In Vitro Fertilization

JURASSIC AGE TECHNOLOGY In Vitro fertilization Chromosome mapping Genetic Screening Mammal cloning

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IN VITRO FERTILIZATION In Vitro Fertilization & Embryo Transplant – IVF-ET

Fertilization that is artificially performed outside of the woman’s body. Process: One or more eggs are surgically removed from a woman’s ovary, fertilized with her husband’s sperm in a laboratory dish, and developed in the dish for a few days, after which the tiny embryo is transferred into the woman’s uterus in the hope that pregnancy will proceed normally. First test tube baby - Louise Brown, born on July 25, 1978, at Lancashire, England - Drs. Robert Edwards & Patrick Steptoe First test tube baby in the U.S. - Elizabeth Jordan Carr, born on Dec. 28, 1981 in Norfolk Gen. Hospital, Norfolk, Virginia.

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Justifications/Reasons for IVF-ET: Needed by married couples who are unable to reproduce because of infertility possibly involving both male and female anatomical defects. Male: - problems with the sperm (low sperm count) Female: - defects in the fallopian tubes and the uterus (obstruction in reproductive tract) - ovulation disorders - endometriosis Procedure: 1.. Suppression 11. Oocyte retrieval III. Implantation of embryo in the uterus:

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Types of IVF-ET: 1. Wife’s ovum is fertilized with husband’s sperm in a test-tube, then embryo is transferred to wife’s uterus. 2. Use of surrogate mother: a) Wife’s ovum is fertilized with husband’s sperm; their embryo is transplanted to surrogate mother; b) Donor’s ovum is fertilized with husband’s sperm and embryo is transplanted to uterus of wife; c) Fertilization of female donor’s ovum with male donor’s ovum; then the embryo is transferred into the uterus of the wife. Surrogate parenthood: This is resorted to when the wife who wishes to bear and raise a child is medically incapable of carrying a pregnancy for the reasons that: * no uterus * afflicted with medical condition where pregnancy will endanger her life.

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Types of surrogate motherhood: 1. “Full” surrogate motherhood – the union of the surrogate mother’s egg and the social father’s sperm. 2 . “Partial” surrogacy - the wife is able to produce fertilizable eggs but medically unable to carry a pregnancy. Her eggs are fertilized in vitro with the sperms from her husband and the resulting embryo is transferred to the uterus of a surrogate mother. The gestational mother is called a “surrogate carrier”.

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Four principal ethical & public policy questions that have been raised about surrogate motherhood arrangements: 1. If the surrogate mother decides during the pregnancy or at the time of delivery to keep the child that she had agreed to bear for a couple, who should have parental rights? 2. To what extent should the adopting couple be able to control the lifestyle of the surrogate mother during the pregnancy?

3. If the child is born with physical or mental handicaps, are the adopting parents nonetheless obligated to accept the child as their own? 4. If the surrogate mother receives payment, for what is the payment made, and how can exploitative or coercive relationships be avoided? 6

Benefits of IVF-ET:

1. Makes it possible for many couples to conceive children, who would not otherwise be able to do so; 2. Research into improving IVF-ET may lead to better and more effective contraceptives: 3. Research with animals using the techniques of IVF-ET can be employed to determine the ways in which various environmental toxins and drugs affect the developing fetus – the aim is to discover means by which specific chemicals alter development and result in defective offspring. 4. Gene repair - might make it pos-sible to locate defects in genes, that when uncorrected, lead to faulty development of

the fetus. Additional know-ledge might allow faulty genes to be replaced or repaired, thus opening an entirely new chapter of fetal medicine. 5. Surrogate mothers: a) A woman with abnormal uterus who is not capable of a normal pregnancy might contribute an ovum that, after being fertilized in vitro, is transplanted in the uterus of a second woman whose uterus has been prepared to receive it. The “host” or surrogate mother then carries the baby to term. b)Prenatal adoption – a woman unable to ovulate normally but otherwise capable of pregnancy, might choose to “adopt” an embryo, carried by another woman. 7

Defects/Difficulties: 1. Complete separation of reproduction from love-making. 2. Many fertilized embryos may be produced but not carried to term. Only a single fertilized ovum is selected for implantation. The others are simply discarded. The destruction of fertilized ova is viewed as tantamount to abortion.

