Ethics and views behind reproduction
IVF Issues – Facts, Figures, Ethical and Emotional Issues
A) SCIENTIFIC ISSUES
1) European Society for Human Reproduction and Embryology 2008 REPORT for 2005 data:
Please note the current success rate for IVF in Ireland is only 21.1% (in keeping with the European-wide average). This figure is reported as “deliveries per IVF cycle started in Ireland. The study abstract fails to report this figure and confusingly reports “clinical pregnancies per aspiration or per embryo transfer” ranging from 26.9% up to 30.3%. It is important to realise this is not the success rate per 100 people who started treatment but selective reporting of a sub-group within the study. According to ESHRE’s data 15 to 24% of all IVF pregnancies ended in miscarriage! Only 21.1 per hundred couples achieved a successful delivery, for the most recent data available in Ireland. Interestingly Italy onlyhavean 8% live birth rate, where they have legal guidelines to protect the embryo from conception. This shows that to achieve a reasonable success rate with IVF, you must be prepared to produce excess embryos over and above the one or two you intend to replace. This is problematic if one considers the scientific evidence that human life begins at conception.
2) IVF Not proven to be effective for unexplained Infertility:
IVF is becoming popular when there is no specific explanation for infertility as it may be able to overcome a variety of problems. However, it is expensive, complicated and can have many adverse effects (including multiple births). The review of trials found that IVF ……… research is not conclusive. Adverse outcomes and costs have not been adequately addressed in the trials.
3) IVF BABIES AT MORE RISK OF BIRTH DEFECTS THAN NATURALLY CONCEIVED BABIES:
Children conceived with assisted reproductive technology (ART), for example IVF, have about twice the risk of having a major birth defect or low birth weight than children conceived naturally,Australian and US studies show.In the Australian study, children conceived with ART had a 9 per cent chance of a major birth defect compared with a 4 per cent chance in naturally conceived children. The study was published in the medical journal New England Journal of Medicine (2002; 346: 725-30). This increased risk was the same whether the children were from single or multiple pregnancies, the review of all births in Western Australia showed. The use of ART also increased the chances of multiple major defects, chromosomal and musculoskeletal defects. Age of the mother and parity (the number of times she has given birth before) and the sex of the child did not affect the results. The US study showed a 2.3 per cent increased risk of low birth weight in term singleton children (as opposed to children from multiple births, such as twins) conceived with ART compared to children conceived naturally (New England Journal of Medicine 2002; 346: 731-37).
The risk did not vary according to the cause of infertility, and because the mothers were all apparently healthy, the increased risk of low birth weight after ART may be directly related to the techniques themselves, the authors suggested.
B) ETHICAL ISSUES
1) Creation and Transfer of a Single Embryo in Reproductive Technology:
This paper from the Southern Cross Bioethics institute in Australia, analyses the many complex moral issues involving IVF, even is a couple does everything possible to avoid embryo loss in the process. CLICK HERE for full paper. If one considers that human life begins at conception, when the embryo has a unique genetic code that will guide its growth and development until old age, this paper shows how impossible it is for IVF to be practiced in a way that respects that new life.
2) IVF in the UK – over 2 million embryonic lives lost since 1991:
2,137,924 human embryos were created by specialists while assisting couples in the UK to have babies between 1991 and 2005, according toBioNews. During this period, the HFEA informs us that the total of live babies born through IVF procedures was 109,469. In other words only 5.1% of all embryos created resulted in a Live Birth.
3) Catholic Church Teaching and IVF:
a) Irish Catholic Bishops – Towards a Creative Response to Infertility
b) Irish Catholic Bishops – Assisted Human Reproduction – Facts and Ethical Issues
c)DignitasPersonae (12th Dec 2008) was released by the Congregation for the doctrine of the faith to answer advanced issues regarding bioethical questions, including assisted reproduction.
The document states that all assisted reproduction must respect 3 basic principles
Couples must be married.
Conception must occur through normal intercourse.
The embryo must be treated with the full respect due to all human life from the moment of conception.
Techniques such as IUI, IVF and ICSI do not respect these basic principles so they are unethical and should be avoided by all Catholics, patients and doctors alike.
C) SPIRITUAL ISSUES
Are you suffering with Infertility? ….Are you having a hard time dealing with it? Are friends and family hurting more than helping you? Do you feel pressure from them or the culture at large to use methods such as in vitro fertilization (IVF)? Perhaps you are tempted by IVF, since nothing else, it seems, will give you the child you so desire.
