Playing God or advancing the frontiers of medical science?

Fertility treatment has always been a highly controversial area of medicine and ever since its inception IVF has had its critics. Now some of the newer techniques are prompting fresh ethical dilemmas, as Liz Bestic reports

When Professor Sir Robert Edwards developed the in vitro fertilisation (IVF) procedure for treating infertility in the 1970s, he was well aware of the ethical issues of creating a human being in a petri dish, but was steadfastly unafraid of the controversy. Objections to his work only died away when it became clear that the babies born by IVF were healthy and that their parents were overjoyed to be able to start a family.

Advances in human reproductive technology have created a whole range of issues from allowing older parents to conceive, using the sperm of dead fathers and “designing” the precise characteristics of babies. These advances have always aroused people’s deepest concerns, causing outrage and prompting accusations of playing God but usually, in time, arriving at acceptance.

There have also been concerns about laboratory mix-ups. In some cases legal action has been taken against an IVF clinic, leading to complex paternity suits. In these cases, the Human Fertility & Embryology Authority (HFEA) has had to step in. The regulator now requires clinics to use a double witnessing system so that the identity of the specimens is checked by two people at each point where they are moved.

HFEA has played a crucial role throughout the development of reproductive medicine in ensuring ethical questions are discussed fully and publicly. Sometimes that itself has caused controversy, particularly in the genetic screening of embryos. In 2004, HFEA granted the first licence to a clinic to screen embryos for diseases they might develop as adults. The authority was accused of taking a major ethical decision behind closed doors.

Advances have always aroused people’s deepest concerns, causing outrage and prompting accusations of playing God

In 2008, HFEA was also criticised when they banned sex selection – deciding the sex of a baby – for non-medical reasons. In the same year they also recognised same sex couples as legal parents of children conceived through the use of donated sperm, eggs or embryos and caused a huge outcry among religious groups.

However, it has been pre-implantation genetic diagnosis (PGD) which has proved the most controversial procedure to date. PGD is a technique where embryos created outside the body can be tested to see whether they carry a genetic disorder, and corrected, before being transferred to the uterus.

One of the main ethical concerns about PGD is that the procedure is tantamount to saying that those affected by a particular condition should not have been born or are less valued as individuals. Other critics are concerned PGD may be seen as a means of selecting the physical characteristics or intelligence of children.

Dr Paul Serhal, an IVF specialist at University College Hospital London, who in 1990 founded the Centre for Reproductive and Genetic Health, says: “Of course some people feel uncomfortable when doctors start to interfere with nature and others wonder where it will end. Where does society draw the line – at the colour of a baby’s eyes?” At the moment choosing the sex of a baby is against the law in the UK, but legal in other countries, for example the United States.

HFEA is clear that it would be unacceptable to test for any social or psychological characteristics, normal physical variations, or any other conditions which are not associated with disability or a serious medical condition. Following a public consultation in 1993, HFEA only licensed PGD for certain severe or life-threatening disorders at a limited number of clinics.

For clinicians who work in this field, the choice is simple. Dr Serhal was the lead doctor who recently treated a couple in whom three generations of women in the husband’s family had been diagnosed with breast cancer in their 20s. “These parents have now been spared the risk of inflicting this disease on their daughter,” he says.

“The lasting legacy will be the eradication of the transmission of this form of cancer that has blighted these families for generations. This little girl will not face the spectre of developing this genetic form of breast cancer or ovarian cancer in her adult life.”

For those who are on the side of genetic testing, the beauty of PGD is that it not only ensures that a child is born without the genetic link to a particular cancer or condition, but they will not pass it down to their own children.

In the case of “saviour siblings”, however, where to draw the line is not so clear. “You are creating a child without a genetic disease so that you can then use the cord blood to give bone marrow to the child who is sick,” explains Dr Serhal.

The landscape of IVF is changing day by day. Now there is a technique for freezing eggs called vitrification which gives a pregnancy success rate almost equal to using fresh eggs. It means that women can now decide when they want to freeze their eggs. But this raises ethical questions too.

Dr Serhal poses the question: “At what age should a woman be allowed to freeze her eggs, bearing in mind the optimal age is as young as possible? I would say, have your babies as soon as you can – even as young as 25. In theory we may say ‘no’, but who knows for the future.”