3. Process promotes false attitude that the child is not a gift but a product and a possession who exists prima- rily to satisfy a parental need rather than for his/her own sake; 4. Denies the right of the child to its own parents. Children begotten by AID may wonder: - do they have really parents? - Are they begotten by unknown fathers? - Are they manufactured in a laboratory? 5. It is impossible to assess the risks to the fetus and to the person it may become. British incidence show a very low success – 9%. Pregnancies were oftentimes complicated: * spontaneous abortions - 26% * ectopic pregnancy 5% * multiple pregnancies - 19% * CS, single pregnancies - 46% * CS, multiple pregnancies- 72% * Premature delivery & fetal hypertrophy - 3% higher than normal delivery 8

6. May encourage the development of eugenic ideas about improving the species. Rather than having children of their own, would-be parents might be motivated to seek out ova/sperm from people who possess physical and intellectual characteristics that are particularly admired. 7. Would-be parents might be inclined to exercise the potential for control over the sex of their offspring 8. Determination of the sex of the embryo would allow the potential parents to decide whether they wish to have a male or female child. 9. Likely to promote a social climate in which having children becomes severed from the family. Procedure places emphasis on the mechanic of fertilization and in doing so, minimizes significance of the shared love and commitment of the parents of a child conceived by normal intercourse. 10. The procedure offers opportunity for an unmarried woman to have a child without having anything to do with the biological father of the child. `

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Essential Ethical Consideration: The child must be brought into existence by the natural love act of the married couple. IVF-ET separates love-making from procreation. Arguments: 1. Freezing and storage of early human embryos. 2. Donation or sale of human embryos 3. Early gender selection 4. Early diagnosis of genetic or chromosomal abnormalities Freezing and Storage: - problems: Metaphysical Problem: What status to ascribe to an undifferentiated human entity that can be preserved for years in a status of suspended animation.

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Ethical & Legal Problems: 1. The legal status of the human embryo. Is it a human being in the embryonic state or is it considered a “thing”? IVF involves the loss of embryos during the different phases of the procedure; excess embryos are discarded while others are utilized for research. – Violates a fundamental right, hence, morally illicit. 2. The mode of obtaining semen masturbation is morally illicit. 3. Utilizing donor sperms or ova or hiring surrogate mothers is clearly immoral. It presupposes anonymous paternity (biological adultery). Moreover, heterologous IVF carries dangers of consanguinity or incest. 4. Rupture of the unitive from the procreative aspect of the sexual act. It is morally illicit to give rise to a new person with an act distinct from the conjugal act. 5. Risk on the life of the fetus: Can the life of the fetus be protected when the embryo is transferred to an artificial womb? 11

6. Would it be illicit to transplant an embryo naturally conceived from the uterus of its mother to a foster mother for the good of the child or because of serious danger to the mother? 7. Sperm bank? a. Freezing, storing embryos will also facilitate the donation or sale of human embryos to third parties. b. Should frozen, stored embryos be regarded as the “property” of the couple whose reproduc- tive cells combined to produce the embryos? 8. Sex determination - will have possible longterm effects on the sex ratio. 9. Embryos found to be affected by genetic or chromosomal abnormality are discarded. 10. Since it involves introduction of third-party gametes, it undermines the family or that it could have negative effects on the husband or the potential child.

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Moral questions raised by artificial procreation: Artificial insemination, In vitro fertilization, Surrogate motherhood)

1. These new reproductive technologies lead to the manipulation of the ovaries and sperms of donors, ovary culture, octogenesis, interspecies fertilization, etc., to a situation in which reproduction is converted into one more of those “techniques”, completely separated from the family and left “to the responsibility of the learned”. One would have arrived at the greatest folly of history: a society that “edits children, without father or mother . . . and where the word LOVE has no meaning. 2. Donation or sale of human embryos: -closely paralles the question of semen donation or sale. 3. Early gender selection: raises subtle, and hotly-debated questions about sex determination and possible long term effects on the sex ratio. 4. Pre-implantation diagnosis of genetic or chromosomal abnormalities: Any embryo found to be affected by a genetic or chromosomal abnormality would presumably not be transferred but, rather, would be discarded. 13

ETHICAL EVALUATION The child must be brought into existence by the natural love act of the married couple. Instruction Donum Vitae which contained the conclusions drawn by the Congregation for the Doctrine of the Faith on biomedical experiments published on Feb. 22, 1987: 1. Respect for the human embryo. Therapeutic interventions on the human embryo are licit “as long as they respect the life and integrity of the embryo and do not involve disproportionate risks for it but are directed towards its healing” 2. “Unless there is moral certainty of not causing harm to the life and integrity of the unborn child and the mother, and on the condition that the parents have given their free and informed consent to the procedure” only then can we consider licit any type of research and experimentation on embryo and human fetuses. 3. “Corpses of human embryos as fetuses, whether deliberately aborted or not, must be respected like mortal remains of any other human being”. 14

4. The document stresses “the special gravity of the voluntary destruction of human embryos obtained in vitro for the sole purpose of research”. 5. It also rejects other forms of biological or genetic manipulation of human embryos against the dignity of the human being proper to the embryo and that transgress the right of the person to be conceived and born in and of marriage. (Twin fission, cloning, parthenogenesis). 6. The freezing of embryos, even when carried out un order to keep alive an embryocryopreservation – “constitutes an eoofense against the respect due to human beings by exposing them to the grave risks of health or harm to their physical integrity”. 7. Likewise, certain attempts to influence chromosomic and genetic inheritance that are not therapeutic but are aimed at choosing the sex or other qualities “are contrary to the personal dignity of the human being, to his or her integrity and to his or her identity”.