Introduction

The new reproductive technology (NRT) is no exception any more, since Louise Brown, the first "test tube" baby, was born on 25 July, 1978 (Simmons, 2009). Before her parents Lesley Brown and John Brown met Drs Edwards and Steptoe, they had been trying to conceive a baby for nine years, but never succeeded. Because Lesley Brown was diagnosed with fallopian tubes obstruction, at that time, it indeed meant hopelessness of being pregnant without a miracle. Then the ungovernable longings for having a baby impelled Lesley Brown to participated in Drs Edwards and Steptoe's experiments. Lesley Brown was not the only volunteer during the procedure, but she fortunately became the first successful case (Deech & Smajdor，2007). At present, 4 million "test tube" babies have been born around the world（website), thanks to Drs Edwards and Steptoe's great contribution from 1977. But what if geneticists announce that genetics and traits can be predetermined for unborn babies today? Then what will parents order for their new babies? Blond hair or ruddy eyes? Bird’s wings or fish's gills? How about the mermaid’s beauty and Einstein's intelligence? Those questions need to be reflected by young generations, because that may be no longer an imagination of the future. Jeffrey Steinberg, a pioneer of in vitro fertilization (IVF), and the founder of the LA Fertility Institute as well, has already maintained in 2009 that his clinic would carry out trait-selected serves soon (Mara, 2011). Since the first efficacious treatment of infertility, IVF is still being improved. Besides, ethical and regulatory issues around this new technique never stop making controversy. This paper will briefly summarize the revolution of in vitro fertilization (IVF). After, the success rates and defect of IVF will be analyze. Finally, the ethical and regulatory issues that IVF arouse will be discussed.

in vitro fertilization (IVF) Revolution

As mentioned above, IVF is the main treatment of infertility today. It is usually carried out after all other assisted reproductive technology (ART) failed, such as IUI (inrauterine insemination) and AI (artificial insemination) (Becker, 2000). IUI and AI are done in vivo, so I will not present them in this paper. Literally, the term "in vitro" refers to a Latin term which means "within glass". The early studies about laboratory biology that interact with living organism had to be performed in glass containers. Nowadays "in vitro" is used to distinguish from "in vivo" procedure which means carrying out in the body in biological experiments (dictionary). The first test tube baby, Louise Brown, is the milepost that advanced technique can deal with the infertility problem from a female perspective that had been nagging humans for a long time. First, both being over or under weight can affect normal ovulation due to hormonal imbalances. Second, there are abnormalities in the lining of the uterus or a blockage in the fallopian tubes that block the conveyance of ova from the ovaries to the fallopian tubes. Third, in some cases, ovulation just never occurred with some women. All of these problems are really common and cause no chance for sperm to meet a ovum in the fallopian tubes (Deech & Smajdor, 2007). Therefore, gestation may never happen in some ladies' lives. Thankfully, Drs Edwards and Steptoe provided a opportunity for sperm and egg to meet and mix with each other in vitro. In vitro fertilization (IVF) Louise Brown was the typical case of the initial IVF. This technique demands healthy gametes (egg and sperm) that can successfully be fertilized. First, mature ova or ovum from a woman's ovaries are removed outside of the body. Second, the fertilization of sperm and eggs will be done outside the woman's body (in Petri dishes with fluid medium). Then the fertile egg (zygote) can be implanted to the woman's uterus, if the egg fertilizes successfully. Finally, some corpus luteum hormones, or progesterone, may be used to increase the fertility rate and decrease the miscarriage rate, if the woman carries successfully. Through the process above, local anesthetic is required in some countries (Simmons, 2009; Deech and Smajdor, 2007). Dr Edward who developed this therapy was conferred with the Nobel Prize in Physiology or Medicine in 2010. In addition, the early experiments were severely restricted by the acquirable quantity of a woman's ova. That was because normally, clinicians could only gain one or two mature eggs from a female volunteer per month to combine with sperm. Another reason perplexed clinicians and physiologists at that time was that the technique of in vitro culture was not advanced as it is in today (Simmons, 2009). Therefore, the success rates of IVF were extraordinarily low before ovulation induction and superovulation therapies were involved (Becker, 2000). Superovulation Currently, in order to maximize the fertile chances, clinicians ask for as many ova from female patients as possible undergoing in vitro fertilization procedure. Later, clinicians implant the only fertile egg or the "best" developed egg to the woman's womb. A conventional and typical method that is involved in one IVF cycle for induced ovulation is presented in the following. First, a woman going through IVF procedure needs to take drugs with hormone to inhibit ovulation in the first two weeks. Then ova can be accumulated at a woman's ovaries, and ovulation will not happen until the woman takes another hormone which works in a reversal way -- boosting multiple eggs. Finally, a“ripening”hormone must be given around thirty-six hours before the extraction, which needs to be done under the monitor with ultrasound, in order to harvest eggs with a tinny needle which is inserted into the vagina (Deech & Smajdor, 2007; Nargund G, Reid F, Parsons J, 2001). This progressive therapy presents not only an important role in enhancing the success rates, but also lays the foundation in a great deal of developments in IVF. All in all, this is a treatment that deal with women who may be diagnosed with fallopian tube obstruction, endometriosis, repeated miscarriage and so on (Simmons; Deech & Smajdor, 2007). However, even if enough ova have been already obtained, in vitro fertilization cannot be succeeded without viable sperm. Sometimes the sperm are not strong enough to reach the egg before running out of energy, or the sperm may meet an egg with immune infertility, which means the egg repels to mix with the sperm. Sometimes male patients may be diagnosed with oligospermia (low sperm count), azoospermia (no sperm), obstructive azoospermia (OA, meaning blockages in the genital tracts) and so on (Palermo G, Cohen J, Alikani M, Adler A, Rosenwaks Z, 1995). To deal with all those issues mentioned above, intracytoplasmic sperm injection emerged as the time required.

