taiwan's first test-tube baby, little Master Chang, is a gifted student.
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The joy of becoming a mother wiped from Lin Yueh-hui's memory all the torments of the medical process.
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An overseas Chinese who succeeded in finding heirs in the motherland mailed a thank you card to the doctor on the eve of Mother's Day, pasting on it photos of her two darling children. (courtesy of Chang Sheng-ping)
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Liu Chi-hung with test-tube babies and their parents. (photo courtesy of Liu Chi-hung)