Menopause as a stage in a woman's life that marks the end of her reproductive years

Part A 

What is menopause? Can women normally have babies after this period? 

Menopause is a stage in a woman's life that marks the end of her reproductive years. In most women, it occurs between the late forties and early fifties. The woman stops producing ova and thus cannot become pregnant ( Blagosklonny, 2015). Women can only have babies at this age through a donation of an ovum, but not naturally. The ova could be implanted in the body after external fertilization in a laboratory. 

Since Dr Walker had not passed through menopause, would you say that she probably was still fertile? How would you know for sure if you were her gynecologist? 

Menopause means a woman is no longer fertile, and thus Dr Walker was still fertile. One year of unprotected intercourse without pregnancy is an indicator of menopausal infertility. Asking Dr Walker about her sex life would be one way of ascertaining whether she is fertile. 

Why are women more susceptible to producing babies with genetic disorders as they get older? 

As women age, their ova start dividing abnormally due to a decrease in reproductive hormones. The abnormal division causes monosomy, trisomy, or tetrasomy, which is responsible for the higher risk of bearing a child with genetic disorders, especially Down’s syndrome ( Blagosklonny, 2015). 

Are men's sperm just as likely to carry mutations in advanced age as eggs? Why or why not? 

Men's sperm are produced throughout a man's life and thus, men are less likely to cause a congenital disability as women of the same age ( Blagosklonny, 2015) . For instance, a 45-year-old father is far less likely to give birth to a child with a birth defect than a 45-year-old female. However as the father ages beyond 60, the chances of causing a birth defect to their child increase by four times due to mutations in the sperm. 

Part B 

At what maternal age, in your opinion, is it NOT okay to give birth to a baby? At what paternal age is it NOT okay to become a new father? 

Mothers in their late thirties and beyond cause a greater danger of congenital disabilities to their children. Newman & Greenberg (2000) point out that giving birth while below 35 is, therefore, the ideal age for women, to avoid mutations. As a man ages, the quality of sperm he produces reduces, and thus his fertility and viability of the sperm tappers off. Men below the age of 40 are the healthiest to fathers since the chance of mutation is 1 in 686 embryos (American Society of Reproductive Medicine, 2019). Men in their fifties can also be fathers, but the chances of a mutation rise to 1 out of 53. At 60, the chances of miscarriage before 20 weeks of pregnancy, besides mutations also increase. Sixty years is, therefore, the maximum age at which a man should become a father, whether by natural pregnancy or in vitro fertilization. 

What are the concerns of the couple at this point in their lives? 

Melissa and Michael are worried about genetic mutation on their child due to their advanced age. In vitro, fertilization is a possible solution, but it does not eliminate the chances of Melissa’s ova carrying genetic defects. They could, therefore, consider receiving an egg donation from a younger woman, then implanting it in Melissa’s womb. 

Should medical doctors deny certain people the right to use reproductive technology? When should they? 

Medical doctors have an opinion on their patient's decisions but are not allowed to make decisions on behalf of the client. Client autonomy is advocated for in healthcare and thus, doctors should not deny people the right to use reproductive technology at any time or age ( Jaenisch, 2014). The couple could be aged or not, and the desire to use reproductive technology is entirely their decision. The doctor only advises on the possible consequences as a professional. 

Part C 

What hormones are responsible for maintaining a healthy uterine lining? What is the condition of a uterine lining that is ready for implantation? 

Progesterone is produced by the corpus Luteum in the early stages to maintain the strength of the uterine lining in preparation for pregnancy. Estrogen is also produced to keep the uterine lining strong enough to hold an embryo. A uterine lining that is ready for implantation is thick and has numerous blood capillaries in preparation for a rapidly developing embryo ( Khan-Dawood & Dawood, 2015) . 

Since many eggs are fertilized, some of the embryos implanted will not live. Would this be the same thing as abortion? Why or why not? 

During in vitro fertilization, the eggs that are fertilized are numerous to increase the chances of any of them forming an embryo. According to ASRM, (2019), those that are not implanted are preserved in case the implanted one does not survive, or are destroyed. The debate on whether this is abortion has been contentious, but it is not abortion. In vitro fertilization is mostly used by couples that are unable to bear children naturally, and is a trial and error method, and all fertilized eggs cannot be implanted. They have to be disposed of, not as abortion, but because they cannot be all useful. 

