Repost of Initial Post: Ethical Concerns About Assisted Reproductive Technologies (ARTs)

It has been brought to our attention that our original post seems to have disappeared. We're not exactly sure where it went, so we're posting it again just to make sure that everyone can access it. Please see below for our original post. Thanks!


Assisted Reproductive Technology (ART) Background:

The science and study of ART began in the 1970’s with in-vitro fertilization (IVF) for women who couldn’t conceive. The first successful live birth through IVF was in 1978, and since then, the science has grown and evolved at an extraordinary level. There are many new ways that families can conceive a baby including artificial insemination, IVF, intracytoplasmic sperm injection, gamete intrafallopian transfer, zygote intrafallopian transfer, surrogacy, egg donation, and semen donation. Many different people use ART including single parents, infertile parents, and gays and lesbians. Many of these families simply cannot conceive, however others use it because they would like to screen for diseases and disabilities or choose the baby’s gender. This is possible through pre-implantation genetic diagnosis (PGD), and is often standard in many clinics.

Because ART is relatively new and a controversial subject, there is very little federal regulation on it. Some states regulate it, but regulations vary. Since there is little regulation, there is also little research on statistical information about it. It is estimated however that about 12% of women of childbearing age in the U.S. have used ART (Assisted), and there are over 400 fertility clinics in the U.S. (Pertman). Costs for ART are high, ranging from $10,000 to $14,000 per cycle plus even more for birth complications. It is common for most women to have to go through more than one cycle because of complications, which adds on to the costly bill. Also, “in 2000, 35% of all live births resulting from ART were multiple births” (Assisted). ART is covered by some insurance policies, however, only the most expensive health insurance plans which excludes individuals from lower classes. There are also no legal regulations of these insurance policies to prevent discrimination, however, it seems that if you have the money, you can find a way to get it done. Since there are limited regulations, it was difficult to find age limits for ART. However, on most of the clinical websites, the age limit for women to use their own eggs is 45, we could not however find any listed age limits for women using donated eggs.


A Trend in Older Women Having Babies, Using ART:

As we have learned in our Sociology class, there is a trend of women marrying at later ages and as a result, having children at later ages. This is because there are more opportunities for women now. They are going to college, and graduate school, and starting their careers instead of getting married right out of high school. The only problem with this, is that women are not biologically designed to have children at these later ages. After age 30, the probability of having a baby decreases 3.5 percent per year. The probability of miscarriage increases significantly along with the chance of having a baby with chromosomal disorders (Aging). Even with the help of IVF, chances of an older woman giving birth are quite low. There is only a 10 percent pregnancy rate for women over the age of 40 with IVF, using their own eggs. This is why many clinics set an age limit of 45 years for women using their own eggs with IVF. However, if these same women use donor eggs, their chances increase to 65 percent. The need for a use of donor eggs has lead to another trend in women freezing their own eggs while they are young and healthy, so that they will be able to use them when they are ready to have a baby. One also needs to take into consideration the dangers and health complications that come with older women giving birth. For example, they are more prone to heart disease. Egg freezing is still in the experimental stage, so it is suggested to only women who have no other options, however, many women who are worried about their biological clock are looking more and more into the procedure. It brings up the concern over whether or not older women have the stamina to raise children, and what it is doing to our families.


IVF and the Risk of Multiple Births:

In the past two decades, the number of twin births in the United States has increased 50 percent and the number of higher order multiple births (triplets, quadruplets, etc.) has increased by 100 percent, while single births have only increased by 6 percent. This dramatic rise in the rate of multiple births is primarily due to the increasing use of assistive reproductive technologies such as in-vitro fertilization. IVF has an average success rate of less than 30 percent, decreasing further as maternal age increases. In order to increase the chances of a successful pregnancy, usually more than 1 embryo is transferred to the uterus, increasing the risk of a multiple birth. IVF increases the likelihood of a multiple birth by 20 percent, and studies have shown that 45 percent of all IVF births are multiple. Multiple births increase the risk of complications such as premature delivery, low birth weight, fetal and infant death, pre-eclampsia, gestational diabetes, and caesarean section. Often times when there are three or more fetuses, one or more of them are eliminated through a process called reduction to augment the chance of healthy development of the others.

