Question

what is IVF and what positive/negative ethical and eugenic concerns arise in relation to preimplantation diagnoses?

Answer 1

# IVF

In vitro fertilization (IVF) is a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child.

During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus. One full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process can take longer.

Why it's done

In vitro fertilization (IVF) is a treatment for infertility or genetic problems. If IVF is performed to treat infertility, you and your partner might be able to try less-invasive treatment options before attempting IVF, including fertility drugs to increase production of eggs or intrauterine insemination — a procedure in which sperm are placed directly in your uterus near the time of ovulation.

# What Causes of Infertility Can IVF Treat?

When it comes to infertility, IVF may be an option if you or your partner have been diagnosed with:

* Endometriosis

* Low sperm counts

* Problems with the uterus or fallopian tubes

* Problems with ovulation

* Antibody problems that harm sperm or eggs

* The inability of sperm to penetrate or survive in the cervical mucus

* Poor egg quality

* Genetic disease of mother or father

# preimplantation

The use of preimplantation genetic diagnosis (PGD) to screen embryos for aneuploidy and genetic disease is growing. New uses of PGD have been reported in the past year for screening embryos for susceptibility to cancer, for late‐onset diseases, for HLA‐matching for existing children, and for gender.

# Ethical Concerns of PGD

For all its expense and inconvenience, preimplantation genetic diagnosis does not escape the moral objections that many have to abortion. True, no fetus is destroyed, and the tested embryos are not harmed. Yet, embryos are created that the couple never intends to use, and chances are no one will "adopt" the unimplanted embryos that carry the unwanted mutation. Hence, those who think that human life, from fertilization forward, shares the moral status of living persons view PGD and abortion in the same light: both practices disregard or at least devalue the sanctity of life. The ethical position currently expressed in US judicial decisions and health policy confers progressively greater moral status on embryos, fetuses, and newborns along a continuum demarcated by developmental milestones such as appearance of the neural streak at about 14 days, development of the nervous system, fetal viability, and so on. Individuals who share this progressive view of moral status might suffer less from discarding embryos than from destroying a fetus.

Others object to PGD for the same range of ethical reasons that they oppose germline gene therapy and genetic engineering. Selective implantation prevents certain genotypes from coming into existence, thus threatening genetic diversity and discriminating against those with disabilities; it commodifies children, mocking the true meaning of parenting and jeopardizing the parent-child relationship; and it deprives people of the opportunity for personal and moral growth that can be realized from making the most of what "nature" bestowed upon them.

The first of these objections—curtailing genetic diversity—has been voiced by advocates for those with disabilities. Spokespersons from this camp argue that elaborate, expensive, and unnatural procedures for selecting embryos without serious genetic mutations conveys the message that people with disabilities are less highly valued than those without. The majority of bioethicists, while acknowledging that this claim of prejudicial devaluing has merit, contend that the possible psychological harm done to persons with disabilities does not justify restricting the reproductive freedom of couples who wish to reduce their risk of having a child with a disability.

The technique can, at present, be used to select embryos by sex and may, in the future, be able to allow selection for certain other non-health-related traits. These real and potential applications raise a host of ethical concerns beyond the possibly prejudicial avoidance of offspring with disabilities. Sex selection because of a sex-linked disorder is generally acceptable to those who accept PGD at all, but many oppose selecting sex for "family balancing" or because parents prefer to have a son rather than a daughter, or vice versa. Trait selection for talent, personality, or non-health-related physical attributes comes under greater ethical scrutiny, even though it is not technically possible at this time. The "chosen child" faces a determinism more forceful and rigid than genes, according to David King: parental determination that the child fulfill the intention or talent or skills it was selected to embody .

# Ethical issues in current and expanded uses of PGD

Two main sets of ethical objections make PGD and proposals for its extension controversial. One set of objections arises from the need to create and then select embryos on chromosomal or genetic grounds, with the deselected embryos then usually discarded. Other objections concern the fact of selection itself.

Objections to PGD based on its effect on embryos replay debates over abortion and embryo status that have occurred in many other contexts, from abortion to embryonic stem cell research. People who think that the embryo or fetus is a person will object to creating and destroying embryos, and oppose most uses of PGD. Others believe that preimplantation embryos are too rudimentary in development to have interests or rights, but that they deserve special respect as the first stage toward a new person (American Society of Reproductive Medicine, 1994). Under this view PGD is ethically acceptable when done for good reasons, such as preventing offspring with serious genetic disease. Indeed, PGD may prevent selective abortions for those diseases. A major issue with new uses of PGD is whether they sufficiently benefit important human interests to meet the demands of special respect for embryos that supporters of PGD may require.

A second set of objections arises from the fact of selection itself, and the risks of greatly expanded future selection of embryos and children. Sometimes based on religious views about the nature of human reproduction, ethical objections to selecting offspring traits raises two kinds of ethical concerns. One kind is deontological—the ethical judgement that it is wrong to choose traits of offspring, no matter how well intentioned. Dr Leon Kass has articulated this view, as has the President’s Bioethics Council in the United States, which he chairs. They argue that human reproduction is a ‘gift’ and that any form of selection or manipulation turns the child into a ‘manufacture’ and thus impairs human flourishing (Kass, 1998, 2000, 2002; President’s Bioethics Council, 2002). The second kind of concern is consequentialist. It arises from fears that increasing the frequency and scope of genetic screening of prospective children will move us toward a eugenic world in which children are valued more for their genotype than for their inherent characteristics, eventually ushering in a world of ‘designer’ children in which genetic engineering of offspring becomes routine.

While recognizing the strong objections of some people to PGD on these grounds, the following discussion assumes that the use of PGD to screen for aneuploidy and serious Mendelian disorders is ethically and legally acceptable when performed according to applicable regulatory guidelines. It concentrates instead on new indications for PGD, and asks whether they would also meet ethical standards of acceptability