Up@dawn 2.0

Friday, May 5, 2017

Final Post 2/2: Infertility Treatments

Artificial insemination (AI) is a relatively simple process, one begun by J. Marion Sims in the 1850s, though it was considered highly controversial then. There are currently two methods of AI in employment; the most common method is intrauterine insemination (IUI) and the other is intracervical insemination (ICI), which is also referred to as intravaginal insemination. The first step in the AI process is to select a sperm donor, and then begin the process of taking fertility drugs while being carefully monitored by one’s doctor to ensure conception. This process can take months before the body is ready to accept the donor sperm. Once the time is right, a speculum is inserted into the vagina, as if in a normal pelvic examination. Using a thin catheter and syringe, the donor sperm is then injected into the uterine cavity. If a woman has opted for ICI instead of IUI, a soft catheter is used to inject the sperm into the cervix. After insertion, a sponge cap is placed inside the vagina to keep the sperm inside or near the cervix. AI is typically the method chosen if the male partner is infertile or if he possesses a low sperm count or if the couple is a same-sex female couple.7
The second method of conceiving outside of regular means to overcome infertility is the process of in vitro fertilization. Developed by Robert Edwards and Patrick Steptoe, IVF is a drawn out process, which begins with a woman taking clomiphene citrate, a synthetic hormone during her first menstrual cycle after IVF has begun. The hormones induce the woman to produce many more eggs than would normally be released during a regular ovulation; she can produce up to twenty-two eggs in an IVF cycle. Once released, the eggs are then extracted from the woman in a surgery called laparoscopy, during which the woman is placed under a light anesthesia. The surgeons then make two small incisions to locate the ovaries; once located, the ovaries are held still with forceps and a hollow needle is inserted to extract the eggs. Once extracted, the eggs are placed within a test tube. The male partner of the woman is then asked to give a sperm sample, or, if no partner exists or if the couple is a same-sex one, the donor sperm is added to the test tube containing the eggs. The fertilized eggs are then placed in an incubator. Eighteen hours after fertilization, the egg will have ideally multiplied into a two-celled organism, and the replication process continues from there. In most IVF centers, the embryos are implanted into the woman at the four or eight cell phase. The process of inserting them is the same as the process of AI. A woman lies on her back as for a regular pelvic examination, and a catheter is used to implant the embryo in her uterus.8

Though there is no definitive cure for infertility, treatments such as artificial insemination or in vitro fertilization aid in conception for couples who would otherwise have extreme difficulty producing children 100% naturally. For completely sterile couples, adoption remains the only option as of yet, but there is hope that, in the constantly changing world of medical advancements, a solution will yet be discovered. If Baby Louise Brown could beat the odds and survive the IVF and embryo transfer process, then there is hope for infertility treatments yet. 

