Ethical issues in Assisted

Reproductive Technologies (ART)

References:
Effy Vayena, Department of Reproductive Health and Research
www.gfmer.ch
Assisted Reproductive Technologies (ART)
 All treatments or procedures that include the in vitro handling
of human oocytes and human sperm or embryos for the
purpose of establishing a pregnancy

 (in vitro fertilization and transcervical embryo transfer, gamete intrafallopian

transfer, zygote intrafallopian transfer, tubal embryo transfer, gamete and embryo
cryopreservation, oocyte and embryo donation, gestational surrogacy)
First Successful IVF:
Birth of Louise Brown in 1978

Louise Brown celebrated her 25th birthday in July 2003

 Rapid developments in the field of ART

 “Moral panic” about the changes that IVF brought about

continuous ethical dilemmas

 Legislation
Rapid Developments
• Better protocols for ovulation induction
• Success rates
• ICSI (intracytoplasmic sperm injection, a technique for in vitro
fertilization in which an individual sperm cell is introduced into an egg
cell)
• PGD ( preimplantation genetic diagnosis)
• Cloning techniques (animal cloning and claims for human cloning)
Moral Panic
• No society has been neutral about reproduction
• social values
• morals
• fears

•Separation of sex from reproduction

•Reproduction with the involvement of a third party
•Gender issues
•Pronatalist attitudes
Ethical Concerns
• Ideology or religion
– Status of the embryo
– Sanctity of the family’s genetic lineage

• Utilitarian principles
– Best for society
– Best interest of the child
Ethical Concerns

Status of embryo safety

justice

risks-benefits

beneficence
autonomy
autonomy
Infertile individual
Infertile couple
Child
Physician Society
Ethical Concerns/Autonomy
 Autonomy

 Patient’s autonomy (respect for autonomy)

Reproductive freedom

Decision based on accurate information

Issue of success rates

•Woman requests implantation of seven embryos

Ethical Issues/Autonomy
• Eligibility
– all infertile couples
– only married couples
– single women without partners
– gay couples
– lesbian couples
– menopausal women
– HIV-positive women or couples

•58-year-old couple seeks ART

 A gay couple, Janice and Lisa, had been in a stable relationship for
over five years and decided to have a family. One would become pregnant
using donor sperm, and they would both raise the child in a loving
environment.
The women had top private health cover, so could easily afford the
procedure, both were professional women and could also easily afford the
costs associated with raising a child, however, neither disclosed their
sexual preference when they entered the program. (There was formal
opportunity to do so in the various application forms)
 Upon discovering the nature of their relationship the Director of the
clinic, refused to allow them to continue in the program on the basis that
the legislation allows for couples where conception cannot occur naturally.
He stated that a preliminary medical examination revealed both
women could in fact conceive naturally, their problem in not achieving
conception was due to a sexual preference, not a biological problem, thus
they did not actually need the in-vitro procedure to have a baby, moreover
given that the couple were gay, they did not qualify for access to the
program.
Ethical Concern/ Donation
Gamete donor
 Sperm  Oocyte
Ethical Issues/Donation
•EGG DONOR NEEDED
•Couple seeks egg donor with 1420 SAT or 33 ACT, 18-28 yrs old, 5’4”-5’10”,
attractive, athletic and healthy. Grandparents European and at least one
Jewish.Compensation is $25,000. Email photos and scores to [email protected]

Commercialization
» Ethical arguments against (exploitation, potentiality,
dignity, risk for distinctions in genetic pedigree)
» Ethical arguments for (justice, pay for a service, reward,
reproductive tourism)
Ethical Issues/Donation
 Alternative sources of donor eggs
• Eggs and ovaries from aborted female fetuses Repugnance
Respect of dignity
Best interest of the child
• Donation of eggs and ovaries after a woman’s death
• Existence of consent
• Best interest of the child
• Egg sharing
Ethical Issues/Donation
 Donor anonymity

(i) the right of autonomy and privacy of the parents;

(ii) the right of privacy of the donor;
(iii) the right of the child to know his/her origins.
Ethical Issues/PGD
• Pre-implantation genetic diagnosis (PGD)
 screening of cells from preimplantation embryos for the
detection of genetic and or chromosomal disorders before
embryo transfer

•Status of the embryo

•Discrimination
•“Designer” babies
•Sex selection
•Destruction of unwanted embryos
Ethical Issues/PGD
Sarah is 30 years old. Previous genetic testing shows that she
is a carrier for cystic fibrosis (CF). Her partner is a carrier as well.
Despite the fact that she is not infertile, she seeks IVF
treatment at an assisted reproduction clinic at an NHS Trust
Hospital in order that any resulting embryos can be screened using
pre-implantation genetic diagnosis (PGD) and only embryos without
the CF gene will be implanted
Ethical Issues/Risks-Benefits
• The welfare of the child
– Medical risks
– Family environment
– Social environment
• Who is making the decisions for the welfare of the child?
– Parents
– Medical personnel
– Society and the law
• Is it in one’s best interest to be born?
Ethical Issues/Risks-Benefits
40%

30% 3.4
4.3
4.2 4.1
4.6
20%

24.7 27.3
10% 22.8 20.9 22.7

0%
1989 1991 1993 1995 1998

Twi Triplet or more

n

• High incidence of multiple pregnancies

Ethical Issues/Multiple Pregnancies
Two reasons driving the increase
•Need for better success rates
•Patient’s “choice”/ pressure (lack of accurate information)

International attempts to
reduce multiple pregnancies
Ethical issues/ ART in developing countries
• Magnitude of infertility

• Access to quality ART clinics/justice- safety

• Issue of resource allocation/justice

Main Arguments
 “overpopulation”

 limited resources and burden of disease

 poorly trained practitioners offering demanding

services

 cultural and religious values

Slippery Slope

an argument in which a party asserts that a relatively

small first step leads to a chain of related events
culminating in some significant (usually negative) effect. ...
Designer Babies and Genetic
Engineering
Lifted from the materials of Matea Bagaric
Overview
 What is a designer baby?
 Real-life situation
 Designer babies today
 Advantages and disadvantages of designer babies
 For or against designer babies?
 HFEA
 The Fertility Institutes
 Conclusion
 Discussion
What is a Designer Baby?

