Ethical and Moral Considerations Related to in Vitro Fertilization

In Vitro Fertilization

This is a paper that outlines the morality issue behind in vitro fertilization. It has 12 sources.

As scientific progress advances more rapidly than the ability of mankind to assimilate and comprehend its influence on life concerns, fields such as Assisted Reproductive Technology (ART) are turning heretofore basic issues like procreation into complex ethical and moral dilemmas.

In 1978, with the birth of Louise Brown, the first child conceived through in vitro fertilization (IVF), man finally realized his power to create, not passively through instinctual processes but consciously and actively. [Daar 1999] The desire to have children is strong in the human heart and infertility is a serious and painful issue. There are however more aspects to having a child than mere desire and the means by which the child is created is amongst the most important. Over the past few decades science has allowed individuals biologically otherwise incapable of reproducing, to make or have children by artificial methods such as in vitro fertilization.

The natural act of procreation lessened in consequence with man's ability to use various techniques to achieve his goal. The steps involved in the reproductive process became insignificant, it was the ultimate end that became important, and that these were irrevocably interlinked was invalidated. Moral codes and values needed to be formatted to cope with this new circumstance of human existence, and law and government policies were not prepared. Bioethics is a recent field that studies the latest social and moral issues modern science produces but it still has a long way to go before it can define and regulate what still are the mysteries of life no matter how familiar; such as birth.

InVitro fertilization

Infertility affects about 4.9 million couples in the United States, or one in every twelve. Approximately one-third of infertility is due to causes in the female. IVF was originally developed to help women whose fallopian tubes were blocked and for whom reconstructive surgery was impossible or had already been unsuccessful. The basic techniques aimed at optimizing conditions for fertilization of an ovum and sperm outside the female reproductive tract and the facilitating embedding of the fertilized egg in the uterus. [Monash 2001]

Medications are used initially to stimulate the ovaries to produce multiple follicles that will contain many eggs. In what is called a "fresh cycle," the eggs are retrieved and transferred to the laboratory. They are placed, along with sperm, in a special culture medium that encourages fertilization and growth of high-quality embryos in just a few hours. [Monash 2001]

Following fertilization, the oocyte becomes a zygote, and cell division commences. It is at the 6-to-8-cell stage that the embryo is transferred back into the uterus. As multiple embryos have been produced to increase chances of yield a limited number of high quality embryos are transferred, while the others are usually cryopreserved, or frozen, for future use in a "frozen embryo transfer" (FET). [Monash 2001]

Sometimes a "donor cycle, " is required when the woman is not able to produce her own eggs, or their quality will not support fertilization, implantation and pregnancy. Ova are then retrieved from a woman who has undergone ovarian stimulation and fertilized with sperm from the husband of the recipient couple or a donor. The resulting embryos are then transferred to the recipient female, whose body has been prepared for implantation and pregnancy. [Monash 2001] Nearly 0.2% of American and 1% of British babies are being born after IVF and there are now more than 300,000 IVF babies worldwide. [Monash 2001]

Literature Review

Assisted reproduction by IVF has many aspects and produces various complex ethical issues. The treatment itself has social, emotional and financial ramifications. It affects the parents and the child conceived, and is associated with risks such as medication side effects, multiple births or multifetal reduction to limit the number of pregnancies after successful embryo transfer. The outcome of the multiple embryos produced for the process but not necessarily used to fulfill their potential of creating a human being is an important issue. So are various social issues such as genetic screening, and 'designer babies' made to order. Religion also complicates a process that began with the best of intentions however naive.

Fate of the Embryo

The decision on how the many embryos produced during the IVF cycle are to be disposed of depends on whether one views them as a potential human beings or just a group of cells. Like abortion this issue has been the topic of much debate in the context of parental obligation and rights, and also human stem cell research.

Parental Rights

The highly publicized the highly publicized divorce of Junior and Mary Sue Davis in 1992 [Daar 1999] focused national attention on this issue. It emphasized the fact that often conception and pregnancy could be separated by a significant amount of time due to cryopreservation. [Daar 1999] The question it raised was what rights did either parent have on an embryo that had not been implanted and should they be equal to those of ordinary individual able to reproduce without assistance?

