Pre-embryo: therapeutic approaches

Ethics and assisted reproduction

In vitro fertilization and assisted reproductive technology have made great progress during the last 20 years. Genetic material donation, human embryo cryopreservation, selective embryo reduction, preimplantation genetic diagnosis and surrogacy are currently practiced in many countries. On the other hand, embryo research is practiced only in a small number of nations, whereas human cloning has thus far been universally condemned. The rapid evolution and progress of all these techniques of assisted reproduction has revealed certain ethical issues that have to be addressed.

The ethical, legal and religious aspects of preembryo research

Recent advances in the field of reproduction have made it possible to obtain preembryos and to use them in many research applications. These include research into improving methods of IVF treatment, contraceptive research, preimplantation diagnosis, gene therapy, the study of malignant disease, and others. The benefits, academic and scientific, are enormous. Apart from these benefits are many moral, legal, religious and ethical problems and reservations. Potential sources from which the preembryos may originate may also lead to controversy. Pressure groups in various societies seek to hasten governments into legislation or other means of control. We conducted a Medline search of all pertinent literature since 1980, and the findings are reviewed following. Regulated use of preembryo research is ethically acceptable by most groups in society. Suggestions for regulation are provided.

Preembryo research: medical aspects and ethical considerations

Recent advances in the field of reproduction have made it possible to obtain preembryos and to use them in many research applications. These include research into improving methods of IVF treatment, contraceptive research, preimplantation diagnosis, gene therapy, the study of malignant disease, and others. The benefits, academic and scientific, are enormous, but many moral and ethical issues and reservations exist. Potential sources from which the preembryos may originate may also lead to controversy. Pressure groups in various societies seek to hasten governments into legislation or other means of control. We conducted a MEDLINE search of all pertinent literature since 1980, and these findings have been reviewed.

Ethical issues relating to reproduction control and women's health

There are many ethical aspects which derive from the application of reproduction control in women's health. Women's health can be enhanced if women are given the opportunity to make their own reproduction choices about sex, contraception, abortion and application of reproductive technologies. The main issues that raise ethical dilemmas following the development of assisted reproduction techniques are: the right to procreate or reproduce; the process of in vitro fertilization itself-is it morally acceptable to interfere in the reproduction process?; the moral status of the embryo; the involvement of a third party in the reproductive process by genetic material donation; the practice of surrogacy, cryopreservation of pre-embryos; genetic manipulation; experiments on pre-embryos, etc. Induced abortion raises ethical issues related to the rights of the woman versus the rights of the fetus. For those who consider life to begin at conception abortion always equals murder and is therefore forbidden. Those who believe in the absolute autonomy of the woman over her body take the other extreme approach. The discussion surrounding abortion usually centers on whether it should be legal or illegal. Access to safe abortion is critical to the health of women and to their autonomy. The development of new effective contraceptive methods has a profound impact on women's lives. By the use of contraception it is possible to lessen maternal, infant and child mortality and to reduce the prevalence of sexually transmitted diseases. Research and development of new effective reversible contraceptives for women and men is needed. Dissemination of information about the safety and effectiveness of contraceptive methods is of great importance. Female genital mutilation is still practiced worldwide due to customs and tradition among various ethnic groups. The procedure is considered to be medically detrimental to the physical and mental health of women and girls, and is considered by many as oppression of women. The practice has to be stopped. Recognition of the fetus as a 'patient' has a potential effect on women's right for autonomy; they have no legal obligation to undergo invasive procedures and to risk their health for the sake of their fetuses. The woman carries ethical obligations toward her fetus. This obligation should not be enforced by the law. At present women bear most of the burden of reproductive health. All of them have a right of access to fertility regulation. Governments and society must ensure the women's equal rights to health care just as men have in the regulation of their fertility.