In June 2006, the American Society for Reproductive Medicine recommended that doctors only transfer one embryo for women under age 35. However, countless women undergoing IVF treatment still insist on the transfer of multiple embryos. In many cases, the cost of IVF is not covered by medical insurance, and after enduring painful procedures and spending $10,000 plus, most women would rather risk a multiple birth than risk a failed attempt at pregnancy. Experts believe that the biggest obstacle in reducing the number of multiple births is the lack of insurance coverage. In Europe, most IVF is covered by national health insurance, resulting in more instances of single-embryo transfer and higher success rates.


Ethical Issues Surrounding Preimplantation Genetic Diagnosis (PGD):

In assisted reproductive technology doctors perform a preimplantation genetic diagnosis with the fertile egg. There are two things that doctors test to discover different diseases, chromosomal analysis to assess the number or structure of chromosomes present in the cells; and DNA analysis to detect specific gene mutations. With this testing parents are able to pick the eggs that have no diseases, or eliminate the eggs all together if all have mutations.

There are many different questions that arise from preimplantation genetic diagnosis. One of the main ethical issues involves whether and under what circumstances the use of PGD is acceptable. In PGD the creation and mostly destruction of human embryos becomes a huge issue for some people. When searching for disease like Huntington Disease that does not affect the person until later in life, should the embryo be destroyed when they have decades to live unaffected by this disease. Also should embryos be destroyed if they have a certain genetic mutation that could cause a certain disease but may also be nothing? In the future parents may have the ability to decide what their child will look like, musical talents and creativity just to name a few. This would cost a great deal of money and would eventually lead to upper class having a greater advantage because it costs so much money. These ethical issues are just a few that come from preimplantation genetic diagnosis.


Assisted Reproductive Technologies and Sex Selection:

Throughout history many adults have preferred a specific sex for their child, for a variety of reasons, and have tried a number of non-medical means in order to conceive a child of their desired gender. For many people, this desire still exists, but now the practice is scientifically feasible. Originally, sex selection was intended for and limited to future parents who wanted to choose the sex of their child for medical purposes. For example, certain genetic diseases are sex-linked, so families with a known history of a particular sex-linked disease can choose the gender not related to that disease in order to prevent that specific disease from being passed on to their child. Another reason that parents may wish to choose a specific gender for their child is for the purposes of “family balancing,” which is a term for adults who select a particular sex because they already have at least one child and want to control the number of male and female children that they have. However, in the United States, unlike in some other countries, there are no laws that dictate the conditions in which one can choose the sex of their child. Therefore, anyone in this country, who has the appropriate resources, can choose the sex of their child for any reason.

There are three ways to select the sex of one’s future child: preimplantation genetic diagnosis (PGD), various sperm-sorting techniques, and genetic engineering. PGD, an in vitro fertilization technique, is the most effective (and the most expensive) method of selecting the sex of one’s child, as it has a 100 percent success rate. PGD is now being used by some doctors to screen out chromosomally abnormal embryos in an attempt to make IVF pregnancies as successful as possible. In addition to detecting chromosomal abnormalities and serious genetic diseases, PGD can determine the sex of an embryo. Consequently, once the unhealthy embryos are eliminated from the picture, future parents are typically allowed to choose the sex(es) of the embryo(s) that they want to transfer. Therefore, some people consider it to be morally acceptable for infertile couples who are undergoing IVF to select the sex of their child, but, they cringe at the idea of couples undergoing PGD for the sole purpose of selecting the sex of their child.

