Abstract
In the few years since Joyce Carol Oates described conception as “shrouded in mystery,” advances in reproductive technologies have further eroded the aura of the unknown in conception. Human eggs are fertilized in the laboratory, stored as embryos in glass straws in freezing tanks, and subjected to various therapeutic and nontherapeutic manipulations. As studies on embryos increase in frequency and variety, and as they move from the laboratory to the physician’s office, they give new urgency to the need to promote an ethical debate about the benefits of embryo micromanipulation for couples, embryos, and society at large. This chapter reviews emerging techniques in embryo micromanipulation and identifies ethical issues that must be addressed before the techniques are systematically offered in medical clinics.
“Conception (in contrast to the fully public fact of birth) suggests not only the unknowable but the forbidden: our birth dates are matters of public record but our dates of conception are permanently shrouded in mystery.”1
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Notes and References
Joyce Carol Oates (1985) A terrible beauty is born. How? New York Times Book Review, August 11, p. 1.
See,e.g., Jacques Testart, Bruno Lassalle, Robert Forman, Armelle Gazengel, Joelle Belaisch-Allart, Andre Hazout, Jean-Daniel Rainhorn, and Rene Frydman (1987) Factors influencing the success rate of human embryo freezing in an in vitro fertilization and embryo transfer program. Fertility and Sterility 48, 107–112.
Peter Aldhous (1990) Pro-life actions backfire. Nature 345, 7.
See Institute of Medicine (1989) Medically Assisted Conception: An Agenda for Research,National Academy Press, Washington, DC; Jan Tesarik (1989) Viability assessment of preimplantation concept: A challenge for human embryo research. Fertility and Sterility 52,364–366; CIBA Foundation (1986)Human Embryo Research: Yes orNo Tavistock Publications, London, UK; Embryo Research (1985), Lancet i,2.
See Andrea L. Bonnicksen (1989) In Vitro Fertilization: Building Policy From Laboratories to Legislatures,Columbia University Press, NY, pp. 75–82. The Department of Health, Education and Welfare disbanded the Ethics Advisory Board in 1979, which in effect imposed a moratorium on federal funding of research involving human embryos. According to federal law, such proposals must be reviewed by an ethics board before being considered for funding. Recent efforts to create a new EAB have been unsuccessful. See Andrea L. Bonnicksen (1989) Developments in the Status of Human Embryo Research: Revising the Policy Agenda, paper presented at the 1989 Annual Meeting of the Midwest Political Science Association, Chicago, IL.
Yury Verlinsky, Eugene Pergament, and Charles Strom (1990) The preimplantation genetic diagnosis of genetic diseases. Journal of In Vitro Fertilization and Embryo Transfer 7, 1–5.
Howard W. Jones, Jr. and Charlotte Schrader (1989) And just what is a pre-embryo? Fertility and Sterility 52, 189–191;
Rafael I. Tejada and William G. Karow (1986) Semantics used in the nomenclature of in vitro fertilization, or let’s all be more proper, Journal of In Vitro Fertilization and Embryo Transfer 3, 341–342.
Clifford Grobstein (1985) The early development of human embryos, Journal of Medicine and Philosophy 10, 213–236, at 216.
G. John Garrisi, Beth E. Talansky, Lawrence Grunfeld, Valdi Sapira, Daniel Navot, and Jon W. Gordon. Clinical evaluation of three approaches to micromanipulation-assisted fertilization, Fertility and Sterility 54 671677, at 676.
Jones and Schrader, p. 190.
Ethics Committee of The American Fertility Society (1990) Ethical considerations of the new reproductive technologies, Fertility and Sterility, Supplement 2, 53, 63S.
Jones and Schrader, p. 189.
Ethics Advisory Board, Department of Health, Education and Welfare (1979) Report and Conclusions: HEW Support of Research Involving Human In Vitro Fertilization and Embryo Transfer,US Government Printing Office, Washington, DC.
See Davis v. Davis,No. E-14496 (Blount County, TN, Equity Division [I], September 21, 1989 [equating the embryo with a child]); Instruction on respect for human life in its origin and on the dignity of procreation: Replies to certain questions of the day, Doctrinal Statement of the Vatican, March 10, 1987 (the human being is a “person from the moment of conception”); (1984) Ethical statement on in vitro fertilization, Fertility and Sterility 41 13 (“gametes and concepti are the property of the donors”).
This can take one of several forms: (1) remove one or more cells from a four-to eight-cell embryo to study, (2) divide the embryo in half to create monozygotic twins and study one-half of the embryo, or (3) excise the trophectoderm tissue (outer cell layer) of embryos at the later blastocyst stage. Verlinsky, Pergament, and Strom, pp. 2–3. So far, research has focused on the first method of examining one or two cells.
