In Vitro Fertilization: Ethical Concerns and Alternatives The longing for a child is so entangled with all other human

longings that it sometimes seems as inevitable as breath. (Henig) The U.S. census has determined that there were over four million live births in the United States in 2002. Undoubtedly, countless celebratory cigars, hugs, and well wishes followed the arrival of these newborns,meanwhile, a small but passionate population wept, believing themselves to be failures or victims of some cosmic injustice.The Center for Disease Control estimates that 7.4% of women that year struggled with infertility, as determined by the inability to conceive over twelve consecutive months. The path through infertility is a difficult one for would-be parents, littered with anxiety, sadness and desperation. For this reason many couples seek any advantage or hope that a doctor can provide.The medical research and treatment field is making true what once was thought possible only in science fiction: artificial joints and organs, laser surgeries, and drug therapies for nearly any condition or inconvenience. On July 25, 1978 Louise Joy Brown was born in England, the worlds first baby formed outside of the womb, bringing humanity one step closer to Huxleys Brave New World. The use of in vitro fertilization as an Assisted Reproductive Technology, or A.R.T., has become a common solution to the fertility problems experienced by many couples. However, the standard practice, while a blessing to infertile couples, is fraught with ethical concerns which the patient must be prepared to consider.

With any treatment option there are questions the couple must ask:How much will this cost? What are the risks involved? What is the success rate? But in the overwhelming flood of emotions caused by infertility, someother very important questionsare often overlooked: Are there other costs beyond the financial? What am I willing to sacrifice to have a baby? Does the fact that something is possible make it acceptable? In vitro fertilization (IVF) is a fertility treatment in which an egg is fertilized outside a womans body and then implanted in the womb with the hope that it may grow to term. Even successful procedures have only a 40-50% chance of producing a live birth according to The Society for Assisted Reproductive Technologies. The process is physically and emotionally draining.One IVF cycle runs 2 months.During the first month the womans own biological cycle is readjusted through a host of hormonal therapies in order to prepare her eggs for retrieval and her uterus for implantation.In the second month the hopeful mother is forced to endure frequent invasive check-ups both before and after implantation.The financial aspects of this procedure need also to be addressed. IVF costs can run between $10,000 and $15,000 per cycle. So to save time, money, and effort the common practice among fertility clinics is to fertilize eight to ten eggs and to implant the two or three that the doctors deem most promising. The remaining embryos can then, at the patients discretion, be frozen indefinitely, donated to scientific research, or simply discarded. (Although scientific donation seems to be a noble gesture, the reality is that each donated embryo is destroyed in the research and experimentation processes). If these embryos are alive and unique

individuals, then their destruction is tantamount to murder. Are they?Is the possibility of one viable pregnancy worth the cost of ending nine other lives? To answer these questions it must first be determined when an egg and sperm together become a living being? Daniel E. Koshland writes, "What is the definition of life? Is an enzyme alive? Is a virus alive? Is a cell alive?" He asks these questions in order to bring about a standard definition of what life is. His ideas as to the requirements for life pinpoint what makes a human life in utero different and separate from simply a process of a pregnant womans body. Koshland has compiled "Seven pillars of life Program, Improvisation, Compartmentalization, Energy, Regeneration, Adaptability, Seclusion, PICERAS, for short[as] the fundamental principles on which a living system is based (Koshland). It is clear that a fertilized egg has a specific program for life in DNA, a blueprint for its cells that directs their growth and function. Koshlands definition of improvisation is aimed more at the species level than the individual. But the cells of a newly formed embryo are certainly compartmentalized. They are also able to create energy through mitochondrial reactions, regenerate replacement cells, keep specific processes from interfering with others and adapt to external influences. In the case of a child in utero such influences would include any substance, food, drug, or even outside air taken in by the mother that might impact the environment of the child.So, science has determined that an embryo is a living being, unique from its mother.