Final Post 1/2: Infertility Treatments

On July 25th, 1978, a baby girl named was born in Oldham, England to Lesley and John Brown; who would name the baby Louise. Baby Louise Brown would become known in medical circles the world over as the first child conceived by in vitro fertilization to succeed. Louise’s story, however, is not the beginning of an era, but rather the culmination of one. There are historical tales of members of the nobility of Europe divorcing their first wives, or marrying much younger women, or even fornicating quite freely in order to beget an heir. King Henry VIII married and subsequently divorced, executed, or lost to illness six wives, and Napoleon divorced his wife Josephine when she failed to produce an heir. (Ironically, Josephine went on to become the “mother” to several of Europe’s current royal families.) The inability to conceive, for those who wish to, is a tragic event still today, even as the social stigmatism attached has been removed, and from this tragedy has arisen an entire chapter of medical science and innovation through which previously barren women are now able to conceive.
            Aristotle, not the philosopher but rather a collection of writers, is quoted as having said: “When a young couple is married, they naturally desire children, and therefore use those means that Nature has appointed to that end.” Unfortunately, nature did not always grant these young couples the means to produce children. In colonial times, it was the Lord who could “choose to bless a couple with offspring.” There was not a method of medical examination to determine if a man or woman was sterile. In 1728, Philadelphian Anna Maria Boehm Miller petitioned for a divorce on the grounds that her husband was unable to procreate with her, and thus could not produce a child, as was the point of marriage. Her husband, George Miller, had what is now known as cryptorchidism, meaning he suffered from an undescended testicle, a condition which can cause sterility. Since he could still produce both an erection and semen, Anna Miller’s divorce was not granted, and the lack of children was instead deemed the Lord’s will.1  Anna Miller’s case was one of many in which religion was turned to in place of a lacking medical treatment. With high infant mortality rates, populating the New World was a growing problem. As the century progressed, however, the source of advice began to shift from religious to medical; to be barren became being infertile, an emotionless medical condition which implied possible medical cures and treatments.
Before medical treatments were employed, women turned to close friend and relatives for advice on how to encourage the conception of a much-desired child. Early “cures” were not so much medical ones as they were changes to a lifestyle or marriage. Men were advised to avoid copulating often with their wives as “grass seldom grown in a path that is commonly trodden in.”  Women’s insensibilities or a possible “imbalance of the humors” were also cited as reasons for barrenness.2 The general consensus was, despite any potential deformations of genitalia on the male’s part, if a man was not impotent, then infertility lay firmly with the woman.
As the colonial era progressed, two prominent figures in infertility studies arose. The first was a young doctor named James Graham emigrated from Scotland to the New England area in the early 1770s, bringing with him his fairly radical theory of linking sexual pleasure with electrotherapy as a cure for infertility. He also offered various remedies to be consumed, such as his “never-failing prescription for fertility”, which instructed consumers to “take one handful of red virgin sage leaves; steep them in a bottle of old red port, then drink a glassful every morning repeat it in two or three months” and then combine it with regular exercise, proper hygiene, and keeping regular hours.3 Though there is no scientific evidence that honoring this recipe would actually aid in the conception of offspring, Graham’s prescription of regular exercise and bathing were widely accepted at the time. Though he only had limited success with actually “curing” infertility, Graham did enjoy quite a bit fame and fortune from his “Temple of Health”, which featured lectures on fertility by a member of the same sex as its attendants and Graham’s famed electric baths. On the opposite end of the spectrum was James Walker, a serious young medical student who sought to change his profession’s view on infertility, but instead returned to Virginia and faded into the background of history. The only remainder of Walker was a small book, originally written as a doctoral dissertation, entitled An Inquiry into the Causes of Sterility in Both Sexes. Where Graham adopted a sexual view on sterility, Walker proposed a purely medical one, stating that the infertility of women came from various medical conditions, including blocked fallopian tubes, and not from lack of achieving orgasm.4
In the 1850s and 60s, there arose a new name in medical treatments: J. Marion Sims. He began as a surgeon in Alabama who actively avoided obstetrics until he was called upon to operate upon a number of slave women who had all undergone difficult births and as a result suffered from vesicovaginal fistula. Though it took him years, Sims did solve the problem of operating on and healing the fistula. As a result of this success, he persuaded various well-connected female philanthropists to support him in a venture to create a women’s hospital, a venture in which he was successful; from his work, Sims would be named in history as the Father of Gynecology.5 The arrival of this new field in medicine meant new treatments could be devised to aid the infertile. Sims was also the first to experiment with artificial insemination, using a syringe with a long, dull, and bent at the end needle.
From the time of Sims in the mid-19th century, we now jump to the 20th. Beginning in 1895, and continuing for more than a decade, American surgeon Robert Tuttle Morris practiced ovarian transplantation, a process in which he implanted sectioned parts of ovaries from fertile women into women who were either infertile or had lost their ovaries in surgery, thirty years before the discovery of estrogen or the coining of the term ‘hormone’.6 During this time period, a test was also devised to test if the fallopian tubes were blocked or not, where previously surgery was the only option. From the 20th century came the two largest infertility treatments which still exist today: artificial insemination and the process of in vitro fertilization and embryo transfer.

Sunday, April 23, 2017

The future we’ve been warned about

...The future we’ve been warned about is beginning to saturate the present. We tend to imagine climate change as a destroyer. But it also traffics in disruption, disarray: increasingly frequent and more powerful storms and droughts; heightened flooding; expanded ranges of pests turning forests into fuel for wildfires; stretches of inhospitable heat. So many facets of our existence — agriculture, transportation, cities and the architecture they spawned — were designed to suit specific environments. Now they are being slowly transplanted into different, more volatile ones, without ever actually moving... (continues in the NYTimes Magazine "climate issue" Apr 23, 2017)
==
The Planet Can’t Stand This Presidency, by Bill McKibben

Drumpf is in charge at a critical moment for keeping climate change in check. We may never recover.

President Drumpf’s environmental onslaught will have immediate, dangerous effects. He has vowed to reopen coal mines and moved to keep the dirtiest power plants open for many years into the future. Dirty air, the kind you get around coal-fired power plants, kills people.

It’s much the same as his policies on health care or refugees: Real people (the poorest and most vulnerable people) will be hurt in real time. That’s why the resistance has been so fierce.

But there’s an extra dimension to the environmental damage. What Mr. Drumpf is trying to do to the planet’s climate will play out over geologic time as well. In fact, it’s time itself that he’s stealing from us.

