II. Definitions
A. Infertility
B. Assisted Reproductive Technology (ART)
C. Methods of ART
D. Frozen Embryos
III. History
IV. Ethical and Legal Issues Surrounding
ART
A. Health IssuesB. Social Issues
C. Legal Issues
V. Technology's Role in Faith Community
VI. Conclusion
The act of reproduction is vital in sustaining the existence of any living
creature. In fact, anthropologist Dr. Helen Fisher cites in her book Anatomy
of Love that "the most essential thing the human animal does is
reproduce" (Rutter, 1996). It is survival of the species: reproduce
or die out. In the human race, it is not a problem of extinction, but of
conforming to social expectations. Fisher notes that men feel the pressure
to "plant the seed" and women feel that motherhood is the sole
factor of "femaleness", while others feel that it is just an issue
of humanity's need to control nature (Rutter, 1996). Granted, these are
the opinions of only a few individuals, yet the topic of procreation is
obviously a very important issue between marriage partners. But what happens
when one cannot reproduce? An estimated one out of every six couples in
the United Sates has difficulty conceiving a child (Rogers, 1988). Fifty
years ago, these infertile partners had only three options: continue trying
to have a baby through natural sexual intercourse, adopt a child, or simply
remain barren. However, recent developments in reproductive technologies
have created many alternative methods for conception. Assisted reproductive
technologies caught on quickly, and in 1995 three million American couples
sought procreative help (Rutter, 1996). Along with the emergence of any
new technology comes ethical and legal issues which must be considered,
especially in Christian settings. However, it is possible that assisted
reproductive technologies can be a realistic and ethical option for infertile
couples, without compromising the covenants of the faith community.
In order to understand the issues that surround assisted reproductive technology,
it is important to first become familiar with the myriad of terms that are
involved. Infertility is described as the inability to conceive or carry
a baby to term after at least one year of unprotected sex, 2-3 times per
week. This condition can be attributed to a variety of both male and female
factors. Forty percent of all infertility cases are caused by problems with
a woman's hormones, eggs, or reproductive organs while another forty percent
of cases are caused by a low sperm count or slow sperm in men. The remaining
twenty percent is due to unexplained physical, biological, or genetic factors
(Rutter, 1996).
Creighton University sociologist Shirley Scritchfield cites that infertility
rates for married women have actually decreased since 1965, dropping from
11.2 to 8%, even though some subgroups of women have a higher frequency
of reproductive problems. For example since 1965, infertility in young women
ages 20-24 increased because of more cases of sexually transmitted diseases
(STDs). STDs can cause pelvic inflammatory diseases which scar the fallopian
tubes and inhibit the movement of the egg from the ovary to the uterus.
Women ages 30-45 are members of a second subgroup with increased fertility
problems. In 1990, 18% of first birth mothers were ages 30 and higher (Rutter,
1996). Many women are waiting longer to have children because they want
to settle into their career before starting a family. This was not a factor
several decades ago, because most women were expected to stay at home and
take care of the children.
There are many ways in which infertility can be remedied with the utilization
of assisted reproductive technologies (ART). These methods attempt to bypass
any or all of the problems associated with infertility to aid in the process
of fertilization (Thomasma & Kushner, 1996). Each procedure of ART involves
microscopically manipulating sex cells and/or embryos which are smaller
than the period at the end of this sentence using methods from low technology
to high technology. The simplest method includes administering fertility
drugs, orally or by injection, to control ovarian stimulation or induce
ovulation. These medications increase the number of eggs the ovaries will
produce or change the time at which the eggs are released (Thomasma &
Kushner, 1996). Besides the obvious uses of fertility drugs, many women
who do not have problems getting pregnant take this medication in order
to regulate their menstruation cycle.
Artificial insemination (AI) is another ART procedure that requires simple
technology. There are three types of these collaborative reproductive methods:
artificial insemination by husband (AIH), artificial insemination by donor
(AID), or surrogate motherhood. In the first two methods of AI, the semen
is introduced into the women's vagina, cervical canal, or uterus during
ovulation using a syringe (Nelson, 1973). During its first few years of
inception, AI was a procedure that was administered in a doctor's office,
but over time the method has simplified. In fact, over-the-counter insemination
kits are now available for interested individuals.