Unlike in cases where the woman is reproductively normal, the law in the case of Davis vs. Davis gave the male progenitor an opportunity to override a woman's fundamental right to control her early embryo. Gender equality was given precedence and an inequality emphasized between the rights of a fertile and infertile woman. On the basis of the difference in location of the embryo men were allowed a say in whether a child is or is not born whereas with coital reproduction, once a man takes action that could result in a pregnancy, he waives his right to control the fate of his progeny. [Daar 1999] The reason given has been the lack of direct physical relationship between the woman and the cryopreserved embryos. [Daar 1999]

The court in Kass v. Kass, advocated an equal treatment approach, reflecting "from a propositional standpoint it matters little whether the ovum/sperm union takes place in the private darkness of a fallopian tube or the public glare of a petri dish. Fertilization is fertilization and fertilization of the ovum is the inception of the reproductive process." [Daar 1999]

This decision was however later reversed. Such a decision would have meant that Maureen Kass would have exclusive rights to determine the fate of her embryos and could delay implantation for many years, leaving her ex-husband in reproductive limbo. [Daar 1999] A man in a normal sexual relationship however would know if he is becoming a father within the limited period of 9 months whereas a male participating in an IVF procedure might have to wait for years. The Kass trial court thus directed that Maureen Kass exercise her right to implant the embryos "within a medically reasonably time," but this has still to be determined legally. [Daar 1999]

Cryoprecipitation

Due to the poor success rate of IVF, numerous human embryos are typically generated. It is estimated that there may be between 200,000 and a million human embryos frozen at sub-zero temperatures and stored at infertility clinics across America. According to the American Bioethics Advisory Commission human embryos created by IVF are human beings with the same rights as all human beings, which include the absolute right to life. Frozen human embryos are not merely "potential persons" but unique human beings at an early stage of development whose dignity has been assaulted by freezing them in liquid nitrogen, which exposes them to grave danger if not certain death. [American Bioethics Advisory Commission 2003]

This statement complicates the main way that human embryos are commonly disposed world over. In Victoria, Victorian State Legislation governs practices concerning ART and embryo storage limiting embryo storage to 5 years. Extensions to storage can be obtained by application to the ITA (Infertility Treatment Authority in Victoria). In Queensland the NH&MRC (National Health and Medical Research Committee) guidelines limit embryo storage to 10 years. [Monash 2001, Swan 1989]

Many couples due to religious or personal opinions do not want to destroy the extra human embryos, considering them to be babies, but are also unwilling to add them to the family. Instead they pay a monthly storage fee while postponing any sort of decision. If clinics are unable to contact the family for a year then these embryos may be disposed of, but some store them indefinitely unwilling to take this step while others either donate them to research labs or dispose them. [NBAC 1999, Author not available. 2003] third recent alternative that has emerged is placing these embryos created for IVF procedures with adoptive couples. Legal contracts are drawn up between the two families with both adoption and property transfer language for the protection of the families in the event that future laws change the status of human children living in the embryonic stages of development. Currently there are no laws in any state that regulate the adoption of human embryonic children. [NBAC 1999]

Cryoprecipitation is an important part of the IVF procedure so as to ensure high yield and prevent excessive discomfort to the mother by repetitive induction and retrieval but the issue takes on an uncomfortable aspect when embryos are considered to be more than cells; in fact when they are considered to be babies.

