SHBQ 4224 Bioethics _Lecture 3 Elizabeth Luvai (PhD)

Reproductive Technology
For most of human history, there was only one way to conceive a child (through sexual intercourse), one
way to gestate it (in the womb of the woman who conceived it), and—according to common practice—
one way to raise it (under the control of those contributing the egg and sperm).

Not anymore.

The revered, time-tested order of procreation and parenthood has changed, thanks to an explosion of
innovation in what is known as assisted reproductive technology (ART).

Assisted reproductive technology (ART).

ART procedures:

 doctors can fertilize a woman’s egg in a laboratory dish to produce an embryo that can be
implanted in any normal uterus;

 test ART embryos for genetic abnormalities before implantation (and cull defective ones);

 mechanically bring together selected sperm and eggs in fallopian tubes for fertilization;

 freeze embryos, eggs, and sperm for later use (and possible destruction);

 create embryos from donor eggs and sperm to offer up for adoption;

 in a sterile laboratory container, fertilize an egg by injecting into it a single sperm cell.

Assisted reproductive technology (ART)

The point of these advances is widely understood, but their uses are controversial. At every turn, they
generate ethical questions:

 Serious debate about the nature and meaning of the family,

 Welfare of children,
 Treatment of women,
 Moral status of embryos,
 Value of human life,
 Sanctity of natural procreation,
 Legitimacy of reproductive rights

In normal (unassisted) reproduction:

Sperm inches through the woman’s uterus and into one of the fallopian tubes, where a single sperm cell
penetrates and thus fertilizes the egg released that month from an ovary.

The resulting embryo (technically a zygote) backtracks through the fallopian tube, returning to the
uterus where it implants itself in the uterine lining. At successful implantation, pregnancy begins.

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Infertility

Usually defined as the inability to get pregnant after one year of unprotected sex) can befall a couple if
there is a problem with any one of these processes.

- a couple can become infertile if ovulation does not happen,

- either sperm or egg is of low quality,

- the fallopian tubes are blocked (often because of malformation or injury),

- the embryo is abnormal,

- implantation is unsuccessful.

In up to 90 percent of cases, physicians can treat such problems with conventional methods—drugs and
surgery. But increasingly they turn to some form of ART, which usually means in vitro fertilization.

In vitro fertilization (IVF)

Is the uniting of sperm and egg in a laboratory dish, instead of inside a woman’s body? (In vitro means
“in glass” and refers to such outside-the-body containers; the term contrasts with in utero, or “in the
uterus.”) The idea is to create embryos that can be transferred to the woman’s uterus, where they can
develop to term.

IVF and embryo transfer consists of five main steps:

1. Ovarian stimulation (superovulation). The woman takes ovulation stimulants (fertility drugs) to
prompt her ovaries to produce several eggs at once instead of the usual one per month. Standard IVF
procedure calls for multiple eggs because often some of them will be defective, and not every embryo
may implant or develop properly once transferred to the uterus

[Link]/fertilization. The retrieved eggs are inspected, and the ones judged to be of highest
quality are mixed with sperm (a step called insemination), which results within a few hours in sperm
cells penetrating the eggs (fertilization). Typically, some eggs will not fertilize, and occasionally none will.
Sometimes the chances of fertilization are greatly increased by a technique known as intracytoplasmic
sperm injection (ICSI), in which an egg is pierced and a single sperm cell is injected into it

4. Embryo culture. After fertilization, the embryos are left to grow in a culture medium. Within 48 hours,
each one consists of 2 to 4 cells; in three days, 6 to 10 cells. Around the third day, fertility experts can
screen the embryos for genetic diseases using a technique known as preimplantation genetic diagnosis
(PGD). Only embryos found to be free of defective genes are selected to be transferred to the uterus.

5. Embryo transfer. Delivery of embryos to the uterus is generally painless and is performed in the
doctor’s office up to six days after egg retrieval. To increase the chances of pregnancy, two or more
embryos are usually transferred at once. The embryos, along with the fluid surrounding them, are
placed in a long, straw like tube called a transfer catheter. Then the catheter is eased into the vagina and
through the cervix, and the embryos are pushed from the tube into the uterus. If all goes well, an
embryo implants in the uterine lining.

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IVF variations

Gamete intra-fallopian transfer (GIFT):

In this process, ovarian stimulation and egg retrieval proceed as they do in IVF, but then the eggs and
sperm (gametes) are transferred together to a fallopian tube to fertilize.

