Tag: reproductive medicine

Bioethics Blogs

Web Round Up: Time to Chill? Egg Freezing and Beyond by Moira Kyweluk

A focus on age-related fertility decline, and exploration of ways to expand the timeline and options for biological parenthood have been consistent cultural and web-wide fixations. The $3 billion United States fertility industry was in the headlines once again this month including coverage of the launch of Future Family, a service offering  a “fertility age test” to women and negotiated-rate infertility medical care, alongside newly published research on ovarian tissue preservation, an alternative to oocyte cryopreservation or “egg freezing”, both procedures aimed at potentially extending a woman’s fertility window.

In the wake of findings presented in July 2017 at the European Society of Human Reproduction and Embryology conference in Geneva, Switzerland by Marcia Inhorn, Professor of Anthropology and International Affairs at Yale University, popular media headlines blared:  “Why are women freezing their eggs? Because of the lack of eligible men”  and “Women who freeze their eggs aren’t doing it for career reasons.” The study analyzed interviews from 150 women in their late 30s and early 40s who opted for egg freezing in Israel and the United States. Results “show that women were not intentionally postponing childbearing for educational or career reasons, as is often assumed in media coverage of this phenomenon, but rather preserving their remaining fertility because they did not have partners to create a family with. The researchers conclude that women see egg freezing as ‘a technological concession to the man deficit’, using it to ‘buy time’ while continuing their search for a suitable partner to father their children.”

The American Society of Reproductive Medicine, the regulatory board that governs the safe and ethical use of fertility technologies, reclassified egg-freezing technology from “experimental” to standard-of-care in 2012.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Transferring Embryos with Genetic Anomalies

Jackie Leach Scully argues that respect for equality and diversity, and not just respect for the parental autonomy and the welfare of the future child, should inform policies governing the use of preimplantation genetic diagnosis.

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The Ethics Committee of the American Society for Reproductive Medicine recently published an Opinion on “Transferring embryos with genetic anomalies detected in preimplantation testing.” The Opinion aims to help providers deal with the rare but ethically difficult situation when prospective parents want to transfer embryos with a known genetic anomaly that is linked to a serious health-affecting disorder.

Preimplantation genetic diagnosis (PGD) is typically used by couples to avoid transferring a genetic anomaly to their children. Using PGD to ensure the transfer of a genetic anomaly, rather than avoid it, seems deeply counter-intuitive. Yet, there are several scenarios where this might happen. For example, this might be a reasonable option when the only transferable embryos carry the genetic anomaly, or when the embryos carry a different, but potentially just as serious, genetic variation.

The most problematic cases, however, occur when prospective parents express an actual preference for children with ‘their’ genetic condition – an anomalous condition that others perceive in negative terms. It’s an uncommon situation, but despite its rarity steps have been taken to block attempts by prospective parents to ‘choose disability’, such as the UK’s legislation on reproductive medicine. The legislation prohibits the use of an embryo (or gamete, in the case of egg and sperm donation) that has a genetic anomaly “involving a significant risk” of “a serious physical or mental disability, serious illness, or a serious medical condition” unless there are no other unaffected embryos or gametes that could be used instead.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In Memoriam: John A. Robertson

by David Magnus, Ph.D.

Sadly, the field of bioethics lost one of its best this week. John Robertson, a law professor at the University of Texas and a major figure in law and bioethics, passed away on July 5th. John was an important scholar whose work spanned major contributions to scholarship on end of life, organ transplantation, and genetics, but he is best known for his work on reproductive technology. John’s articulation and defense of the importance of procreative liberty, though both his articles and his important book, Children of Choice, stands as an exemplar for scholarship in bioethics. I have used his work in my classes for over 20 years, because no one has better articulated the perspective he brought to bear on issues in reproductive technology.

In addition to his scholarly contributions, what I will miss most about John is that he was a tireless and enthusiastic mentor and advocate for younger scholars. Without his support, I doubt that my career would have turned out the way it has. First, if you are reading this blog, you are aware of the success of the American Journal of Bioethics. The journal owes a great deal of its success (and perhaps its continued existence) to John. When the journal was first launched, most leaders in the field expressed a great deal of skepticism about the need or value of another journal. John not only supported us and encouraged us, he made a major contribution to ensure our success. As the Chair of the ethics committee of the American Society for Reproductive Medicine, John was instrumental in promoting a position to accept uses of new technologies for sex selection (at least in the context of family balancing).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Ethics of In Vitro Gametogenesis

Françoise Baylis comments on the ethics of using gametes derived from human induced pluripotent stem cells for future human reproduction.

