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Submitted by Dr. Hesham Al-Inany, M.D. Lecturer, Gynaecology
& Obstetrics dept. Kasr El-Aini hospital, Cairo University, Egypt.
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During Gamete Micromanipulation sperms are injected into an ovum to assist in
union of the gametes.
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The ethical aspects of gamete micromanipulation
There has probably been no medical procedure which has been examined
so carefully from the moral point of view as assisted reproductive technology
(ART) .
The ethical evaluation is influenced by many factors mainly the person,
religious authority, community, cultural background and the law. What
is ethically acceptable in one sitting or in one era may not necessarily
be acceptable in another sitting or era. There is a general opinion that
there is no moral problem intrinsic in the use of this process in the
gametes of husband and wife.
Leroy Walters (1987) summarized 85 reports from various countries which
show that ART is acceptable by committees representing countries all over
the world. One major document was issued in 1987 by the congregation for
Doctrine of the faith of the Vatican rejected ART on the grounds that
it involved a separation between "the goods and meaning of marriage" .
The separation of these two dimensions meant, according to Donum Vitae,
that procreation was deprived of its proper perfection, and was therefore
not in conformity with the dignity of the person. In otherwards, the child
must be conceived through an act of love and specifically through sexual
intercourse.
The Ethics Committee of The American Fertility Society replied to Donum
Vitae in a special supplement in the February 1988 issue of Fertility
and sterility published as part of volume 49. The Ethics committee found
that the conclusion reached by Donum Vitae was problematical, but it agreed
with the instruction that "the one conceived must be the fruit of his
parents love". The Committee could not understand how the conclusion was
drawn in Donum Vitae that this love must in all circumstances mean sexual
intercourse.
In the opinion of the American Fertility Ethics Committee, what happens
to "the goods and meaning of marriage" involves the total relationship
and not necessarily the individual act. The Committee pointed out that
human actions are often not ideal, and in that sense, are deprived of
their proper perfection. Such actions, however, are not necessarily morally
wrong.
Ethically the patient and her partner should be investigated according
to recent standards of investigations and the patient should have a condition
which necessitates the use of some technique of assisted reproduction.
The importance of the criteria just mentioned is to guard against the
excessive use of gamete microfertilisation without adequate investigation
and with assurance that simpler techniques are used prior to resorting
to the more complicated technique of micromanipulation.
There must be gamete laboratory and personnel efficient according to the
standards promulgated by the American Fertility Society. This is important
to provide for flexibility and therapy during the procedure so that the
best results can be gained.
The risk of chromosomal abnormality should be always considered during
the procedure. Male subfertility may be associated with a higher percentage
of chromosomally or genetically abnormal sperm. There is increased incidence
of spina bifida and transposition of the great vessels from babies born
after different techniques of ART in Australia and New Zealand. (Lancester
1987). This may be related to the high incidence of chromosomal abnormalities
seen in human eggs collected after ovarian stimulation, (Wramsby et al,
1987).
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Ethical aspects in human egg donation
Many in vitro fertilization programs in the United States and other
countries have begun to offer ovum donation to women unable to produce
a viable or healthy egg. Although currently experimental, egg donation
may soon be a medically viable option for the thousands of women who are
unable to provide genetically suitable oocytes for fertilization. Although
not likely to be as widely issued as donor sperm, many IVF programs will
offer the technique.
The ethical, legal, and policy issues presented by egg donation arise
from the separation of the female genetic and gestational bond, and from
the relative scarcity and inaccessibility of ova, as compared with sperm.
Although the gestating and rearing mother will not be the genetic mother.
and the genetic mother neither gestates nor rears, the resulting family
situation may lead to major problems for offspring, families, or donors.
The law is likely to recognize agreements to exclude the egg donor from
rearing rights and duties.
Several theoretical reasons have been advanced for discouraging the use
of extraconjugal gametes. It is said that their use violates the marriage
covenant wherein exclusive vows are exchanged. Furthermore, it is held
that the use of one extraconjugal gamete blurs the child's genealogy.
Egg donation does involve the possibility of greater risk for donors than
occurs with sperm donation, at least when donors are not also undergoing
IVF. Many people consider paying egg donors as morally offensive.
It is generally considered proper in donor programs to be sure that the
donor has been suitably screened for undesirable genetic traits and that
appropriate tests have been done to eliminate infection as AIDS.
Ethical aspects of cryopreservation
From the practical point of view, cryopreservation has proven to be
extraordinarily useful in improving pregnancy rates with assisted reproduction,
and in avoiding the complication associated with multiple pregnancies.
At the same time , it is possible to cryopreserve very early in development
fertilizing or fertilized eggs, which can be utilized at some time in
the future to achieve the reproductive goals of prospective parents.
It needs to be emphasized that long -term risks can not be fully assessed
at the present time. It seems that there is no increase in fetal anomalies
from cryopreserved prezygotes or preembryos, but obviously the assessment
of long-term risks cannot be ascertained.
It also needs to be clear that there are several issues related to the
disposition of unused cryopreserved preembryos which are of extreme importance.
Various catastrophes can happen, such as the death of prospective parents,
separation, divorce, and so forth.
It is very important to arrange for an agreement with prospective parents
prior to the cryopreservation to provide the ultimate utilization of the
cryopreserved material in the event that any one of a number of untoward
events might occur.
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