The term assisted reproductive technology refers to treatments used to assist people in achieving a pregnancy(Types of assisted reproductive treatment, 2016). The increasing uses and applications of genetics knowledge and reproductive science in society both provide benefits for individuals and populations and raise social, economic, legal and ethical questions about assisted reproductive technologies challenge social and ethical norms. The further study on assisted reproductive technologies not only benefits thousands of people but also raises huge ethical and legal dilemma’s within society.
Biological concepts:
The reason for Assisted reproductive technologies is due to sub-fertility which is any form of reduced fertility with prolonged time of unwanted non-conception ( C. Gnoth E. Godehardt P. Frank-Herrmann K. Friol Jürgen Tigges G. Freundl, 2005) and infertility which is defined as the inability to conceive or carry a pregnancy after a year of unprotected sex. The causes may relate to production of the sperm or eggs, function of the male or female reproductive systems, other health issues or be unexplainable (telethon kids institute, 2018). Some studies have also concluded that infertility can also be caused by age in both women and men. A study conducted on maternal age and foetal loss found that “natural ageing of mitochondrial and nuclear DNA contributes to the degeneration of follicles and oocytes at a rapid rate after the age of 38 years. This results in failure of fertilisation and implantation and an increasing risk of miscarriage as well as an increased risk of genetic abnormalities” (Nyboe Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. ,2002).
The types of technologies available include: – Ovulation induction
– Artificial insemination
– donor conception
– In-vitro fertilisation
– Gamete intrafallopian transfer
– Intracytoplasmic sperm injection
– Preimplantation genetic diagnosis- – Surrogacy
– Blastocyst transfer
The most common technologies are IVF or in-vitro fertilisation and pre-implantation genetic diagnosis. IVF is a procedure, used to overcome a range of fertility issues by joining an egg and sperm outside of the body allowing the fertilised egg to grow in a protected environment for a few days before being transferred into the woman's uterus which can increase the chance of pregnancy(IVF treatments, 2018) whilst pre-implantation genetic diagnosis is a procedure used prior to implantation to help identify genetic defects within embryos. This serves to prevent certain genetic diseases or disorders from being passed on to the child.(Preimplantation genetic diagnosis, 2018). While IVF is a technique used to transfer fertilised eggs back into a mother, preimplantation genetic diagnosis is a way to screen and test for any defects in the fertilised eggs before being transferred. IVF and Pre-implantation usually are paired together when using assisted reproductive technologies to ensure that the patients all get the best results and have a higher chance of fertility. A recent study conducted by US journal Fertility and Sterility researchers at Yale University School of Medicine found that “of every 100 eggs fertilised in an IVF laboratory, only 5 will become live births”, which means that 95% of IVF embryos either die in the petri dish, the womb or are discarded (Cook. M, 2009).
Conducted studies:
There are many reasons for reproductive technologies but a main reason is age in both males and females.The study conducted wanted to estimate the association between maternal age and fetal death (spontaneous abortion, ectopic pregnancy, stillbirth), while taking into account a woman's reproductive history(Nyboe Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M.,2002). The subjects of the study included all women with a reproductive outcome (live birth, stillbirth, spontaneous abortion leading to admission to hospital, induced abortion, ectopic pregnancy, or hydatidiform mole) in Denmark from 1978 to 1992 with a total of 634 272 women and 1 221 546 pregnancy outcomes(Nyboe Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M.,2002). The results of the study found that overall, 13.5% of the pregnancies intended to be carried to term ended with fetal loss. At age 42 years, more than half of such pregnancies resulted in fetal loss. The risk of a spontaneous abortion was 8.9% in women aged 20-24 years and 74.7% in those aged 45 years or more. High maternal age was a significant risk factor for spontaneous abortion irrespective of the number of previous miscarriages, parity, or calendar period. The risk of an ectopic pregnancy and stillbirth also increased with increasing maternal age(Nyboe Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M.,2000).
Another study conducted tested In vitro fertilisation with preimplantation genetic screening. “Pregnancy rates in women of advanced maternal age undergoing in vitro fertilization (IVF) are disappointingly low”(Mastenbroek S, Twisk M, van Echten-Arends J, 2007). It has been suggested that the use of preimplantation genetic screening of cleavage-stage embryos for aneuploidies may improve the effectiveness of IVF in these women. The results of the study found that four hundred eight women (206 assigned to preimplantation genetic screening and 202 assigned to the control group) underwent 836 cycles of IVF (434 cycles with and 402 cycles without preimplantation genetic screening). The ongoing-pregnancy rate was significantly lower in the women assigned to preimplantation genetic screening (52 of 206 women [25%]) than in those not assigned to preimplantation genetic screening (74 of 202 women [37%]; rate ratio, 0.69; 95% confidence interval [CI], 0.51 to 0.93). The women assigned to preimplantation genetic screening also had a significantly lower live-birth rate (49 of 206 women [24%] vs. 71 of 202 women [35%]; rate ratio, 0.68; 95% CI, 0.50 to 0.92),(Mastenbroek. S, Twisk. M, van Echten-Arends. J, 2007). This states that preimplantation genetic screening did not increase but instead significantly reduced the rates of ongoing pregnancies and live births after IVF in women of advanced maternal age (Mastenbroek. S, Twisk. M, van Echten-Arends. J,2007).
