Tag: reproductive technologies

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 Blogs

It takes a Village to…make… a Child?

Depending upon your political persuasion, Hillary Clinton is either famous or infamous for popularizing the concept that it takes a village to raise a child. Taking the village’s influence back to the point of conception, Assisted Reproductive Technologies (ART), specifically a potential novel combination of human Induced Pluripotential Stem Cells (hiPSCs) and in vitro gametogenesis (IVG), just might make it possible for that same village (that is, more than two parents) to actually make the child.

Jon Holmlund has written extensively in this blog regarding both the technique and ethical considerations of hiPSC and more recently human extended pluripotential stem cells (hESCs) (e.g. see here for a recent example). Roughly, hiPSCs/hESCs create stem cells (cells that have the potential to become any other cell in the human body) from common cells such as adult skin cells. IVG is the process that has the potential to change the hiPSCs/hESCs into gametes (eggs and sperm) which then can be combined via in vitro fertilization (IVF) to make a baby. If the process can be reliably perfected in humans, there would be no physical barrier for a single individual, non-fertile heterosexual couple, homosexual couple, or frankly any number of people to have a baby that is his/her/their genetic offspring (see summary here for ethical arguments fully supportive of these techniques and here for legal arguments both pro and con). We have already crossed into the concept of group parenting with maternal spindle cell transfer used to prevent mitochondrial disease (the so-called three parent babies). With IVG, we needn’t stop at just three parents (from the Palacios-Gonzalez et.

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

Ethical questions about mitochondrial replacement in humans. Three parents babies

We thus consider it necessary to establish a moratorium on their use in humans, at least until more is known about these aspects. If this knowledge is obtained, ethical questions would still remain to be resolved, among which we consider the most relevant to be those related to the dignity and identity of the human embryo.

Children with two mothers and a father

In January 2017, the prestigious scientific journal Bioethics published a special edition dedicated to the ethical aspects of nuclear transfer techniques aimed at preventing the transmission of mitochondrial diseases, a topic that we have extensively addressed in our Observatory (see HERE).

Its editorial, Ethics of mitochondrial replacement, starts by referring to the recent birth of the first baby resulting from these techniques (see HERE). It then provides a brief description of the main characteristics of mitochondrial diseases, which are inherited exclusively from the mother. It explains that mothers who carry mutations in their mitochondrial DNA (mtDNA) face the uncertainty of not knowing if their genetic children will or will not inherit a serious mitochondrial disease. However the emergence of mitochondrial replacement techniques (MRT) offers these mothers hope, as healthy mitochondria from a donor are used to replace those of the mother. These techniques are maternal spindle transfer (MST) and pronuclear transfer (PNT), which consist, respectively, in removing the nucleus from a healthy egg or zygote, which will keep its mitochondria. The nucleus of the mother’s oocyte (patient or carrier of the mutation) or of another zygote obtained by fertilising the mothers egg is then transferred into the enucleated oocyte or zygote.

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

An Assessment of Mitochondrial Replacement Therapy

By: Alexa Woodward

Last year, a baby boy was born from an embryo that underwent mitochondrial replacement therapy (MRT). MRT was used to prevent this child from inheriting a mitochondrial disease from his mother, specifically infantile subacute necrotizing encephalomyelopathy – a disease that affects the central nervous system and usually results in death within the first few years of life. While controversial, assisted reproductive technologies (ARTs) such as MRT provide prospective parents with additional options and have the potential to improve the quality of human life by preventing disease.

This story is of bioethical interest because this technique results in germline modification, which is the alteration of DNA in the reproductive cells of humans that will be passed on to their offspring. Implementing MRT in humans has consequentially garnered much criticism, from simple health-related implications (such as unknown harms to potential offspring and eugenics concerns) to the futuristic next logical step of scientific intervention; directly editing the nuclear genome.

With MRT, modifications affect the mitochondrial genome (mtDNA), not the nuclear genome. Researchers emphasize the lack of bearing that mtDNA has on personal characteristics and the overall maintenance of “genetic integrity,” especially when compared to using the whole donor egg with an “unrelated” nuclear genome.1 Even so, additional concerns arise regarding the long-term anthropological effects, blurring the distinction between therapy and enhancement, and issues of resource allocation.

Mutations and deletions  in the mitochondrial genome can result in mitochondrial diseases affecting the neurological, musculoskeletal, cardiac, gastrointestinal, renal, and other systems, all of which are incurable.  MRT uses the intended parents’ nuclear DNA in conjunction with a donor’s mitochondria.

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

Teaching Medical Anthropology by Ari Gandsman

In the decade since becoming a full time professor, medical anthropology has been one of my core courses. I have taught it seven times.  Although the basic structure of the course remains similar, emphases have shifted over time. Perhaps I can best highlight the evolution of the course through a discussion of readings I use since readings are the backbone of a syllabus.  Even though I generally do not follow texts closely since I see lectures as overlapping but also supplemental and complimentary to readings, I try to mirror topics that they will be reading about, often highlighting a general theoretical literature or approach while the students read a single illustration.

Starting from the beginning, my history of medical anthropology remains the same, focusing on when “medicine” was subsumed into broad and now antiquated anthropological categories of magic and witchcraft. I never stray far from Evans-Pritchard’s Witchcraft, Oracles & Magic Among The Azande, an apparent professional contractual obligation for meAlthough I have given them the entire ethnography [the abridged in print edition] to read twice in the past, I have more lately just given them a short excerpt, often “The Notion of Witchcraft Explains Unfortunate Events.” I once also used W.H. Rivers Medicine, Magic and Religion but, although fascinating and of historic importance, it proved esoteric for an undergraduate course.  When I first started teaching, I tried to include more on non-Western medical systems, including using ethnographies on Traditional Chinese Medicine or Tibetan medicine. More recent students may be disappointed that I do not delve further into non-Western medical systems, what many students with hazy ideas of the discipline may think a medical anthropology course should almost entirely consist of.