Intracytoplasmic Sperm Injection (ICSI) Traditionally, infertility was regarded as a woman's fault, actually; around one third of infertile cases can be due to male infertility problem (Human Fertilization and Enbroyology Authority, The HFEA guide to infertility 2006/7). Since the first successful case of ICSI occurred in 1992 (Palermo，Joris，Devroey，Van Steirteghem, 1992) , ICSI has been witnessed as an effective method for male-factor infertility problems. Theoretically, ICSI is an injection procedure which directly conveys a single sperm cell into a prepared egg by a very tinny needle (Deech & Smajdor, 2007). It is involved in one IVF cycle in case whether a male patient has a very low sperm count or even no sperm in the semen. In some cases, it is due to the blockage in the tubes which transfers the sperm in the course of ejaculation (Deech & Smajdor, 2007; Becker 2000). Vasectomy or other physical issues result in the same. Therefore, if the valid sperm cannot be obtained by the normal way, masturbation in the clinic (Deech & Smajdor, 2007), or the sperm that be obtained are not well developed, the sperm cannot fertilize the ova. For obtaining as much viable sperm as possible, assisted technique in required. Percutaneous Epididymal Sperm Aspiration (PESA) Microsurgical Epididymal Sperm Aspiration (MESA) Testicular Sperm Extraction (TESE)

