TEST TUBE BABY

LEGAL, ETHICAL AND ISLAMIC

PERSPECTIVE

dr. Meidona N. Milla, MCE

Depatment of Anatomy
Faculty of Medicine
Sultan Agung Islamic University
 QUIZ
1. Bayi tabung merupakan salah satu tipe dari
teknologi reproduksi ( y/n)
2. Pembuahan menggunakan teknologi
reproduksi berbantu selalu terjadi
diluarbtubuh ( y/n)
3. Penerapan teknologi reproduksi dalam islam
dibatasi oleh syarat tertentu: sebutkan!
4. Sebutkan pengembangan teknologi
reproduksi yang anda ketahui!
5. Teknologi reproduksi memiliki risiko tertentu,
sebutkan!
 Topics Overview
• Infertility
• Test Tube Baby at a glance
• History of ART
• Types of ART
• ART risks and success rate
• ART’s Recent Progress
• Issues Regarding ART
• Islamic Perspective on ART
 A. Infertility at a glance

Fertility
is the ability of a man and woman to conceive
through conception process

Conception
is the meeting of male and female gametes,
followed by the fusion of the gamete’s nuclei
and resulting an embryo that will later be
implanted in the womb pregnancy
 Infertility
 the absence of
pregnancy within a year
after regular
unprotected conception
 Prevalence
Happened in 12-15 % of couples in the
reproductive age group
 How can infertility be a problem?
• Impacts:
Physical and emotional problems
Interpersonal change in relationship
• Depression, decrease in memory function and
concentration
• Panic and frightened feeling, etc
 Child Position in Islam
• Child as Life’s pleasant
“dijadikan indah pada ( pandangan) manusia
kecintaan kepada apa-apa yang diingini,
yaitu: wanita-wanita, anak-anak, harta yang
banyak dari jenis emas, perak, kuda pilihan,
binatang-binatang ternak dan sawah ladang.
Itulah kesenangan hidup di dunia, dan di sisi
Allah-lah tempat kembali yang baik(surga) QS
Ali Imron: 14
 Choices for Infertile Couples
• Adoption
• remain childless
• Assisted Reproduction Technology ( ART) 
Test Tube Baby
 B. What is ART?
• A method that is artificially trying to unite
the male and female gametes that are
naturally have low possibility to meet, due to
some factors

 As a therapy for infertility problem

In indonesia is also known as “Teknologi
Reproduksi Berbantu “ (TRB)
One of ART most popular method nowadays
is Test Tube Baby ( In Vitro Fertilization)
 C. ART’s History
World First Test Tube Baby

• First test tube method was pioneered by dr Patrick Steptoe

dan dr Robert Edwards (England ) in 1977
• Applied to Lesley dan John Brown that had infertility problem
for 9 years due to tubal blockage

• on 25 July 1978 , 23.47 pm, world’s first test tube baby,

Louise Joy Brown, was born in Oldham and District Hospital
di Greater Manchester, England.
The Birth of Louise Brown
 Louise Brown
“World First Test Tube Baby”
 in the next 30 years, there were lot of
progress in techniques, culture media and
supportive medicine, resulting around
3,000,000 test tube babies around the
world
 ART History in Indonesia

 Known since 1984

• First Birth ART center Makmal Terpadu
Imunoendokrinologi Medical Faculty
University of Indonesia, RSCM, Jakarta
• The born of first test tube (IVF) baby: 2 Mei
1988
 D. Types of ART
 Intra Uterine Insemination ( IUI)
 In Vitro Fertilization
 conventional
ICSI
 IUI ( Intra Uterine Insemination)
= Artificial Insemination (AI)
sperm from a man is ejaculated, cleaned (washed)

 inseminated to uterus by using a catheter during ovulation

period
 Aim: to shorten the journey of a sperm to meet an oocyte in
female reproductive tract increase the possibility of
fertilisation
 IVF ( In Vitro Fertilization)

• commonly known as test tube baby

• A fertilization method that is performed

outside the body (in vitro)

• Sperm is ejaculated and egg (oocyte) is

retrieved by using specific method for later
are put together in a petri dish, allowing
fertilisation to happen
Conventional IVF Procedure
IVF Procedure
Fertilization Process
Embryo Culture
 Comparison:
natural
fertilization vs
IVF
 IVF-ICSI ( Intra Cytoplasmic Sperm
Injection)
• As modified method from conventional IVF
• Same basic method: oocyte and sperm are
taken out from a man and a woman
• Need only 1 sperm to fertilise 1 oocyte
• Sperm is directly injected through zona
pellucida of oocyte and released in oocyte’s
cytoplasm
 IVF-ICSI ( Intra Cytoplasmic
Sperm Injection)
• Specifically used for very low sperm count or
motility case
IVF-ICSI
ICSI Procedure
ICSI
 E. ART Risks and Success Rate
However, ART have some risks:
OHSS (ovarian hyperstimulation syndrome)
that can cause pain, abdominal swelling and
other discomfort: (Mild 8-23% Moderate 1-7%
Severe 0.25-1%)
Ectopic pregnancy ( less than 5%)
Multiple gestation
Congenital defects, etc
 Success Rate
• Success rates for IVF depend on a number of factors,
including the reason for infertility, where you're having the
procedure done, and your age.