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A recent New York Times article, provocatively titled “Babies from Skin Cells? Prospect is Unsettling to Some Experts,” has once again drawn attention to controversial research by scientists at Kyushu University in Japan who succeeded in making fertile mouse pups using eggs created through in vitro gametogenesis (IVG). This is a reproductive technology that involves creating functional gametes (sperm and eggs) from induced pluripotent stem cells. Induced pluripotent stem cells are cells derived from adult body cells (such as skin cells) that have the ability to become other body cells including reproductive cells (sperm and eggs).

Supporters of this reproductive technology eagerly anticipate similar research in humans. Indeed, enthusiasts are quick to trumpet the potential benefits of in vitro gametogenesis. These benefits fall into three general categories.

First, we are told that research to derive human gametes from induced pluripotent stem cells is important for basic science. It will advance our understanding of gamete formation, human development, and genetic disease. In turn, this increased understanding will create new options for regenerative medicine.

Second, we are told that this research will allow clinicians to improve fertility services. For example, with in vitro fertilization (IVF), women typically have to undergo hormonal stimulation and egg retrieval. This can be onerous in terms of the time required for interviews, counseling, and medical procedures. It can also be harmful. Potential psychological harms include significant stress and its sequelae.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Open ethical debate: Are gene editing techniques ethical in reproductive medicine?

Author’s opinion: The use of these techniques is currently medically and ethically unjustifiable.

The United Kingdom has recently approved mitochondrial transfer (3 parents children) to prevent the development of mitochondrial diseases in the children of mothers affected by these types of conditions (See HERE). This has opened an ethical debate on the use of such techniques, especially if they can modify the germline.

Now, a recent article has addressed their use in the field of reproductive medicine and discussed their use in infertility treatment and disease prevention (see HERE).

It is well known that the efficacy of assisted reproduction techniques is limited, with pregnancy rates when in vitro fertilisation is used of 29.1% per aspiration cycle and 33.2% per embryo transferred; when intracytoplasmic sperm injection is used, these rates are 27.9% and 31.8%, respectively.

It is therefore thought that identifying possible genetic abnormalities and then applying personalised medicine could improve these figures. It is also believed that they could help to resolve human infertility, since half of the cases are thought to be due to a genetic cause, and could be remedied by correcting the corresponding mutation responsible for infertility using genome editing. This has already been applied in different cases of genetic mutations in sperm in the case of azoospermia.

Gene editing in reproductive medicine

However, in the author’s opinion, the use of these techniques is currently medically and ethically unjustifiable for three reasons. First of all, there is still very little experience in genetic modification in humans, as fewer than ten products have been approved for use in these diseases.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The ethics of conscientious objection: Caring for patients and supporting providers

Although conscientious objection arises in various
areas of medicine, notably end-of-life issues (e.g. physician assisted death), it
is ubiquitous in all aspects of reproductive medicine and women’s health care. Indeed,
it is discussed extensively in the academic bioethics literature, clinical
practice, healthcare law and policy (e.g. the Hobby Lobby Supreme Court case), and
in the popular press. Part of the reason conscientious objection is so
commonplace in reproductive medicine and women’s healthcare is because of the
controversial nature of abortion and emergency contraception.

The topic of conscientious objection forces us to
confront the boundaries of professional obligations and individual rights.
Which should be prioritized when they conflict? The common stance of most
professional medical organizations is that providers have an obligation to
refer if they oppose a practice/prescription based on personal beliefs (e.g.
providers should provide a referral if a patient requests an abortion and they
oppose abortion due to philosophical or religious reasons), but not if they
believe the practice/prescription doesn’t align with standard of care (e.g.
providers don’t have to provide a referral if a patient requests antibiotics
for the common cold).

