Human Reproduction- There's More to It, 9-12 Lesson 2

Human Reproduction- There's More to It, 9-12 Lesson 2

Overview

This second lesson enables students to apply what they know about human reproduction via PIV sex (Lesson 1 of this series) to other means of reproduction. They will not only learn the steps in how insemination and IVF work to create a pregnancy, but they will also learn that people other than parents can provide the genetic material (eggs, sperm, and embryos) and give birth to a child for someone else (surrogates). Students will be working in small groups to help one another understand the concepts and to practice using the inclusive language that the educator modeled in the first lesson.

Human Reproduction- There's More To It, HS Lesson 2

Lesson Description

Grade

High School

Suggested Time

60 minute with 15 minute optional supplement

Authors

Rachel Ginocchio, MPH, Roads to Family

In collaboration with:

Gaye Chapman, Portland Public Schools

Nora Gelperin, MEd, Advocates for Youth

Danni/y Rosen, Co-Chair, GLSEN Oregon

In consultation with:

Yesenia K. Char

Yena Perice

Madelyn Mae Rocamora Belden

Jacqueline Singer

Black Student Union (BSU), Cleveland High School

Cleveland Alliance for Racial Equity Leadership (C.A.R.E.)

Cleveland High School and Leodis V McDaniel High School health students

Cleveland LatinX Student Union

Paula Amato, MD, Professor of Obstetrics and Gynecology, Oregon Health & Sciences University

Andy Dettinger, ODHS Youth Services, My Future-My Choice

Jacqueline DiBernardo, Writer, RKW Creative

Mariotta Gary-Smith, MPH, Certified Sexuality Educator

Amy Penkin, MSW, LCSW, Clinical Program Manager, Transgender Health Program, Oregon Health & Sciences University

Ann Scott, MD, FACOG, Doctor of Obstetrics and Gynecology

Jess Venable-Novak, Family Equality

Oregon Sex Education Steering Committee

Oregon Sexual Assault Task Force's (SATF’s) Abuse Prevention Learning Collaborative

Oregon Youth Sexual Health Partnership (OYSHP)

Anatomy Illustrations by:

Mel Latthitham, Graphic Designer, Sweet Bonny

Objectives

Lesson 2 Objectives:

  • List 3 reasons or situations in which penis-in-vagina sexual intercourse (PIV sex) does not work to create a pregnancy (when the pregnacy is intended).
  • Identify 6 steps necessary to start a pregnancy with insemination and in vitro fertilization (IVF).
  • Define the role of donors and surrogates in human reproduction.
  • Practice using respectful, inclusive language when explaining human reproduction.

Essential Questions Covered

  • How does insemination, IVF, donors, and surrogates work to create a pregnancy? In what ways are all the means of reproduction similar and different?
  • What situations or circumstances warrant help in achieving pregnancy?
  • What factors play a role in people’s agency in achieving family formation goals?
  • How does a more inclusive understanding about human reproduction and family formation impact your current decision making or your future goal setting?

Culturally Responsive Practices

The three lessons in this series are about equity, diversity, and inclusion, around human reproduction and family formation. So often, students and their families who are here thanks to assisted reproduction, or who join their family through adoption and foster care are left out of the typical narrative. By teaching the concepts in these lessons, educators will include every student in their class and all of their family structures in the explanation of human reproduction, equally. Throughout the lessons, students are invited to share, explore, and celebrate their large funds of intersectional knowledge (all shaped by their identities, genetics, and experiences) around how they came into the world and what family/kinship/community means to them.

We do want to acknowledge that although the creation of these lessons was driven by the experiences and ideas of students and professionals of various intersecting identities, they are largely written from a western perspective/cultural standpoint.

Information for Educators

The following information will be repeated in each of the three lessons:

The three lessons in this series expand the typical explanation of anatomy and reproduction to be inclusive of every student and every family structure. We discuss penis-in-vagina sexual intercourse, insemination, and IVF. In this way, all students can see themselves in the lessons on human reproduction and family formation. This includes students who are donor conceived

(egg, sperm, and embryo donation), those gestated and birthed via surrogacy, and those who come to their families through adoption, foster care, remarriage, and many other avenues.

This first lesson focuses on fertilization through penis-in-vagina sexual intercourse (PIV sex). The second lesson introduces insemination, in vitro fertilization, donors, and surrogates. The third lesson pulls together all of the concepts introduced in the first two lessons.  

In the second lesson, students will apply their knowledge of how PIV sex works to create a pregnancy to explain insemination and IVF. They’ll then take their understanding further, by learning how people other than parents, such as donors and surrogates, play a role in human reproduction and family formation. The activities will be done in small groups, where students can help each other understand the concepts and where they can practice using an inclusive approach to human reproduction, which the educator modeled in the first lesson.

In the third lesson, students will work in small groups, researching celebrity families. This activity will enable them to pull together all the concepts they learned in the previous two lessons, and to demonstrate their progress in understanding the material.

These lessons are designed with formative assessment questions built in. The educator can speed up or slow down the material, depending on where students are in their understanding and interest in the material and how much class time is allotted to these lessons.

The three lessons in this series are designed to be taught consecutively. However, since teaching time is short, the following are suggestions for modifying the length of these lessons:

  • If students already have a strong foundational understanding of human reproduction through PIV sex, educators can skip Lesson 1.
  • Lesson 3 is a hands-on activity that enables students to apply the knowledge they gained in Lesson 1 and 2, and helps educators assess student understanding. This lesson can be skipped or assigned as homework.
  • If students already have a basic understanding of all means of reproduction (PIV sex,  insemination and IVF), they can dive right into Lessson 3, where they can apply their knowledge and demonstrate their understanding.
  • Depending on students’ level of proficiency, there are sections within the lessons that can be skipped or elaborated on. We have noted these in the lessons.
  • We have kept the slides for these three lessons in one slide deck. We hope this helps teachers pace the material according to students’ proficiency and how much time they have in their class period. When class periods allow for more content, educators can simply skip the wrap-up activities at the end of one lesson and move onto the next.