What is the problem with multiple births on the infants? What can be the problems for the mother? 

According to the Center for Disease Control and Prevention (2019), multiple births are harder to manage, and pose a danger to the mother’s life, especially those on hormonal therapy to maintain pregnancy. The infants could also lack enough nutrition in the womb due to competition. Since the mother is relying on external hormonal support, multiple births could increase the chances of a miscarriage. 

Other Reproduction Techniques 

Cloning is the multiplication of a single cell to produce an exact copy of the donor. There is no need for fertilization, as the cell multiplies n its own. The same applies to nuclear transfer, where a nucleus is transferred into another cell where it multiplies independently ( Jaenisch, 2014) . No cloning has been done for humans yet, and the practices are strictly regulated, as there is an ethical concern on clones turning into giants who cannot survive on earth. 

Cytoplasm/ooplasmic transfer is the injection of ooplasm from a healthy fertile woman into the oocytes of another whose fertility is compromised. In ooplasmic transfer, there is an exchange of mitochondrial genes among the women, which means the child inherits genes from a woman who is not their mother (Barritt et al., 2015). The ethical concern associated with this technique is the introduction of new genetic defects that are not historically expressed a particular lineage. 

Cryopreservation is the storing of sperm and eggs for future use. The reproductive cells are extracted from the body of the individuals while still young and preserved for future in vitro fertilization when they feel ready to have children ( Cobo et al., 2018) Thus way, they do not have to worry about genetic mutation due to advanced age. A concern on possible commercial exploitation by people resorting to selling their reproductive cells has, however, been expressed by experts. 

The techniques are costly and are an option only for the rich. For instance, whole-body cryopreservation costs $200,000 or more, while the head-only preservation costs $80,000. Cloning and nuclear transfer would cost $2 million for one human being (Cobo et al., 2018). However, insurance companies should not be compelled to cover such procedures since they are expensive, and have ethical concerns that scientists find a barrier to their execution. 

Advice to Dr Walker 

Being of advanced age does not mean that a couple cannot have children of their own. With the availability of necessary resources, you and Michael can opt for a cytoplasmic transfer to ensure the child is free of genetic defects. The technique could then be combined with in vitro fertilization, then transfer the embryo into your womb and have hormonal therapy during pregnancy to keep the baby healthy. 

References 

Barritt, J. A., Willadsen, S., Brenner, C., & Cohen, J. (2015). Cytoplasmic transfer in assisted reproduction.  Human Reproduction Update ,  7 (4), 428-435. 

Blagosklonny, M. V. (2015). Why men age faster but reproduce longer than women: mTOR and evolutionary perspectives.  Aging (Albany NY) ,  2 (5), 265. 

Center for Disease Control and Prevention. (2019). Assisted Reproductive Technology. Retrieved on 10 th October 2019 from https://www.cdc.gov/art/artdata/index.html 

Cobo, A., Bellver, J., Domingo, J., Pérez, S., Crespo, J., Pellicer, A., & Remohí, J. (2018). New options in assisted reproduction technology: the Cryotop method of oocyte vitrification.  Reproductive biomedicine online ,  17 (1), 68-72. 

Jaenisch, R. (2014). Human cloning-the science and ethics of nuclear transplantation.  The New England journal of medicine ,  351 (27), 2787. 

Khan-Dawood, F. S., & Dawood, M. Y. (2015). Estrogen and progesterone receptor and hormone levels in human myometrium and placenta in term pregnancy.  American journal of obstetrics and gynaecology ,  150 (5), 501-505. 

Newman, J., & Greenberg, N. (2000, April 1). How Old is Too Old to Have a Baby? Discover Magazine. Retrieved from http://discovermagazine.com/2000/apr/feathow 

The American Society of Reproductive Medicine. (2019). Multiple births or multiple gestations. Retrieved on 10 th October from https://www.reproductivefacts.org/topics/topics-index/multiple-births-or-multiple-gestation/