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Professor

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The Impact of Assisted Reproductive Technologies on

Motherhood

Abstract

This paper will seek to explore the effect of Assisted

Reproductive technologies on motherhood. The introductory part of

this paper will give the definitions of the three closely related

and intertwined concepts that will be used throughout the paper;

that is Assisted Reproductive Technology, the concept of

motherhood and the concept of infertility. The background of the

paper will give in detailed form the causes of infertility. It

will focus on the four main factors that lead to infertility such

as the cervical factors, the uterine factors, the pelvic factors

and the PCOs. The following part of the paper will also address

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the salient issues and effects of the ARTs on the nature of

motherhood. Overall, this paper will give a general conclusion of

the topic under discourse.

Introduction

This paper will commence by giving definitions of various

concepts, these will include the concepts of motherhood, assisted

reproductive technology as well as the concept of infertility. To

begin with, motherhood in one sense refers to the state of

maternity or being a mother. It also entails in details all the

qualities that are aligned to being a mother. Overall therefore,

it is the relationship between a mother and its offspring. This

relationship ought to be kinship in nature. The second concept is

the assisted reproductive technology. In as much as there is no

standard definition for this concept, a majority of the

reproductive health practitioners as well as scholars in

consensus converge at this definition. They agree that this

concept refers to a process of sexual interaction that is

bypassed either by the following means and methods; Artificial

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Insemination as the first means and the fertilization of oocytes

in an artificial environment where the variables are manipulated

to obtain the expected results. An example of this is the utility

of in vitro fertilization. Lastly, it should be pointed that the

concept infertility is actually very common in reality. This

condition affects close to 13-14% of couples who may have

attained an age group that is productive. However, in as much as

this percentage of prevalence has been stable in the last decade,

it is important to point out that the demand for services related

to fertility as well as infertility has increased substantially.

The drastic rise of these services has been partially attributed

to the generation referred to as baby boom which is in the

process of entering into an age group that is reproductive; this

is at a time of technological advances that are highly

publicized. Concisely therefore, the concept infertility refers

to the lack or failure to conceive after close to 12 months after

unprotected sex. This paper shall thus address the issue of

infertility, the utility of assisted reproductive technology and

their impacts on motherhood.

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Causes of Infertility

The first part of this paper will focus on infertility with

particular reference to its causes. Reproductive health

practitioners have listed the following as the most common causes

of infertility among women. The four causes revolve within and

around the cervical factor, the ovulatory factor (Polycystic

Ovarian Syndrome- PCOs), the uterine factor which in scientific

terms is endometriosis and the pelvic factor.

The mucus fluid like gel found in the cervix always varies

during a normal menstrual cycle. However it should be noted that

during the process of ovulation, this fluid is watery, stretchy

and thin in nature. In other occasions, this fluid is thick as

well as hard making it impossible for the sperm cells to get

through. During the process of ovulation when the mucus exhibits

a stretchy character, it may still make it difficult for the

sperm to be transferred from the vagina via the mucus to the

uterus. Other women have conditions that may make the cervix more

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difficult to penetrate. One the most common causes of cervical

infertility is the occurrence of an earlier surgery in the

cervix. For instance, if a woman has an unusual PAP smears. PAP

smear is the test that seeks to identify the presence cancer

cells in the cervical area. This may often require the utility of

surgical treatment, the freezing of cervical cells which is

referred to as cryosurgery, the removal of cone shaped pieces of

the cervical canal which is often referred to as the cone biopsy

or the utility of a LEEP procedure which refers to the utility of

an electrified loop for the removal of unusual parts within the

cervix. All these processes can affect the cervix canal as well

as its ability to develop quality mucus. Additionally, the

outbreak of adverse conditions in terms of health more often than

not always affect and cause damage to the mucus production cells.

Some of these health practices can also lead to the blockage of

the canal as well as convert the canal into a pinpoint opening.

The most commonly utilized process is the D & C which entails the

opening of the cervix and removing its contents. Abortions,

miscarriages and the termination of pregnancies often utilize the

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above procedure; processes which may bar the sperm from

interacting with the egg via the cervix consequently leading to

infertility.