Suggestions for scope and sequencing: Our lessons fit well after students have a basic understanding of puberty, the difference between sex (female, male, and intersex) and gender, sexual orienation, consent, health equity/disparaties and media literacy, and before contraception and STI prevention. For resources on these topics, please see “Links for Supplemental Materials” at the end of this lesson.

All the materials created for these lessons begin with RTF, which stands for Roads to Family. We hope the RTF designation helps you keep organized with all the available resources.

In addition to the three lessons on human reproduction, Mariotta Gary-Smith has also written two additional lessons which guide the students in their exploration of family, kinship and community. We highly recommend these lessons either before or after this series. These lessons begin with the letters MGS.

Please keep in mind that although you (as the educator) might be unfamiliar with some of the material in these lessons, many students in class are here thanks to assisted reproduction, including donor conception and surrogacy. Some of these students have been explaining assisted reproduction to their peers since they were in elementary school. They may be willing to share their funds of knowledge and expertise, but it may also be a relief for them not to be the one explaining things. When assisted reproduction is part of mainstream education it destigmatizes and normalizes everyone’s experience!

We have chosen to use the term PIV sex, to represent penis-in-vagina sexual intercourse, since this is the type of sexual intercourse than can lead to a pregnancy. Others use sexual intercourse or vaginal intercourse. There is no one right term to use, so use the vocabulary that is best for your community, and feel free to change the slides and handouts accordingly. Just be sure to clearly define the terms you use.

If any of the words in the lessons cause you to feel uncomfortable, it can be helpful to practice them out loud several times, in the privacy of your own home, before introducing the concepts to the class.

Please know your state and district policies regarding what you can and can not teach in regards to comprehensive sexuality education.

Links and Materials for the Lesson

Educator Materials

Before the lesson, please read:

For the Lesson:

  • For small group activities, students can work with peers at their tables, or the educator can pre-assign groups.
  • The slides for this lesson: Lesson 2 Slides
  • The handouts for this lesson:
  • Family Vocabulary - If you already make enough copies for lesson 1, you do not need to reprint this. You’ll need enough copies for the educator, scribe and each table group.
  • Reproduction Vocabulary - If you already make enough copies for lesson 1, you do not need to reprint this. You’ll need enough copies for the educator, scribe and each table group.
  • Reproduction Infographic - This is a new handout, needed for Lesson 2 and Lesson 3. Make a copy of both pages for each student. A double sided copy works well, if possible.
  • For the Warm-Up activity, you will need an additional large sheet of paper taped to the wall/space on the dry erase board where responses from warm up activity can remain. Label this “Including…”
  • Computer, LCD projector, screen, and speakers to broadcast sound from videos.
  • A watch, clock or stopwatch for keeping track of time.
  • Group Agreements, Parking Lot, Word Wall, Anonymous questions bos/digital version from Lesson 1.

 

Student Materials

At each table group and for the scribe:

Each student will need:

Table groups will also need (place in center of table):

  • Paper and pen/pencil or markers
  • Paper for anonymous question box

 

 

Lesson Overview

Before the Lesson

Gather all educator and student materials. Set-up classroom for small group activities.

Slide 1: Title slide

Note to Educator: The title slide can be up when students come into class.

Note to Educator: To follow is a suggested narrative for you to use with your class. Please modify so that you use the language and concepts most appropriate for your community, and that which meets your district and/or state policies, which may dictate what you can and can not discuss. We have indented and italicized notes to you that are not part of the narrative, we have highlighted media links in blue, and questions to ask the student in green.

During the Lesson

Climate Setting (2 Minutes)

Slide 2: The zones

Growth Zone

Just as we did with Lesson 1, we are aiming to be in the growth zone again today. Please remember to take care of yourself if you feel panicky or unsafe.

Group Agreements

These are the group agreements we came up with for Lesson 1.

Note to Educator: You can point to where the group agreements are written and read, or have a student read some of the salient ones out loud.

Student Inquiry: Are there any group agreements anyone would like to add or revise since our last lesson?

Parking Lot

I’ll continue writing down questions that we are not able to answer in class, that might need some research.

Class Scribe

Use whatever method of determining scribe worked in Lesson 1. Give scribe both sets of vocabulary sheets: Family Vocabulary and Reproduction vocabulary.

Introduction (3 minutes)

Note to Educator: Spend 2 minutes answering student’s questions from the question box and/or have students that volunteered to answer questions from the Parking Lot share their findings. Let students know that other questions will be answered during today’s lesson.

Slide 3: Today’s agenda

Our agenda for today is to begin with a warm-up exercise. We will then discuss how pregnancy can occur through insemination and IVF, sometimes with the help of donors and surrogates. We’ll brainstorm some reasons why some people are able to access the fertility services they need and why others can’t. We’ll wrap up by sharing our thoughts about the possible benefits of having learned a more inclusive approach to human reproduction. Throughout the lesson, you’ll be working in small groups, and I’ll be listening for and coaching you to use respectful communication as you practice explaining new concepts and vocabulary to one another.

Student Inquiry: Any comments, feedback, questions on what today’s lesson is about?

Warm-Up Activity (5 minutes)

Work with your group and come up with a list of at least 3 situations in which someone wants to start a pregnancy, but penis-in-vagina sex (PIV sex) would not work. So, I’m not talking about situations where people use birth control to prevent a pregnancy. I am talking about situations in which people intend for a pregnancy to happen, but the body is not able to create a pregnancy or situations in which baby-making ingredients are missing.

Note to Educator: You can modify how students conduct this activity. Students can work at table groups, in pairs, or independently — whatever works for your setting.

Give students 2 minutes.

Note to Educator: Sometimes students bring up specific examples and sometimes they are more general. Either is OK. Learning new concepts can be challenging. Offer students grace if they struggle to communicate their ideas. At the same time, if students use slang or derogatory terms, gently restate their answer, and remind them that today is all about using language that invites and explains. Here are some responses you might hear.

