Medical Ethics of In Vitro Fertilization­

While the obvious benefits of in vitro fertilization (IVF) cannot be ignored, there are a lot of medical ethics that need to be adhered to in order to carry out and maintain a transparent and safe process. This article will focus on some of the ethical issues that rise when speaking about IVF.
In vitro fertilization is one of those medical procedures that is constantly under debate. Perfect diligence and a transparent approach to the various processes of IVF are of utmost importance for it to be successful. It is true that IVF has brought insurmountable joy to many a couple. But it is also true that being such a sensitive procedure, it requires a strong code of ethics to be followed. The American Medical Association (AMA) has laid down guidelines for them in its Principles of Medical Ethics. A brief overview of the same is given below. In addition to these, you must be aware of the state laws regarding embryonic research before you go ahead with this procedure.

Collection and Disclosure of Data
While IVF cannot really be termed as a ‘regular’ medical procedure, it needs to be treated just like one. This means the gathering and maintenance of data from both parties is essential. Not only maintenance, but also the appropriate disclosure of accurate information regarding the procedure is one of the issues that needs to be supervised to a great extent in IVF or any other method of assisted reproductive technology (ART) for that matter. This includes accurate submission of data on the part of the donors. All the required medical records must be submitted to the center so that the appropriate tests are conducted to gage if they are suitable for the procedure. The norm of patient confidentiality needs to be maintained here just like any other procedure. IVF is a procedure which requires informed consent. This means that the couple undergoing the procedure needs to be made aware (by the center) of everything from the high cost to the risks involved to the probability rate of the process. In addition to the maintenance of records of patients, the center is also required to issue publications of the success rate of pregnancies resulting from IVF conducted there.

Proper Handling of Embryos
Once the process is initiated and underway, it is the duty of the center carrying out the procedure to ensure the proper handling of the embryos that are formed.

There have been cases reported wherein embryos have inadvertently been exchanged between couples by the staff at the fertility center. To avoid such grave negligence, centers are required to use Radio-Frequency Identification (RFID) to catalog the embryos. These computerized devices verify the code assigned to each embryo before being used; hence the chances of mix-ups are reduced. This system has replaced one which involved the presence of two witnesses at the time of labeling and delivery of the embryos.
Another important ethical issue regarding the embryos that are created at a fertility center is the use of embryos after their general expiration period of 14 days, especially for implantation. As per the Code of Medical Ethics drafted by the AMA, an embryo cannot be left unpreserved for more than 14 days. It must be used for implantation or preserved for research.
The embryo that is created is not to be used for any purpose other than implantation, unless expressly given permission for. Introducing a human embryo in an animal’s body or using it for human cloning is strictly prohibited.

Preservation of Embryos
The preservation of embryos is one of the most vital steps in the IVF process.

Maintaining a conducive climate for the creation of an embryo is the most important responsibility of the center.
After creation of the embryos, their preservation is the next important step. In the case that all the embryos are not implanted, the fate of the remaining embryos is to be decided by the couple undergoing the process.
Freezing the embryos without the consent of the donors and the couple utilizing them is not permitted under any circumstances. All parties have an equal say in the consent to be given.
It is a possible 5 pronged family (donor of sperm, donor of eggs, the couple, and/or the surrogate mother) that needs to give the permission to freeze the embryos, either for research, or for a repeat procedure.
Some couples wait to evaluate the progress of the child (created by IVF), and if need be, have the remaining embryos implanted in order to develop and harvest its tissue for its already born sibling. This is a technique that many couples are adopting, in order to have a genetically similar sibling for the first born.
Under no circumstances is the sale of an embryo by the center permitted. If need be, they can be donated, but only by the two people that donated the gametes, with the consent of the couple (in case of surrogacy).

Splitting of the Pre-Embryo
Splitting of the embryo after creation is a process carried out by fertility centers. This process increases the chances of conception and hence is advised by many. However, according to the Code of Ethics by the AMA, the center cannot split the embryo created for a couple without their knowledge and consent. Again, any unused portion of the embryo cannot be used without the approval of the parties concerned.

Use of the Embryo in Research
Using embryos created for implantation, for research before implanting them, is strictly prohibited. For that matter, use of any embryo for any process other than implantation, unless expressly created for it (with the permission of the gamete providers) is prohibited. Unused embryos also cannot be used for research unless the providers agree to it. After acquiring the permission of the donors, the embryos need to be evaluated and approved by the ethics committee at the fertility center to gage if they are fit for the proposed use. The research conducted must comply with the guidelines provided by the AMA Council.

Artificial Selection
It is an unfortunate reality that apart from its tremendous benefits and joy that it brings to sterile couples, the procedure does come with one very disturbing downside. An instance of a deaf British couple (Tom and Paula Lichy) wanting to created an in vitro baby which would also be deaf is a glaring example of the misuse of the procedure, by the couple as well as the fertility doctor. The dictation and introduction of desired traits within in an embryo, in an effort to produce ‘designer babies’ is under constant debate, not to mention the legal issues that such a procedure entails. The process of selecting and rejecting genes of an embryo are bound to leave a deep impact on the child that develops from the embryo. While the prospect of creating a whole new race of ‘perfect’ babies is something that seems like an obscure stretch, the overwhelming rate at which it is gaining popularity cannot be ignored.

Communication of Possible Side Effects
As mentioned above, informed consent is the step that the fertility center must take before initializing anything related to IVF. This includes the physical effects of the procedure on the carrier and the child that will be created as a result. There have been many documented side effects of IVF, which include:

An increased risk of ovarian cancer and breast carcinoma due to genetic errors in the process.
Ovarian hyperstimulation syndrome due to the hormones injected to stimulate the ovaries’ receptiveness to the sperm.
Other possible complications can include liver dysfunction, thromboembolic phenomena, renal impairment, shock, and even death.
Not only side effects, even the actual implantation procedure comes with its share of risks. These risks are magnified if the person performing the implantation is inexperienced. These risks include puncturing of internal organs, trauma to the ovary, hemorrhages, etc.
The general practice is to have a transfer of 3 to 4 embryos in one cycle. This number may reach a maximum of 5. More than this can be considered harmful for the woman, as well as the possibly created fetuses. In the world renowned case of Nadya Suleman (a.k.a Octomom), a whopping 12 embryos were implanted, out of which 8 formed fetuses, resulting in her giving birth to 8 babies. This case garnered a lot of criticism from the medical community as well as the general public. The medical community commented that the doctor exercised no concern for the woman as well as the babies by implanting such a large number of embryos. He was subsequently disbarred from practicing.
Studies are being conducted all around the world and are more strongly voicing the concern that IVF babies are more likely to acquire birth defects. Heart valve defects, cleft lips, cleft palates, and others are some of the most common defects that are being observed in case of these babies.

Disclosing all this information, along with the required statistics to a couple that intends to undergo the process is imperative. Non-compliance by any party involved in the creation of an IVF baby can amount to legal action.

In light of the ever-increasing popularity that stem-cell research is gaining in the field of medicine, it can be said that the field of IVF will only gain momentum in the future. Let’s hope that this in turn will result in an alteration and introduction of new guidelines of ethics to be followed, making it a safer and more fruitful process.
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