Birth defects and birth failures also have impact on the

nature of the cervix. In some instances, women are always born

with defected canal and cervix. It is a common occurrence on the

women whose parents were under the prescription of DES during

their pregnancy to curb cases of miscarriages. Women with

conditions known as cystic fibrosis are always unable to produce

the stretch and watery mucus which are conditions necessary for

quality fertility levels.

Polycystic Ovarian Syndrome (PCOS)/ Ovulatory factors

This is also sometimes referred to as the Stein-Leventhal

syndrome. It is also described as hyper androgenic persistent

ovulation. It is a benevolent disorder that usually leads to

infertility. These ovulatory factors are associated with

irregular menses as well as ovulation, the resistance of insulin,

acne, obesity as well as hirsutism. A majority of women who are

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infected with PCOS often have their ovaries characterized with an

array of persistent cysts. Concisely therefore, how does the PCOS

lead to infertility in women? This question has a number of

responses. First is the fact that a fertility that is impaired is

a core characteristic of PCOS. This has always been associated

with the elevation and rise in levels of insulin which go hand in

hand with the stimulation of an excessive amount in the

production of androgen by the ovaries. The androgens that are

produced cause the emergence and development of follicular

wasting that are premature. These follicular wasting often causes

an inconsistent or an absence of ovulation which is a fundamental

determinant of infertility. When it comes to the diagnosis of the

PCOS, it is important to highlight a number of symptoms

associated with it. Some of these symptoms revolve within and

around the absence of periods as well as irregular periods,

deficiency of ovulation, a gain of weight, the excessive growth

of hair which in biological terms is called Hirsutism, the acne,

the resistance of insulin, as well as balding of the male

pattern. An ultrasound examination may also show a number of tiny

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cysts on the ovary. PCOS may also lead to the darkening of the

female skin under the arms, at the nape of the neck as well as at

areas of the breast; a condition known as Ancthosis nigrans.

Laboratory testing is an essential part when it comes to

diagnosis; however it is critical that multiple values should be

looked upon collectively through blood work as well as hormonal

testing. The utility of ultrasound of the pelvis should be

typically performed whenever the medical practitioner suspects

PCOS. In cases where less than 10 cysts are detected in both

ovaries which are less than 10milimeters, this is the standard

requirement of the ultra sound criteria. Additionally, it should

also be noted that 1.5-3.0 is the size of a normal and typical

ovary. The presence of polycystic ovaries with little or lack of

symptoms as well as consistencies in the flow of blood is not a

confirmation for the diagnosis of PCOS symptoms.

Upon confirmation of the presence of PCOS, it can be treated

by a number of mechanisms. Such mechanisms range from the utility

of contraceptives, the utility of fertility drugs and surgical

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therapy as well as the use of anti androgens. Surgical therapy

can be performed by either the resection of the ovarian wedge as

well as the drilling of the ovarian Laparoscopic.

Uterine factors are also contributing agents of infertility.

This condition is sometimes referred to as Endometriosis. This

describes a non malignant disorder where the working endometrial

tissue is near the outside of the uterus. The occurrence and

prevalence of this disease among women often ranges from about

10-15% for women who are aged between 25-44 years and are in

active menstruation. However, it also occurs among teenagers. It

is also estimated that 25-50% of women who are infertile suffer

from this condition. Its prevalence is also higher in the close

relatives of women who suffer from endometriosis. Concisely

therefore, hereditary factors play a big role in the prevalence

of this condition. Women who delay to conceive and those of Asian

descent are also likely to suffer from this health condition.

The causes and triggers are have not yet been medically

established, however a number of theories try to explain its

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causes. One such theory is known as the theory of retrograde

menstruation or the transfer of the mashed endometrial tissue in

a reverse manner through the fallopian tube and to the abdominal

cavity. The endometrial tissue can get attached to various

internal tissues and organs on the outer side of the uterus.