The position of most medical organizations on
conscious objection raises some concerns. First, there are logistical and
feasibility concerns. While it may be easier to uphold providers’ conscientious
objection in densely populated areas, in rural areas where there may only be
one provider, thereby making it difficult to find someone to refer patients to.
It is burdensome for patients to travel far away to receive medical care that
they could receive locally if the provider did not have a conscientious
objection.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Pregnancy risks in older women

Older women preganacy risks. As obstetric complications in these women remain high American Society of Reproductive Medicine made an ethical evaluation

Advanced reproductive age is a risk factor for women’s fertility, pregnancy loss, foetal abnormalities, stillbirth and obstetric complications. The American Society of Reproductive Medicine Ethics Committee recently evaluated the ethics of assisted reproduction practices in older women. Difficulties linked to older women preganacy can be avoided by using donor eggs. However, obstetric complications in older women remain high, especially those related with the delivery and risks of hypertension and cardiovascular problems. Physicians should therefore be obliged to perform a thorough medical evaluation of candidates for these procedures whenever the woman is aged over 45 years. In any case, these procedures should be advised against for women aged over 55 years (see more HERE).

La entrada Pregnancy risks in older women aparece primero en Observatorio de Bioética, UCV.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Pregnancy risks in older women

Older women preganacy risks. As obstetric complications in these women remain high American Society of Reproductive Medicine made an ethical evaluation

Advanced reproductive age is a risk factor for women’s fertility, pregnancy loss, foetal abnormalities, stillbirth and obstetric complications. The American Society of Reproductive Medicine Ethics Committee recently evaluated the ethics of assisted reproduction practices in older women. Difficulties linked to older women preganacy can be avoided by using donor eggs. However, obstetric complications in older women remain high, especially those related with the delivery and risks of hypertension and cardiovascular problems. Physicians should therefore be obliged to perform a thorough medical evaluation of candidates for these procedures whenever the woman is aged over 45 years. In any case, these procedures should be advised against for women aged over 55 years (see more HERE).

La entrada Pregnancy risks in older women aparece primero en Observatorio de Bioética, UCV.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Human infertility. Microsurgery for the treatment of tubal obstruction. Ethical and medical aspects

‘Reconstructive microsurgery could be important in the treatment of infertility’

One topic discussed in relation to the treatment of human infertility is the efficacy of tubal microsurgery for the treatment of Fallopian tube obstruction and its efficacy compared to in vitro fertilisation.

Up until 1980, microsurgery was the only option for treatment of these patients. Later, with the advent of in-vitro fertilisation, for various reasons — not least of which were economic ones — tubal microsurgery became a secondary option. However, the question of its efficacy has now been raised again, especially in view of the fact that the efficacy of IVF appears to have reached its peak; in the United States, for example, the possibility of achieving a pregnancy ranges between 28% and 30% after the first ovarian stimulation cycle.

After evaluating the different types of tubal problems that can be treated with microsurgery and the different techniques used, the American Society for Reproductive Medicine (read HERE) concluded that reconstructive microsurgery could be important in the treatment of infertility. To this we would like to add the ethical aspect that the use of this microsurgery entails, since it does not present any ethical difficulties, unlike in vitro fertilisation.

La entrada Human infertility. Microsurgery for the treatment of tubal obstruction. Ethical and medical aspects aparece primero en Observatorio de Bioética, UCV.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Don’t feel comfortable asking others if they are having regularly scheduled unprotected vaginal penile penetrative intercourse? Then don’t ask


One of the first questions a newly
married straight couple often gets from well-meaning friends and family is
“when are you going to start trying?” For those of you who are wondering what
this question is getting at, it is asking them if they are going to start to
try to get pregnant. It is interesting to analyze the language used here.
People typically talk about “trying” without ever specifying what they are in
fact trying to do. Part of the reason for this may be because people assume the
meaning is obvious from the context, such as “they’ve been trying for six
months but haven’t gotten pregnant yet.” Another reason probably has to do with
our societal discomfort talking about sex.

We use general and vague terms to
imply that we are talking about sex, but often don’t feel comfortable out right
discussing it. For example, the birth control pill is generally just referred
to as “the pill.” There is still shame and stigma surrounding sex, particularly
for women and sexual minorities, so it may be easier and safer for a woman to
talk about being on “the pill,” even though everyone knows what she is
referring to, than to overtly announce that she is using contraception.

Even though we as a society may not
feel comfortable explicitly discussing sex, we still feel that it is our
business. From a legal perspective, look at how carefully reproductive medicine
is regulated. For instance, certain reproductive procedures (e.g. abortion and
sterilization) can require waiting mandatory periods – something that is not
common in other areas of nonelective medicine.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.