Human Embryo Research

The dilemma becomes even more grotesque and complicated when examples such as that of the Geron Corp. In Menlo Park, California are considered. These laboratories obtain donated human embryos from IVF clinics. [NBAC 1999, Author not available. 2003] They are allowed to develop from a few cells to about a 100 cells for about 12 days and then the human embryonic stem cells that will form the various types of tissue, are harvested to be grown into specific types. These are used for advanced medical research and transplantations. It is justifiable and indeed laudable if we could be sure that all we were dealing with were human cells not the being itself. [NBAC 1999]

Arguments for the continuation of this process are the fact that these abandoned embryos would be destroyed anyways, and they could be put to important use helping promote technology that could assist in medical advancement. Pluripotent stem cells can however be extracted from the placentas left over from healthy live births, cord blood, adult bone marrow, and even fat thus human embryos need not be an exclusively pursued avenue of medical discovery. [Author not available. 2003]

There is some evidence that stem cells derived from adults may in fact be a better source than live human embryos. Therapies derived from the patient's own stem cells have little probability of rejection. It has been found that only adult stem cells have the ability to create insulin-secreting cells that have potential for normalizing blood glucose in diabetics. Embryonic stem cells seem to lack that capability. [Author not available. 2003]

Genetic Screening

Another controversial issue associated with IVF is the ability to screen and interfere with the implantation process after genetic screening of the embryo. Usually if any defects are observed then the 'pre-embryo' is not transferred to the uterus and thus several chronic and irreversible conditions such as cystic fibrosis and Duchenne muscular dystrophy are avoided without the painful necessity of abortion. However this has created such ethical dilemmas as considering the rights of the embryo. Depending on what we consider the status of the embryo to be genetic testing is accused of interfering with the natural course of development and the right to life. Questions arise on which genetic conditions justify termination of pregnancy. Sometimes genotype is not the only determining factor in a disease and so to base such a crucial decision as continuance of pregnancy, on mere genetics is akin to playing God. [Shanner and Nisker 2001]

Eugenics

This ability to screen genetically has another aspect. That of producing children with pre-determined and desired characteristics. This has both a beneficial and sinister facet to its implementation.

In the future we may be able to correct any genetic faults through gene therapy avoiding termination of pregnancy, but this could raise expectations of parents and the terms 'healthy baby' may be replaced with 'genetically perfect.' This is when the more sinister angle of eugenics comes to mind, and man's wish to manipulate. Sex selection is still banned in most countries using IVF but babies have been produced with selected qualities for specific reasons. Adam Nash was born after genetically screening 10 embryos so that he could help donate stem cells to replace his sister Molly's bone marrow. She had Fanconi's anemia. The short-term achievement is no-doubt commendable but the long-term implications are the mechanization and dehumanization of reproduction and the human race. [Singer and Dawson 1988, Sweeney 2002]

Commercializing reproduction

There is a fear that the availability of gametes and embryos will commercialize reproduction. [Shanner and Nisker 2001] Individuals from lower socioeconomic levels tend to be the donors while the better off are usually recipients. Commercialization also occurs by agreeing to pay for IVF treatment by donating embryos. Such sharing programs also undermine informed consent taking advantage of the parents wish to have children with their inability to pay with cash instead of their own embryos. [Shanner and Nisker 2001]

Multiple Births

Not only are multiple embryos produced but also often multiple pregnancies result. Sometimes the number can be dangerous to the mother's health, or not viable. "Pregnancy reduction" is then recommended. This means that the physician will strategically abort a few of the growing babies in order to increase the woman's chances of carrying any to term. Again ethics becomes an issue. The question of abortion is still unresolved, but here we are not only producing conditions that we know will lead to multiple pregnancy, but also determining consciously which babies to abort, perhaps through genetic screening. The power wielded by humans over life seems almost extreme. True that multiple births are less likely to be viable and have more social and economic costs but if the desire to produce human life leads to the application of IVF then responsibility of that life must also be assumed. [Shanner and Nisker 2001]

Surrogacy recent addition to the list of issues associated with IVF that need to be analyzed is surrogacy. Natural surrogacy has been an accepted form of treating infertility for years and in the UK IVF surrogacy is now also an option. [Brinsden 2000] The process however raises many ethical and moral issues. As the surrogate is human and the process of pregnancy and birth are highly personal and life changing events often the birth mother may decide that she wishes to keep the child. This will undoubtedly cause pain to the infertile couple who have set such store in this method but legally The Human Fertilisation and Embryology Act 1990 has declared that no pre-pregnancy contracts are enforceable by the law, and that the birth mother is the legal parent.