Surrogate motherhood is used when the female is infertile, but the husband
can produce viable sperm. This procedure requires the couple to enter a
contract with a woman outside of the marriage. She is artificially inseminated
with the husband's sperm and carries the baby to term. After the birth of
the child, the woman transfers all parental rights to the couple, who are
now free to adopt the child (Rogers, 1988). In many instances, surrogate
motherhood creates hard feelings and even legal battles between the two
parties involved. At the time of the contract, surrogates feel that the
procedure is simply a way to make money. However, some women feel that after
nine months of bonding with the fetus they cannot separate themselves from
the child after birth.
Within the last twenty years a new method called in vitro fertilization
emerged to become the most common method of ART. For this procedure, the
egg and the sperm are united outside (in vitro) of the body in a
petri dish, and the resulting zygote is implanted back into the uterus.
To ensure the ovaries produce enough eggs, the females are placed on fertility
drugs such as Clomid or Pergonal which stimulates the ovaries to develop
several eggs instead of one. While it is necessary to use the medications,
they may produce undesired results. Most women release only five to ten
eggs while on fertility drugs, but sometimes as many as forty eggs are delivered
(Goel, 1992). If more than one egg becomes fertilized the couple must decide
to keep the extra embryos or destroy them.
Initially IVF used laparoscopy and general anesthesia, but now utilizes
transvaginal ultrasound guided needle aspiration and local anesthesia to
remove the oocytes from the ovaries (S. L. Jones, 1994). The eggs are obtained
using a fine, hollow tube and needle inserted through slits in the abdomen
near the ovaries. Once the eggs have matured 5-6 hours in an incubator,
they are mixed with the husband's (or donor's) sperm in a nutrient liquid.
Fertilization occurs in approximately 3-4 hours, and the zygote is allowed
to incubate another 40 hours, or until it reaches the 4-cell stage. Once
it reaches this state, the embryo is transferred to the mother's uterus
via the vagina and cervix (D.G. Jones, 1984). Once again, ultrasound is
employed to aid in this part of the procedure. The reintroduction of the
womb must be carefully monitored. It is very important that the zygote attaches
to the endometrium as soon as possible. If not, the embryo may travel into
the fallopian tubes and start developing, creating an ectopic pregnancy.
The main use of IVF is to help couples have a child using their own sex
cells when a woman's fallopian tubes are blocked. Although this procedure
is relatively common, there are also a number of more advanced ART methods.
In gamete intrafallopian transfer (GIFT), the eggs are removed during surgery,
immediately mixed with sperm, and replaced in the fallopian tubes through
small incisions in the abdomen. For two weeks following the procedure, the
women is put through a regimen of hormones to encourage the embryo to implant
in the uterus ("Fertility Clinics," 1996).
A number of advanced ART methods challenge male infertility. Intracervical
insemination (ICI) and intrauterine insemination (IUI) involve injecting
sperm into the female body using a syringe. In zona drilling (ZD), the layer
surrounding the egg cell called the zona pellucida is penetrated by a sperm.
A micropipette injects a stream of acidic fluid intended to thin the layer
and reduce the surface strength, which allows weak sperm to get through.
However, this method may prove too effective because it can create a condition
called polyploidy, which means more than one sperm penetrates a single egg
(Thomasma & Kushner, 1996). This may cause abnormalities which disorient
the sexual chromosomes of the fetus. Instead of XX and XY individuals, the
resulting child may have an extra male (Y) chromosome: XXY or XYY.
The most technical of ART procedures is intra-cytoplasmic sperm injection,
or ICSI. This method is most beneficial for couples with severe male infertility
factor (very low number of sperm). Using a sharpened mircropipette a single
sperm is injected into the egg which reduces the danger of genetic polyploidy
(Thomasma & Kushner, 1996). This method is in its first stages and is
currently only being administered in research hospitals.