…..This talk looks at the difficulties with which couples and in particular women suffering from infertility have to deal. Afteranalyzingthe temptations the woman has to face such as self-pity, anger, envy, not allowing herself to mourn, running away from the cross, this talk points out the wrong responses that people surrounding the infertile couple tend to give: telling them to get over it, being curious about the reason for their infertility, blaming them. These can stem from simple clumsiness, but often express a lack of compassion and the failure to stand under the cross with the persons who suffer.
Scientific view
Religion: Objection to playing God
“Biotechnology is assuming a more predominant role in the generation of human offspring at the price of diluting our notion of man as a procreating being…. Man begins to see himself more and more as an individual who stands apart from what he produces, rather than as a being who is created in the image of a Triune God whose inner life is dynamically procreative,”
Technologies of assisted reproduction such as in vitro fertilization (IVF) have been controversial on religious grounds since their inception, but nonetheless, within Islam, Judaism, Confucianism, Hinduism, and most forms of Christianity, adjustments have been made to facilitate the fertility of their adherents [24]. Catholicism remains the only major world religion that unequivocally condemns the use of IVF. The Vatican argues that the research,development, and practice of IVFinvolve the destruction of embryos, i.e., the destruction of humanlife,’andby engaging in assisted reproduction, humans are technologically interfering with a process that should remain under god’s dominion (Ratzinger 1987). To the catholic church, surrogacy; artificial insemination by husband or donor; and IVFare not allowed, because procreation without sexual union in considered unnatural, and the church has been quite vocal about its criticism. Church considers in vitro fertilization wrong because it separates human procreation from conjugal union. In the process, couples make themselves the masters of human life instead of its stewards. The strongest protest is on the use of these supernumerary embryos in research which hamper the divinity and dignity of human life.
Several contradictory views:
Success rates of this technique vary with the treatment, patient condition and with respect to other condition. Because of the stress and expense of the procedure, customers became attuned to clinic success rates. This put pressure on clinics to produce encouraging statistics, which they did by selecting their highest rate from among the dozens of possible numerators and denominators. A spate of newspaper articles attested to confusing success rates and inflated claims. A criticism beleaguered at some IVF providers is that the clinics are misleading infertile couples by not adequately informing patients of their chances of actually bringing a baby home from the hospital while others shield IVF providers by stating that the success rate in natural conception is not radically different from that achieved by the IVF clinics. Some of this confusion can be accredited to the fact that many clinics report their success rates in terms of pregnancies established, while patients are concerned with live, healthy babies. As Hesiod would say “We know how to speak many falsehoods which resemble real things, but we know, when we will, how to speak true things.” In more complex permutations of in vitro fertilization, third parties who may be known or unknown to the couple, become involved in the reproductive process. It is now technically possible to use donated sperm, donated eggs, and donated embryos. Surrogate motherhood employs a “borrowed” uterus; one woman carries afetusfor another infertile woman and then gives the child after. In future, it may even be possible to use an artificial uterus and to bring an infant to term completely outside of the womb.
Conclusions:
“When science and technology open doors that should not be opened, a Pandora’s box spews forth evils that menace humanity. We invented the atom bomb and germ warfare. These inventions are now part of human history forever. Scientists have opened another perilous door: they are manufacturing human life and using their product asan object of experimentation.”
It is quite evident that a consensus on IVF cannot be achieved, since the whole area of infertility treatment by ART touches fundamental issues of life, family and society structures that are influenced by religion and tradition, which differ vastly among different cultures and societies.
In vitro fertilization is but one of the many approaching medical procedures capable of significantly modifying human activities and relationships. In order to balance responsibility with scientific research, we must ask not only, “Is it possible?” “How to do this?” we must also ask, “Is it ethically approvable to do?” or “what will be the altogether social impact?” At one end of the spectrum, will be people who feel that this technology allows couples to manipulate Nature to produce children and will object to it. At the other end will be people who believe that this technology is a triumph of man’s ingenuity which can be used to overcome Nature’s constraints. It will never be possible to reconcile these viewpoints-since these are based on deeply held personal beliefs and we will have to learn to live with this moral dichotomy. Since it may never be possible to have a consensus on this issue, this decision should not be left to moralists, or philosophers-or the government, or the doctors. Instead, the decision should be left to each individual couple, who provide the reproductive apparatus to create the baby.
Turning children into commodities:The use of contraceptives and abortion!