Another theory is believed to be the dysfunction of the

immune system where it is believed that the prevalence of

endometriosis in some women is as a result of inadequate immune

system. In women who do not suffer from endometriosis, their

immune system may destroy any forms of ectopic implants that may

be developed. In women with this condition however, there is

always a manipulated immune system where the body is not able to

destroy the growth and development of such implants.

Additionally, other scientists are of the theoretical perspective

that this condition is an auto immune disorder. By this sort of

anarchy the implication is that the human body creates and

develops antibodies to the endometrial cells. Such antibodies may

demolish a healthy endometrium that is found within the uterus.

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These antibodies are also notorious in the destruction of ectopic

implants.

The symptoms of this condition include the presence of pain

in the pelvic region as well as cramping before, during and after

periods. It is also associated with pain during sexual

intercourse. In addition, this condition is also associated with

the inability and failure of conception. Fatigue as well as sharp

pain during urination is also a salient characteristic of this

condition. Constipation, nausea and Gastrointestinal symptoms in

the form of diarrhea are also associated with this condition.

Inflammation of the pelvic are in the form of Pelvic inflammatory

disease (PID) , adhesions I n the pelvic area as well

neoplasms /cancers that are both persistent or malignant in

nature, torsion of the ovary, physical and sexual abuse and

causes that are non gynecologic in nature are core symptoms of

endometriosis.

Endometriosis leads to infertility in women in the following

ways; it is a result of adhesions as well as scarring which

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develop in the reproductive tract following inflammation. The

scar tissue as well as adhesions in the pelvic area may reduce

fertility in either of the following ways; through the

obstruction and distortion of the form of the fallopian tube.

This consequently inhibits the trajectory of the sperm towards

the egg. In case the sperm fails to reach the egg, the cells

might come across unfriendly conditions that are unfavorable for

the process of fertilization. Lastly, the scarring of the

endometriosis may hinder the fallopian tube to such an extent

that if an egg is fertilized, it might be impossible for it to be

transferred to the uterine walls for implantation to take place.

Diagnosis of this condition can utilize two techniques. Both

of these techniques involve visualizing activities in the pelvic

area and cavity to verify the absence as well as the presence of

the ectopic implants. The two techniques include laparoscopy and

laparotomy. In cases of suspected ectopic implants, the two are

biopsied with the end objective of determining the existence

endometrial cells.

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Assisted Reproductive Technologies (ARTs) and their implications

on motherhood

It is important to highlight that the following categories

of people are eligible to utilize assisted reproductive

technologies among others; Women who suffer from tubal diseases,

cases of unexplained fertility, women who suffer from premature

ovarian defect, endometriosis, immune cases and causes of

infertility, individuals who are characterized by the male factor

of infertility such as unusual and abnormal production of sperms

among others.

In the introductory part of the paper, having already given

a definition of the concept of Artificial Reproductive

Technologies, this section will therefore deal with the

methodologies through which ARTs can be applied and induced. In

basic terms, this reefers to the utility of medication that help

in the stimulation of the body to enable it produce one or

several eggs. The induction of ovulation can be a simple practice

that includes taking daily pills. However it can be complicated

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by practices such as the utility of injections; that is

introducing fertility medications through the use of injections.

Its simplest form embraces the induction of ovulation through

swallowing clomiphene. However for more intensive methods of

inducing ovulation, more effective medication known as

gonadotropins may be utilized. These are medications that are

inject able in nature and are a composition of the Luteinizing

hormone (LH) and the follicle stimulating hormone (FSH) or just

FSH alone. The injections of these hormones might be very

effective in helping a woman to create, produce as well as

release her eggs. Therefore the success rate of inducing

ovulation to help trigger pregnancy in women is highly variable.

This is because it is dependant the age of the patient, the

diagnosis as well as the type of medication being administered

among others.

