INFERTILITY: THE CHOICES, THE ISSUES



                        

                                   
Imagine the anguish of a married couple who desperately want to have a child yet because of infertility cannot. They look to medical science for help and find that many techniques and therapies have been developed to overcome infertility. Does it matter which one they choose, if any.

Today infertile couples have options that were not available just decades ago. But along with the choices comes a serious question. What are the ethical and moral implications of assisted reproductive techniques? Before we consider that, though, let us see how various religious groups view such treatments.

                            SOME TYPES OF FERTILITY TREATMENTS

 

1.       AI [ARTIFICIAL INSEMINATION]. A procedure in which semen is introduced into the female reproductive organs by other than natural means. AI is an option often tried before the procedures described below.

2.       GIFT [GAMETE INTRAFALLOPIAN TRANSFER]. A procedure that involves removing eggs from a woman’s ovary, combining them with sperm, and using a LAPAROSCOPE [an instrument used for examining the abdominal cavity to place the unfertilized eggs and sperm into the woman’s fallopian tube through small incisions in her abdomen.


3.       ICSI [INTRACYTOPLASMIC SPERM INJECTION]. A procedure in which a single sperm is injected directly into an egg.

4.       IVF [IN VITRO FERTILIZATION]. A procedure that involves removing eggs from a woman’s ovaries and fertilizing them outside her body. The resulting embryos are then transferred into her uterus through the cervix.


5.       ZIFT [ZYGOTE INTRAFALLOPIAN TRANSFER]. A procedure in which eggs are collected from a woman’s ovary and fertilized outside her body. A resulting fertilized egg is then inserted into her fallopian tube through a small incision in her abdomen.
                                      WHAT DO RELIGIOUS GROUPS SAY?

In 1987 the Catholic Church issued a document that addressed the morality of infertility procedures. The statement, known as DONUM VITAE [The Gift of Life], held that if a medical technique assist the marriage act in achieving conception, such a treatment may be viewed as moral.

On the other hand, the document indicated that if a medical procedure replaces the marriage act, such a treatment is morally wrong. According to this view, surgery to correct tubal blockage and the use of fertility drugs would be considered moral, but test-tube fertilization would be immoral.

The following year a U.S. Congressional committee surveyed religious groups as to their stand regarding fertility treatment. The final report showed that a majority of them accepted traditional medical interventions, artificial insemination using the husband’s sperm, and in vitro fertilization treatment, provided that both the egg and the sperm belonged to the married couple.

Moreover, most of the groups surveyed declared that the destruction of embryos, artificial insemination by a doctor, and surrogate motherhood are mostly wrong. The dictionary defines a surrogate mother as “a woman who becomes pregnant usually by artificial insemination or surgical implantation of a fertilized egg for the purpose of carrying the fetus to term for another woman.”

In 1997 the European Ecumenical Commission for Church and Society [EECCS], a body of Protestant, Anglican, and orthodox churches, indicated in a position paper that in their ranks there are divided opinions on assisted reproduction.


Emphasizing that individual conscience and personal responsibility are involved, the paper stated: “The implication is that it is difficult to speak of ‘the’ position of the member churches of EECCS. There is, rather, a plurality of position.”


It is evident that opinions on assisted reproduction differ a lot. The UN World Health Organization admits that the field of assisted reproductive techniques “constantly challenges social norms, moral and ethical standards and legal systems.” What are some factors that people should consider before making a decision involving assisted reproduction? 

                                                            WHAT ARE THE RISKS

 

HUMAN ERROR: In the United States, the Netherlands, and Great Britain, fertility clinics have by mistake mixed up and embryos. In one case a couple got twins of another race, and in another case a woman gave birth to twins who were of two different races.

MULTIPLE BIRTHS: Studies have shown that multiple births –a result of multiple embryos transferred into a womb –increase the chances of premature birth, low birth weight, stillbirth, and long-term disability.

BIRTH DEFECTS: According to one study, children conceived through IN VITRO FERTILIZATION have an increased risk of birth defects, such as heart or kidney problems, cleft palate, and undescended testicles.