  • Anyone who doesn’t have sperm.
  • Anyone who doesn’t have eggs.
  • A single person doesn’t have all the necessary baby-making ingredients such as egg cells, sperm cells, or a uterus.
  • A single man or gay couple/relationship is missing eggs and a uterus.
  • Single woman or lesbian couple/relationsip is missing sperm.
  • Two cisgender women or two cisgender men are missing ingredients.
  • Transgender and non-binary partners, e.g., a cisgender woman and a trans man are missing sperm, or a cisgender man and a trans woman are missing eggs and a uterus.
  • An asexual person who doesn’t have penis-vagina sex.
  • An intersex person whose fertiltiy is impacted by their chromosomes, hormones, or body structure.
  • A person with a physical disability whose reproductive systems might need help to conceive.
  • Cisgender people in a heterosexual relationship dealing with infertilty. It is okay if students list causes of infertility separately: hormonal, chromosomal, or structural issues that prevent the reproductive system from doing what it needs to, to create a pregnancy.

Student Inquiry: What group wants to share what they came up with?

Note to Educator: As groups share their responses, write the list on the large paper taped to the wall, or on the whiteboard, under the title “Including.’’

At the end of today’s lesson, we’ll check in and see if our expanded understanding of human reproduction now includes each and every one of these individuals, relationships and circumstances.

So, in general, PIV sex does not work for anyone who wants to create a pregnacy but is:

  • In a relationship that doesn’t have all the baby-making ingredients (egg cells, sperm cells, uterus).
  • Whose body is not able to get sperm or eggs to where they need to go to create a pregnancy.
  • Whose uterus is not able to carry a pregnancy — miscarriage.
  • Who does not want to make a baby with PIV sex.

Student Inquiry: Who can tell me what infertility is?

In general, the medical community defines infertility as not being able to get pregnant after about 6 months to a year of unprotected PIV sex.

Student Inquiry: Anyone see any problems with this definition?

Note to Educator: There are a few issues here. Some issues students might raise include:

This definition is based on heterosexual, cisgender couples. It does not account for single people or LGBTQAI+ relationships. In general, they likely (1) don’t have all the necessary baby-making ingredients (2) don’t engage in PIV sex and (3) might have a medical condition that prevents them from achieving pregnancy and birth. When people don’t meet the criteria of a narrow definition, they can be denied affordable, responsive care. For example, a lesbian couple, or a single, or asexual person that does not engage in PIV sex, can’t “document” that they’ve tried unsuccessfully for a year, and so their insurance company can deny them coverage for necessary fertility services.

One third of the time infertility is due to the sperm and sperm transport system, one third of the time it is due to the egg or baby transport system, and one third of the time it is due to a combination of factors, or it’s unknown. So infertility impacts all types of reproductive systems equally. But most importantly, infertility is no one’s fault.

For all of these reasons — reasons that have to do with gender identity, sexual orientation, relationships, and medical conditions — many of you may choose to pursue other means of reproduction one day.

But this lesson is not just about normalizing, demystifying, and destigmatizing your possible future fertility options or those of the people in your life who you care about.

Today’s discussion, more importantly, is about understanding that many people are here because of insemination, IVF, donors, and surrogates. My hope is that everyone will not only better understand their own conception story, but that you better understand the conception stories of your friends, classmates, and those you read about in the media.

PIV sex is not always an option or the preferred way for folks who would like to add children to their family.

Assisted reproduction describes all the ways, other than PIV sex, to intentionally form a pregnancy.

Insemination (15 minutes)

The Mechanics

Slide 4: Human reproduction

The first type of assisted reproduction we are going to introduce you to is called insemination. After that, we’ll talk about IVF.

Student Inquiry: Can someone look at the slide or your Reproduction Infographic and explain the basics of  insemination?

Note to Educator: After one student gives it a try, ask if other students have anything to add. Then review, bringing in some of the correct vocabulary that the student has used. If no student volunteers, you can give the explanation.

Step 1.

Unlike sex, where ejaculation happens inside the vagina, ejaculation with insemination is captured in a container.

Step 2:

Sperm that is in a container can be suctioned out of the container with a needleless syringe (a syringe without a needle) and …

Step 3:

deposited into the vagina or the uterus.

After sperm are placed in the body, sperm swim through the obstacle course of the egg and baby transportation system — the exact same way they do when semen is ejaculated directly into the vagina through PIV sex.

Slide 5: Fertilization

The rest of the story is the same as with PIV sex.

If an egg (or two) has popped out of an ovary and into the fallopian tube when the sperm arrive, the egg and sperm can join together, creating a fertilized egg.

As the fertilized egg tumbles through the fallopian tube, it begins to divide into 2 cells then 4, then 8, and so forth. By the time the embryo reaches the uterus, it is a ball of cells about 50-150 cells big and it can implant, or attach to the uterus. Pregnancy and birth can continue as they would have, if conception had happened with PIV sex.

Hopefully you recognize all of the same photos on this slide, from Lesson 1.

So the only difference between creating a pregnancy by penis-vagina sex and insemination, is that insemination assists sperm in reaching the egg.

Student Inquiry: Any questions, thoughts, or comments about the mechanics of insemination?

Note to Educators: If students use the term artificial insemination, you can gently let them know that that’s old terminology because it can have a negative connotation. It’s okay that some people call insemination assisted insemination because it assists the sperm in reaching the egg. 

Some students will refer to insemination as IUI. That’s great. That just refers to a specific type of insemination, when sperm is placed into the uterus. IUI stands for intrauterine insemination. ICI is when semen is placed into the vagina, and is short for intracervical insemination.

The Ingredients — Sperm Cells

Slide 6: Sperm donors and intended parents

Since sperm is in a container outside the body, it can come from an intended parent — a person who intends to raise the child once they are born.

But it can also come from a donor — a sperm donor is someone who gives their sperm to someone else so they can start a pregnancy.