Assisted reproductive technology (ART) therefore is a form

of medical intercession that is developed with the aim of

increasing levels of fertility among the infertile couples

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thereby increasing the chances of pregnancy. Infertility in this

case is the failure of a woman to conceive after 12 months of

unprotected sexual intercourse. Therefore, ART and its utility

involves the separation of procreation from any forms of sexual

interaction. ARTs utilize a number of techniques as well as

strategies such as In Vitro Fertilization (IVF), Artificial

Insemination (AI), gamete donation, gamete intra-fallopian

transfer (GIFT), sex selection, diagnosis of genetic pre

implantation as well as gestational surrogate mothering among

others. Their utility however has elicited deeply rooted concerns

in relation to motherhood and family ties.

The new technological advancements in terms of development

of ARTs have had drastic implications in the social arena thereby

undermining the previous assumptions in the biological realm in

terms of relationships between the children, mothers as well as

fathers in a family setting. Insofar, it is thus at this point

that questions may arise over the difference between gestational,

social and genetic motherhood. In the case where three women take

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part in the decision involved to produce children. Therefore, who

is the real mother of the child? Concisely therefore, with the

complex nature of inter penetration as well as technology within

the modern day reproductive situations, new social accounts need

to be created with specific concerns on what it implies to create

a family as well as what motherhood actually constitutes. New

narratives that emphasize the amazing kinship possibilities need

to be made accessible. At the same time, these new narratives

should explain the duties of motherhood as well as family

groupings.

This new technology has had a direct impact on the

basic unit of the society which is the family and has affected

the overall nature of motherhood as well as matters that pertain

to motherhood such as the development of the child. This in one

sense means that the presence of Assisted Reproductive

Technologies have made it possible for the conception of children

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with the absence of any form of generic relationship to either of

their parents. Motherhood means the presence of kinship relations

between a mother and its offspring. This method of conception has

been in itself been a barrier to motherhood.

The accessibility to ARTs also means that new babies

can be conceived despite the fact that they may never have a

social relationship with either of their genetic father and

mother. For instance, a child who is conceived via the utility of

donor sperm may never know his or her the genetic parents.

Therefore, how does this scenario impact on the nature of the

mother who brings up this child as their own? Conventionally, the

presence of infertile groupings in society which is inclusive of

both the male and the female sexes, the homosexual couples, the

single women and single men as well as the post menopausal women

who seek the services of ARTs. In as much as older motherhood is

a relatively new practice in society, what is exclusive is the

drastic rise of this category of women conceiving through the

utility of technological means to bring an end to the

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reproductive cycle. A majority of these women squarely fall in

the category of the fresh middle age. It is important to point

out that this category of motherhood has been subjected to a

number of stereotypes as well as stigmatization which has

affected motherhood as a whole. In a positive perspective, the

presence of the ARTs has also made women seek an increase in the

duration of motherhood. A number of post menopausal aged women

have sought these services and consequently resulted to the

creation of new old age motherhood.

In other instances, mothers have been faced with

concerns of the welfare of the children obtained via the use of

ARTs and whether the children are entitled to the right to have

knowledge of their actual biological parents. In many instances,

this has fragmented motherhood and families created through the

ART as a result of the existence of genetic disconnection. To

that extent, this feeling of disconnection has often impacted on

the nature of motherhood and a low self esteem of the traditional

family and motherhood roles.

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It is however important to point out that research

studies have shown that the mothers who conceived children

through the Assisted Reproduction Technology often express more

warmth toward the child and are more emotional towards their

children. Additionally, it also shows that these women exhibit

more interaction with their children and reported less cases of

stress. This is in comparison to the mothers who through natural

means conceived their children. Equally this was true for the

fathers. It therefore follows that in some instances, children

who are conceived through artificial means are shown this levels

of affection because of their dire desire to have children

naturally; slightest opportunity presented to these parents to

have children leads to these levels of affection.

The introduction of ART means such as In vitro

fertilization has led to the development of family structures

that would have otherwise never existed. In FVF which is an ART

method that entails the use of the mother’s egg and the father’s

spermatozoa, a child has direct relationship to the parents.