We are now at the point where basic ART is considered standard fertility
treatment, but as in any technology, the initial trials were very rudimentary.
The Bible actually contains the first documented assisted reproductive procedures.
Surrogate motherhood was used in several instances to remedy barrenness.
Sarah and Rachel both used the assistance of their maids as surrogates to
insure that their husbands had sons (Neuberger, 1987 & Snyder, 1988).
During biblical times (and even in today's society) a woman without a child
is considered unfulfilled and some women will do anything in order to conceive.
The first case of ART in modern times occurred in 1790, when John Hunter
reported that a man used a syringe to vaginally deliver his semen to his
wife. In 1884, Dr. William Pancoast, a professor at Jefferson College of
Medicine in Philadelphia, impregnated a woman using sperm from the "best
looking medical student" in his class. This event was kept secret for
twenty five years because many physicians and clergy felt that this conception
was sinful and equal to adultery or even rape (Thomasma & Kushner, 1996).
In fact, many people still have similar feelings which is the basis for
much of the controversy that surrounds ART.
During the 1940's, many others feared that a 1932 science-fiction novel
by Aldous Huxley was actually coming true (Bohle, 1979). Brave New World
forecasted a time when humans would be generated by asexual reproduction
in an assembly-line fashion. Each child born would be "pre-conditioned"
to a certain destination in order to control the human species (Thomasma
& Kushner, 1996). Obviously, Huxley's ideas created a great deal of
panic. Many people were not ready for science to be so thoroughly involved
in such an intimate act between loving, married couples. God intended procreation
to be a natural occurrence, not something that was incubated or monitored.
However, the need to create new methods to cure infertility remained.
In 1950, English scientist Christopher Pulge, enhanced the viability term
of frozen sperm by adding glycerol to the semen. Now the frozen sperm lasted
several years instead of only a few days or months. In 1953, Dr. R. G. Bunge,
urologist at the University of Iowa, reported the first successful human
birth from frozen sperm. During this same time, Iowa City and Tokyo set
up the first sperm banks which enabled men to collect their sperm and store
it for a fee. Men planning vasectomies could store their sperm in case they
changed their minds about the procedure. This was also a favorable option
for those males in high-sterility risk occupations like professional athletes,
policemen, and those exposed to radiation. In fact, one prominent Midwestern
man stored some of his sperm in case his adolescent son was sterile. The
father thought that his sperm could impregnate his son's future wife to
ensure the preservation of the family blood line (Nelson, 1973).
Up to this point in history, females were always viewed as the cause of
infertility among married couples. Many physicians and psychologists believed
that a woman who did not get pregnant was merely suppressing her "true
femininity" (Rutter, 1996). These views began to change as technology
advanced and tests were made available to check both male and female fertility.
After going through a regimen of many of these fertility tests, English
couple Mr. and Mrs. Brown discovered the cause of their inability to conceive
children: Mrs. Brown's fallopian tubes were scarred due to pelvic inflammatory
disease. The couple did not give up, however. With the help of Dr. Patrick
Steptoe and Professor Robert Edwards, Louise Brown was born in 1979, the
first "test-tube" baby using IVF (Thomasma & Kushner, 1996).
The birth of this little miracle child rocked the world, creating both celebration
and concern. Along with the ability to conceive offspring outside of the
uterus, IVF created the possibility of freezing embryos for future usean
idea that caused much controversy to many people. In the embryos frozen
through cryopreservation, divisions are arrested in the two, four, or eight
cell stage. These embryos are placed in an aluminum container filled with
cryoprotectant solution, cooled with liquid nitrogen to -200 degrees Celsius
and stored in special containers (Goel, 1992). The storage of frozen embryos
is just one of the ethical questions that surround ART.
Ethical and
Legal Issues Surrounding ART
Once as taboo as asking a person's weight or income, having kids and other
fertility issues are dinner table conversation in our modern society. Even
so, it is important to realize that going through with infertility treatments
is not an easy decision. In Birth to Death, Dr. Michael McClure states
that ART "leads to ethical, moral, and legal questions based on what
we should do, as opposed to what we can do" (Thomasma & Kushner,
1996). Each new technological method generates new medical, ethical, and
legal questions to be seriously contemplated by the infertile couple before
proceeding, because even the simplest of procedures may cause adverse consequences.