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

The Future of Bioethics: Organ Transplantation, Genetic Testing, and Euthanasia

By Ana Lita

When you think of bioethics, some of the first hot-button topics you may consider are organ transplantation, fertility and genetic engineering, and end-of-life-care. The Global Bioethics Initiative serves as a platform to address many bioethical questions and engages in public debates to develop resolutions to present and emerging issues.

Dr. Ana Lita, founder of the Global Bioethics Initiative, discusses the various areas GBI addresses and highlights the organization’s contributors in their prospective fields. She acknowledges the valuable contribution of the current president of GBI, Dr. Bruce Gelb, in the field of organ transplantation. She also addresses the original co-founder of GBI, Dr. Charles Debrovner, and his lifelong passion in the field of fertility and genetic engineering. Lastly, Dr. Lita offers a brief insight into the future of Bioethics in these uncertain times.

ORGAN MARKETS AND THE ETHICS OF TRANSPLANTATION 

Recent developments in immunosuppressive drugs and improved surgical techniques have now made it much easier to successfully transplant organs from one human body to another. Unfortunately, these developments have led to the rise of black-markets in human organs. This underground market is where people who need kidneys to survive or to improve the quality of their lives, for example, purchasing such organs from impoverished persons in the developing world. In January 2017, scientists announced that they successfully created the first human-pig hybrid and a pig embryo with some human characteristics. Given the increasing need for transplant organs, should such markets be regulated and legalized?  Could the success of therapeutic cloning eliminate the need to consider this option?

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

Having a Baby at 50

Pop star Janet Jackson, who turns 51 this coming May, gave birth to her first child last week. She and her husband have allegedly been working with a fertility specialist for some time. Many people react with horror, or even disgust, to the idea of this. However, people have had similar emotional reactions to interracial and same-sex marriage. Rather than relying on emotion, I propose the following framework for evaluating reproductive technologies: procreative liberty and procreative responsibility.

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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

Public opinion on legalizing surrogacy in China?

Yegang Su comments on the Chinese government’s apparent interest in public opinion on legalizing surrogacy in China.

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Recently, a news report on surrogacy in China was tweeted by the WeChat public account of Liaowang Institute. The Institute is a high-level, Chinese think tank established by the Central Government’s official news agency, Xinhua. I read the original news report published in China Newsweek, and was surprised to learn about the scale and sophistication of the surrogacy industry in China. (A partial English translation of this news story is available through South China Morning Post.)

The China Newsweek article provides a description of a complex business ecosystem that includes: entrepreneurs, doctors, seekers and bearers of surrogacy services, salespersons and care workers. The news report also uses ‘contract’ language. For example, those providing surrogacy services are hired as “reproductive labourers,” they are paid a monthly wage and their pay fluctuates with the stages of pregnancy. The work involved is explained to the recruited women surrogates as “renting their wombs.” These women are described as between 24 and 32 years of age and married, and they must have previously given birth. Most of the women are reported as being from rural areas and motivated for financial reasons.

Internet Backbone (representation of principal internet data routes)

I forwarded the China Newsweek article to some bioethicists and scientists working on ethical, legal, and social issues related to assisted reproductive technologies in China. The one person who replied, also expressed surprise at how little was known about the practice of surrogacy in China.

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

Fertility Treatment Failure May Harm Women’s Heart Health

March 14, 2017

(Medical News Today) – Fertility therapy failure may raise the risk of poor heart health for women, according to the results of a new study published in the Canadian Medical Association Journal. Researchers found that women who did not become pregnant after undergoing gonadotropin-based fertility therapy – treatment often used in preparation for in vitro fertilization (IVF) and other assisted reproductive technologies – were at greater risk of heart failure and stroke than those whose fertility therapy was successful.

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

With 2 children now permitted, Chinese women are thawing embryos

As China relaxes its one-child policy, more women are using frozen embryos to conceive a second child.

The international media gave particular attention to a 46-year-old Chinese woman who gave birth earlier this month using an IVF embryo frozen 16 years ago.

The woman, who chose to remain anonymous, gave birth via IVF to her first child in 2000, and asked the hospital to freeze her remaining 18 embryos.

A decade and a half later – with the Chinese government having announced its ‘universal two-child policy’ – the woman approached the hospital again to have the other embryos thawed. She has now given birth to a healthy baby boy.

“I’m just really ecstatic to have another child,” the woman told state-news agency Xinhua following the birth of her son.

According to IVF agencies in the country, the average age of women using assisted reproductive technologies has increased as women take advantage of the government’s new policy. 

“In 2016, we received about 1,000 woman above 40 years old seeking to have more babies, and the average age of women to have their eggs retrieved rose from 32.7 years to 33.7 years,” Xu Yanwen, a director at the First Affiliated Hospital of Sun Yat-sen University, told Xinhua.

With Chinese clinics struggling to cope with demand, Australian company Monash IVF has begun to offer a special service for women from mainland China. Monash will treat approximately 100 patients from the mainland this year, with a possibility of more in the future.

This article is published by Xavier Symons and BioEdge under a Creative Commons licence.

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.