PESA, MESA and TESE are all additional techniques that are used to obtain the viable sperm or sperm cells by a very fine needle. PESA, MESA, TESE are done under local anesthesia or gentle anesthesia (Silber SJ, Van Steirteghem AC, Liu J, Nagy Z, Tournaye H, Devroey H, 1995; Dohle GR, Ramos L, Pieters MHEC, Braat DDM, Weber RFA, 1998). Usually, PESA will be performed as the first choice, which the sperm are drew from the epididymis, because these sperm that can be taken are most developed, contrast to the other two. When PESA failed, MESA can be performed as the second protocol, which the sperm is drew from the testes. TESE will be only applied after nether PESA and MESA failed, this treatment has to remove a slice of tissue from the testes, then clinicians try to find out the sperm cells from this slice of tissue under the microscope. But the sperm cells are not well developed as the sperm existed in the epididymis, therefore not only the success rates may be influenced, but also the fertile eggs may be not well divided (Silber SJ, Van Steirteghem AC, Liu J, Nagy Z, Tournaye H, Devroey H, 1995; Dohle GR, Ramos L, Pieters MHEC, Braat DDM, Weber RFA, 1998). The truth is that the IVF procedure involved with TESE does show a lower success rates, compared with PESA and MESA are involved (Tesarík J，Greco E，Cohen-Bacrie P，Mendoza C, 1998). RISK Although the pregnancy rates and the birth rates of the IVF cycle without ICSI and PESA, MESA or TESE seems equal to the IVF cycle with ICSI involved with PESA or MESA (Silber SJ, Van Steirteghem AC, Liu J, Nagy Z, Tournaye H, Devroey H, 1995), if there is a possibility that the unborn male babies will inherit the male infertility problem from the sperm donators is still considered and monitored by experts. Good news is that the IVF baby, Louise Brown, has already carried a baby and born a son naturally (web). Moreover, the birth defect is one of the most controversial issues of IVF. Fortunately, most studies cannot prove a considerable and remarkable cases of higher birth defect after going through IVF procedure without calculating ICSI (Kurinczuk, 2003). However, there are a deal of cases clearly show that as the more the fertile eggs experienced go through IVF, the less birth weights can be carried (Pinborg A, Loft A, Schmidt L, Andersen AN, 2003).

Preimplantation Genetic Diagnosis (PGD) Preimplantation genetic diagnosis (PGD) is a additional procedure before the embryos is implanted into the woman's uterus. In order to monitor whether or not the embryo has genetic diseases, especially when one of the prospective parents have a risk of serious genetically transmitted disease, such as hemophilia, or the unborn baby is desired to have a tissue type which is required by the sick sibling (Deech & Smajdor, 2007 ), PGD has been wildly used. This technique biopsies a single cell which is removed from the embryo. Then a genetic analysis can be done under microscope. Therefore, the embryo which is detected with serious genetically transmitted disease or without the required tissue type will not be implant into a woman's uterus. Ethics and Regulations Today, the IVF has already helped many infertility families to carry babies successfully. However, there are several accidents occurred result in a lack of regulations. IVF may causes these following ethical and moral problems :
1) IVF and surrogacy Even if a contract must be signed before surrogacy, it is still very hard for the surrogates and the principals to comply with it. Sometimes, the surrogates may reduce to surrender the babies that they carried, because they changed their mind, and they do not want to leave the babies. Sometimes neither of the surrogates and the principals accept the children due to the congenital blemish. In this point, a complexly ethical and legal question which can cause chaos in the society must be figured out. In one side, beyond all doubt, the surrogates help a lot. Sometimes the surrogates are indispensable. In another side, it seems no different between a baby and a commodity under the surrogacy. Therefore, it can completely deconstruct the traditional ethics of the family and the society. Furthermore, who are the test-tubes babies' parents? For example, the gametes (eggs and sperm) may come from the third party; and the fertilization is done in a test tube; then the pregnancy procedure may be carried out in a surrogate's womb. Based on the three variations, the baby may have five mothers and fathers -- "genetic father", "genetic mother", "carried mother", "father in sociological theory" and "mother in sociological theory " in the most complicated condition. Obviously, the sentiments can be separated from the duties and the rights can be separated from the ethic. For the parents, who have the rights and obligations to the children? To make the problems worse, who should assume full repressibility when the children have serious illness? The hospital? The gametes (eggs and sperm) donators ? Or the parents in the law ? Regulation about those issues is required to be established definitely.
(2) Gender Selection Gender selection can be done by using PGD. And the imbalance in the population of male and female in India has been becoming visible result in the local culture and the advanced technique of gender discrimination. The same result is also expanding in China. 163 million women have been minified in Asia since few decades ago. However, a reverse policy has been carrying out for a long time in England where the first test tube baby was born. The Human Fertilization and Embryology Authority forbids gender selection. The same policy has been performing in Italy. The initial purpose of gender discrimination before the babies are born was prevent the serious genetically transmitted diseases which can be only inherited by male babies from the beginning. But currently, some experts suspected that when some kinds of genetic diseases have been successfully prevented, whether or not some new genetic diseases have been carrying in the new generations. Because PGD is still a really new technique, there were not enough cases can prove it. Conclusion In vitro fertilization, since this new technique produced, controversies around it have never stop. In one hand, IVF provides a opportunity for some families which have been in despair of carrying a baby and satisfy the requisition of having a complete family. It is not only a physical meet, but also a emotional meet. In another hand, although IVF has a remarkable and striking achievement in humans' developing history, the defect of this technique cannot be neglected. Actually, it is still anarchic in the regulation system, and the shortage of this technique requires a great number of breakthrough. Furthermore, IVF leads to a issue involved with money and ethic in the society. Comprehensive consideration of the whole advantages and disadvantages, the more job must be done in order to improve this technique, a tolerant and positive attitude is also required in order to deal with the social and ethical issues which are aroused by this new technique. After all, each new theory must go through a procedure from immaturity to completion. Believably, IVF will be being improved in a humanitarian avenue .