Why should members of the public support assisted reproductive
technologies?
There are more benefits using ART than disadvantages or defects as the process is safe and has proven helpful since 1978 when Louise brown was conceived through IVF. Some reasons for members of the public to support ART are blocked tubes, male infertility and older patients with low ovarian reserve. Women who have blocked or damaged fallopian tubes can use IVF procedure as said by Prof. Campbell. S, “to provide the best opportunity of having a child using their own eggs”(Prof. Campbell. S, 2014). With older patients who have low ovarian reserve, “IVF can be used to maximise the chance of older patients conceiving”. Prof. Campbell. S, states that his clinic “use Natural IVF to focus on quality of eggs, rather than quantity” to insure that patients have the best chance of reproduction, (Prof. Campbell. S, 2014). Also males who have a high infertility rate will have a better chance of conceiving through IVF rather than naturally due to the rate of which his sperm is either healthy or defective. Prof. Campbell. S also states that by using “intra-cytoplasmic sperm injection (ICSI)” they have a better chance at fertility(Prof. Campbell. S, 2014). There are many more reasons to support ART so that the future of ART can grow and produce more lives to enter this world.
The disadvantages of ART and techniques such as IVF:
The disadvantages for IVF include side effects and risks of treatment, multiple births as well as ectopic pregnancy. Some risks of medical treatments such as IVF comes with a “small chance of developing side effects, the most severe of these being severe ovarian hyper-stimulation syndrome (OHSS)”(Prof. Campbell. S, 2014). According to Prof. Campbell the use of little to no drugs in natural and mild IVF cycles means that the small percentage of developing unwanted risk
of OHSS is “dramatically decreased or eliminated”(Prof. Campbell. S, 2014). Multiple pregnancy is another risk factor or disadvantage of IVF because more than one embryo is inserted back into the uterus which can lead to a higher possibility of multiple pregnancies with a low percentage around “20-30%” of IVF multiple pregnancies (Prof. Campbell. S, 2014). Multiple pregnancies can create an increased chance of “premature labour, miscarriage, need for caesarean, stillbirth and infant health problems” as stated by Prof. Campbell. S. The last disadvantage that is of a great concern to little people is ectopic pregnancy. With IVF treatment, the risk of an ectopic pregnancy doubles, to 1-3%, particularly in women with damaged fallopian tubes.(Prof. Campbell. S, 2014). Although the disadvantages seem more prominent and overwhelming, medical clinics are able to use tests such as Preimplantation genetic diagnosis to see whether the fertilised egg is healthy enough to be placed back into the uterus.
The ethical, legal and social considerations of ART:
Some of the reasons ART has been criticised against is due to Ethical, legal and social considerations surrounding the issue.
– politics of the embryos and what to do with the unused ones, there are many issues about the politics of the embryos and their treatment.
The ethical issues are:
– Can’t dispose of embryos without couples consent, written consent has to be received before further disposal of embryos can occur.
– Third party reproduction, when another person enters into the babymaking mix, it involves risks and raises many important ethical concerns(OBOS Infertility contributors,2011)
– Wasted fertilised eggs, “95% of IVF embryos either die in the petri dish, the womb or are discarded” (Cook. M, 2009).
The legal issues are:
– Can’t dispose of embryos without couples consent
– Practitioners can be caught for misrepresentation and failure to get informed consent, some
practices may form the basis for legal claims of misrepresentation and failure to obtain
informed consent (Assisted reproduction technologies- legal considerations, 2010)
– Donors name must be kept confidential due to moral responsibility, this is the basics of legal
considerations
– Constrains the exercise of discretion by physicians in their selection of patients
The social issues are:
– Religious traditions don’t support ART due to same-sex couples having children unnaturally – feminists don’t accept the ethical issues around ART
– Donors name must be kept confidential due to moral responsibility
(Assisted Reproductive Technologies – Ethical And Religious Perspectives On Arts, 2010)
Conclusion: In conclusion, ART are very effective procedures even though 95% of fertilised eggs are disposed off after IVF (Cook. M, 2009), but the results allow those who can’t have children naturally through many different procedures such as Ovulation induction, Artificial insemination, donor conception, In-vitro fertilisation, Gamete intrafallopian transfer, Intracytoplasmic sperm injection, Preimplantation genetic diagnosis, Surrogacy and Blastocyst transfer. All well tested procedures that have high birth rate which is wanted when couples have experienced Infertility