Although the percentage is very low, some women have negative reactions
to some ART procedures. For example, there is some evidence linking fertility
drugs to ovarian cancer (Thomasma & Kushner, 1996). Also during the
IVF procedure, there is an increased risk of ovarian or tubal damage as
the eggs are drawn out of the body (Goel, 1992). This risk is becoming increasingly
smaller as the removal procedure advances. There was also a case of a woman
from Washington who claimed that she contracted AIDS after an ART procedure
with donor sperm. The Center for Disease Control cites only 7 such cases
and now requires clinics to do routine AIDS testing on donor sperm (Hoffman,
1996). Mothers are not the only individuals at risk during ART procedures.
The most serious health concerns currently studied are associated with the
health of the resulting embryo. In her article "Give Me Children or
I Shall Die!" Cynthia Cohen discusses some of the risks involved with
children born of IVF (1996). There was some research done which suggests
that IVF children are two to three times more likely to suffer from neural
diseases such as spina bifida. This data, taken from an Australian study,
also cites fertility drugs increasing the risk of serious birth impairments
in the resulting children. American researchers conducted a follow-up study
on the health status of children born from IVF and found no significant
differences in the rate of physical or neurological abnormalities (1996).
In Birth to Death, David Thomasma and Thomasine Kushner tell that the birth
defects in ART children are not significantly different than those from
the general population (1996). However, because ART methods like IVF are
relatively new, it is not possible to conduct long-term studies.
Another issue that must be discussed as a couple before proceeding with
ART methods is the cost involved. Is it ethical for a couple to spend up
to $8000-$10,000 per treatment when most conceptions do not occur until
at least the third or fourth treatment ("Fertility Clinics," 1996)?
In fact, the cost of a successful delivery of an ART infant ranged from
$44,000 to $212,000 (Thomasma & Kushner, 1996). The issue of cost is
especially pertinent because most couples who enter fertility clinics have
no insurance coverage for the treatment. Massachusetts is the only state
that requires insurance companies to cover fertility procedures. This has
resulted in the state having five times more couples who enter into ART
treatments ("Fertility Clinics," 1996).
Usually the problems surrounding ART are more social than medical. Each
type of method creates different circumstances for the couple. For example,
in Moral Dilemmas in Modern Medicine, Drs. Snowden and Mitchell cite
that in some cases with AID-born children, a father may not feel the same
bond with the child as the mother, because technically he or she is not
his genetic offspring (Lockwood, 1985). The husband may resent the donor
and feel like the child is not really his own. This can work in the opposite
way, as well. The wife may feel a detachment from her husband and feel a
bond with the man who donated the sperm for her child (Bohle, 1979). Surrogate
motherhood poses some similar moral and psychological dilemmas, because
like AID, it can create problems pertaining to the identity and responsibility
for the offspring. In fact, because of this, some states have actually made
it illegal to enter a contract with a surrogate mother (Thomasma & Kushner,
1996). Here begins the controversial legal issues associated with ART. Although
there are examples of confusing legality in almost every type of ART procedure,
surrogate motherhood can cause the most problems. During the last fifteen
years, there has been 5000 legally contracted surrogate births. Twelve of
these contracts were challenged by the surrogate mother, but there was only
two cases where the court granted sole parental rights to the surrogate
motherand this was only because the adoptive parents divorced before the
child was born. Attorney John Weltman gives several pieces of advice that
will help prevent many hurt feelings among the involved individuals of surrogate
motherhood. The most important aspect, Weltman says, is the need for honesty
between the infertile couple and the surrogate (1997). It is important that
the three sit down and discuss all of the possible consequences that may
arise to ensure the successful transfer of parental rights.
Other areas of ART produce many court cases, as well. During the early 1990's
Steve and Maureen Kass struggles through several attempts at IVF to produce
a child. Although the couple froze several, not one child was conceived.