• Pregnancy was achieved in an average of 29.4% of all cycles

(higher or lower depending on the age of the woman).
• The percentage of cycles that resulted in live births was
22.4% on average (higher or lower depending on the age of
the woman).
 F. ART Recent Progress
 Cryopreservation

“ a method that aims to preserve a cell or tissue by using cryo

agent (liquid nitrogen/liquid oxygen /liquid carbon
monoxyde) that will freeze the cell or tissue in very low
temperature”

sperm, oocyte, embryo, reproductive tissue

cryopreservation
Cryopreservation Process
 Objectives
 Efficacy of surplus embryos or oocytes that are obtained from an
IVF cycle to allow further use in the next cycle

 Preservation ovarian or testis tissues before cancer therapy

 Sperm cryopreservation for certain cases:

– Medical conditions that affect the ability for ejaculation (i.e:
multiple sclerosis, diabetes).
– Dangerous working area that can cause reproductive toxin
exposure
– Have to undergo some procedures that can affect the condition
of the testis, prostate or ejaculation capability (ie. Prostate
surgery)
– A man that will undergo vasectomy
 PGD ( Preimplantation Genetic
Diagnosis)
• A technique that is used to know and anlayze
the DNA and chromosomes structure of an
embryo before it is implanted in uterus, aims
to determine whether the embryo has genetic
disorder that is possibly passed from the
parents
 Surrogacy
•  the transfer of an embryo from a couple to other woman’s
womb
They also use surrogate mother…
 G. Issues Regarding ART

• Sex Selection
• Sperm Banking
• Designer babies
• Post Mortem Fertilization
 Sex Selection
through PGD process, that
will allow us to know the
sex of the embryo 
parents can possibly
choose the preferred one
  Sperm Banking
 Sperm cryopreservation from many men that
is usually intended to use as a donor
Some reasons for creating sperm bank:

– the intention to help infertile couples

– To get genius or super children  by choosing the sperm
from a genius or specific good characteristics donor
– avoid human extinction
– improve medical achievements
  Designer Babies
•  through sperm banking, consuments are allowed to choose
sperm with specific characteristica ( ie. Eye color, hair color,
race, inteligence degree, etc)
Designer Baby
  Post Mortem Fertilization
•  cryopreserved gametes or embryos are
possible to fertilised and transferred back to a
wife’s womb although the husband is already
dead.
 H. Islamic Perspectives on ART

• Is included in contemporer ijtihadiah problems, since it is not

specifically written in Al Quran and As Sunah.
• Must be carefully discussed among the islamic scholars for
the islamic law determination
 Related Islamic Daleels
• Position of children in Islam

It was suggested by Prophet Muhammad (pbuh) , to have more

children, as it is one of the main objective in a marriage:

“Menikahlah kalian dengan perempuan yang penyayang dan

subur (peranak), sebab sesungguhnya aku akan berbangga di
hadapan para nabi dengan banyaknya jumlah kalian pada Hari
Kiamat nanti.” (HR. Ahmad)
• One of Islamic values is that we are not supposed to easily give
up hope and suggest us to keep on trying in order to find Allah’s
bless.

• Allah has promised that in every difficulty there are easiness

afterward (QS.Al-Insyirah:5-6)

“ Maka sesungguhnya bersama dengan kesulitan itu ada kemudahan.