Zygote intra-fallopian transfer (ZIFT):

Like IVF, this procedure depends on fertilization occurring in vitro, but an embryo (zygote) is transferred
not to the uterus but to a fallopian tube. Some people believe that ZIFT offers an increased chance of
implantation, but it too constitutes less than 1 percent of attempts at assisted reproduction. Couples are
generally not limited to using their own sperm and eggs in IVF and its variations.

Sperm donors are screened for sexually transmitted diseases and other health problems, and donor
sperm is collected, frozen, analyzed, stored (in sperm banks), and used when needed.

Egg donors are screened in the same way that sperm donors are, and donor eggs are acquired through
standard ovarian stimulation and egg retrieval. The eggs are checked for maturity and, usually soon after
retrieval, fertilized with donor sperm or sperm from the partner of the woman trying to become
pregnant.

IVF benefits

1. High Success Rate of Pregnancy

IVF has been shown to increase a person’s chances of conception even in women over the age of 30. As
the top assisted reproductive technology, IVF provides the highest success rate for all infertility issues.
Over time, a woman’s eggs lower in quantity and quality due to the natural aging process. With IVF, only
the most viable eggs are selected for the procedure.

2. Helps to Overcome Infertility in Both Men and Women

In addition to the natural aging process on a woman’s eggs, infertility can be related to ovulation
conditions, reproductive tract blockage, low sperm count, and/or scarring or damage to the fallopian
tubes. IVF involves retrieval of eggs and sperm or use of donor eggs and sperm, voiding the need for a
healthy uterus.

3. Less Chance of Miscarriage

With IVF, preimplantation genetic testing (PGT) is used to analyze if there are any abnormal genetics
that offer a high risk of miscarriage. Use of advanced technology focuses on the integrity of the embryos
before transfer to the uterus.

4. Open to Anyone

IVF offers a viable option to men and women who may not otherwise have the opportunity to
experience parenthood. Infertile couples, and single people are able to have the same prospect through
donor sperm/egg, surrogacy, and assisted fertilization.

5. Donated Eggs/Sperms Can Be Used

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For some men and women, infertility complications and health conditions can see the need for use of
donated sperm and/or eggs. By using the science of IVF, these people have a greater chance to begin a
new chapter in their lives as parents.

6. You Can Select the Perfect Time

Many people decide to focus on their education and careers in their 20s and through most of their 30s
before deciding to have children. Following this option can prove to be challenging as the quality and
quantity of eggs and sperm can diminish over time. IVF can be used to fertilize any eggs and sperm that
were previously cryopreserved or to be used with donor eggs and sperm.

7. Improves the Chances of Having a Healthy Baby

8. The miracle of life is priceless and every new parent

IVF risks and ethical issues

1. IVF is expensive, and its success rates are lower than most people think. The average cost of a
single attempt to overcome infertility using IVF is $10,000 to $15,000. On average, a live birth is
the outcome in about 55 percent of IVF cycles for women aged 35 and younger in which the
woman’s own eggs are used. The rate varies with age: The older the woman, the lower the
chances of a live birth. In most cases, then, more than one (expensive) cycle is required to
achieve a live birth, and many health insurance plans will not cover the cost.
2. For the woman, the physical demands of the IVF process—the surgery, the monitoring, the
waiting—can be uncomfortable, inconvenient, and stressful. The surgery itself comes with a risk,
however low, of side effects such as bleeding, infection, and damaged tissue.
3. There is also a chance of complications from taking the fertility drugs that instigate
superovulation, including abdominal pain, memory loss, mood swings, nausea, temporary
allergic reactions, and headaches
4. The most worrisome among these is a rare but potentially dangerous condition known as
ovarian hyperstimulation syndrome, characterized by swollen and painful ovaries.
5. Multiple pregnancies—caused mainly by transferring several embryos at once—increase the
chances of high blood pressure, anemia, gestational diabetes, and uterine rupture. Multiple
pregnancies—a common result of IVF cycles—dramatically raise the risks to children’s life and
health. The chances of prenatal and postnatal death are higher than for single pregnancies, and
premature birth is much more likely. Prematurity increases the risk of cerebral palsy, blindness,
heart defects, serious infection, respiratory distress syndrome, and other grave maladies.
6. For the child, there are concerns that ART techniques may lead to birth defects, low birth
weight, and diseases such as cancer.
7. Several issues—technological and ethical— arise from the handling of the unused embryos that
inevitably result from IVF. The common practice is to freeze, or cryopreserve, the extra
embryos for possible transfer in the future. Fertility clinics freeze thousands of embryos every
year, and hundreds of thousands of them are now in cryostorage. Freezing a woman’s leftover
embryos gives her the option of using them in future IVF cycles rather than going through
another arduous (and expensive) round of ovarian stimulation and egg retrieval.
8. Frozen embryos can remain in cryostorage for years—because the couple divorces, because one
or both of them die, because they disagree about what to do with the embryos. One alternative

