Invitro Fertilization IVF

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Invitro Fertilization (IVF) Pre-Implantation
Genetic Diagnosis (PGD)

• Ashley Feinstein
• Amanda Garbutt
• Yiyin Xiong

Engineering 124 Spring 2003
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(No Transcript)
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Process of IVF

• Hyper ovulation
• Egg Retrieval
• Artificial Insemination
• Embryo Transfer

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IVF Statistics

• From 1998 Center for Disease Control
• 7,800/cycle
• 30 pregnancy rate/cycle
• 3-4 embryos transferred/cycle
• 12 of IVF pregnancies involve multiple fetuses

• In the event of multiple implants, your options
  include
• Fetal Reduction
• Risks include potential loss of all fetuses
• Bear all
• Risks include premature birth

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PGD Genetic testing performed prior to embryo
transfer
The debate around PGD has been building since
the late 1980s, when doctors at London's
Hammersmith Hospital learned how to tease a cell
from a 3-day-old embryo and study its chromosomes
for gender. (Zitner 2002)

• Adds 2000 to IVF
• Reduces rate of miscarriages from 23 to 10
• Does not increase chance of pregnancy

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Commonly, more than 100 diseases can be detected
through testing, including

• Hemophilia A
• Muscular dystrophy
• Tay-Sachs disease
• Cystic fibrosis
• Down Syndrome

Removal of one cell for testing
PGD is not a new technology, but is due to the
application of old techniques to the new
knowledge gained from the Human Genome Project.
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Viable and Desirable?
This information is helping parents choose which
embryos they want--and which to reject as
unhealthy, or merely undesirable. (Zitner 2002)
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Undesirable Embryos

• Disease Free Embryos
• Frozen in storage
• Donated to infertile couples
• Donated to stem cell research/usage

• Disease Carrying Embryos
• Donated to research
• Discarded

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Impact (Part I)
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Refutation of a Common Misconception
While PGD may decrease the rate of specific
diseases in a population, it will not alter the
gene pool.
Even if genetic engineering produces a designer
baby, human nature will not be altered unless
such changes occur in a statistically significant
way for the population as a whole. Mankinds
gene pool is very large and contains so many
different alleles that modifying, eliminating,
or adding to those alleles on a small scale will
change an individuals patrimony but not the
human races. Fred Ikle argues that any future
attempt to eugenically improve the human race
would be quickly overwhelmed by natural
population growth. It is entirely plausible
that an advanced, democratic welfare state would
reenter the eugenics gameIt would be the state,
under these circumstances, that would make sure
that the technology became cheap and accessible
to all. And at that point, a population-level
effect would very likely emerge (Fukuyama
2002) Basically, what the above states is that
genetic engineering will not lead to
modifications in the gene pool unless the
technology becomes cheap and encouraged by the
state. It is only at this point that the gene
pool will begin to change.
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Impact (Part II)
GenRich is controversial it could be harmful
or beneficial. The GenRich will use
technology to ensure that their children have
significantly more advantages than the random mix
of the gene pool, widening the gap between the
rich and poor. (Wagner 2003) The wealthy
citizens, whose offspring will become the
GenRich do us a great service. They test
these technologies for us and even pay enormous
sums for the privilege. In a way, they function
as guinea pigs for the rest of humanity. If you
had to think of who youd like to test these
technologies, what better group can you imagine?
Theyre well informed, highly motivated, eager,
hard to coerce and they are definitely
volunteers. (Jonietz 2003)
Production mentality is a problem. Where
amniocentesis usually provides information about
a single fetus, embryo screening allows parents
to judge and reject many potential children at
once. And because it bypasses the pain of
abortion, some fear it will be used too freely,
coarsening attitudes toward the embryo. Fetuses
become products rather than children. (Zitner
2002)
"Would this selection (of gender) place our
society on a "slippery slope" to other kinds of
unacceptable selections? Possibly, but only if we
continue to use this powerful technology without
a thorough analysis of its ethical justification
and without a professional standard that clearly
articulates a strong set of moral values."
(Scannell 2001)
Fukuyama defines eugenics as, the deliberate
breeding of people for certain selected heritable
traits. Human genetic engineering raises most
directly the prospect of a new kind of eugenics,
with all the moral implications with which that
word is fraught, and ultimately the ability to
change human nature. (Fukuyama 2002)
The power to change the future of the human race
is, in some ways, more frightening than the
weapons of mass destruction we hear so much about
today. It is a weapon of mass creation. (Wagner
2003)
And if scientists in one nation are genetically
altering unborn children, wouldnt it be hard for
other nations to resist joining in a genetic
arms race to develop a new generation better
able to compete in the global economy or in
war? (Wagner 2003)
On the potential for discrimination, Hughes, a
Wayne State doctor, said I went into this to
help people with disease. Last time I checked,
your gender is not a disease. (Zitner 2002)
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Ethics The issues at hand
World Views
Utilitarianism
Rights Ethics
Care Ethics

