What Are the Implications of All of This?

All of the aforementioned ethical principles come up when considering the quandaries that arise during the processes involved in ART.  This list explores many ethical dilemmas, but by no means covers every one:

Posthumous Reproduction
Once it became known that it was possible to cryopreserve (or freeze) sperm for later use, people began to implement this technology for many purposes beyond the sperm bank.  Today, the death of a husband or partner before procreation is less devastating for a wife or significant other because it is possible to procure sperm posthumously.   Techniques such as stimulated ejaculation, microsurgical epididymal sperm aspiration (MESA), or testicular sperm extraction (TSE) can be employed to procure sperm from a dead or brain dead individual.  Technology is also being developed so that ova may be cryopreserved as well.  These techniques are also very useful for couples where the husband is undergoing chemotherapy and wishes to preserve his sperm beforehand in case of sterility.  However, once they are used to bring the child of a dead partner into the world, the legal borders become very blurred.


Oocyte Donation to Postmenopausal Women
The central ethical issue in this case is whether the interests of women and children are served by technology that allows women to conceive postmenopausally.  In many cases, a woman who has lost a child or who has never had a child will wish to have a child late in life.  There are mixed opinions on whether or not this is ethically sound.


1)  Parenting is highly stressful both emotionally and physically, and there is an age at which people are more fit to
     be parents.  Older women and their partners may not be able to meet the overwhelming demands of rearing a
     young child, or even a teenager.

2)  Children are also being successfully raised by teenage mothers, this does not mean that teenage pregnancy
     should be encouraged for physicians.

3)  In postmenopausal pregnancy a woman faces greatly increased medical risk of hypertension, diabetes, multiple
     gestation, preterm labor, preeclampsia and other complications associated with pregnancy and childbirth.
     There are no tests to detect the propensity of an older woman to develop hypertension.

4)  The possibility of multiple gestation as the result of IVF or GIFT also poses great ethical and physical

Current policy on oocyte donation to postmenopausal women is made on a state-by-state basis.  Currently ____ out of 50 states have legistaion on postmenopausal oocyte donation.

Multiple Gestation

There are many situations in ART that call for administering drugs that cause superovulation (the release of a large number of eggs during the monthly cycle), and this often brings with it associated moral dilemmas.  Sometimes, when fertilization cannot be achieved naturally, a large number of eggs are deliberately released in order to provide greater probability of success for in vitro fertilization or GIFT. Suddenly, prospective parents may be faced with the problem of either what to do with the many fertilized eggs awaiting implantation, or how to deal with  carrying eight or nine fetuses.

A multi-fetal pregnancy creates a physical danger to both the mother and future children. The larger the number of embryos, the greater the likelihood that the pregnancy will terminate prematurely, leaving the babies in danger of physical and mental damage.  If some of the embryos are aborted the others stand a better chance of surviving, developing normally, and being carried to term. But, if fertilization is to occur in vitro, successful implantation often requires fertilizing many embryos, implanting a number of the healthy ones (not all will implant), and facing the problem of what to do with the "excess" others.

Current medical practice is to implement a multi-fetal pregnancy reduction (MPR). In this procedure (originally called selective abortion or selective termination), a needle is inserted into the mother's womb early in the pregnancy and, guided by ultra-sound, some of the fetuses are killed. It is impossible to "select" the most viable or healthy of the embryos at this early stage of the pregnancy, and the selection is indeed a matter of chance.  How this process effects the parents emotionally should also be factored in when thinking about the ethical implications of this procedure.  As with all other cases of abortion, even if the children that result from this procedure are everything the parents ever dreamed of, those fetuses that never came to term will always pose the question of "what if?"


The American Society for Reproductive Medicine issued new recommendations for embryo transfer in IVF procedures.  The ASRM Practice Committee report recommends that in patients with the most favorable prognosis, no more than two high-quality embryos should be tranferred during IVF.  The number of embryos recommended to transfer increases for patients with worsening prognosis because they have a higher likelihood of miscarriage.

Genetic Discrimination

Advances in medical technology help to predict genetic predisposition for disease; however, results of genetic tests can also be used for purposes of discrimination.  The more we are able to tell about a person's genetic makeup, the more we are able to discriminate against.  In the past, genetics was focused on discovering those single-allele genetic diseases that could be diagnosed with certainty.  These are diseases like Huntingtonís, Cystic Fibrosis, certain forms of Alzheimerís, Sickle Cell Anemia, and Duchenne Muscular Dystrophy.

Today, we have reached a point where we are able to test for multiple-allele genetic diseases that are much more common, such as asthma, arthritis, diabetes and many forms of cancer.  The difficulty with these tests is that they do not give a 100% positive result, but instead show the probability of developing the disease.  Many of these diseases have either no treatment or, in the case of cancer, very expensive treatments.  Thus many patients are reluctant to get tested for these more common diseases for fear that the results will be used against them.  Many insurance companies or employers will discriminate against people based on how much their conditions might cost many years down the line, even if they are healthy today.

Many infertile couples would be able to bypass this issue by using pre-implantation genetic testing to determine whether a fetus has a genetic defect and only implanting those fetuses that were unaffected.  A routine practice with IVF is to create multiple embryos in a lab, perform biopsies on them, and then implant only those with no indication of a genetic defect. This practice has elements of eugenics, the science of creating or breeding genetically superior humans. Eugenics was what spurred the genocide of the Holocaust.

Discriminating against disabled embryos is ethically murky because the severity and nature of a genetic disease cannot truly be realized until a person has been allowed to develop.  However, if parents are going to worry about genetic defects of fetuses conceived using donor eggs and sperm, then donors should be screened before they are allowed to donate.  That, in itself, is a form of discrimination.  It's a never-ending cycle.


Frozen Embryos
Often couples will leave the "extra" embryos that result from the early stages of IVF treatment cryopreserved for later use or will choose to donate them to other couples.  This is a good idea in theory, but many couples will leave their embryos stored indefinitely and this brings up the ethical question of to whom these embryos belong.  Often a couple will leave the frozen embryos in storage for inordinate lengths of time.  In these cases, do the fertility programs have the right to dispose of the embryos?  Also, what guidelines exist for the donation of frozen embryos to other couples who are attempting to conceive?


In cases where couples have signed informed consent forms and are willing to donate their cryopreserved embryos to other couples, the American Society for Reproductive Medicine has issues guidelines to help facilitate embryo donation.  These guidelines state that all "parents" of donated embryos must be:
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