Student Inquiry: People find donors in any number of ways. Anybody know?

Slide 7: Sperm Donors

Sperm banks: Intended parents can search through profiles of donors and learn about their race, ethnicity, skin, eye, and hair color, level of education, what they do professionally, their medical health, and their interests, as well as see baby photos.

People also find sperm donors through apps and social media.

Family and friends can also be donors. Family donors work only if the person providing sperm is not genetically closely related to the person providing the egg, because that can result in long-term health problems for the resulting child.

Follow the DNA

Since our DNA comes from the egg cell and the sperm cell that create us, people who are donor conceived, get half of their DNA from the donor.

Student Inquiry: Any questions, thoughts, or questions about sperm donors?

Note to Educator: In the US, donors who are friends or family members often give their sperm for free. But, sperm donors who donate through sperm banks are technically compensated for their time and effort - not paid for their sperm. That is because in the US it is illegal to sell human cells, tissues, or organs. Many people feel that the word donor is a misnomer. But, for better or worse, that’s standard language for now, so that’s why we are using the word donor in class.

Cryopreservation

Slide 8: Freezing sperm

Once sperm is outside of the body, it can also be frozen in a medical lab or clinic.

Student Inquiry: Who can think of a reason why someone might want to freeze, or cryopreserve sperm?

Note to Educators: Solicit one or two answers. You don’t have to go through every reason.

  • Fertility preservation. We know that fertility begins to decrease as people get older. Some people who are busy with work, school, or other activities might freeze gametes when they are younger, so they can use them to grow a family at a later time.
  • Transport. Frozen gametes can be safely shipped
  • Medical reasons: Someone dealing with cancer might freeze sperm before chemotherapy, if there is a chance the cancer itself or the treatment for it will render them infertile, or unable to reproduce.
  • Dangerous job: People in the military will sometimes freeze sperm before being deployed if they might be exposed to dangerous chemicals or be injured during combat.
  • Gender-affirming surgery: Many transgender people are happy with their body as is. Others take hormones, and as adults, have affirming surgery so their body matches or better aligns with their gender. Sometimes either hormones or surgery can lead to difficulties with fertility. Sometimes people freeze their gametes before medical transitions or treatments

I bring up sperm freezing because people find themselves in situations where they have to make decisions about preserving their fertility, sometimes way earlier than they ever imagined - like when a teenager is dealing with cancer.

Basically, freezing sperm enables people to use it later on. Before frozen sperm can be used, it must be thawed, or warmed up.

And by the way, all of the reasons you came up with for why people freeze sperm, also applies to why people freeze eggs. We will talk about eggs in a minute.

The Ingredients — Eggs Cells and Uterus

Insemination also gives us some new possibilities with the egg cell and the uterus.

Anyone with eggs and a uterus, regardless of their gender or sexual orientation, can use insemination. Sperm can be placed in their body, and they can potentially get pregnant.

Student Inquiry: What about for people who don’t have a uterus? Like a single man or a gay couple (two people with a sperm delivery network) as one example? They are missing the egg and baby delivery system. Does anyone know how they could use insemination to grow their family?

Slide 9: Genetic surrogates

They could use a genetic surrogate. A genetic surrogate is someone who provides the egg, so they are an egg donor, but they also carry a pregnancy, and give birth to a baby for someone else. A genetic surrogate is also called a traditional surrogate, because this is the first kind of surrogacy there was. The important thing to remember is that with insemination, since the surrogates' eggs will unite with the sperm, it's the surrogates DNA that joins with the genetic material of the sperm.

Student Inquiry: What are some other situations in which someone may build their family with the help of a surrogate?

Note to Educator: Examples students might give:

  • Single man (given in example above).
  • Gay couple (given in example above).
  • A trans woman (with sperm).
  • Someone without a uterus.
  • Someone who has had multiple miscarriages.
  • Someone with an intersex condition.
  • Someone who has a genetic health issue that they do not want to pass onto a child, or other reasons why they do not want to pass their genetics to a child.
  • Someone who does not want to be pregnant and/or birth.

These are great examples. Lots of different people can rely on the help of a gestational surrogate to help them grow their family.

Formative Assessment Activity

For the next 5 minutes, you are going to talk to the people at your table/in your group, to add what you just learned about insemination to your Reproduction Infographic. Put your name at the top because I will be collecting these at the end of class. I am not going to grade it, but I want to see how well the class is understanding the material, and we will need the Infographics for the next lesson.

Note to Educator: If you do not want to collect and/or use it as an assessment tool, remind students that they need to bring it back for the next class.

First, above the stick figures, first add in the people who can provide sperm, using words that are respectful to others. You can even color in the figures if that is something you would enjoy.

Then add the basic steps of insemination below the containers.

If you’re having trouble, check in with your peers.

On your table, there are also a couple of other resources that can help you. One is a list of different kinds of families, and another gives the definitions for all the medical terms we have talked about with human reproduction. Feel free to use these to help you with your activity.

I’ll be moving around the room and can offer tips or guidance if you are struggling with the concepts or wanting to try out some of the new language.

Note to Educator: As students work in groups, the educator can roam the room and listen. Educators can help facilitate conversation when necessary, assess if students understand the concepts and if they are communicating respectfully and compassionately. If not, the educator should encourage, coach, interject, disrupt or redirect when necessary. Educators can use suggestions on the handout “Tips for Using Inclusive Language” as a guide.

After 5 minutes, educator can show them Slide 30 with the answers filled in.

Slide 10: Completed insemination infographic

Here is my completed Infographic with my additions in blue.

Student Inquiry: Anyone have different words they used to describe the people who can provide the baby-making ingredients?

Note to Educator:

People who are donor conceived use different names to describe their parent’s sperm donor, but in this class, it’s important that the educator and students use the word donor or sperm donor, without the word dad or father attached to it. That is a respectful way of referring to someone whose cells help create another human.