J. L. Watt, A. A. Templeton, I. Messinis, L. Bell, P. Cunningham, and R. O. Duncan (1987) Trisomy 1 in an eight cell human pre-embryo. Journal of Medical Genetics 24, 60–64;
Roslyn R. Angell, A. A. Templeton, and R. J. Aitken (1986) Chromosomal studies in human in vitro fertilization, Human Genetics 72, 333–339;
Michelle Plachot, J. de Grouchy, Anne-Marie Junca, Jacqueline Mandelbaum, Catherine Turleau, P. Coullin, J. Cohen, and J. Salat-Baroux (1987) From ooctye to embryo: A model, deduced from in vitro fertilization, for natural selection against chromosome abnormalities. Annales de Genetique (Paris), 30, 22–32;
R. R. Angell, A. A. Templeton, and I. E. Messinis (1986) Consequences of polyspermy in man, Cytogenetics and Cell Genetics 42, 1–7.
eve K. Nichols (1988) Human Gene Therapy, Harvard University Press, Cambridge, MA, p. 6.
Dorothy Warburton (1987) Reproductive loss: How much is preventable? New England Journal of Medicine 316, 158–160.
Researchers have established a correlation between an embryo’s appearance (whether it is fragmented or has one or three pronuclei instead of the normal two) and the incidence of chromosomal errors, showing a “high incidence of chromosomal errors in morphologically abnormal early preimplantation embryos.” Sai Ma, Dagmar K. Kalousek, Christo Zouves, Basil Ho Yuen, Victor Gomel, and Young S. Moon (1990) The chromosomal complements of cleaved human embryos resulting from in vitro fertilization Journal of In Vitro Fertilization and Embryo Transfer 7 16–21, at 16.
Mark W. J. Ferguson, Contemporary and future possibilities for human embryonic manipulation, in Experiments on Embryos (Anthony Dyson and John Harris, eds.), Routledge, London, UK, pp. 6–26, at 7.
Kate Hardy, KarenL. Martin, Henry J. Leese, Robert M. L. Winston, and Alan H. Handyside (1990) Human implantation development in vitro is not adversely affected by biopsy at the 8-cell stage. Human Reproduction 5, 708–714, at 708. Researchers have also studied the RNA synthesis activities in human embryos. J. Tesarik, V. Kopecny, M. Plachot, et al. (1986) Activation of nucleolar and extranucleolar RNA synthesis and changes in the ribosomal content of human embryos developing in vitro. Journal of Reproduction and Fertility 78, 463–470.
Soon-Chy Ng, Ariff Bongso, Henry Sathananthan, and Shan S. Ratnam (1990) Micromanipulation: Its relevance to human in vitro fertilization. Fertility and Sterility 53, 203–219, at 214; Ferguson, p. 7.
C. Coutelle, C. Williams, A. Handyside, K. Hardy, R. Winston, and R. Williamson (1989) Genetic analysis of DNA from single human ooctyes—A model for preimplantation diagnosis of cystic fibrosis, British Medical Journal 299, 22–24; Verlinsky, Pergament, and Strom, p. 3.
Hardy, Martin, and Leese. The agency was known as the Interim Licensing Authority when this project was approved.
They concluded that the biopsy, while reducing the cellular mass, does not adversely affect the preimplantation development of biopsied embryos in vitro. Ibid.
1bid.,p. 711. See also Virginia N. Bolton, Susan M. Hawes, Clare T. Taylor, and John H. Parsons, Development of spare human preimplantation embryos in vitro: An analysis of the correlations among gross morphology, cleavage rates, and development to the blastocyst, Journal of In Vitro Fertilization and Embryo Transfer 6 30–35, at 35.
Ethics Committee of the American Fertility Society, p. 63S; Ferguson. Twinning will raise multiple questions. Should it be used regularly as a back-up in IVF? As a way of giving a couple the pleasure of twins but withouthaving them at the same time?
Zona drilling is done by applying acid, by mechanical means with a microneedle, or by variations of either of these techniques. Garrisi et al., 67–72.
S. C. Ng, T. A. Bongso, S. S. Ratnam, Henry Sathananthan, Clement L. K. Chan, P. C. Wong, Leiff Hagglund, C. Anandakumar, Y. C. Wong, and Victor H. H. Goh (note)(1988) Pregnancy after transfer of multiple sperm under the zona. Lancet ii 790.
Ismail Kola, Orly Lacham, Robert P. S. Jansen, M. Turner, and A. Trounson (1990) Chromosomal analysis of human oocytes fertilized by microinjection of spermatozoa into the perivitelline space. Human Reproduction, 5, 282–285.
Jon W. Gordon, Larry Grunfeld, G. John Garrisi, Daniel Navot, and Neri Laufer (1989) Successful microsurgical removal of a pronucleus from tripronuclear human zygotes. Fertility and Sterility 52, 367–372.
Henry E. Malter and Jacques Cohen (1989) Embryonic development after microsurgical repair of polyspermic human zygotes. Fertility and Sterility 52, 373–380, at 373.
Ibid.
Gordon. For unsuccessful attempts, see references listed by Gordon.
/bid.
