ivf and pgdfinal

8/8/2019 IVF and PGDfinal

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Invitro Fertilization (IVF)

&Pre-Implantation Genetic

Diagnosis (PGD)

Ashley Feinstein

Amanda GarbuttYiyin Xiong

Engineering 124; Spring 2003


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The technology of invitro fertilization (IVF) has been available to

infertile couples and women seeking motherhood via alternate means since the

late 1970s. In addition, recent advancements in human genome mapping lead

to the emergence of new applications for reproductive technologies, most

notably, pre-implantation genetic diagnosis (PGD). The procedures involved in

IVF are relatively common and uncontroversial; however, the addition of PGD

to the process calls to consciousness an awareness of the possibilities and

potential abuses of science. Of special concern is the need to weigh the goal

of pregnancy and disease-free life against the medical and moral risks involved,

specifically, social eugenics, multiple gestation, inherent tendencies toward

production mentality, and manipulation of human life. The challenge to arrive

at an ethical response to the questions posed by reproductive technologies lies

in the need to discuss these issues within the frame of various worldviews and

ethical theories. This theoretical dialogue presents the opportunity to

formulate regulations promoting positive and beneficial usages of IVF and PGD.


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Process of IVF

1. Hyper ovulation

2. Egg Retrieval

3. Artificial

Insemination4. 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)

*increase in multiple births

*infertile couples can reproduce*surrogate parenthood

(womb donors, $28K-$45K)

IVF

*decreased rate of specific

diseases in the population(refer to next slide)

*decreased rate of miscarriage

PGD

Factual


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Refutation of a Common MisconceptionWhile 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 thatmodifying,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 theeugenics 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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Ethics: The issues at hand

weighing the goal of

pregnancy and live birthagainst the medical and

moral risks of multiple

gestation.

using PGD inherently makes assumptions about

the quality of life, challenging basic tenets of

society such as equality.

requires society

to make a decision

on when life begins.


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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

Care based ethics Address the view of the potential

child Will the child have adequate support

and a stable home?

If there are multiple fetuses, will thechildren receive adequatecare/attention?

[PGD has] the laudable goal ofstopping deadly genetic diseasessuch as Tay-Sachs andHuntingtons. This research has

growing support because it cansave children from enormoussuffering 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 MoralCommunity

forRights 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

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)

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.


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Utilitarianism

The alleviation of suffering formany is important. IVF helps many infertile couples

achieve a life-long dream ofhaving a child.

PGD helps those same couplesreach their goal of a disease freechild.

A disease free society ispreferable for all members.

The greatest good for the greatest number suggests that


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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 ofmaterial causes that can be understood and

manipulated by human beings.(Fukuyama 2002)

The Judeo-Christian point of view holds that man is createdin 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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EasternW

orldviews

Confucianism An ethical societal structure based

on relationships and authority Filial relationships often stressed

Treat others as you yourself wouldlike to be treated

Therefore, IVF and PGD should be

allowed as long as social order and

construct are maintained.

Taoism abjure all striving

Life should be lived with effortless action

one shouldgo 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.

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 thereis medical need

Clinics set policies; no

federal or state restrictions


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Final Thoughts

the number of pre-embryo transfers/cycle. the accuracy of clinical statistics.

PGD, which should be used for medical screening ONLY.

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 minimizationof 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


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R

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