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is to donate the unused embryos to an infertile couple, which means that the prospective
parents will have no genetic connection to the child born to them.
9. Without legal guidance and ethical consensus, fertility clinics must decide what to do with
frozen embryos that are unused, unclaimed, or undonated. Often they either donate the
embryos for research or destroy them.

To those who believe that embryos have a right to life, both of these options are morally impermissible.
But even people who don’t believe that embryos are persons may think that embryonic life should not
be treated as if it has no moral worth at all.

Surrogacy

Introduction

A surrogate is a woman who gestates a fetus for others, usually for a couple or another woman. She
contracts with them to carry the pregnancy to term, to relinquish the baby at birth, and to let them
legally adopt it. Te surrogacy can take two diferent forms.

In what has been called traditional surrogacy, sperm from either the couple’s male partner or a donor is
used to artifcially inseminate the surrogate (the “surrogate mother”).

Since the egg fertilized is the surrogate’s, the baby produced from this arrangement is genetically
related only to the surrogate and to whoever supplies the sperm.

In gestational surrogacy, the surrogate receives a transferred embryo created through IVF using the
sperm and egg of others (the contracting couple or donors). Because the gestational surrogate (also
called the gestational carrier) does not contribute her own egg, she has no genetic connection to the
baby.

A woman may opt for gestational surrogacy because she has an abnormal uterus or no uterus (because
of hysterectomy or congenital defect) or because she suffers from health problems that make pregnancy
dangerous, such as cystic fibrosis and serious forms of diabetes and heart disease.

A couple may turn to a traditional surrogate for many of the same reasons. In both kinds of surrogacy,
the intended parents generally want more than just a child—they want a biologically related child. For
them, then, adoption may be less attractive

Surrogate arrangements are generally complex and legally unsettled. Surrogacy contracts may specify all
of the surrogate’s prenatal duties (including those regarding her alcohol consumption, smoking, prenatal
testing, medical treatment, and sexual intercourse)

Intended parents in the pregnancy (for example, their presence or absence at the birth), the
permissibility of abortion in case of fetal abnormalities, the arrangements for adoption of the child, and
the money to be paid to the surrogate (including prorated compensation if there is a miscarriage).

Whatever the financial arrangements, they cannot be construed as transactions involving the buying or
selling of children, which is illegal. (Some states forbid surrogacy agreements allowing any kind of
payment.)

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So money paid to surrogates—now probably in the range of $10,000 to $30,000—is supposed to be

regarded as compensation for such things as her time and effort or her diminished job opportunities.

Cloning
Introduction

Clones, in the sense used by biologists, are genetically identical entities, whether cells, DNA molecules,
plants, animals, or humans.

Cloning is the asexual production of a genetically identical entity from an existing one.

In animals and humans, since the genetic blueprint for an individual is in each of its cells (mostly in the
nucleus), all the cells of a clone contain the same blueprint as all the cells of the clone’s progenitor.

An animal or human clone is not a perfect copy of an individual—not like a photocopy of an original
document—but a living thing that shares a set of genetic instructions with another.

Cloning steps

The primary cloning method for producing live-birth mammals, and the one most likely to be considered
for human cloning, is known as somatic cell nuclear transfer (SCNT). The usual steps are:

Extract the DNA-packed nucleus from an egg cell (creating an enucleated egg). The egg and somatic
nucleus can come from two different individuals or the same individual.

Replace the egg’s nucleus with the donor nucleus of an ordinary body (somatic) cell from the adult
individual to be cloned. (It’s also possible to use cells from existing embryos.)

Stimulate the reconfigured cell with chemicals or electricity to start cell division and growth to the
embryo stage.