Sesungguhnya sesudah kesulitan itu ada kemudahan”
• The choice of a couple to do IVF as medical solution due to
their condition that cause difficulty to conceive naturally is
considered as mubah, as it is classified as seeking for cure.
• Muhammad (pbuh) has ordered , that if you are sick you
should try to find a cure for the disease .
• “Rasulullah saw had spoken:

• «‫ُهَل َعَضَو اَّلِإ ًءاَد ْعَضَي ْمَل َّلَجَو َّزَع َهَّللا َّنِإَف اْوَواَدَت‬
‫»ُمَرَهْلا ٍدِحاَو ٍءاَد َرْيَغ ًءاَوَد‬
Berobatlah kalian, sesungguhnya Allah tidak meletakkan
penyakit kecuali juga meletakkan obatnya, kecuali satu yaitu
kematian ( from Usamah bin Syarik, HR Abu Dawud)
• However, the mubah classification is based on 2 conditions:
1. IVF is carried out by using sperm and oocyte from legally
married couple

fromRuwaifi’ ibn Tsabit al-Anshari that Rasulullah (pbuh) have

spoken:

• « ‫م َيِقْسَي ْنَأ ِرِخآلْا ِمْوَيْلاَو ِهَّللاِب ُنِمْؤُي ٍئِرْمالِ ُّلِحَي َال‬

َ‫»ِهِرْيَغ َعْرَز ُهَءا‬
Tidak halal bagi seseorang yang mengimani Allah dan Hari
Akhir menyiramkan airnya (spermanya) ke tanaman orang lain
(HR Ahmad)

 a woman’s egg/oocyte should be fertilised only by her

husband’s sperm
2. The transferred of the embryo resulted from IVF process can
be done only when the husband is still alive
since the pregnancy of a woman without lived husband in the
beginning of the pregnancy is categorized as haram , since
after the husband’s dead followed by iddah period a woman is
considered in a divorced condition with former husband
3.third party involvement ( gametes or womb)
is categorized as haram, as it is similar as zina,
and zina is extremely forbidden in Islam

Surat Al-Isrâ [17] : 32).

 Basically zina is forbidden due to 2 reasons:

1.zina is classified as prostitution (al-fuj û r, al-
fâ’isyah)
2.Zina can cause child uncertainty regarding the
parents and children (ikhtilâth al-ansâb).
 Others factors:
• Man are created by Allah SWT as couples
• The interaction between man and a woman is
regulated by Islamic laws
• One of the marriage’s objective is to continue the
generation
• Pregnancy is legal and accepted only if it is
happen in legally married couple
• The nasab (pedigree) in Islam is very important
regarding the wali, descendent and muhrim law
 Islamic basic laws
 About Sperm banking

sperm banking that means using a man’s sperm who is not the
husband as a donor is cclasiified as haram, as it is
categorized as zina

QS Al Isra:32

‫شِحاَف َناَك ُهَّنِإ ۖ اَنِّزلا اوُبَرْقَت اَلَو‬

َ‫اًليِبَس َءاَسَو ًة‬
“ Dan janganlah kamu mendekati zina; sesungguhnya zina itu adalah suatu

perbuatan yang keji. Dan suatu jalan yang buruk ”

 QS An Nur: 2

• ‫رونلا‬ ‫لُك اوُدِلْجاَف يِناَّزلاَو ُةَيِناَّزلا‬

َّ ‫َمِهِب ْمُكْذُخْأَت اَلَو ۖ ٍةَدْلَج َةَئاِم اَمُهْنِم ٍدِحاَو‬
‫َنوُنِمْؤُت ْمُتْنُك ْنِإ ِهَّللا ِنيِد يِف ٌةَفْأَر ا‬
‫ط اَمُهَباَذَع ْدَهْشَيْلَو ۖ ِرِخآْلا ِمْوَيْلاَو ِهَّللاِب‬
َ‫َنيِنِمْؤُمْلا َنِم ٌةَفِئا‬

• Perempuan yang berzina dan laki-laki yang berzina, maka deralah tiap-tiap
seorang dari keduanya seratus dali dera, dan janganlah belas kasihan
kepada keduanya mencegah kamu untuk (menjalankan) agama Allah, jika
kamu beriman kepada Allah, dan hari akhirat, dan hendaklah
(pelaksanaan) hukuman mereka disaksikan oleh sekumpulan orang-orang
 Islamic Basic Laws
 About Surrogacy
o classified as haram if fertilised egg is put or transferres to other
woman’s uterus
o Using donor’s egg and the embryo is transferred back to the wife’s
uterus classified as haram
o Using donor’s sperm and the embryo is transferred back to wife’s uterus
 classified as haram

 Three methods above will cause mix up and lost of nasab of a child
 mentioned from Abu Hurairah RA that he heard rasulullah
was spoken ;:
“Siapa saja perempuan yang memasukkan kepada
suatu kaum nasab (seseorang) yang bukan dari kalangan
kaum itu, maka dia tidak akan mendapat apa pun dari
Allah dan Allah tidak akan pernah memasukkannya ke
dalam surga. Dan siapa saja laki-laki yang mengingkari
anaknya sendiri padahal dia melihat (kemiripan)nya, maka
Allah akan tertutup darinya dan Allah akan membeberkan
perbuatannya itu di hadapan orang-orang yang terdahulu
dan kemudian (pada Hari Kiamat nanti).” (HR. Ad Darimi)
About Post Mortem Fertilization