Students may have come up with clever names like DNA deliverers, gamete gifters, or other such terms. These are all respectful and are interesting because they are attempts to get away from the industry standard of referring to them as donors. If a student brings up a new idea, it’s worth checking in with the class to see if they feel like it is a respectful alternative, but be careful not to ask/single out any donor conceived students.

Go ahead and check your answers. Be sure to ask a classmate if you need some help or raise your hand.

Note to Educator: Give students 1 additional minute to make changes.

Student Inquiry: Any additional questions, thoughts, or comments about insemination, donors or surrogates?

Note to teacher: If students ask how insemination helps an infertile couple, you can explain that typically, when heterosexual couples use insemination, it is done at a medical clinic. Here a doctor attaches a flexible tube to the end of the syringe. They thread this through the vagina and deposit the sperm in the uterus. The hope is that with less swimming to do, the sperm will be more successful in fertilizing the egg.

Let’s take a brain break!

Note to Educator: Invite students to take 15 seconds to stretch, breathe deeply, or whatever else you usually recommend.

IVF (20 minutes)

Slide 11: Pregnancy with IVF

Sometimes sex and insemination do not work to begin a pregancy or they are not the preferred way intended parents want to bring a child into the world. In these instances, in vitro fertilization comes into play. IVF is a lot more complicated than insemination, and alot more expensive, but many of the concepts you just learned about insemination apply to IVF. So we are going to take the knowledge you already have, and build on it.

Note to Educator: The discussion on IVF will serve as a formative assessment. Many of the concepts for IVF and insemination are similar (donors, freezing gametes, surrogates), so your students will be applying the knowledge they gained from insemination to answering questions about IVF.

The Mechanics

Student Inquiry: Can anyone look at the photos and explain the basic mechanics of IVF? If you notice, only the first two photos are different than the other means of fertilization.

Note to Educator: After one student gives it a try, ask if other students have anything to add. Then review, bringing in some of the correct vocabulary that the students have used. If no student volunteers, you can give the explanation. 

Step 1. Sperm are placed in a container, same as with insemination. As a small side note, sometimes adults can’t ejaculate sperm, e.g., if they had a vasectomy and were not able to reverse it surgically. In those instances, sperm for IVF can be surgically removed from the testicle or epididymis.

Step 2. Eggs are also placed in a container. We’ll talk more about this in a minute.

Step 3. The next step is the same — fertilization. But, how fertilization happens is a little different than with PIV sex or insemination.

The eggs and sperm are joined together outside of the body. An embryologist is someone who is specially trained to work with egg cells and sperm cells once they are outside the body. The embryologist fertilizes the eggs in a Petri dish, in a clinic’s laboratory. Many of you have seen a Petri dish before, maybe in a science class. The dish provides a clean, nutritious, safe place for fertilized eggs to develop.

The embryologist either adds sperm to the dish with the eggs and the sperm swim around looking for an egg to fertilize. Or, the embryologist uses a high powered microscope to inject a single sperm into a single egg.

Step 4. The eggs that successfully fertilize can start to divide in half, and then the two halves divide into 4 cells and then 8 cells, same as we’ve already learned. After developing in the Petri dish for about 3-5 days,

Step 5. An embryo (or sometimes more) is placed into the uterus, where gestation and birth can continue as they would have, if pregnancy had happened with sex or insemination.

So, mechanically, the only difference between creating a pregnancy with IVF, is that fertilization happens outside of the body.

Student Inquiry: Any questions, thoughts, or comments about the basic mechanics of IVF?

The Ingredients — Sperm Cells

Student Inquiry: Who can use their knowledge of insemination to tell me who can provide sperm for IVF?

Right! Since the sperm is outside of the body, in a container, it can come from the intended parent — who intends to raise the child once they are born.

Or, the sperm can come from a sperm donor — who gives their sperm to someone else, so they can make a baby!

In addition, previously frozen and then thawed sperm can also be used for IVF.

Let’s talk about the eggs and IVF.

The Ingredients — Egg Cells

With IVF, eggs are also removed from the body. But, removing eggs from the ovaries is a lot more complicated than ejaculating sperm into a container. First, people take fertility medication to increase the number of eggs that mature each month. So instead of one egg developing as is typical, 10-15 eggs mature in the ovaries. But before the eggs are ovulated from the ovary, a fertility doctor surgically removes the eggs and places them into the Petri dish.  

Student Inquiry: Since eggs are removed from the body, who besides the intended parent can provide eggs for IVF?

Slide 12: Egg donors and intended parents

Right! The eggs can come from an egg donor. An egg donor gives their eggs to someone else, so they can add to their family. People find egg donors in many of the same ways they find sperm donors.

Slide 13: Egg donors

There are egg banks and egg agencies —  that help intended parents find donors. But people also find donors through apps and social media, and friends and family can be donors.

Follow the DNA

Keep in mind that it is the egg donor’s DNA that combines with the DNA from the sperm to create the pregnancy.

Cryopreservation

Student Inquiry: Who can use their knowledge from the discussion with insemination to share what else we can do with eggs once they are outside of the body? 

 

Slide 14: Freezing eggs

We can freeze them! When ready to be used, eggs can be thawed and united with sperm to begin a pregnancy. People cryopreserve eggs for the same reason they freeze sperm — to save them for later or to more safely transport them.

Student Inquiry: Any additional questions, thoughts, or comments about eggs and IVF?

The Ingredients — The Uterus

Since embryos are made outside of the body, the embryos can be placed into the uterus of the intended parent.

Student Inquiry: Who can use their knowledge of insemination to tell me who else can provide the uterus for IVF?

Slide 15: Gestational carriers and intended parents

Embryos can also be placed into the uterus of a gestational surrogate. Another word for a gestational surrogate is a gestational carrier. Either term is accurate. A gestational carrier is pregnant with and gives birth to a baby for someone else. But unlike a genetic surrogate like we talked about with insemination, the gestational carrier’s eggs are never used to create the pregnancy. With IVF, the eggs come from the intended parent, or from a donor. It is not the gestational carrier’s genetic material that gets passed to the child. The DNA comes from whoever provided the egg. Many families use the term surrogate for both, but there is a big distinction!

