ISLAMIC

PERSPECTIVE
O
ASSIST REPRODUC TECHNOL
ED TIVE N OGY
Pipette
Necote Eg
injects sperm g
into egg

Sper
m

dr. Meidona N. Milla, MCE

Depatment of Anatomy
Faculty of Medicine
Sultan Agung Islamic
University
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”

 Often physically healthy

 No symptoms or pain
 BOTH ( husband and wife
should consult to infertility
specialist )
 Prevalence
Happened in 12-15 % of couples in the reproductive
age group
 CAUSES OF FEMALE INFERTILITY
Congenital
Endocrine omalies
Disturbances
actors
Acquired F

Anomalies
of
the Uterus
 How can infertility be a problem?
Interpersonal changes
in relationship

Depression

INFERTILITY Panic and

Physical and emotional Frieghtened Feeling
problems between couples
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
• Seeking for medical treatment
from simple method --> ART
( Assisted Reproductive Technology)
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
Hormonal Oocyte Incubation for
Stimulation Retrieval few hours

culture
Fertilization Mixed with
assessment washed sperm

Embryo Embryo
assessment transfer
IVF Procedure
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
Ovarian Multiple Miscarriage Ectopic
hyperstimulation births pregnancy

~
·
Infections Bleeding
0
Anesthesia
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”

What to preserved?
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 analyze 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
G. Issues Regarding ART

• Gamete / Embryo Donation

• Surrogacy
• Sex Selection
• Designer babies
 Gamete or Embryo Donation
 Sperm cryopreservation from many men that is
usually intended to use as a donor
 SPERM SOURCES
A. Intended B. Donor
Father own
Sperms
E sperms
G1--~~~~-1-~~~~-+~~~~--1
G

s 1.
G Intendedown
Mother Surr
Surrogacy
1 A. Gestational Surrogacy
1 B. Gestational

0 eggs
u1--~~~~~1--~~~~~1--~~~~--
2 A. Ge
Gestational 2 B. Gestational
c
R 2.Donor
E eggs Surrogacy Surrogacy

51--~~~~-1-~~~~-+-~~~-----1
3. 3(tradition al)
A. Natural (traditional)
3 B.
Surrogat Natural
e's uc ' <• _..,.,._.,.I-;: ~ -,m
eggs Surrogacy
~...., Surrogacy
 Surrogacy
• the transfer of an embryo from a couple to other woman’s
womb
They also use surrogate mother…
 Sex Selection
through PGD process, that will
allow us to know the sex of the
embryo  parents can possibly
choose the preferred one
 Designer Babies
• through sperm banking, combined with PGD, consuments
are
allowed to choose sperm with specific characteristica ( ie. Eye
color, hair color, race, inteligence degree, etc),
Designer Baby
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
Maka sesungguhnya bersama dengan kesulitan itu ada kemudahan
sesungguhnya bersama dengan kesulitan itu ada
kemudaha
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:

« •

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:

« •

Tidak halal bagi seseorang yang mengimani Allah dan

menyiramkan
Hari Akhir airnya (spermanya) ke tanaman orang lain (HR
Ahmad)

husband’s
 spermegg/oocyte should be fertilised only by
a woman’s
her
2. The transferred of the embryo resulted from IVF process
can be done only when the husband is still alive and in a
legal married condition
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-fujûr, 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

“Dan janganlah kamu mendekati zina; sesungguhnya zina itu adalah suatu
perbuatan yang keji. Dan suatu jalan yang buruk ”
 QS An Nur: 2

• 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 yang
beriman
Islamic Basic Laws
About Surrogacy
o classified as haram if fertilized egg is put or transferred to
other woman’s uterus
oUsing donor’s egg and the embryo is transferred back to the
wife’s uterus classified as haram
oUsing 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 considered 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. Test 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
9. Assisted Reproduction - Islamic Views on the Science of Procreation., Norhayati Haji
AhmadEubios Journal of Asian and International Bioethics 13 (2003), 59-60