A baby whose genetic makeup has been artificially selected by

genetic engineering to ensure the presence or absence of
particular genes or characteristics

Knowledge Issue:
Should couples be given the right to alter their children’s genes to
their own preference and liking?
Real-Life Situation
 In October of 2000, Adam Nash was the world’s first designer baby born by pre-
implantation genetic diagnosis (PGD)
 PGD refers to screening procedures performed on embryos to check for genetic
disorders prior to implantation and pregnancy
 Combined with in-vitro fertilization (IVF), a process by which egg cells are
fertilized by sperm outside the womb
 Embryos grown to the eight-cell stage and are checked for genetic disorders
 It’s a major treatment in infertility, but is now being used for other reasons
Real-Life Situation
 His parents were both carriers of Fanconi Anemia and passed this
genetic disorder onto their daughter, Molly
 To save Molly, a bone marrow transplant was needed
 Doctors fertilized several of Adam’s mother’s eggs, but only implanted
the one that was both genetically healthy and a match as a donor
 This means the other embryos that could have grown into human beings
were killed
 Now, Molly is healthy and has been given a second chance at life
Mr & Mrs Nash
Designer Babies Today
 To date, genetic technology has only been used to treat serious
disease in children
 Discoveries about the influence of genes on human traits opens
the possibility of transferring these techniques to human beings
 Developing technology makes it possible to alter anything from
gender to disease, and eventually appearance, personality, and IQ
 Some believe that parents will inevitably want to choose their
children’s genes, thus creating designer babies
Advantages
 Allows couples who can’t conceive normally to have children
 Allows couples to balance gender in their families
 Genetic screening reduces the baby’s chances of being born with a
serious genetic disease
 Increases the likelihood of a healthy baby
 Reduces chances of miscarriage
 Reduces chances of termination due to disorder
 Can be used to save lives
Disadvantages
 Moral and ethical concerns:
 Too much like playing God
 Killing embryos that could have grown into humans
 Social concerns:
 High cost leads to gap in society
 Could lead to eugenics: individuals are “bred” or designed to suit social
preferences
 Genetically enhanced people may start to feel superior to those who haven’t been
enhanced
 Such groups of people may become prejudiced against one another due to a
feeling of lost common humanity with non-enhanced people
Disadvantages
 Safety concerns:
 Can lead to ovarian hyper-stimulation syndrome (OHSS)
 Unskilled lab technology could damage embryo during biopsy
 The removal of cells from eight-cell embryos has implications for
the well-being of people created by PGD
For or Against Designer Babies?
 What is HFEA?
 Stands for Human Fertilization & Embryology Authority
 Dedicated to licensing and monitoring UK fertility clinics and all UK research
involving human embryos, and providing impartial and authoritative
information to the public
 Genetic engineering not allowed under British law because of the
possibility the child would be seen simply as a “medical product”
 Head of ethics and policy for the British Medical Association, Dr.
Vivienne Nathanson says, “We would have very serious concerns that
he is a commodity rather than a person”
For or Against Designer Babies?
 James Yeandel, spokesperson for HFEA says, “An application for use of PGD
for a purpose such as creating a transplant match would have to be considered
by the authority’s licensing committee.”
 In 2004, HFEA considered a relaxation of regulations governing designer
babies so that parents could screen embryos for genetic traits and use them as
donor siblings
 The authority debated whether parents should be allowed to test embryos
solely for desirable characteristics and not just for genes that cause devastating
illnesses at a young age
 If approved, it would permit screening techniques to create babies whose
umbilical cord blood could save the life of a sick sibling
For or Against Designer Babies?
 What are the Fertility Institutes?
 They provide a variety of fertility and infertility services, including PGD
 They have nothing against the designer baby and have the world’s leading, highly successful,
and most respected gender selection program (99.9% accuracy)
 Can be found in Los Angeles, New York, and Mexico
 Couples will be able to select both the gender and physical traits of their children
 Growth of PGD is unfettered by any state or federal regulations in the United States
For or Against Designer Babies?
 Survey results:
 56% supported using genetic tests to counter blindness
 75% supported using genetic tests for mental retardation
 10% of respondents said they would want genetic testing for athletic
ability
 10% voted for improved height
 13% backed the approach to select for superior intelligence
Conclusion
 It seems unmoral and unethical to test embryos for certain genes and to tamper with
them
 Technology is still developing so safety concerns are high
 Many children’s lives could be saved
 Fewer children would be born with genetic disorders
 The idea is still new, so it’s hard to say who is right and who is wrong
 There are many advantages and disadvantages of the designer baby, and we should
keep an open mind and unbiased attitude towards them
Discussion Questions:
1. Do you support the idea of designer babies? Why or why not?

2. Would you use genetic engineering on your children simply to make

them more intelligent or better looking?


Bibliography
 www.givf.com/pgd/whatispgd.cfm
 www.actionbioscience.org/biotech/agar.html
 www.articlecity.com/articles/parenting/article_1348.s
html
 www.sciencecentral.com/articles/view.php3?type=art
icle&article_id=218392351
 News.bbc.co.uk/2/hi/health/954408.stm
 www.hfea.gov.uk/
 http://online.wsj.com/article/NA_WSJ_PUB:SB1234
39771603075099.html