References list

Becker, G. (2000). The Elusive Embryo: How Women and Men Approach New Reproductive Technologies. London, England: University of California Press, Ltd.

Deech, R., & Smajdor, A. (2007). From IVF to Immortality: Controversy in the Era of Reproductive Technology. NY: Oxford University Press Inc., New York.

Dohle, G.R., Ramos, L., Pieters, M.H.E.C., Braat, D.D.M., Weber, R.F.A. (1998). Surgical sperm retrieval and intracytoplasmic sperm injection as treatment of obstructive azoospermia.Hum Reprod，1998，13（3）:620-623.

Gorringe, R., et al.(2009). Oxford Advanced Learner's Dictionary. England: Oxford University Press.

Hvistendahl, M. (2011). Unnatural Selection. In Psychology Today. Jul/Aug, 2011, Vol. 44 Issue 4, p80-87, 8p.

Kurinczuk, J.J. (2003). Safety issues in assisted reproduction technology: From theory to reality—just what are the data telling us about ICSI offspring health and future fertility and should we be concerned?. Hum Reprod , 2003, 18 (5): 925–31.

Nargund, G., Reid, F., & Parsons, J. (2001). Human Chorionic Gonadotropin-to-Oocyte Collection Interval in a Superovulation IVF Program. A Prospective Study. In Journal of Assisted Reproduction and Genetics, Vol. 18, No. 2, 2001.

Palermo, G., Cohen, J., Alikani, M., Adler, A., & Rosenwaks, Z. (1995). Development and implementation of intracytoplasmic sperm injection (ICSI) In: Intracytoplasmic sperm injection : the revolution in male infertility. Reprod Fertil Dev 1995, 7:211.

Palermo, G., Joris, H., Devroey, P., Van Steirteghem, A.C. (1992). Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet，1992，Jul, 4. 340(8810)：17-18.

Russell, C. (2010). Four Million Test-Tube Babies and Counting. E-Journal of The Atlantic. Retrieved May 3, 2012, from http://www.theatlantic.com/technology/archive/2010/10/four-million-test-tube-babies-and-counting/64198/ Silber, S.J., et al. (1995). High fertilization and pregnancy rate after intracytoplasmic sperm injection with spermatozoa obtained from testicle biopsy. Human Reproduction，1995，10(1)：148-152.

Simmons, K. (2009). New Reproductive Technologies. Encyclopedia of Gender and Society. Ed. Jodi O'Brien. Vol. 2. Thousand Oaks. 2009. p604-608.

Tesarík, J., Greco, E., Cohen-Bacrie, P., Mendoza, C. (1998). Germ cell apoptosis in men with complete and incomplete spermiogenesis failure. Molecular Human Reproduction, 1998, 4(8): 757-762.

Walsh, F. (2008). 30th birthday for first IVF baby. From: Medical correspondent, BBC News. Retrieved May 3, 2012, from

http://news.bbc.co.uk/2/hi/health/7505635.stm