Académique Documents
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Reproduction
• These include:
• In vitro fertilization (IVF)
• Gamete intrafallopian transfer (GIFT)
• Zygote intrafallopian transfer (ZIFT)
• Intracytoplasmic sperm injection (ICSI)
• Surrogacy
What Exactly is Infertility?
• Definition has evolved over the years.
• Prior to 1975, a couple was declared infertile when the woman did not
conceive after five years of unprotected coitus.
• In 1975, the World Health Organization reduced the time to two years
and
• Conclusion
• Increased investment in health care
• Reduction of the cost of ART
• Prevention of infertility.
Issue 2: Is ART ethical?
• Culture and Religion has the strongest impact on humans perspective of live.
• Major religions and their view on ART:
• The Catholic Church deems certain fertility methods immoral. In 1987, a document
entitled Donum Vitae (The Gift of Life), issued by the Congregation for the Doctrine of the
Faith.
• The Church does not accept IVF as a fertility method as it involves practices that not only
undermine the sanctity of life, but also replace the sacred procreative marriage act in the
bringing forth of life.
• IVF procedures often involve the deliberate discarding of embryos that show little promise
of surviving to term. This means that human life is potentially treated as a mere defective
commodity at its earliest developmental stages, and terminated.
• It is also clear that IVF replaces the marriage act with a laboratory procedure to engender
life. The husband and wife merely provide the “raw materials” – the eggs and sperm.
• Worse still, if “donor” eggs or sperm are used, the child is subsequently unaware of his or
her lineage, which could result in them lacking knowledge of possible inherited health
problems, or even the potential for siblings to unknowingly commit incest.
Issue 2: Is ART ethical? Contd
• Islam
• The basic concept in Islam is to avoid mixing genes, as Islam enjoins the purity of genes and
heredity. It deems that each child should relate to a known father and mother. Adoption is
not allowed, as it Implies deceit of children about their true genetic linkage and hereditary
• Since marriage is a contract between the wife and husband during the span of their marriage,
no third party intrudes into the marital functions of sex and procreation. A third party is not
acceptable whether he or she is providing a sperm, ovum, an embryo or a uterus- Donor not
allowed
• If the marriage contract has come to an end because of divorce or death of the husband,
artificial reproduction cannot be performed on the female partner even using sperm cells
from the former husband
• Cryopreservation : The excess number of fertilized ova (pre-embryo) can be preserved by
cryopreservation. The frozen pre-embryo is the property of the couple alone and may be
transferred to the same wife in a successive cycle but only during the validity of the marriage
contract.
• Multifetal pregnancy reduction : multifetal pregnancy reduction is only allowed if the
prospect of carrying the pregnancy to viability is very small. It is also allowed if the life or
health of the mother is in jeopardy
Issue 3: Use of Donor Eggs/Sperm
• Parentage: Who are the parents? Are they the ones whose genetic material
(sperm and egg) combine to form the child or the people who raise the child?
• Disclosure:
• Should children know that one or both of his or her (rearing) parents did not provide the egg
or sperm which brought them into being?
• Should children have access to the donor(s) (genetic parents)?
• Should genetic parents have visitation rights?
• Exploitation
• Should the donor be paid?
• Eligibility
• Same sex couple, single parents, elderly couple,
Issue 4: Embryo cryopreservation
• Left over embryos are cryopreserved, owners don’t get to use them after
all.
• Four possible fates for these embryos exist
• Thawing and discarding
• Donating to research
• Indefinite storage
• Donating the embryos to another couple for the purposes of uterine transfer
• In the event of divorce who gets custody of the embryo?
• All of these strategies have staunch supporters and detractors.
• Myriad of laws in different countries.
Issue 5: Surrogacy and Gestational
Carriers
• Conflicting data exists about the risks of IVF on the developing embryo.
• Multiple studies have failed to find a clinically relevant association between
IVF or embryo cryopreservation and adverse maternal or fetal effects
• Other studies have suggested that infants of IVF pregnancies may be at a
small but statistically significant increased risk for rare epigenetic and other
abnormalities
• There is a general consensus that IVF confers a small but measurable
increased risk for a variety of congenital abnormalities including anatomic
abnormalities and imprinting errors as compared to the general population
Issue 11. Reporting Regulations
• The dynamic nature of ART and the rapid evolution of the field result
in constant paradigm shifts that require frequent and comprehensive
evaluation by professional organizations and society alike.