Transfer the cloned embryo to a host uterus for development and birth

Types of cloning

1. Reproductive cloning

Adult DNA cloning

2. Recombinant DNA technology

DNA/ molecular/ gene cloning

3. Therapeutic cloning

Embryo/ Biomedical cloning

Reproductive cloning

The cloning that has provoked the most public consternation and media attention is the creation of a
genetic duplicate of an adult animal or human, what has often been called reproductive cloning.

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This kind of cloning suddenly became front-page news in 1997 when scientists announced that they had
managed to clone an adult sheep, resulting in the birth of an apparently healthy clone called Dolly.

She was the genetic twin of her adult “parent” and the first mammal so cloned.

After her, scientists cloned additional animals in similar fashion—cattle, goats, pigs, cats, rabbits, mice,
and more—and are working on others.

Why Cloning Humans is Ethically Unacceptable

Controlling Someone Else's Genetic Makeup

Child can reject any aspect of its upbringing, but it could never reject the genes that were chosen for it

Such control by one human over another is incompatible with the ethical notion of human freedom, in
the sense of that each individual's genetic identity should be inherently unpredictable and unplanned.

Human cloning

To date, no human has been successfully cloned, and for technical and moral reasons none is likely to be
cloned any time soon.

At this stage of the technology, both scientists and policymakers have serious concerns about the safety
and ethics of human reproductive cloning.

Safety and ethics of human reproductive cloning.

 Eugenic – pseudoscientific set of beliefs and practices that aim to improve the genetic quality of
a human population. Reduce genetic diversity
 Clone may have reduced life expectancy
 Clone may be abnormal
 Lack of self-identity
 Replaceable
 Dominated by the ‘father’ or ‘mother’
 Upset traditional family relationship
 Twin of the cell donor?
 Relationship with its brother and sister
 Relationship with spouse of the cell donor

Applying major theories

We have the power to control human reproduction as never before. The question is: Should we?

In the name of reproductive freedom and control, is it morally permissible to employ ART, surrogacy,
even cloning?

Utilitarian theory

The utilitarian will answer yes if the benefits of the technology outweigh its harms, no if they do not.

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Based on current knowledge of the good and bad effects, most utilitarian's would probably see a net
gain in the use of IVF and surrogacy arrangements, and they would likely endorse cloning if its risks to
children could be decreased to an acceptable level.

They presumably would calculate that IVF’s real but low risk of birth defects and maternal complications
is outweighed by the happiness brought to infertile couples, and the loss of embryos in the process
would not be a major factor.

They would likely make a similar calculation regarding surrogacy, assuming that surrogacy arrangements
are properly regulated. But some utilitarian's may embrace a different calculus.

They may reason that cloning and IVF are impermissible because the considerable money spent on them

Kantian perspective

From a Kantian perspective, it is possible to either oppose or defend reproductive technologies.

Someone could argue, for example, that IVF, surrogacy, and cloning are impermissible because they
treat children merely as a means, instead of an end in themselves.

Children are “manufactured” and sold as commodities to serve the ends of others.

But a Kantian could refuse to take this view, arguing instead that couples who create children do so
precisely because they wish to respect and love their offspring as persons.

What matters is not how children are brought into the world, but how they are treated after they arrive.

Natural law theory (Roman Catholic interpretation)

Reproductive technologies must be rejected across the board.

IVF is wrong because it defies the natural link between procreation and sexual union.

It also involves the destruction of human embryos, each of which has a right to life.

Surrogacy is immoral because it too is procreation outside of marriage and an affront to the integrity of
the family.

Human cloning is to be repudiated because it unnaturally separates procreation from sex and is a
violation of the rights of the child.

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Further reading

Kenneth D. Alpern, ed., The Ethics of Reproductive Technology (New York: Oxford University Press,
1992).

American Society for Reproductive Medicine, “Reproductive Facts,” 2015, [Link]

Dan W. Brock, “An Assessment of the Ethical Issues Pro and Con,” in Cloning Human Beings: Report and
Recommendations of the National Bioethics Advisory Commission, vol. II, sect. E (Rockville, MD: NBAC,
June 1997), 1–23.

Justine Burley, ed., The Genetic Revolution and Human Rights (Oxford: Oxford University Press, 1999).
Centers for Disease Control and Prevention, “Assisted Reproductive Technology (ART),” October 27,
2015,

Walter Glannon, “Reproductive Rights and Technologies,” in Biomedical Ethics (New York: Oxford
University Press, 2005), 71–94.

Jonathan Glover, Choosing Children: The Ethical Dilemmas of Genetic Intervention (Oxford: Oxford
University Press, 2006)

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