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However the utility of Donor Insemination (DI) leads to a child

that is related to the mother and not related to the mother in

terms of genetics. In cases where both the spermatozoa and the

egg cells are donated through DI, the child does not have any

form of genetic relation to either parent. The latter child is

similar to an adopted child because of the absolute lack of

genetic relationship with the parent. However, the parents have

direct contact with the pregnancy thus developing a relationship

with the child from the time of birth. The level of motherhood in

this type of conception is substandard in nature due to the

psychological effect and feeling that the child belongs to a

different father. This motherhood is thus enveloped in low self

esteem motherhood.

Cases of surrogacy have always resulted to the conception of

a child who is not genetically related to either of the parent

Einwohner (1989). This has made it possible for a child to have

at least five parents as follows. The sperm cell donor, the egg

cell donor, the mother who gives birth to the child as well as

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the adopting parents whom the child socially recognizes as the

legitimate parents. The development of these new types of

families therefore has some serious psychological implications on

the part of the child and motherhood as a whole (European

Commission Working Party on Ethical and Legal Aspects of New

Reproductive Technologies, 1989).

More often than not, there have been numerous arguments

specifically by the researchers as well as practitioners of the

field of adoption; that is children should be accorded the right

to know their biological parents. Children who lack or are denied

such information are likely to be in a state of confusion with

specific regards to their identity and there are more vulnerable

to emotional problems. The use of ARTs has also led to parallels

being drawn with the adoptive scenarios. It has been found out

that missing links in terms of genetic affiliation between the

parent and the child always pose and hinder the relationship with

the non genetic parents (Wamock, 1984). Such occurrences have

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always affected the nature of the traditional motherhood as well

as the overall development and growth of the child.

In addition, it has also been established that the secrecy

that envelopes DI as well as the egg donation always undermine

the relationships in families which have negative implications on

the nature of motherhood. It makes the products of gamete

donation be in a state of confusion with regards to their

identity. Such secrets are therefore detrimental to the basic

family structure leading to anxiety among the parents and the

child limiting the nature of motherhood. Therefore, this

particular issue on whether or not to tell the children of their

whereabouts and origins in the field of sociology still remains a

hot topic and ethical issue with regards to assisted

reproduction. Generally, parents of these children have not been

given encouragement to tell their children of their origins. A

growing organization of opinion however believes that keeping

such information from these children is a form of injustice and

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impunity. This is because they are entitled to the right to

information.

In more general terms with regards to the effects of

Assisted Reproductive Technologies for the functioning of a

family as well as the development of the child have also been

identified. Such include the potential negative implications on

family relationships as a result of the infertility experience of

the parents when it lasts for several years. Therefore, it has

been proposed that parents who have not accepted the reality on

the whereabouts of their infertility always experience

difficulties in raising their children. This is thus a major

problem for adoptive parents. On the other hand in as much as

other couples may find the experience of infertility to be

harmless on their marriage, others have found infertility

stressful as well as the procedures of treatment harmful have had

difficulties in their marriages (Cook et al, 1989). If such

problems and difficulties persist through the raising of the

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child, the child is likely to suffer from effects of sub standard

motherhood practices and approaches.

Nonetheless, there is a growth in empirical terms that show

that the development of a child is closely intertwined to the

levels of parent child attachment as depicted by the attachment

theory where a child’s attachment to the parents is not

biological but as a result of parental responsiveness. Since the

majority of children who are obtained from gamete donation are

never told about their origins. This usually affects the quality

of motherhood as well as mother child relationship. In conclusive

terms regarding the Artificial Reproductive Technologies, in

recent years the social setting of the family structure has been

given attention with regards to the effects of social

environments on family relationships. Therefore, it is essential

to be aware of the negative attitudes and perceptions that exist

in relation towards these technologies. Procedures in the forms

of Di and IVF have been considered unnatural and to some extent

immoral. Eventually, families that obtain children via the

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utility of these technological advancements have often been

subjects of overt prejudice from the wider community, relatives

as well as their friends.

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Cook, R , Golombok, S , Bish, A arid Murray, C (1995) Keeping

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