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The ethical aspects of gamete micromanipulation

Author: Dr. Hesham Al-Inany, MD | Submitted: March 28, 2002. Updated: September 21, 2009.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

 

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ABSTRACT: Assisted reproductive technology (ART) is probably one of the most studied medical procedures from the moral point of view. Gamete micromanipulation involves new possibilities as well as new challenges.

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 summarized 85 reports from various countries which show that ART is acceptable by committees representing countries all over the world [1]. 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" [2].

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 [3]. 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. This may be related to the high incidence of chromosomal abnormalities seen in human eggs collected after ovarian stimulation [4].

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.

Conflict of interest statement

None.

CITE THIS ARTICLE:
Dr. Hesham Al-Inany, MD. The ethical aspects of gamete micromanipulation. Doctors Lounge Website. Available at: http://www.doctorslounge.com/index.php/articles/page/296. Accessed December 22 2014.

References



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