One might argue that, using those same seven pillars, pests such as termites and staphylococcus are also defined as unique living creatures and that attempts to eradicate them should be considered just as woeful as the destruction of an embryo. From a purely scientific standpoint that argument is valid. However, science is not the appropriate arena in which to argue questions of morality. It cannot provide answers, only evidence, as to when a certain being should be granted a right to live over another. If science cannot be trusted to determine how and when to bestow rights upon an individual, it then becomes societys responsibility.In an article for the Journal of American Academy of Pediatrics, Dr. Amnon Goldworth writes: Some conclude from this that the pre-embryo is a person who possesses rights from the moment of conception. However, personhood is a social construct that is shaped not only by an understanding of objective nature but also by community needs and values. It is not surprising that different concepts of personhood have been adopted at different times and places. Aristotle indicated that ensoulment (personhood) occurs 40 days after conception for the male fetus and 80 days after conception for the female fetus. Muslims believe that personhood occurs 14 days after conception. From the 17th century onward, European common law recognized personhood only after quickening. Within this historical context, any attempt to decide when protoplasm is endowed with rights by merely resorting to a scientific examination of biologic processes is bound to fail."

Whether by interpreting Gods intentions or exploring various logical conclusions, people have crafted myriad differing viewpoints. Society needs an arbiter. Are there institutions whose purpose is to decide and develop rules regarding difficult social questions? Yes, the legislative and judicial branches of the United States government.

TheU.S. legal system declares an embryo a potential victim of abuse and murder in section (a) (1) of the Unborn Victims of Violence act, while simultaneously declaring: (c) Nothing in this section shall be construed to permit the prosecution (1) of any person for conduct relating to an abortion for which the consent of the pregnant woman, or a person authorized by law to act on her behalf, has been obtained or for which such consent is implied by law

If a pregnant woman is attacked, the law states that the child in utero is a separate victim from the pregnant woman, who is entitled to see her attacker brought to justice. However the pregnant woman could choose to abort the child without any fear of prosecution. In this scenario the child ceases to be entitled to any rights to its own protection. The contradiction in this law alone shows that the legal system may not be capable of a simple definition of when a person should be granted rights. Now that scientific reason and the authors of societys legal structures have proven unsuccessful in adequately concluding whether or not a fertilized egg should be considered a person, with the same rights and privileges granted to people after birth, the infertile couple is still left with the unresolved questions: What are we willing to sacrifice to have a child? and Is there any way to avoid pursuing a procedure we might later regret? It is important, then, not to ignore alternatives to the standard practice of IVF. For example a couple could simply choose to have only one egg fertilized per cycle. While this greatly decreases the chance of a successful procedure, 5.9% of IVF patients in 2010 opted to do such("Clinic Summary Report"). Presumably, they made this choice on moral or

religious grounds, finding a compromise between the promise of science and the clear conscience of morality. Another alternative to the standard practice of IVF is adoption. Couples that choose to grow their families through adoption help not only themselves. They create a nurturing, stable family for a child who mightotherwise grow up in different foster or group homes. They also provide a relief to their childs birthparents, easing the grief that can overwhelm a mother forced, for whatever reason, to give up her child. In 2008, 135,813 children were adopted in the United States (How Many Children). Instead of wrestling with whether or not they are destroying human life through IVF, adoptive couples can become parents to the parentless. Adoption does have its drawbacks. Like IVF, it too is costly. Depending on how comfortable potential adoptive parents are with certain medical situations or ethnic backgrounds, domestic adoption can total more than $40,000 (Employer-Provided Adoption Benefits). But by the time couples have begun considering IVF, they have most likely run the gamut of family doctors, obstetricians, urologists, surgeons and lab technicians. They have become accustomed to large medical costs. What drives them away from adoption is most often not the price tag; it is the goal. Women, especially, desire to have a biological child, one who resembles her and her partner; and most of all one whom she is able to carry in her own womb. There is good news on the horizon for those couples adamant about having a biological child, but that also have ethical reservations concerning IVF. Emerging assisted

