By Valvic Nnamdi
Our human species is not exactly known for its willingness to comply with divine instruction. But when God said unto them “be fruitful and multiply” they were more than eager to comply. They took the task to heart, turning a duty into a pleasure. The majority of couples had no problem. But a minority, however, were distressed because of delay or inability to conceive and bring forth children because of patho-physiological factors. Medicine tried to help this minority to conceive naturally but still, there remained a group who could not reproduce naturally without assistance. Thus, assisted reproductive techniques include medical procedures used primarily to address infertility. In 1978, the field of assisted reproduction technology recorded the first baby conceived in vitro (in glass). When this baby was born, a completely new frontier was opened up in reproduction medicine and new hope was given to infertile couples. The technology brought happiness and harmony to many families. With the introduction of intracytoplasmic sperm injection, ART is now not limited to infertile couple. It can help fertile couple as well to “conceive healthy children through the application of the new technologies of preimplantation genetic diagnosis and embryo selection.” Further into the future, ART could allow a much better understanding of the early stages of human development and differentiation and opened up a new field of stem cell research, bringing a new hope for the treatment of certain serious diseases, for which no effective treatment is currently available. There is no denying the fact that ‘in the past, the basic options for infertility were either to accept one’s fate and go on with life or to adopt. Many chose this latter option and have had most of their heart’s desires fulfilled. However, for many, there is still a desire to have a child of one’s own. As Shannon puts it “as satisfying as adoption is for many, for others a critical part of having a child is conception, pregnancy, and giving birth. That of the having a child of one’s own remained an unfulfilled hope until 1978 when Mr. and Mrs. Brown gave birth to the first child conceived outside the human body… human reproduction was changed forever.” Thus, this article is bent on the critical evaluation of the new technologies in assisted reproduction to know if they tamper with our general definition of humanity, if they make us act more or less as a machine, or even turn our bodies as objects or mechanical instruments that produce children in a laboratory.
TYPES OF ASSISTED REPRODUCTIVE TECHNOLOGY
There are so many methods or types of assisted reproductive technology. These methods include:
- In vitro Fertilization (IVF): this means “fertilization outside of the body.” It is the most effective and the most common form of assisted reproduction technology. In this process, “Ova are obtained from the woman having previously been given hormones to make her super-ovulate. The ova are then fertilized in vitro by male sperm. The resultant embryos are then transferred to the woman’s uterus with the expectation that an embryo will successfully implant itself on the uterine wall and the pregnancy carried to term.” Shannon describing IVF states that, in this method, a woman’s ovaries are hyper stimulated with hormones and then eggs are retrieved either through surgical procedures or by a tube inserted through the vagina to the ovary. The eggs are put in a petri dish, and semen previously collected from the man is added. The eggs that are fertilized are put into an incubator for a few days to allow the cells to divide, and then they are inserted in the woman. This technique many a time fails altogether and none of the transferred embryos develops into a full foetus. In some other cases, a number of the transferred embryos successfully develop, giving rise to surplus fetuses.
- Artificial Insemination: it is one of the oldest methods of artificial reproduction. It is a response to complete or incomplete male infertility due to impotence or defective formation of spermatozoa, where the female partner has no reproductive problem. In this case, male sperm is introduced into the woman by the means of syringe or other instrument with fertilization occurring when the sperm fuses with the woman’s ovum. Thus, according to Shannon, “sperm is obtained from either the woman’s partner or a donor and is inserted into her either with a syringe or through a catheter.”
- Surrogacy: this is a situation where the gametes are obtained from a couple and another woman is employed who conceives by artificial fertilization and bears the child to term for the couple. As Ekwutosi puts it, “the egg from the wife is fertilized with sperm from the husband and inserted into another woman who acts as the surrogate mother. Immediately after birth, the child is handed over to the couple.”
Other methods are Zygote intrafallopian Transfer, Gamete intrafallopian transfer, and intracytoplasmic sperm injection. These are the methods of assisted reproductive technology.
FACTORS AFFECTING ART
Religious and Cultural factor: the concept of reproduction without coitus, has generated a lot of controversies in both religious and cultural circles. So many cultures see human life as sacred and must always follow the natural pattern of how God created man. The stance of the catholic church is based on the status of the embryo as a person right from conception.
Inequitable access to ART: equitable access to IVF remains a fundamental issue especially in our country Nigeria where only a fraction of the populace has access to health insurance, which does not cover expensive procedure such as that. The cost of a cycle of IVF in Nigeria is approximately 3000-10000 US Dollars where the minimum wage is 95 US dollars or less. Economic factor is a great factor affecting ART.