MOTHERS’ HEALTH: Complications from hormonal treatment or a multiple-fetus pregnancy increase the risks for mothers. 






                                    WHAT ARE THE ISSUES INVOLVED?
A basic factor to consider is the status of a human embryo. This relates to the crucial question, When does life begin –at conception or later on during pregnancy? The answer would certainly affect the decision that many couples make regarding treatment.

If, for example, they believe that life begins at conception, then there are some key questions that must be considered.

1.       Should the couple allow doctors to follow the common procedure of fertilizing more eggs than the one or more being inserted, thus, keeping a surplus stock of embryos for future use?
2.       What would happen to such stored embryos if the couple became unable or unwilling to have more children?
3.       What would happen to any stored embryos if the couple divorced or if one of them died?
4.       Who would shoulder the weighty responsibility for developing such embryos?

The issue of what is to be done with unused or stored embryos cannot be dismissed lightly. Legal guidelines in certain countries now demand that the couple present a written consent specifying how the extra embryos should be handled –that is, if they should be stored, donated, used for research, or allowed to perish.

Couples should be aware that in certain places it is ethically acceptable for a fertility clinic to destroy stored embryos without any written authorization if they have abandoned for more than five years. Today, hundreds of thousands of frozen embryos are stored at clinics worldwide.

Another factor to consider is that couples may be urged to donate unused embryos for stem cell research. The American Infertility Association, for example, has encouraged couples to make their unused stored embryos available for research.

One purpose of stem cell research is to find new ways of treating illnesses. But this field of research has been a subject of much controversy because the process of extracting embryonic stem cells essentially destroys the embryo.

New genetic technologies raise yet other ethical issues. Consider, for example, preimplantation genetic diagnosis [PGD]. This technique involves submitting embryos to genetic screening and then selecting the one –perhaps of the desired gender or free of a certain disease-causing gene –that is to be implanted into the uterus.

Critics warn that PGD could lead to gender discrimination or that it might eventually be used to let couples choose other genetic traits for their children, including hair or eye color. PGD raises the ethical question, What happens to the embryos that are not selected?        

                                         WILL THE MARRIAGE BOND BE AFFECTED?

When considering certain forms of fertility treatment, there is another aspect to consider. How would the use of a surrogate mother or donated sperm or eggs affect the marriage bond? Some techniques may introduce a third party [a donor] or even a fourth party [two donors] or fifth party [two donors, and a surrogate mother] into the childbearing process.

Regarding treatment that involves donated genetic material, the parties involved need to consider other factors too.

1.       What long-term emotional effects may such a birth have on the parents when only one of them –or neither –is the genetic parent?
2.       How will the son or daughter handle learning that his or her birth resulted from such an unusual form of conception?
3.       Should the child be informed about his or her parentage and be allowed to look for the biological father or mother?
4.       What are the moral and legal rights and obligations of the one or more individuals who donated genetic material?


                                                       WHAT ABOUT ANONYMITY

The policy in many countries is to keep donors anonymous. The Human Fertilization and Embryology Authority, which regulates the use of human reproductive material in Britain, explains: “Except where donation is intentionally between people known to each other, current and past donors will remain anonymous to the couples treated with their eggs or sperm, and to the children who may be born as a result of that treatment.”

However, this policy of anonymity is the subject of heated debate in some places. A few countries have changed their policy or laws accordingly. Those who are against the policy of anonymity emphasize that children must have a full sense of their identity.

A report says; “Over 80 per cent of adopted people search for birth relatives, many of them to help satisfy the long-standing curiosity about origins which most people share. Almost 70 per cent want to identify important background information about possible hereditary medical conditions of birth parents.”

Another report, based on interviews with 16 adults conceived by donor insemination, revealed that “many were shocked to discover their biological origins.” The report added: “Many of the children faced problems with personal identity and feelings of abandonment. There were feelings of deceit and mistrust towards the families.”
                                              
                                                      HOW WILL YOU DECIDE?

Medical science will no doubt carry the development of assisted reproduction even further. Some predict that in the future 30 percent of all babies born will be result of this technology. The debate over the ethical and moral issues involved will continue.