reproductive technologies, such as immature egg retrieval and egg cryopreservation, could eliminate the need for fertilizing multiple eggs per cycle and the subsequent destruction of unused embryos. Currently, an IVF patient is given hormones to overstimulate her egg production, allowing doctors to retrieve more than the one or two eggs a woman would naturally release each month. These hormones can have adverse effects on women ranging from mood swings to ovarian cysts. Researchers hope to abolish the need for such hormones using immature egg retrieval. Within 10 to 12 days of the onset of normal menstruation, these researchers performed an ultrasound needle aspiration of the very small follicles in the womans ovaries and removed immature eggs. These eggs were subjected to a complex process of maturation in the laboratory and then fertilized using ICSI [Intra Cytoplasmic Sperm Injection] (Sher 251). This procedure still allows for more eggs to be fertilized than necessary, and by itself does little to assist those with moral or ethical reservations toward IVF. However, if used in conjunction with another new technology, egg cryopreservation, the standard practice of in vitro fertilization could be rewritten. A womans eggs are the largest cells in the human body and filled with mostly fluid. This makes it difficult to properly, safely freeze and then thaw them.As all the fluid expands during the freezing process the cell wall and spindles can be damaged. When this occurs it is highly unlikely that, if fertilized, the egg would be able to implant itself in the uterus. Today, survival rates for frozen, genetic material filled embryos are much higher than those of frozen eggs. However, technological advances have brought successful egg

cryopreservation closer to reality. Egg freezing skirts the ethical dilemma as to whether life in its earliest form is being manipulated. Eggs, like sperm, are considered to be cells that do not have life potential on their own (Sher 249). Without the benefit of these future technologies the question still remains: what should be done in the mean time? Infertile couples must be cautious. It is clear that in vitro fertilization has been a wonderful tool for thousands of couples that would not have been able to have their own children naturally. It is important to remember that there is nothing wrong with pursing a family through IVF. The ethical dilemma concerns only the destruction of unnecessary embryos, or human lives. This concern has the potential of being overlooked as more and more couples look expectantly to IVF, and as it becomes more commonplace and accepted. "Today scientists doing in vitro fertilization don't think much about [ethical] lines. When a fertility expert at an IVF clinic wiggles a probe to retrieve an egg or squints into a microscope to watch the "dance of love" play out in a petri dish, she probably is not asking herself questions about when life begins or who should play God. Her ultimate goal is to make a baby, and after the births of hundreds of thousands of babies made in just this way, questions about whether the ends justify the means, are virtually never asked." (Henig) The onus falls on each individual couple to realize the magnitude of the decisions they are making, andnot to be overcome by desperation for a baby.Questions regarding the ethics of assisted reproductive technologies will continue to weigh on the hearts of those dealing with infertility. President Ronald Regan, in an address at Kansas State University once explained his method of alleviating these concerns. Simple morality dictates that unless and until someone

can prove the unborn human is not alive, we must give it the benefit of the doubt and assume it is (alive). And, thus, it should be entitled to life, liberty, and the pursuit of happiness.Life is a beautiful and special miracle. A person is more than just a body. He is a multitude of possibilities and full of potential. A person deserves the respect of a decision carefully and thoughtfully made.

Works Cited Society for Assisted Reproductive Technology. "Clinic Summary Report." Society for Assisted Reproductive Technologies. Society for Assisted Reproductive Technologies, n.d. Web. 23 Apr 2012.
Child Welfare Information Gateway. (2011).Employer-provided adoption benefits.Washington DC: U.S. Department ofHealth and Human Services, Childrens Bureau. Goldworth, Amnon. "The Ethics of In Vitro Fertilization." Pediatrics in Review. American Academy of Pediatrics, 1 Aug. 1999. Web. 27 Feb. 2012. Henig, Robin Marantz. Pandora's Baby: How the First Test Tube Babies Sparked the Reproductive Revolution. Boston: Houghton Mifflin, 2004. Print. Child Welfare Information Gateway. (2011). How many children were adopted in 2007 and 2008?Washington, DC: U.S. Department of Health and Human Services, Childrens Bureau. Koshland, Daniel E., Jr. "The Seven Pillars of Life." Editorial.Science AAAS. American Association for the Advancement of Science, 22 Mar. 2002. Web. 27 Feb. 2002. Reagan, Ronald. Remarks at Kansas State University. Alfred M. Landon lecture Series on Public Issues. Kansas State University, Manhattan, KS. 9 September, 1982. Sher, Geoffrey, Virginia Marriage Davis, and Jean Stoess.In Vitro Fertilization: The A.R.T. of Making Babies. 3rd ed. New York: Facts on File, 2005. Print. "Unborn Victims of Violence Act of 2003." House Judiciary Committee. U.S. Government, 8 July 2003. Web. 2 Apr. 2012.

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