Invitro Fertilization (IVF)

&
Pre-Implantation Genetic
Diagnosis (PGD)

Ashley Feinstein
Amanda Garbutt
Yiyin Xiong

Engineering 124; Spring 2003

1
 The technology of invitro fertilization (IVF) has been available to
infertile couples and women seeking motherhood via alternate means since the
late 1970s. In addition, recent advancements in human genome mapping lead
to the emergence of new applications for reproductive technologies, most
notably, pre-implantation genetic diagnosis (PGD). The procedures involved in
IVF are relatively common and uncontroversial; however, the addition of PGD
to the process calls to consciousness an awareness of the possibilities and
potential abuses of science. Of special concern is the need to weigh the goal
of pregnancy and disease-free life against the medical and moral risks involved,
specifically, social eugenics, multiple gestation, inherent tendencies toward
production mentality, and manipulation of human life. The challenge to arrive
at an ethical response to the questions posed by reproductive technologies lies
in the need to discuss these issues within the frame of various worldviews and
ethical theories. This theoretical dialogue presents the opportunity to
formulate regulations promoting positive and beneficial usages of IVF and PGD.
Engineering 124; Spring 2003

Process of IVF

1. Hyper ovulation
2. Egg Retrieval
3. Artificial
Insemination
4. Embryo Transfer
                                                                              

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Engineering 124; Spring 2003

IVF Statistics
From 1998 Center for Disease Control:
• $7,800/cycle
• 30% pregnancy rate/cycle
• 3-4 embryos transferred/cycle
• 12% of IVF pregnancies involve multiple fetuses

In the event of multiple implants, your options include:

•Fetal Reduction
•Risks include potential loss of all fetuses
•Bear all
•Risks include premature birth
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 Engineering 124; Spring 2003
PGD:
Genetic testing performed prior to embryo transfer

“The debate [around PGD]

has been building since the
late 1980s, when doctors at
London's Hammersmith
Hospital learned how to tease
a cell from a 3-day-old
embryo and study its
chromosomes for gender.”
(Zitner 2002)

•Adds $2000 to IVF

•Reduces rate of miscarriages from 23% to 10%
•Does not increase chance of pregnancy
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Engineering 124; Spring 2003

Commonly, more than 100 diseases can

be detected through testing, including…
• Hemophilia A
• Muscular dystrophy
• Tay-Sachs disease
• Cystic fibrosis
• Down Syndrome
Removal of one cell for testing

PGD is not a new technology, but is due to the application of

old techniques to the new knowledge gained from the Human
Genome Project.
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Engineering 124; Spring 2003

Viable and Desirable?

“This information is helping parents choose which

embryos they want--and which to reject as unhealthy, or
merely undesirable.” (Zitner 2002)

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Engineering 124; Spring 2003

Undesirable Embryos

Disease Free Embryos Disease Carrying Embryos

• Frozen in storage • Donated to research
• Donated to infertile • Discarded
couples
• Donated to stem cell
research/usage

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Engineering 124; Spring 2003

Impact (Part I)

F a c tu a l

IV F PG D

* i n c r e a s e i n m u lt i p l e b i r t h s * d e c r e a s e d r a t e o f s p e c i f ic
* i n f e r t il e c o u p l e s c a n r e p r o d u c e d i s e a s e s in t h e p o p u l a t i o n
* s u rro g a te p a re n th o o d ( r e fe r to n e x t s lid e )
( w o m b d o n o rs , $ 2 8 K - $ 4 5 K ) * d e c r e a s e d r a t e o f m is c a r r ia g e

