Infertility: Biological, Social and Ethical Concerns with In Vitro Fertilization

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Introduction

In Vitro Fertilisation (IVF) is a procedure than has been gaining popularity in the last 40 years. It has allowed more than 8 million babies to be born that would have otherwise not been due to infertility, and involves the joining of an egg and sperm in a specialised laboratory environment. The fertilised egg or embryo is grown for several days before being transferred into the mother or surrogate’s uterus in the hopes that it will successfully attach to her uterine lining. The first successful case of IVF was in 1978 after the birth of Louise Brown, and ever since advanced fertility treatments have been growing in popularity.

Although IVF is used to overcome the often depressing and degrading issue of infertility, it can also negatively impact society, the offspring of even the parents in the process. These issues and more will be discussed in the following report.

Figure 1: Graph to show pregnancy rate through IVF in Australia https://www.ivf.com.au/sites/default/files/images/1st_pic.png

Biological Process

IVF is an extensive process and begins by the mother being prescribed fertility medications for several months to allow her ovaries to produce several eggs ready for fertilization. This process is called ovulation induction. Once enough mature eggs have been produced, a doctor will remove them in a process called egg retrieval through a minor surgical procedure. The eggs are them mixed with sperm cells from the mother’s partner or donor in a laboratory through insemination. Fertilization then occurs. In some cases, sperm that have a lower motility may be directly injected into the eggs to further promote fertilization. The cells in the fertilized eggs then divide and become embryos. 3-5 days after the egg retrieval, 1 or more embryos are placed into the mother’s uterus through embryo transfer. If any of these embryos attach to the lining of the uterus pregnancy will occur.

Figure 2: Image to show the process of IVF http://www.ocfertility.com/wp-content/uploads/2018/10/IVF-graphic-1a.jpg

IVF can be used for couples who experience:

Fallopian tube damage or blockage
A genetic disorder
Unexplained infertility
Impaired sperm production or function
Previous tubal sterilization or removal
Uterine fibroids (benign tumours in the wall of uterus)
Endometriosis
Ovulation disorders

Risks can include:

Multiple births (resulting in low birth weather and/or early labour)
Premature delivery and/ore low birth weight
Ovarian hyperstimulation syndrome (ovaries become swollen and painful)
Miscarriage
Ectopic pregnancy (egg implants outside uterus, e.g. in the fallopian tubes)
Birth defects
Cancer

Biological, Social and Ethical Concerns with IVF

Biological issues

IVF has allowed millions of previously infertile couples to have children, and in doing so may have negatively impacted human evolution. From a biological point of view, a couple who is infertile will cease to have children, and this has the ability to either lower or maintain a population’s numbers. By bypassing this biological issue, more and more children are being born and this has the ability to dangerously contribute to overpopulation.

Another issue associated with IVF is genetic alterations. Although it is not common, being able to choose which embryos are implanted into the mother or surrogate allows – in some situations – for the parents to customise their child. They may be able to select their gender, presence of certain illnesses, or even specific physical traits. This ability to manipulate the genes of a child is incredibly dangerous, and if allowed it may make way for a society of carefully designed and perfected offspring who will know only perfection.

Social issues

One of the main social issues associated with IVF is the presence of religion in one’s life. According to a report published by the Pew Research Center in 2012, more than eight-in-ten people in the world identify with a religious group. The most common religions being Christians, Muslims, Hindus, Buddhists among many others. The following table constructed by the Pew Research Center reflects the percentage of each religion followed compared to the world’s population at the time (2012). Those under the category ‘unaffiliated’ did not register as following any particular religion.

Table 1: Table to show percentage of followers of major world religions in 2012 conducted by the Pew Research Center.

Of these most common religions, only some allow the use of IVF. For example, those who consider themselves a Jew, are allowed to participate in IVF as they are obligated to “be fruitful and multiply”. However, for those who are a part of the Catholic church, assisted reproduction is prohibited as it separates procreation and sexual normal function (Pope Pius XII, 1956). “Children are a gift and a blessing from God and that although science makes some things possible it does not make them right.”

