On Bioethics

catholic moral standing on the special ethics of life

Archive for In Vitro Fertilization (IVF)


A leading British immunologist has warned that many fertility clinics are offering women an unnecessary, potentially dangerous and possibly counterproductive treatment. Ashley Moffett, of the University of Cambridge, says that many clinics administer steroids or intravenous immunoglobulin to lower the level of uterine natural killer cells — despite the fact that there is scant evidence that this will increase fertility.”This has somehow slipped through the net of any regulation,” Dr Moffett told Nature Medicine. “It is bizarre that women who may be in early pregnancy are exposed to this sort of risk.” Immunoglobulin has a number of potential side effects, including kidney failure and hepatitis. The UK’s fertility regulator only deals with the creation and handling of embryos, not drug regimes for fertility patients.

“The get-out clause is that [doctors] discuss it with their patient,” says Raj Rai, of Imperial College London. “But this is disingenuous, because how is a patient supposed to decide?” ~ Nature Medicine, June 07




Glowing newspaper profiles of IVF doctors who bring bundles of joy to desperate couples are common enough in the US, the UK and Australia. But it is seldom that they emphasise how often the doctor consults the Bible for guidance. Recently, the Kampala Monitor profiled Dr Edward Tamale Ssali, who practices in Bukoto, in southern Uganda. He is responsible for the first birth of a frozen embryo baby and the first birth to a surrogate mother in East and Central Africa. A devout Christian, he rises every day at 5am and reads his Bible. He also hosts a TV program, Faith and Science, on Sundays. “I would be earning a lot overseas but I decided to station here,” he told the Monitor. “There is more to life than money. The Bible says that the life of a man doesn’t consist in the things that he owns.” ~ Monitor, Jun 3   



Lord Robert Winston
The contrarian Lord Robert Winston, one of the pioneers of IVF, has once again attacked his colleagues in the IVF industry, this time for having been corrupted by money and for exploiting women who are desperate to get pregnant. “One of the major problems facing us in healthcare is that IVF has become a massive commercial industry,” he said at the Guardian Hay Festival. “It’s very easy to exploit people by the fact that they’re desperate and you’ve got the technology which they want, which may not work.”Lord Winston was particularly scathing about his London colleagues: “Amazing sums of money are being made through IVF. It is really rather depressing to consider that some IVF treatments in London are charged at 10 times the fee that is charged in Melbourne, where there is excellent medicine, where IVF is just as successful, where they have comparable salaries. So one has to ask oneself what has happened. What has happened, of course, is that money is corrupting this whole technology.”

Nor did he spare the UK’s fertility watchdog, the Human Fertility and Embryology Authority: “The regulatory authority has done a consistently bad job. It’s not prevented the exploitation of women, it’s not put out very good information to couples, it’s not limited the number of unscientific treatments people have access to, it doesn’t prevent sex selection and all sorts of other things people don’t like because there are all sorts of ways around the law.” ~ Guardian, May 31   



With 90% of pregnant women aborting a Down syndrome child after a positive prenatal test, American parents of Down syndrome children are turning into activists to protect their children’s future. According to a special report in the New York Times, a dwindling Down syndrome population — now about 350,000 in the US — could mean less institutional support and reduced funding. Even though many of these parents describe themselves as pro-choice, they oppose eugenics. “For me, it’s just faces disappearing,” says a New Jersey mother. “It isn’t about abortion politics or religion; its a pure ethical question.” A number of people are asking doctors to send them couples who an abortion so that they can meet their children.They have a greater sense of urgency after the American College of Obstetricians and Gynecologists recommended in January that all women, regardless of age, be offered a new screening test to detect Down syndrome early in a pregnancy. Although critics term this a “search and destroy” mission, some doctors see nothing wrong with it. Cute as they may be in childhood, they claim, Down syndrome children may be at risk of early-onset Alzheimer’s disease, thus saddling ageing parents with even more onerous responsibilities. 

There are many couples who do not want to have a baby with Down syndrome,” said Deborah A. Driscoll, of the University of Pennsylvania, an author of the recommendations. “They don’t have the resources, don’t have the emotional stamina, don’t have the family support. We are recommending this testing be offered so that parents have a choice.”

But as the Times points out, doctors often paint too gloomy a picture. “She may be able to count change for the bus,” one doctor told a pregnant Delaware woman. “But what’s going to happen when the bus doesn’t come?” Her Down syndrome daughter, now 5, does not yet take the bus, but she does ride horses. ~ New York Times, May 9   


Genetic testing is shaking the mindset even of abortion advocates, says the New York Times. Although 70% of Americans would support women who terminate a pregnancy if a child has a serious genetic defect, all but the staunchest supporters of pro-choice policies question whether any defect whatsoever is reason enough. The problem is that the pro-choice stand is colliding with a commitment to tolerance of human difference. And now that tests make it possible to select for late-onset diseases like breast cancer or arthritis, and may some day make it possible to select for intelligence or eye colour — not to mention sex — pro-choice disability advocates are finding hard to draw the line.”It so buys into this consumer perspective on our children,” says Marsha Saxton, of the World Institute on Disability, in Oakland, an abortion-rights supporter.