9
 Engineering 124; Spring 2003

Refutation of a Common Misconception

While PGD may decrease the rate of specific diseases in a
population, it will not alter the gene pool.
Even if genetic engineering produces a designer baby, “human nature will not be altered
unless such changes occur in a statistically significant way for the population as a whole.”
Mankind’s gene pool is very large and contains so many different alleles that “modifying,
eliminating, or adding to those alleles on a small scale will change an individual’s
patrimony but not the human race’s.”
“Fred Ikle argues that any future attempt to eugenically improve the human race would be
quickly overwhelmed by natural population growth.”
“It is entirely plausible that an advanced, democratic welfare state would reenter the
eugenics game…It would be the state, under these circumstances, that would make sure
that the technology became cheap and accessible to all. And at that point, a population-
level effect would very likely emerge” (Fukuyama 2002)
Basically, what the above states is that genetic engineering will not lead to modifications in
the gene pool unless the technology becomes cheap and encouraged by the state. It is only
at this point that the gene pool will begin to change. 10
 Impact (Part II)
Engineering 124; Spring 2003

A x io lo g ic a l

IV F PG D

* p r o d u c t io n m e n t a l i t y * o c c u p a t io n o f s u r o g a t e m o t h e r h o o d * E u g e n ic s
* s t e m c e ll r e s e a r c h * p la y in g C r e a t o r * g e n e t ic s a r m s r a c e
* c h a l le n g e s b e g i n in g o f l i f e * " G e n R ic h " * d is c r im in t a io n
* m a rk e t fo r g a m e te s * s lip p e r y s lo p e

“GenRich” is controversial; it could be harmful or beneficial.

Production mentality is a problem. “Where amniocentesis usually provides
“[The ‘GenRich’]
information about will
a use technology
single fetus, to ensure
embryo that theirallows
screening childrenparents
have significantly
to judge more
and
"Would
Fukuyama
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power
if this
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change
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of future
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Hughes,
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(Wagner
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2003)
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the rest of humanity. If you had to think
(Wagner 2003) of who you’d like to
standard
ultimately that
the clearly
ability to articulates
change human a strong
nature.” set of
(Fukuyama moral
2002)
test these technologies, what better group can you imagine? They’re well informed, highly
values." (Zitner 2002)
(Scannell 2001)

motivated, eager, hard to coerce and they are definitely volunteers.” (Jonietz 2003)
11
Engineering 124; Spring 2003
th ics World Views Ut
ilit
h ts E ari
Ri g
Ethics: The issues at hand… a ni
sm
Care Ethic
s

…weighing the goal of …requires society

pregnancy and live birth to make a decision
against the medical and on when life begins.
moral risks of multiple
gestation.

…using PGD inherently makes assumptions about

the quality of life, challenging basic tenets of
society such as equality.
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Engineering 124; Spring 2003

Care based ethics

• Address the suffering of the mother
due to her inability to have a child
“naturally”
• “When having children, people…
often roll the genetic dice and hope
for the best. With embryo sorting,
"they can start their pregnancy on
Day One with a commitment to
continuing it."
(Zitner 2002)
• PGD can save parents massive
heartbreak and financial strain
• Address the view of the potential
child
– Will the child have adequate support
and a stable home?
– If there are multiple fetuses, will the
children receive adequate
care/attention?
• “[PGD has] the laudable goal of
stopping deadly genetic diseases
such as Tay-Sachs and
Huntington’s. This research has
growing support because it can
save children from enormous
suffering and early death.”
(Wagner 2003)

Care ethicists would be in favor of IVF and PGD as long as

the decision is loving and promotes positive relationships.
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Engineering 124; Spring 2003

Definition of Moral Community

for Rights Based Ethics
Before one can decide to whom rights apply, one must determine
the moral community.
“As individuality is a sine qua non for personhood, it seems safe to consider 14
days of normal embryonic development to be the minimum requirement before
a human being can emerge. Other criteria might place the earliest time point at
a later stage, for example, 28 days, when the neural tube closes and the
development of the central nervous system necessary for rationality begins. Or,
with Aristotle and St. Thomas Aquinas, one might consider 40-90 days of
development to be necessary to allow a human soul to be present; or as the
Roman Catholic Church taught for centuries, one might require body-form and
movement to be present before full human status was recognized.” (J.E.S.Hansen)

Therefore, embryos lack rights as individuals because they

are not part of the moral community.
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 Engineering 124; Spring 2003

Rights Based Ethics

Embryos are mass-produced, screened, discarded and used in
experiments: are they products or people with rights?
According to Hansen (see previous slide), the treatment of embryos is not an issue.