The marriage soon ended in divorce and there was a struggle over who got
ownership of the frozen embryos. In 1995, the New York Supreme Court ruled
that the mother had sole right to determine the embryo's fate. This judgment
contradicted the ruling of the Tennessee Supreme Court several years earlier
(Hoffman, 1996).
The Kass case is just one example of the varied issues surrounding the use
of frozen embryos. There are also controversies with storage of frozen embryos.
One law states that these embryos cannot be stored for more than five years,
but after five years what is done with the unused embryos? Recently, Italy
destroyed over 3000 unused embryos because they were frozen for ten years
(Biggin, 1996). If a person believes that human life begins at conception,
the idea of destroying these embryos is morally wrong. This also leads to
another debate. Many ART techniques result in multiple fertilizations because
the fertility drugs used to augment the chance of conception sometimes create
triplets, quadruplets and so on. Does the woman have the right to keep only
the fetus(es) she wants and terminate the rest, or does each fetus have
the right to life?
Technology's
Role in the Faith Community
All of these questions are especially puzzling to those individuals involved
in a faith community. Not only must legality of ART procedures be considered,
but the morality of the issues, as well. Are ART procedures condoned by
God, or are they just another example of how humans are trying to play God?
fertility treatments really There are many strong opinions on both sides
of this argument. Many religious groups and theologians are adamantly opposed
to ART procedures for various reasons. For example, the Roman Catholic church
believes that any "interference with nature is not acceptable"
in any form. They condemn AI, even when the husband is the donor (Bohle,
1979). This belief is echoed by many Christians in Graydon Snyder's book
Tough Choices. They find ART procedures to be sinful because the
child is conceived without the act of love (1988). God intended that procreation
be joined with sexual intercourse in the bonds of marriage, and any other
methods of reproduction are immoral because they are not sanctioned by God
(Bohle, 1979). This notion is troubling because many times children are
conceived in a marriage by the "act of love," but there really
is no love displayed between the couple.
This viewpoint is shared by many others like theologian Joseph Fletcher.
They believe that sexual intercourse is secondary to the relationship itself.
Fletcher claims that the essential part of a marriage is the love between
a husband and wife, and therefore ART does not actually break the bond of
marriage when the child is conceived out of love (Bohle, 1979). In 1974,
Fletcher wrote a book entitled The Ethics of Genetic Control:
Ending Reproductive Roulette which discussed many topics including artificial
insemination. He believes that each new technology "represents a way
of exercising rational and responsible control over life and reproduction"
(Thomasma & Kushner, 1996). The following is a quote that reveals Fletcher's
stance on ART:
Man is a maker and the more rationally contrived and deliberate
anything is, the more human it is. Therefore, laboratory repro-
duction is radically human compared to conception by ordinary
heterosexual intercourse (Thomasma & Kushner, 1996).
Obviously, this is just the opinion of only one man, yet his ideas do pose some interesting, and maybe even valid questions. Fertility treatments are a complicated subject, and it is very important that couple, along with members of their faith community, sit down and examine the reasons why they want to go ahead with the procedures. Many times couples feel like it is their duty to procreate, but many their time and money could be better spent in another aspect of child care. For example, there is always a need in the church for youth sponsors, advocates, and teachers. Maybe instead of investing thousands of dollars into unreliable procedures, that money could be used to adopt a child or send an underprivileged child to college.
It seems that too many times people take advantage of technology and use
it for selfish purposes. We have become so accustomed to technology in every
area of our lives, but especially in the health field, that we expect "miracles"
to occur without even questioning their origin. It is important to remember
that little miracles like children are gifts from God, not humans. We must
also realize that technology itself is a gift from God, and, therefore,
it should not be feared. This fact should comfort Christian skeptics who
wonder if new technological procedures (like ART) are starting to "play
God." This is and should be a valid concern to the faith community;
however, it is possible that our values may radically change as technology
increases. Based on what is taught and described in their own faith covenant,
Christians must decide what constitutes their personal values and how these
decisions will affect their personal relationship with God.
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