• weighing the goal of pregnancy and live birth
  against the medical and moral risks of multiple
  gestation.

requires society to make a decision on when life
begins.
using PGD inherently makes assumptions about
the quality of life, challenging basic tenets of
society such as equality.
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Care based ethics

• Address the suffering of the mother due to her
  inability to have a child naturally
• When having children, peopleoften roll the
  genetic dice and hope for the best. With embryo
  sorting, "they can start their pregnancy on Day
  One with a commitment to continuing it."
• (Zitner 2002)
• PGD can save parents massive heartbreak and
  financial strain

• Address the view of the potential child
• Will the child have adequate support and a stable
  home?
• If there are multiple fetuses, will the children
  receive adequate care/attention?
• PGD has the laudable goal of stopping deadly
  genetic diseases such as Tay-Sachs and
  Huntingtons. This research has growing support
  because it can save children from enormous
  suffering and early death.
• (Wagner 2003)

Care ethicists would be in favor of IVF and PGD
as long as the decision is loving and promotes
positive relationships.
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Definition of Moral Community for Rights Based
Ethics
Before one can decide to whom rights apply, one
must determine the moral community.
As individuality is a sine qua non for
personhood, it seems safe to consider 14 days of
normal embryonic development to be the minimum
requirement before a human being can emerge.
Other criteria might place the earliest time
point at a later stage, for example, 28 days,
when the neural tube closes and the development
of the central nervous system necessary for
rationality begins. Or, with Aristotle and St.
Thomas Aquinas, one might consider 40-90 days of
development to be necessary to allow a human soul
to be present or as the Roman Catholic Church
taught for centuries, one might require body-form
and movement to be present before full human
status was recognized. (J.E.S.Hansen)
Therefore, embryos lack rights as individuals
because they are not part of the moral community.
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Rights Based Ethics
Embryos are mass-produced, screened, discarded
and used in experiments are they products or
people with rights? According to Hansen (see
previous slide), the treatment of embryos is not
an issue.

• Based on John Lockes principles, all people have
  the right (in America) to life, liberty and the
  pursuit of happiness.
• What becomes of the idea that everyone is created
  equal if you start designing children?
• Loss of autonomy because of a necessity to be
  competitive in society
• Inherently discriminatory makes assumptions
  about quality of life
• "Most people with disabilities rate their quality
  of life as much higher than other people think.
  People make the decision to reject embryos
  based on a prejudice that having a disability
  means having a low quality of life.
  (Zitner 2002)

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Utilitarianism
The greatest good for the greatest number
suggests that

• The alleviation of suffering for many is
  important.
• IVF helps many infertile couples achieve a
  life-long dream of having a child.
• PGD helps those same couples reach their goal of
  a disease free child.
• A disease free society is preferable for all
  members.

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Western Worldviews

• The Newtonian/Cartesian Paradigm suggests that
• one should use available technology
• technology will replace sexual reproduction by
  natural means
• sees a human beingas the sum of a series of
• material causes that can be understood and
• manipulated by human beings.(Fukuyama
  2002)
• The Judeo-Christian point of view holds that man
  is created in Gods image.
• For Christians in particular, this has
  important implications for
• human dignity. These reproductive
  technologiesare wrong
• from this perspective because they
  put human being in place of
• God in creating human life.
  (Fukuyama 2002)

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Eastern Worldviews

• Taoism
• abjure all striving
• Life should be lived with effortless action
• one should go with the flow
• Therefore, if you are infertile and unable to
  have a child by natural means, then you should
  not try to achieve this goal through IVF or PGD.

• Confucianism
• An ethical societal structure based on
  relationships and authority
• Filial relationships often stressed
• Treat others as you yourself would like to be
  treated
• Therefore, IVF and PGD should be allowed as long
  as social order and construct are maintained.

• Buddhism
• Compassionate care
• Have respect for the life cycle
• Precautionary principle
• Therefore, IVF should be allowed because it shows
  care for all, but PGD should be banned.

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International Policies on PGD

• Banned PGD for ALL usages

• Used to select childs gender only when there is
  medical need

• Clinics set policies no federal or state
  restrictions

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Final Thoughts
For our society, IVF and PGD are ethically
appropriate. Not only do these technologies
allow for parenthood in reproductively challenged
couples, but they allow parenthood with a
minimization of risks like disease. There is the
concern of the slippery slope, or couples who
might try to abuse the technology, therefore the
government should impose regulations on

• the number of pre-embryo transfers/cycle.
• the accuracy of clinical statistics.
• PGD, which should be used for medical screening
  ONLY.

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References