Based on John Locke’s principles, all people have the right (in America) to “life,
liberty and the pursuit of happiness.”
•What becomes of the idea that everyone is created equal if you start designing
children?
•Loss of autonomy because of a necessity to be competitive in society
•Inherently discriminatory; makes assumptions about quality of life
"Most people with disabilities rate their quality of life as much higher than
other people think. People make the decision [to reject embryos] based on a
prejudice that having a disability means having a low quality of life.“
(Zitner 2002)
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Engineering 124; Spring 2003

Utilitarianism

The greatest good for the greatest number suggests that…

• The alleviation of suffering for

many is important.
– IVF helps many infertile couples
achieve a life-long dream of having
a child.
– PGD helps those same couples reach
their goal of a disease free child.
• A disease free society is
preferable for all members.

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Engineering 124; Spring 2003

Western Worldviews
The Newtonian/Cartesian Paradigm suggests that…
– one should use available technology
– technology will replace sexual reproduction by natural means
“…sees a human being…as the sum of a series of
material causes that can be understood and
manipulated by human beings.”(Fukuyama 2002)
The Judeo-Christian point of view holds that man is created in
God’s image.
“For Christians in particular, this has important implications for
human dignity. These reproductive technologies…are wrong
from this perspective because they put human being in place of
God in creating human life.” (Fukuyama 2002)

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 Engineering 124; Spring 2003

Eastern Worldviews
Taoism
– abjure all striving
– Life should be lived with effortless action Confucianism
– An ethical societal structure based
– one should “go with the flow”
on relationships and authority
Therefore, if you are infertile and unable to – Filial relationships often stressed
have a child by natural means, then you
– Treat others as you yourself would
should not try to achieve this goal through like to be treated
IVF or PGD.
Therefore, IVF and PGD should be
Buddhism allowed as long as social order and
– Compassionate care
construct are maintained.
– Have respect for the life cycle
– Precautionary principle
Therefore, IVF should be allowed because
it shows care for all, but PGD should
be banned.

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Engineering 124; Spring 2003

International Policies on PGD

•Banned PGD for ALL usages

•Used to select child’s

gender only when there
is medical need

•Clinics set policies; no

federal or state restrictions 19
Engineering 124; Spring 2003

Final Thoughts
For our society, IVF and PGD are ethically appropriate. Not only
do these technologies allow for parenthood in reproductively
challenged couples, but they allow parenthood with a minimization
of risks like disease. There is the concern of the slippery slope, or
couples who might try to abuse the technology, therefore the
government should impose regulations on…

• the number of pre-embryo transfers/cycle.

• the accuracy of clinical statistics.
• PGD, which should be used for medical screening ONLY.

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Engineering 124; Spring 2003

References
“‘Designer baby’ ethics fear.” BBC News 4 October 2000.
http://news.bbc.co.uk/1/hi/health/955644.stm (1 May 2003).

Fukayama, Francis. Our Posthuman Future: Consequences of the Biotechnology

Revolution. New York: Farrar, Straus, and Giroux, 2002.

Jonietz, Erika. “Choosing our children's genetic futures.” With Gregory Stock.
Technology Review 106.1 (February 2003): 78-79.

Lagay, Faith, PhD. “Preimplantation Genetic Diagnosis.” American Medical

Association.
http://www.ama-assn.org/ama/pub/category/5717.html (1 May 2003).

Scannel, Kate. “To Be or Not to Be--Preimplantation Genetic Diagnosis.” Ethics

Rounds: 10 (4). 2001.
http://www.kaiserpermanente.org/medicine/permjournal
/fall02/ethics.html (1 May 2003).

Wagner, Caroline. “The Weapons of Mass Creation; Are we ready for genetically
enhanced 'designer people'? If so, who will make the titanic decisions
involved?” Los Angeles Times, 13 Feb. 2003. ProQuest. ISSN 04583035
(17 Apr. 2003).

Zitner, Aaron. “A Girl or a Boy, You Pick.” Los Angeles Times, 23 July 2002.
ProQuest. ISSN: 04583035 (17April 2003)

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