Some religious conservatives say that they trust God to give them the child that is meant to be,” wrote Ann Althouse, a law lecturer at the University of Wisconsin, on her legal blog. “But isn’t there something equivalent for social liberals? Shouldn’t they have moral standards about what reasons are acceptable for an abortion?” ~ New York Times, May 13   


In the absence of clear legislation, a Chinese entrepreneur has set up a nationwide network of surrogacy offices, with more than 120 surrogate mothers. Liu Baojin, the 28-year-old founder of daiyun.com, says that surrogacy is ethical and legal in China. He says that he gets at least 10,000 yuan for each successful match. The surrogate mother, if educated, could earn about 70,000. 

However, since Chinese law does prohibit IVF clinics from engaging in surrogacy, Mr Liu’s surrogate pregnancies are achieved in the old-fashioned way, leaving him open to criticism for immorality. Liu Zhijun, a sociologist at Zhejiang University, says that surrogacy corrupts social morals and violates human rights. It often ends in tragedy, with extra-marital affairs, family disputes and even crime. ~ China Daily, May 15


The average payment in the US for egg donation was US$4,217, according to a recent article in the journal Fertility and Sterility. However, at least one centre told the authors that it paid $15,000 for eggs and stories abound of college students being paid tens of thousands of dollars. The American Society of Reproductive Medicine has set guidelines which stipulate that payments of $5,000 or more “require justification” and that payments over $10,000 are not appropriate.

No one is comfortable with payments for eggs, an invasive and uncomfortable process at best, and painful and dangerous at worst. Little research has been done on the long-term effects of fertility drugs.

Bioethicists also worry whether the allure of dollars to cover college fees or credit card bills might cloud young women’s judgement. “We hear about egg donors being paid enormous amounts of money, $50,000 or $60,000,” Josephine Johnston, of The Hastings Center told the New York Times. “How much is that person actually giving informed consent about the medical procedure and really listening and thinking as it’s being described and its risks are explained?”

The problem is that without compensation, women are unlikely to donate eggs, either for fertility treatment or for research. “I just completed an outreach initiative to 21 institutions across the state that we’ve funded,” Dr Geoffrey Lomax, of the Institute of Medicine, said. “No one has had an egg donated specifically for research.” ~ New York Times, May 15




British House of CommonsAfter months of consultation, the British government has released a draft overhaul of its contentious fertility legislation. Many significant changes have been made, but the bellwether issue is the creation of chimeras, or hybrid animal-human embryos. Although there had been signs that the government would ban these, the proposed legislation allows them. Health Minister Caroline Flint denied that it had caved in to pressure from scientists and patient groups. She said that the government always wanted to leave the door open to such research and that scientists had made a strong case for it.Scientists were pleased, although Dr Stephen Minger, head of the stem cell team at King’s College London, lamented that Parliament was too involved. Only scientific and ethical experts were competent to regulate the fast-moving field of embryonic research. “This system of a panel of scientists, bioethicists, lawyers and informed lay members… has always worked perfectly well. It’s the only way to do it. What we definitely want to avoid is government trying to legalise science,” he commented.

Opponents were scathing. Josephine Quintavalle, of the lobby group Comment on Reproductive Ethics, said bluntly: “It is appalling that the government has bowed to pressure from the random collection of self-interested scientists and change its prohibitive stance. This is a highly controversial and terrifying proposal, which has little justification in science and even less in ethics. Endorsement by the UK government will elicit horror in Europe and right across the wider world.”

The possibility of creating hybrid embryos was just one amongst many proposals which would have seemed radical when the 1991 decision was first made to permit embryo research and establish the Human Fertilisation and Embryology Authority. These include: 

* A child can be created without a legal father, but two legal mothers. Children do not necessarily need a father in IVF procedures. 
* Embryos can be screened for serious medical conditions. 
* Eggs or sperm can be removed from incompetent persons without their consent. 
* Not-for-profit surrogacy agencies will be able to charge reasonable expenses for organising surrogate mothers.

Although the list of procedures which the government proposes to legalise and regulate is long, a few are explicitly banned. Sex selection is still on the black list, as are artificial gametes, genetic modification of IVF embryos and deliberately selecting a disease or disorder (such as deaf parents choosing to have a deaf child). ~ BBC, May 17; Guardian, May 17