Another social issue is how legality effects the process of IVF. In Australia, legislative changes have recently been made to allow access to IVF to be much more streamlined. A focus has been put on abolishing discriminatory barriers for those in same sex relationships, and those who are infertile. However, this process has not been so easy all over the world. One of the main legal difficulties with IVF is the ownership of remaining embryos not used by the couple. For example, in 1981 an American couple went through the IVF process in Australia with help from an anonymous sperm donor. Two embryos were placed in cryopreservation, however the couple died in a plane crash in 1983 without ever leaving a will. This is where the main issues first arose, as the embryos no longer had an owner, as they could equality be the property of the surrogate, the sperm donor or even an adoptive father and mother. Another issue is that this couple were incredibly wealthy, so these embryos had the possibility of inheriting millions of dollars. Issues like this are becoming more and more common with the increasing popularity in IVF, and generally stem from the ownership of an embryo.

Ethical issues

One of the most often talked about factors of IVF is its ethicality, as there will always be superstition around new and transformative discoveries. One of the main questions is about harm, and what may come of the embryo/child, parent or even society.

A popular query is whether an embryo can be considered as a ‘person’, and whether destroying or donating them is ethical. If the embryo is considered human, destroying it is illegal as it’s considered as murder, but if it is only considered as protoplasm (material of a living cell) there is no harm in destroying it. Personhood is merely a social construct and although many have attempted to pinpoint it’s exact occurrence it is currently impossible. Some consider personhood to begin at conception while others believe it’s at birth, this is why it’s such a hard moral issue to solve.

Another question of ethicality is whether the IVF process is safe for the mother, whether it be a surrogate or not. During IVF, multiple embryos are placed inside the mother to increase the chance of offspring successfully developing, however this can also lead to multiple pregnancies which can take a toll on her health. And in more serious cases, there is a slight increase of fatalities compared to natural pregnancies. In a report by Susan Bewley, an obstetrician at Kings College in London, 42 deaths were recorded after 100,000 IVF pregnancies while only 6 deaths were seen among 100,000 natural pregnancies in the general population.

One final issue is the effect that IVF can have on the community surrounding the infertile couple. One might argue that financial resources needed to support ill citizens in society are being wasted with IVF on a couple who are biologically not expected to reproduce.

Opinion and conclusion

It is clear to see that IVF has the ability to change the lives of couples living with the disappointment of infertility. Although it is constantly criticised for its controversial nature, it cannot be ignored that in vitro fertilization can be a life changing miracle. IVF has become incredibly successful, and although some believe it could lead to a change in mankind’s evolution, it is most definitely not a big issue in perspective. It is issues like climate change and global warming that are posing the biggest threat to humankind, and if IVF can bring hope and joy to families across the world, then why not let it?

References:

Hanevik, H., Hessen, D., Sunde, A. and Breivik, J. (2019). Can IVF influence human evolution?: Table I. https://academic.oup.com/humrep/article/31/7/1397/1749729
HN Sallam, N. (2019). Religious aspects of assisted reproduction. [online] PubMed Central (PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096425/ [Accessed 13 Oct. 2019].
CultureWatch. (2019). IVF and Legal problems – CultureWatch. [online] Available at: https://billmuehlenberg.com/2014/09/16/ivf-and-legal-problems/ [Accessed 13 Oct. 2019].
WebMD. (2019). Do IVF Pregnancies Raise Death Risk for Mothers?. [online] Available at: https://www.webmd.com/infertility-and-reproduction/news/20110127/do-ivf-pregnancies-raise-death-risk-for-mothers [Accessed 16 Oct. 2019].
Plannedparenthood.org. (2019). What Is In-Vitro-Fertilization (IVF)?. [online] Available at: https://www.plannedparenthood.org/learn/pregnancy/fertility-treatments/what-ivf [Accessed 16 Oct. 2019].
Amnon Goldworth. The Ethics of In Vitro Fertilization [online] Available at: https://pedsinreview.aappublications.org/content/20/8/e28 [Accessed 16 Oct. 2019}

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