Sperm-sorting technologies, such as flow cytometry and MicroSort, work by separating X-bearing sperm from Y-bearing sperm. This can be done in a number of ways including separation by weight (X-bearing sperm are slightly heavier than Y-bearing sperm) and through the use of DNA-specific dye. Sperm-sorting technologies are less expensive than PGD, but they are also less effective; it typically takes more than one attempt for a pregnancy to occur and it is less likely that parents will end up with a baby of their desired sex.

Genetic engineering is different from both of the previously mentioned sex selection methods because it is not currently being used for sex selection. However, scientists believe that in the near future it will be possible to use this method to directly manipulate the sex of an embryo.

There are many ethical issues surrounding the use of ARTs for sex selection. Several of these ethical issues involve social justice. For example, gender biases may be reinforced because offering parents the means to choose one sex over the other suggests that one is superior. This sense that one sex is better than the other may create an even greater social divide between the sexes and may even lead to sexism. Another problem is the destruction of human embryos. To people who believe that embryos are people, destroying an embryo is essentially the same as killing a person. People opposing sex selection are troubled that embryos created for PGD, that are not of the desired sex, may be discarded for the sole reason of being male or female. Furthermore, access to sex selection through ARTs is unequal. Every type of sex selection method is expensive and time consuming, and they are typically not fully covered by insurance plans. Therefore, it is mostly wealthy, upper-class parents who are able to choose the sex of their children.

Another key ethical issue is that sex selection may create a sex ratio imbalance which could lead to further ethical and societal problems. In addition, choosing the sex of one’s child may negatively influence the child, such as in the case that the child does not meet his or her parents’ possibly gender-stereotyped expectations. Lastly, the practice of sex selection through ARTs brings to the forefront the slippery slope argument. If we’re choosing the sex of our children now, what genetic traits will be choosing in the future? How far is too far when it comes to choosing the genes of another human being?


Questions: (Please include the question number in your response.)

1. How do you feel about women having babies abnormally later in life? How do you think it will affect the family in either positive or negative aspects? Do you think that egg freezing should be an option for all women, or just those that have no other options, for example, recovering cancer patients?

2. Should medical insurance companies be required to cover IVF in order to reduce the risk of multiple births? In your opinion, what would be the ethical implications of such a policy? Is there an alternate solution to reducing the number of multiple births in IVF treatment?

3. How do you feel about PGD? Do you agree with preimplantation genetic diagnosis? How do you think this process is going to affect the future of our society?

4. Do you think that sex selection through the use of ARTs should be legal? Why or why not? If you think it should be illegal, are there any extenuating circumstances in which it should be legal? Also, if sex selection continues to be legal in the U.S., how do you think it will affect the family and society?


- Brianne Caira, Christina Comeau, Julie Conton, and Amy Diamond


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References:

Assisted Reproductive Technologies in the U.S. Retrieved on February 26,2009 from, http://www.religiousinstitute.org/documents/ARTsintheU.S.andEconomicJustice.pdf

Aging and Reproduction (March 2008). Retrieved on February 26, 2009, from http://www.ivf1.com/aging-reproduction/

Black, C. (August 2007). Women freeze eggs to have babies later. Retrieved on February 26, 2009 from http://seattlepi.nwsource.com/health/328287_frozenegg20.html

Hollingsworth, L.E. (2005). Ethical considerations in prenatal sex selection. Health and Social Work, 30 (2), 126-134. Retrieved February 26, 2009, from MEDLINE.

Kalb, C. (2004, January 26). Brave new babies. Newsweek, 45-53.

Koster, O., & Wheldon, J. IVF rush by over-40s. Retrieved on February 26, 2009 from, http://www.dailymail.co.uk/health/article-336030/IVF-rush-40s.html

Liao, S.M. (2005). The ethics of using genetic engineering for sex selection. Journal of Medical Ethics, 31 (2), 116-118. Retrieved February 26, 2009, from MEDLINE.

Sample, I. (November, 2006). Test helps older women decide about IVF treatment. Retrieved on February 26, 2009 from, http://www.guardian.co.uk/science/2006/nov/17/lifeandhealth.familyandrelationships