• Classified as haram. As the husband’s dead, in

Islamic law it is considered that divorce is
happened. Based on:
• “Orang-orang yang meninggal dunia di antara
kamu dan meninggalkan isteri-isteri,
(hendaklah para isteri itu) menangguhkan
dirinya (beriddah) empat bulan sepuluh hari.”
(Qs. al-Baqarah [2]: 234).
• This verse explained that soon after the husband’s death, the
wife have to pass iddah period and after that she is free to re
married again. It means the husband’s death is automatically
will cause divorce condition in this couple and they are no
longer husband and wife

• Based on that post mortem fertilization is categorized as

haram
 About Sex Selection
• Sex Selection through PGD is possible to be
done, however according to Islamic law it is
forbidden, based on:

• Ash Shuraa (QS 42): 49 – 50

“Dia memberikan anak-anak perempuan kepada siapa yang
Dia kehendaki dan memberikan anak-anak lelaki kepada
siapa yang Dia kehendaki (49) atau Dia menganugerahkan
kedua jenis laki-laki dan perempuan (kepada siapa yang
dikehendaki-Nya), dan Dia menjadikan mandul siapa yang Dia
kehendaki.”
 About PGD
• Is allowed as long as the purpose is to pick the
healthy unaffected embryo
 FATWA MUI ( 13 July 1979)
1. Tube baby produced from sperm and ovum from
legally married couple is consedered mubah, as it is
also categorized as ikhtiyar process

2. Tube baby produced from sperm and ovum from legally

married couple and implanted in surrogate mother is
haram based on Sadd az zari ’ ah, as it will emerge
complicated problem related with waris law
3. Tube baby from frozen sperm from dead husband is haram as it
will cause confusion in relationship with nasab and also waris
law

4. Tube baby from sperm and or ovum instead of legally married

couple or using donor is haram, as it is considered as zina.
 Other source

• Fiqh Institution OKI (Organisasi Konferensi

Islam ) in his meeting in Amman 1986
announced that IVF that uses sperm and egg’s
donor is haram
• IVF using husband and wife gametes, and later
will transferred back to the wife’s uterus is
classified as mubah
 Conclusion
• ART is a modern science that is principally considered neutral
as a progress and achievements in biology and medical
science

• Even though it is told that this technique will bring many

benefits for human kind, it is also easily abused, not to
mention will create many ethical issues due to its progress
such as the use of gamete donor, surrogacy, cryopreservation,
etc
 Conclusion..(cont’d)
• ART is allowed as long as:
 does not involved third party
 carried out as final effort in a condition that
is called emergency, after trying all possible
conventional ways.
Performed because there is a good intention
to have children, not for experiment or trials
• The application of ART is considered as mubah, as seeking for
cure for a disease is suggested by the prophet Muhammad
(pbuh), some more, it can be a mean in having more children,
one thing that is recommended in Islam

• However, the risks and success of ART still needs to be

evaluated and monitored intensively and should be in line
with Islamic values.

• Final result of every human’s efforts, including ART is

undoubtfully determined by Allah Azza wajala
Question?
Thank You for Your Attention..

Wassalamu’alaikum wr. Wb..

 Daftar Pustaka
1. http://www.mailarchive.com/satuxsatu@yahoogroups.com/msg00076.html

2. Werner, MichaelA., 2008. Cryobanking. Diperoleh dari :

http://www.mazelabs.com/MLcryobanking.htm

3. Problematika Hukum Islam Kontemporer, Editor Chuzaimah. T. Yanggo, Hafiz Anshry, Buku Keempat,
(Jakarta: PT. Pustaka Firdaus), 21

4. http://www.wikimu.com/News/DisplayNews.aspx?ID=10147

5. Problematika Hukum Islam Kontemporer, Editor Chuzaimah. T. Yanggo, Hafiz Anshry, Buku Keempat,
(Jakarta: PT. Pustaka Firdaus), 21

6. Masjfuk Zuhdi, Masail Fiqhiyah, (Jakarta : PT. Toko Gunung Agung), 2

7. http://www.mui.or.id/mui_in/fatwa.php?id=78

8. http://www.webmd.com/infertility-and-reproduction/guide/in-vitro-fertilization?page=2
• Assisted Reproduction - Islamic Views on the Science of Procreation., Norhayati Haji
AhmadEubios Journal of Asian and International Bioethics 13 (2003), 59-60.
• http://gempurserkamdarat.blogspot.com/2007/08/bank-sperma-apakah-ukuran-
sensitiviti.html
•