What I mean is, we have only a short window to deal with the climate crisis or else we forever lose the chance to thwart truly catastrophic heating... (continues)

Monday, March 27, 2017

The Most Efficient Way to Help the Planet



What can you — just one concerned person — do about global warming?

It may feel like a more urgent problem these days, with proposed cuts to the Environmental Protection Agency and each year warmer than the previous one.

You could drive a few miles fewer a year. Reduce your speed. Turn down your thermostat in winter. Replace your incandescent light bulbs with LEDs. Reduce your meat consumption. Any one of those actions would help.

But none would come close to doing as much as driving a fuel-efficient vehicle. If vehicles averaged 31 miles per gallon, according to our research, the United States could reduce its carbon dioxide emissions by 5 percent.

Improving fuel economy carries particular salience after the Drumpf administration announced this month that it would re-examine the progressively more stringent Obama-era fuel economy standards for vehicles in model years 2022 to 2025.


If every American household drove a vehicle getting 56 miles per gallon, it would reduce U.S. emissions by 10 percent.

The American new-vehicle fleet now averages less than half that. It is expected to average 36 m.p.g. in 2025 if Obama administration standards remain in place, according to the Environmental Protection Agency...


(nyt, continues)

Monday, March 20, 2017

The Seasons Aren't What They Used to Be



CreditJooHee Yoon

SEWANEE, Tenn. — Sexual energies were loosed early this year in Tennessee, then quashed. In February, spring peepers made my ears ring as I walked through wetlands east of Nashville’s honky-tonks. These frogs were a month ahead of their normal schedule.

But what is normal in a year when the calendar says spring starts Monday, yet the season started weeks earlier for plants and animals? When New York was clipped by a snowstorm last Tuesday, the streets had already been dusted with pollen from early-blooming red maples.

Spring has been particularly hasty and irregular this year, but this is no anomaly. In the latter half of the 20th century, the spring emergence of leaves, frogs, birds and flowers advanced in the Northern Hemisphere by 2.8 days per decade. I’m nearly 50, so springtime has moved, on average, a full two weeks since I was born. And you? We now experience climate change not only through the abstractions of science, but also through lived experience.

Early spring felt good; early spring felt dreadful. Now, whiplash as we slam into a snowbank. This is the motion sickness of climate change: The world lurches, and our bodies know that all is not well. What we experienced as spring, a predictable appearance of buds and birds, is passing away. Our children will live in uncharted, unnamed seasons.

In the forests here in Tennessee, instead of tracking foxes in winter snow, I spent February being startled by precocious bloodroot and other wildflowers piercing the leaf litter. Phoebes sallied after sun-warmed flying queen ants and spring azure butterflies. Japanese quince bloomed in garden hedges before January was over, multiflora rose broke bud on Valentine’s Day, and Mardi Gras came with Bradford pears in bloom. Then, in March: snow. A month after frogs sang through 70-degree evenings, freezes in the teens brought silence... (David George Haskell, continues)

Thursday, March 2, 2017

People’s Climate March

Bill McKibben-
I don’t know if you’re like me, but there are days when the sound of Mr. Trump’s voice just makes me want to curl up in a fetal position.

The losses we’ve suffered just in the past week, as the new EPA head started gutting water and air protections, makes me think of the earlier generations of activists who worked so hard to get these laws enacted. Tuesday night I wanted to shout at the TV when, instead of mentioning climate change, he boasted about approving new pipelines.

But then I remind myself that, given the situation, we’re off to a pretty good start fighting his efforts. The Women’s Marches and the airport protests were remarkable moments, and they put a dent in his momentum. We’ll need much more of this kind of resistance.

Specifically, for those of us focused on the climate questions that will define the future of our planet, we need to be fixing on the end of April. On April 22, Earth Day, scientists will march, and I hope the rest of us will be engaging our community: we’ve got to keep explaining to all our neighbors that climate change is the furthest thing from a hoax.

Then on April 29, which falls on about the hundredth day of the new administration, we need to gather in Washington DC and across the country for the People’s Climate March.

When we did this in New York in 2014 it helped propel the plane towards the Paris climate accords. This time we need—powerfully—to make clear that we haven’t gone away, and that we will not let the U.S. retreat.

It will be a solemn day—we’ve just come through the hottest year ever measured on this planet, after all. But it will also be a joyful and rousing one: we’ll be celebrating the launch of a new drive to make our nation run on a 100% renewable energy economy that works for all. We know Trump won’t support it, but we’re getting on with the job at hand: demonstrating the political will for climate justice so that every other politician sprints as far ahead as possible.