Embryos

Slide 16: Embryo donation and cryopreservation

There is one more aspect to IVF that I want to mention.

Student Inquiry: Knowing what we can do with egg and sperm cells once they are outside the body, does anyone know what we can do with embryos once they are outside the body?

Freeze Embryos

Sometimes, when people go through IVF they end up with extra embryos. They can cryopreserve, or freeze them and save them for later to begin a subsequent pregnancy.  

Donate Embryos

Or, frozen embryos can be given to someone else so they can create a pregnancy. So people can donate their embryos, just like they can donate egg and sperm cells.

Formative Assessment Activity

For the next 5 minutes, you are going to talk to the people at your table/in your group, to add what you just learned about IVF to the Reproduction Infographic.

Just like you did with insemination, above the human figures, add in the people who can provide sperm, eggs and the uterus. Again, feel free to color in the figures if that is something you would enjoy.

Then below the drawings of containers, add in the basic steps of IVF.

For some of you, the concepts and words will be new. Rely on your peers, the resource sheets, and I’ll circulate to help you out.

Note to Educator: After 5 minutes, you can show them Slide 17 with the answers filled in.

Slide 17: IVF infographic

Here is a completed Infographic with my additions in blue. I kept my answers pretty simple, so you might have variations on what I wrote, but hopefully you have the basic information. Go ahead and check your answers. Be sure to ask a classmate if you need some help or raise your hand.

Note to Educator: Give students 1 additional minute to make corrections

Student Inquiry: Any additional questions, thoughts, or comments about IVF, donors, or surrogates?  

Don’t forget to hand in your Reproduction Infographic at the end of class.

Time Check!

Note to Educator: Depending on how much time is remaining, and what you are covering in your curriculum throughout the year, you can have a short or long discussion about equity. For a short discussion (4 minutes), continue with this lesson as written. For a longer discussion (15 minutes), skip to the Supplemental Lesson below.

Equity (3 minutes)

Let’s spend a minute thinking about disparities when it comes to family formation. A disparity is a large difference between groups of people that is often unfair; e.g. a disparity between what men and women earn doing the same job. So for example, economic disparities means that some people can access the financial building resources they need while others can’t.

Slide 18: The cost of growing family

As you can see from this slide, fertility care and other means of family formation, like adoption, can be really expensive. Some families have the income and health insurance to pay for expensive family building options. Most, however, need to purchase additional insurance, take out loans, apply for grants, move to less expensive housing, or go into debt. So whether or not people can access financial resources plays a huge role in whether they can obtain the services they need to grow their family.

But, it isn’t just access to wealth that is responsible for disparities in people’s ability to get the services, medicine, legal advice, and support they need. Systemic discrimination based on race, ethnicity, sexual orientation, marriage status, religion, etc. also plays a role.

Student Inquiry: Who can give me an example of how systemic discrimination might impact someone’s ability to form family?

Note to Educator: If students are having a hard time, you can offer a couple of examples:

  • Even when insurance is state mandated, many insurance companies define infertility as 6-12 months of unprotected heterosexual intercourse, with excludes same-sex relationships and single people.
  • Because there is still stigma around donor conception, many traditional, nuclear families don’t tell their children they are donor conceived.

We’ll be talking more about these issues throughout our course this year.

Conclusion (5 minutes)

Slide 19: Affirming names

It takes an egg cell and a sperm cell and a uterus to form a pregnancy, but just how that happens might be more complex and more interesting than you ever imagined.

Sometimes parents provide the baby-making ingredients to create their children. Other times, they don’t.

If you think about all the different kinds of families we listed at the beginning of Lesson 1 - nuclear, single-parent, divorced, blended, LGBTQ+, extended, cohabitating, adoptive, foster families, and so many more — and then layer donors and surrogates into the conversation, there are lots of different words to describe people who conceive and raise children.

Some labels include birth parents, first parents, bio parents, genetic parents, parents of origin, donors, and surrogates. There are many other names families choose and use.

So if you have a friend with two moms and you insist that they have a dad because everyone has a dad, you are not correct! Certainly, a sperm cell helped make your friend, but they get to tell you the name they use for the person whose sperm cell created them. It might be donor dad, biological father or genetic father, but it might not have the word dad or father attached to it at all. They may just call that person by their name or refer to them as their donor. Each family gets to decide the names they use for all the people that create and raise children.

That's why the word parent can mean so many different things to so many people and why there are so many different kinds of family arrangements.

So let’s look back at the list that we developed at the beginning of class to see if we accomplished our goal of including every person and every family structure in the explanation of human reproduction.

Student Inquiry: Did we cover every scenario? Anyone still left out of the picture?

Note to Educator: Read through the list that was generated at the start of the class during the warm-up activity. Let students guide each other in deciding if every scenario where PIV sex does not work to form a pregnancy is not explained.

Final Thinking, Reflection, and Assessment (5 minutes)

I’d love to hear your thoughts about today’s lesson.

Note to Educator: Students can work in small groups/table-groups, to answer these questions. You can walk around the room to assess students' understanding, listen for respectful dialogue, and coach when needed. Or, if you prefer, students can share with the whole class, and you can assess understanding that way. Either way, read each question and give students 1-2 minutes to discuss before reading the next question.

Student Inquiry:

  • Did today’s class change your understanding of human reproduction or family formation? If so, how?
  • Do you feel like the information is relevant to you? If so, how? If not, why not?
  • If a little kid asked you, “Where do babies come from?” Do you think you would answer that question differently than you would have before today’s lesson? Why or why not?  Anyone want to share how they would answer the question?

Wrap-Up (2 minutes)

Word Wall

Any words to add to the word wall?

Note to Educator: Read today’s words on the word wall out loud. Ask students to define any remaining words. Use this activity to assess if students understood the vocabulary and concepts from today’s lesson.