The overwhelming media attention to ART implied ultimate control over sub fecundity, which may have unchained up reproductive intentions among sub fecund people and this desire may result in parents thinking the child as a possession instead of a gift. In vitro fertilization turns children into commodities. Who will judge about giving birth of the children in this world, parents are free to decide but are they having the rights to obstruct the natural process? When a couple is infertile, do they have the right, with the aid of scientists, to circumvent the natural process of generation? Or are the creative powers which people share with God limited in such a way that they should stop short of interfering with natural processes such as the generation of new human beings, even though it is clear that a substitute method for the natural process can be found? Clearly, we have the right to modify our personal entity so that natural actions are more aptly performed. But do we have the right to change our personal entity so that natural actions are eliminated, the same results being achieved through artificial means?
The current ban on parents selecting the sex of their unborn babies is not ethically justifiable according to a review of the arguments for and against “gender selection” of IVF embryos.A leading medical ethicist said there is no evidence that the sex selection of embryos will harm children born from the procedure. He added that there was little risk of the technique leading to a major imbalance of the sexes within the wider population.
One of the review’s authors, Stephen Wilkinson, professor of bioethics at Lancaster University, said there was nothing inherently wrong in allowing parents to use the latest reproductive technology to “balance” their familieswith either sons or daughters.
“We examined the ethics of gender preference and sex-selection techniques in the British context and found no reason to expect harm to future children or the wider society if these techniques were made available for social’ reasons within our regulated fertility treatment sector,” Professor Wilkinson said.
“People who would prefer their new baby to be of a particular sex often have their own very personal reasons for this, to do with their family’s particular circumstances or history. We didn’t find any ethical arguments sufficient to justify a blanket ban on these people seeking sex selection,” he said.
In Britain, people are allowed to choose the sex of their IVF babies only if there is a good medical reason, for instance if there is a risk of a sex-related genetic defect such asDuchennemuscular dystrophy, which affects only boys.
However, there are anecdotal reports of Britons travelling to other countries, such as the United States or India, for either pre-natal genetic diagnosis – where gender is determined before an IVF embryo is implanted into the womb – or abortions based on the gender of a foetus following an ultrasound scan during pregnancy.
The Human Fertilisation and Embryology Authority (HFEA), which licenses fertility clinics in the UK, has ruled several times over the past 20 years that sex selection should not be allowed for “social” reasons, arguing that it is not in the best interestsof either society or the child.
Its last review, published in 2002, the HFEA said: “Public opposition to sex selection for non-medical reasons was clear and consistent. There was also substantial public concern about the welfare of the children born as a result of sex selection when this is carried out for non-medical reasons.”
In 2008, the amended Human Fertilisation and Embryology Act reflected the public mood by specifically outlawing any gender selection of IVF embryos merely for social reasons.
However, Professor Wilkinson and his co-author EveGarrard, who wrote their report while atKeeleUniversity, said there are strong arguments in favour of allowing parents to choose to have either sons or daughters, and not only if they already have anumber of children of one sex.
“Sometimes individual parents strongly want to have the kind of relationship they feel will only be possible with a child of one sex rather than another. This is not necessarily because children of that sex are felt to be more important, but simply in recognition of the fact that the sexes differ and may offer different possible kinds of parent-child relationships,” they said.
“These parental feelings may be very strong indeed: women who already have several sons and very much want a daughter may express their feelings in terms of an overwhelming desire for a girl and for a mother-daughter relationship different from that which is possible with their sons, much-loved though they are.”
Advances in IVF technology have made it easier and cheaper to select the sex of an embryo before womb implantation, which has led an increasing number of people to seek IVF as a way of either balancing their existing families or to have only sons or daughters.
In some countries, notably China and India, the widespread use of pregnancy ultrasounds has led to the selective abortion of female foetuses.
This, and the practice of female infanticide, has led to what the Cambridge economistAmartyaSenhas called the “the missing women” – the estimated 100 million female babies who were never born because of gender selection.
In some Chinese provinces, for instance, there are more than 130 boys under five years of age for every 100 girls. Similar sex ratios are also seen in parts of India, making it difficult for young heterosexualmen to find lifetime partners.
Professor Wilkinson, however, believes this “bad consequence” of wide-scale gender selection should not be usedto justify the ban in Britain.
“Such evidence as there is suggests that unfettered sex selection wouldn’t in fact lead to a skewed population in the UK, even though it has done so insome other countries,” he said.
“But the UK is not such a culture, and so the bad effects which a sex-selection policy might have or has had elsewhere needn’t happen here. Bad effects from the policy elsewhere aren’t enough to show it should be banned here,” he added.
Professor Wilkinson denied that this would mean double standards, with one set of rules for Britain and another set of rules for other countries. “I don’t think it’s double standards because you are upholding the same standards in that you are asking whether there is a bad consequence to the policyof gender selection,” he said.
“The less sexist society is, the more acceptable sex selection is likely to be,” he added.