Here’s the place to sign up: 350.org/PCM2017. But we need you doing more than signing up and showing up. We need you, as always, organizing: getting others to come, filling buses, creating art, suggesting themes.

We need each other, really. That’s what a movement is.
Bill 

Monday, February 13, 2017

DRUMPF’S PIPELINE AND AMERICA’S SHAME

Bill McKibben:

The Drumpf Administration is breaking with tradition on so many fronts—renting out the family hotel to foreign diplomats, say, or imposing travel restrictions on the adherents of disfavored religions—that it seems noteworthy when it exhibits some continuity with American custom. And so let us focus for a moment, before the President’s next disorienting tweet, on yesterday’s news that construction of the Dakota Access Pipeline will be restarted, a development that fits in perfectly with one of this country’s oldest cultural practices, going back to the days of Plymouth Rock: repressing Native Americans.

Just to rehash the story briefly, this pipeline had originally been set to carry its freight of crude oil under the Missouri River, north of Bismarck. But the predominantly white citizens of that town objected, pointing out that a spill could foul their drinking water. So the pipeline’s parent company, Energy Transfer Partners, remapped the crossing for just north of the Standing Rock Sioux Reservation. This piece of blatant environmental racism elicited a remarkable reaction, eventually drawing representatives of more than two hundred Indian nations from around the continent to a great encampment at the confluence of the Cannonball and Missouri Rivers, near where the pipeline was set to go. They were joined, last summer and into the fall, by clergy groups, veterans groups, environmental groups—including 350.org, the climate-advocacy organization I co-founded—and private citizens, who felt that this was a chance to begin reversing four centuries of literally and figuratively dumping on Native Americans. And the protesters succeeded. Despite the German shepherds and pepper spray let loose by E.T.P.’s security guards, despite the fire hoses and rubber bullets employed by the various paramilitary police forces that assembled, they kept a nonviolent discipline that eventually persuaded the Obama Administration to agree to further study of the plan.

More remarkably, it was the U.S. Army that took the lead—the same agency that had massacred and harassed Native Americans since its founding. On December 4th, Jo-Ellen Darcy, the Army’s assistant secretary for civil works, announced that the easement required for E.T.P. to dig beneath the Missouri would not be granted. Instead, the Army Corps of Engineers would prepare an environmental-impact statement, a lengthy process that effectively put the pipeline on hold. “It’s clear that there’s more work to do,” Darcy said at the time. “The best way to complete that work responsibly and expeditiously is to explore alternate routes for the pipeline crossing.” So the Corps set about organizing public hearings and taking testimony; until Tuesday afternoon, we were in the middle of that period, with signatures coming in by the hundred thousand. But at three o’clock yesterday, acting on the President’s suggestion that the environmental review be “expedited,” the Army reverted to ancient form, shutting down the public-comment process and issuing the permits that E.T.P. needs to begin digging again. Suddenly there was not “more work to do.” Somehow, in the eighteen days since Donald Drumpf had taken office, Robert Speer, the acting secretary of the Army, had obtained “sufficient information” to grant the approval.

One feels for the Army brass. Had they continued to act responsibly and in line with their previous commitments, their careers likely would not have progressed. (Speer is apparently no Sally Yates, though those of us worried about the choleric Drumpf and his proximity to the nuclear-launch codes must hope that someone in the Pentagon is.) In any event, digging is scheduled to begin as early as this afternoon. There should, and will, be substantial protests. The first demonstrations began in major cities today, and the Standing Rock Sioux have asked Americans to descend on Washington, D.C., on March 10th. By that point, the pipeline may be all but finished, but the tribe and its attorneys at the environmental group Earthjustice have vowed to keep fighting it in the courts, even once it is carrying oil.

The bigger battle, however, may be in the tribunal of public opinion. The pipeline is a bad idea on many grounds, none of which is likely to sway Drumpf. (The fact that the oil it carries has the same carbon footprint as nearly thirty coal-fired power plants would perhaps seem a plus to him.) Tom Goldtooth, the executive director of the Indigenous Environmental Network, recently noted that Drumpf has yet to meet with any Native American leaders since taking office, which is possibly for the best, given the casual racism that might ensue. But the protests at Standing Rock have reopened the question of how the rest of America, those of us not in the White House, will treat the continent’s original inhabitants. In this standoff, we have confronted our oldest and one of our most shameful stories. That shame will deepen now—which may, once Drumpf is gone, allow us to move closer to real reconciliation. At any rate, we owe a great debt to the protesters, who have acted with a dignity conspicuously lacking in the Oval Office. New Yorker


Bill McKibben, a former New Yorker staff writer, is the founder of the grassroots climate campaign 350.org and the Schumann Distinguished Scholar in environmental studies at Middlebury College.