Who would like to research some of the unanswered questions on our Parking Lot? You can bring your findings to our next class.

Question Box

I would like for everyone to submit questions to our anonymous question box. Like we did in Lesson 1, grab a small piece of paper from your table. Anyone with remaining questions can write them down, but even if you don’t have a question, I want you to draw a picture, or tell me how class was for you. That way, students that have questions will not be the only ones writing. Please put your question box paper in the question box on your way out.

Note to Educator: Many students feel self-conscious if they are the only ones submitting to the question box. It is best to have a stack of the same size/color pieces of paper at tables to be used for the question box. As an alternative, you can use an electronic platform like Padlet/Pear Deck/Menti to build an anonymous way for students to ask questions or make comments.

Trusted Adult

You can reach out to me anytime, about today’s lesson or anything else on your mind. You can also go to a trusted adult in your life.

Lesson Supplement - Disparities

Note to Educator: This additional narrative is for educators that have an additional fifteen minutes in their class period and want to discuss additional disparities that play a role in people’s ability to grow family.

Student Inquiry: What sorts of disparities do you think play a role in people’s ability to grow family? As a reminder, a disparity is a noticeable or significant difference.

Note to Educator: Let students brainstorm for 1 minutes in the larger group. Then have them work in their smaller groups.

  • Race, ethnicity or culture
  • Socio-economic status
  • Mental health
  • Marital status
  • Age
  • Religion
  • Educational level
  • Cognitive, sensory or physical ability
  • Sexual orientation
  • Gender identity
  • Geographic location
  • Other ...

In your small groups, please pick one or two characteristics that are linked to discrimination and discuss how this characteristic might impact someone’s ability to access fertility care or family building services (like adoption or foster care) or you can discuss how these factors impact fertility health outcomes (e.g., success in creating a pregnancy and the birth of a child).

So, for example, even when insurance for IVF is state mandated, many insurance companies define infertility as 6-12 months of unprofected heterosexual intercourse. This means that people in same-sex relationships and single people will have less acces to fertility services. This in turn, impacts the ways in which some LGBTQ+ individuals can form family.

After working in small groups for 5 minutes, be ready to share back to the class.

Note to Educator: Give students 5 minutes to discuss. Then choose two or three groups to share their findings with the larger group.

Student Inquiry: What group would like to share their thoughts?

Note to Educators: Here are some potential responses. If students are stuck, you can use this to prompt them. We have bolded a couple of suggested points. We bolded a couple more examples, if students need more ideas.

  • Even when insurance is state mandated, many insurance companies define infertility as 6-12 months of unprofected heterosexual intercourse, with excludes same-sex relationships and single people.
  • Because there is still stigma around donor conception, many traditional, nuclear families don’t tell their children they are donor conceived.
  • Although the World Health Organization and the American Medical Association recognize infertility as a disease, many insurance plans claim that it is “not medically necessary” and refuse coverage.
  • Some people chose to find donors via social media because they don’t have the money to access sperm/egg banks or egg agencies. If in addition, they can’t afford legal fees and skip writing legal contracts with their donor, this potentially opens them up to legal complications in defining who a child’s legal parents are.
  • People of color are less likely to have health insurance, compared to their white counterparts, thus limiting their access to care.  
  • Some health care providers refuse to treat people based on their marital status, sexual orientation or gender identity.
  • People who live in remote geographic areas are less likely to have access to OB-GYNs, fertility clinics or labs. For example, approximately 18 million women of reproductive age live in locations with no IVF clinics.
  • Some religiously-affiliated clinics (which might be the only ones in a given geography) do not provide IVF, because it conflicts with their religious tenets.
  • Language and cultural barriers discourage non-English speakers from seeking care.
  • Historic and current trauma, racism, bias, and stereotypes in medicine builds barriers to accessing care which in turn, leads to worse health outcomes. For example, some common causes of infertility (e.g. fibroids and endometriosis) are underdiagnosed in Black communities. The longer these conditions go untreated the harder it is to achieve pregnancy.
  • Black, Asian and Hispanic women experience lower success rates with IVF, than non-Hispanic white women. We do not have enough research to truly understand the reasons for this.
  • People with higher levels of education receive more support in navigating the insurance, health care and legal aspects of assisted reproduction.
  • Laws that determine parental rights vary from state to state and often favor straight, cisgender, married couples.
  • Religious and cultural attitudes towards being ‘infertile’ and using assisted reproduction impacts people’s willingness and/or ability to access care.

Thank you for sharing your ideas. Health inequities and disparities are something we will continue talking about as the year unfolds.

Note to Educator: Go back to Conclusion, Final thoughts, and Wrap-Up

After the Lesson

Educator Prep for Next Lesson

Make corrections and add notes to this lesson to help you the next time you teach it!

Check students Reproduction Infographic. If students are having trouble, review the material with students at the start of the next lesson.

Review Lesson 3 and gather materials.

Research answers to questions on the Parking Lot that have not been assigned to students.

Review anonymous questions that students submitted. Prepare responses for questions you’ll answer during the next class and provide resources for questions that students can answer on their own time (questions that don’t warrant class time).

Absent students can watch the videos listed below under Supplemental Materials and attend office hours for further questions.

Remind all students of office hours or how to get additional help with material.