Complications of Procedures and quality assurance: the safety of the various methods of ART has always been in question. The adverse effects of ovarian stimulation such as ovarian cancer due to the artificial hormones used in the process has always caused a limiting factor to the use of ART. Also, multiple pregnancy and its attendant complications during pregnancy or childbirth is one major issue with IVF. This is due to the transfer of multiple embryos to the uterus to ensure that at least one or two survive and develop to birth.
Fate of extra embryo: the fate of the extra embryo is another topical issue. Do they get donated to someone else or are they destroyed? The earlier stance of the Catholic Church regarding the embryo and personhood present a strong argument against their destruction. And also, the acceptability of a third-party gamete is controversial in Nigeria especially where everyone wants to have a child begotten from him or her.
ETHICAL IMPLICATION OF ART
Moralists condemn the method of obtaining gametes. The sperm is obtained through masturbation, condomistic intercourse or interrupted intercourse. These methods are wrong because they separate the unitive end of marital intercourse from its procreative end. ART denies the child the right to be brought up in a normal and healthy family. It is violence against the child to have him born in a condition where he lacks the most essential things of early childhood- family and father. This creates a serious psychological and social problems for the child.
Having a child through heterologous insemination may later be the source of disunity instead of unity, anxiety and unhappiness to the family. The woman may lack emotional attachment due to the anonymity of the donor and the man knowing well that he is not the biological father may always feel a sense of humiliation whenever he sees or thinks about the child.
Again, In vitro fertilization works with a human life that has started its existence outside the woman’s body, in the laboratory. It follows that the attendant dangers are many. Apart from accidents which occur for various reasons resulting in the destruction of the foetus, there are cases when surplus embryos that have resulted from multiple fertilization in the laboratory are deliberately destroyed. This is considered immoral by many moralists. Since the foetus is a human person.
Some argue against surrogacy on the ground that it is tantamount to commercialization of babies and so denigrates the dignity of women. Thus, according to Shannon, “one of the most controversial aspects of surrogacy is whether it is selling a baby. The woman signs a contract and bears the child; she then receives the money and the baby changes families. Some argue that this is the standard account of buying and selling. Others argue that the fee that the woman receives is a fee for service. They also contend that because the child is usually conceived using the husband’s sperm, the child is his and he need not buy it.”
ART also promote sex selection though on the bases of therapeutic end, where certain sex are known to be of a particular linked disorder. However, sex selection purely of the preference of the parents could conceivably, if practiced on a large scale, skew the gender proportions in certain nations where one gender is culturally preferred like Igbo culture of Nigeria where male sex is more preferred.
EVALUTION AND CONCLUSION
Assisted reproduction can raise complicated ethical challenges for the individuals involved, health care professionals and the greater society. Technological breakthroughs and scientific innovations haven continually demonstrate man’s frantic effort to conquer the world so as to solve his practical existential problems. The new techniques developed to tackle the problem of infertility which wrecks the genuine love and profound love of most families who are caught in the web of such ‘misfortune.’
Surely, it would be conceived that such technology should be welcomed with open-hands. It should be seen as a technological saviour that restores the joy of couples and a novelty innovation that brings to a stop the problem of infertility. But people with such expectations could be disappointed seeing this ingenious technological and scientific breakthrough being kicked against. Why? Because there is more to life than scientific innovations.
When we weigh the moral implications of this new technology and its effect on the potential child, against its benefit of producing a child, we may be led to express our concern in accepting this new technique in reproduction.
We must be cautious about science. It appears that some scientific innovations cast a slur on our humanity and develops techniques with serious moral implications which its inventors neglect. It also beclouds our notion about life and reality making us always seeking to use any possible means available to us to solve our problems despite the ethical implications of its outcome. As Meilaender says in the case of artificial reproduction: “Even if the desire of an infertile couple to have children is laudable, and the aim praiseworthy, even if we know of instances in which assisted reproduction seems to have happy results, it is the wrong method of achieving those results. What we accomplish may seem good; what we do is not.’’
In conclusion, in making this judgment, we are not losing consciousness of the fact that the desire to have children reigns supreme in the lives of couples. As Meilaender puts it “for most people having children is the most significant undertaking of their life.” Nevertheless, we must learn to trust God’s providence. Inasmuch as we desire to have our own children, we should also be free from having it at all cost- as our project rather than God’s gift.