Ongoing Quality Improvement

If you have comments, feedback and suggestions that would help improve these lessons in the future, please let us know! Here is a link to a Google Form https://forms.gle/jjbK9DQwdBbWjwP57

Supplemental Resources and Refernences

Links for Supplemental Materials

Educator Materials

School Health Lessons (Reproduction)

Roads To Family has adapted three lessons about human reproduction, written by Advocates for Youth, 3Rs curriculum. Though these are written for younger grades, the hands-on activities can serve as supplemental materials for our lessons, even at the high school level. These lessons can be found on the Oregon Open Learning Hub, https://www.oercommons.org/hubs/oregon

  • RTF Modification Grade 5, Lesson 2: Puberty and Reproduction (pdf and ppt)
  • RTF Modification Grade 5, Supplement: So THAT’S How Babies are Made (pdf only)
  • RTF Modification Grade 7, Lesson 3: Reproduction Basics (pdf and original ppt)

In addition, Roads to Family has written a guide, so that educators know how to use our lessons within the scope & sequence of the 3R’s lessons. This guide also suggests other 3R lessons where more inclusive language about reproduction and family formation can be introduced. These guide can be found in the Oregon Open Learning Hub, https://www.oercommons.org/hubs/oregon

  • RTF Guide to Incorporating Family Concepts into 3Rs Lessons

Assisted Reproduction

Most of the detailed information available on assisted reproduction is written either for people seeking reproductive health services, or health care professionals providing those services. Very little exists to help educators and parents explain assisted reproduction to youth. The following are the most succinct and useful for educators:

The Donor Conception Network

Created resources for families, teachers and the grade-school classroom around donor conception. The cost is about $20

https://www.dcnetwork.org/products/product/primary-school-resources-parents-children-and-teachers

American Society for Reproductive Medicine (ASRM)

Offers education, advocacy, and standards in reproductive medicine and science. Has patient info sheets, videos and podcasts.

https://www.reproductivefacts.org/

https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/assisted-reproductive-technologies-booklet/

 

Fertility IQ

Offers many video-based learning modules on various topics of reproductive health.

https://www.fertilityiq.com/courses

Nova, May 12, 2021, “Fighting for Fertility”

A one hour special on fertility, assisted reproduction and barriers to care, including racial and gender inequities. https://www.pbs.org/wgbh/nova/video/fighting-for-fertility/

Disparities in Health

For additional lessons on disparities in health are available for free from Advocates for Youth, 3Rs Curriculum, High School Supplements: The Impact of Racism and Inequality on Sexual Health; Reproductive Justice: Past, Present and Future; Making the Unconscious Conscious: Impacts of Stigma & Bias, http://3rs.org/3rs-curriculum/download-3rs/

Oregon Department of Education

The sexuality education resources page includes sex education laws, standards and links to a lot of other helpful educator information and resources, including a K-12 Teacher’s Guide.

https://www.oregon.gov/ode/students-and-family/healthsafety/Pages/Sexuality-Education-Resources.aspx

Student Materials

Reproductive Health

The following organizations offer student resources on a variety of sexual health topics:  

www.advocatesforyouth.org, www. amaze.org, www.sexetc.org, www.scarleteen.com, www.kidshealth.org, www.plannedparenthood.org/teens, www.factsaboutcondoms.org www.itsyoursexlife.org, https://www.your-life.com

Student’s that missed today’s lesson can watch this video,

British Fertility Society, Fertility Technologies Shaping Modern Families, https://youtu.be/dOi08g3CLOc

and choose one of the following (or watch both):

Amaze.org, Pregnancy and Reproduction Explained, https://www.youtube.com/watch?v=OejdOS4IqeE

Amaze.org, How do LGBTQ couples become parents

https://youtu.be/qczJ7qSczcQ

Other Materials

Lesson Citations

References for the Lesson

UpToDate was used for the majority of the technical medical information in these lessons:

Barbieri, R. (2021). Intracytoplasmic sperm injection. In K. Eckler (Ed.), UpToDate. Retrieved August 29, 2021

Biro, F., & Yee-Ming, C. (2020). Normal Puberty. In A.G. Hoppin (Ed.), UpToDate. Retrieved August 29, 2021

Ginsburg, E. (2021). Procedure for intrauterine insemination (IUI) using processed sperm. In K. Eckler (Ed.), UpToDate. Retrieved August 29, 2021

Ginsburg, E., & Srouji, S. (2020). Donor Insemination. In K. Eckler (Ed.), UpToDate. Retrieved August 29, 2021

Matsumoto, A. & Anawalt, B. (2020). Male reproductive physiology. In K. Martin (Ed.), UpToDate. Retrieved August 29, 2021

Paulson, R. (2020). In Vitro Fertilization. In K. Eckler (Ed.), UpToDate. Retrieved August 29, 2001

Prager, S., Micks, E, & Dalton, V. (2021). Pregnancy loss (miscarriage): Terminology, risk factors, and etiology. In K. Eckler (Ed.), UpToDate. Retrieved August 29, 2021

Schattman, G, & K. Xu. (2021). Preimplantation genetic testing. In V. Barss (Ed.), UpToDate. Retrieved August 29, 2021

Welt, C. (2021). Physiology of the normal menstrual cycle. In K. Martin(Ed.), UpToDate. Retrieved August 29, 2021

As well as information from:

The American Society for Reproductive Medicine (ASRM)

https://www.asrm.org/, Reproductive Facts: https://www.reproductivefacts.org/

British Fertility Society (BFS), https://www.britishfertilitysociety.org.uk/

https://www.britishfertilitysociety.org.uk/stem/stem-videos/

Victorian Assisted Reproductive Treatment Authority (VARTA), Australia

https://www.varta.org.au/

Sources for discussion on equity and disparities:

“Disparities in Access to Effective Treatment for Infertility in the United States: An Ethics Committee Opinion.” Fertility and Sterility 116, no. 1 (July 2021): 54–63. https://doi.org/10.1016/j.fertnstert.2021.02.019.

https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/ethics-committee-opinions/disparities_in_access_to_effective_treatment_for_infertility_in_the_us-pdfmembers.pdf

Chaves, Karen, Darryl Gray, Barbara Barton, Doreen Bonnett, Irim Azam, Cecilia Hahn, Elizabeth Goldstein, et al. “2019 National Healthcare Quality and Disparities Report,” n.d., 274.

https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2019qdr-cx061021.pdf

Vega, Tanzina. “Infertility, Endured Through a Prism of Race.” The New York Times, April 25, 2014, sec. U.S. https://www.nytimes.com/2014/04/26/us/infertility-endured-through-a-prism-of-race.html.