Jacques Cohen,Carlene Elsner, Hilton Kort, Henry Malter, Joe Massey, Mary Pat Mayer, and Klaus Wiemer (1990) Impairment of the hatching process following IVF in the human and improvement of implantation by assisting hatching using micromanipulation. Human Reproduction 5, 7–13, at 7.
BarbaraF. Culliton (1990) Gene therapy begins. Science 249, 1372.
Ferguson, p. 11.
Harold M. Schmeck, Jr. (1982) Rat gene implant in mice reported. New York Times, December 16, p. 1. See also Jeremy Cherfas (1990) Molecular biology lies down with the lamb. Science 249, 124–126.
Janice Sharp (1991) The patenting of transgenic animals, in Emerging Issues in Biomedical Policy: Annual Volumes (Robert H. Blank and AndreaL. Bonnicksen, eds.), Columbia University Press, NY, (in press).
Robert B. Church, ed. (1990) Transgenic Models in Medicine and Agriculture: Proceedings of a UCLA Symposium Held at Taos, New Mexico, Jan. 28—Feb. 3, 1989, Wiley-Liss, Inc., NY.
W. French Anderson (1990) Genetics and human malleability. Hastings Center Report 20, 21–24.
/bid.
National Institutes of Health (1986) Points to Consider in the Design and Submission of Human Somatic-Cell Gene Therapy Protocols, September 29, reprinted in Nichols, pp. 195–208.
See,generally, Ethics Advisory Board; CIB A Foundation; Anne McLaren (1987) Can we diagnose genetic disease in pre-embryos? New Scientist,December 19, pp. 42–45;
John A. Robertson (1986) Embryo research. University of Western Ontario Law Review 24, 15–37;
Hans-Martin Sass (1985) Moral dilemmas in perinatal medicine and the quest for large scale embryo research: A discussion of recent guidelines in the federal republic, Journal of Medicine and Philosophy 10, 279–290.
E. Joshua Rosenkranz (1987) Custom kids and the moral duty to genetically engineer our children. High Technology Law Journal 2,153, who argues there may be a moral obligation to rescue an ailing embryo if it is possible to do so.
For example, the American Fertility Society concludes that research embryos must be treated with respect and embryos to be transferred to the woman’s uterus be treated with concern beyond respect. Ethics Committee, pp. 32S–33S.
See, generally, Instruction; Paul Ramsey (1972) Shall we ‘reproduce’? JournaloftheAmericanMedicalAssociation 220,1346–1350, and 1480–1485;
Christine Ewing (1989) The case against embryo experimentation: A feminist perspective. Legal Service Bulletin 14, 109–112, 121.
David Jabbari (1990) The role of law in reproductive medicine: A new approach. Journal of Medical Ethics 16, 35–40.
Warburton.
Verlinsky, Pergament, and Strom, p. 4.
See ibid.,p. 4, who wonder if biopsies should become the standard of care for all couples for whom advanced maternal age is a factor.
Office of Technology Assessment (1988) Infertility: Medical and Social Choices, OTA-BA-358, US Government Printing Office, Washington, DC, 150–151.
Andrea L. Bonnicksen (1988) Embryo freezing: Ethical issues in the clinical setting. Hastings Center Report 18, 26–30.
Ferguson, pp. 8–9.
Kate Hardy, Alan H. Handyside, and Robert M. L. Winston (1989) The human blastocyst: Cell number, death and allocation during late preimplantation development in vitro. Development 107, 597–604, at 598.
See Ira H. Carmen (1981) The constitution in the laboratory: Recombinant DNA research as “Free Expression.” Journal of Politics 43 737–762; Roe v. Wade,410 US 113 (1973).
Office of Technology Assessment, p. 251. For example, Louisiana passed a law defining the embryo as a juridical person with the power to sue and be sued. La. Rev. Stat. 14: 87, 121–133.
Margaret Brumby and Pascal Kasimba (1987) When is cloning lawful? Journal of In Vitro Fertilization and Embryo Transfer 4, 198–204.
CIBA Foundation, p. 3; (1987) Draft legislation on infertility services and embryo research. Lancet, ii, 1343.
David Dickson (1989) France introduces bioethics law. Science 243, 1284;
Richard Sietmann (1990) Abortion divides uniting Germanies. Science 249, 1100.
For a summary of commission reports, see LeRoy Walters (1987) Ethics and new reproductive technologies: An international review of committee statements. Hastings Center Report 17 3S–9S.
Bonnicksen, In Vitro Fertilization,pp. 82–90.
John Warden (1990) Lords approve embryo research. British Medical Journal 300, 416.
See Ethics Committee, p. 62S, for citations.
/bid.,p. 63S.
Hardy, Handyside, and Winston. The group kept 181 normal and abnormal spare embryos from IVF cleaving for up to seven days (to up to 125 cells) in order to understand more about the process in which the human embryo expands into two types of cells at the blastocyst stage. The study was conducted to learn more about the early development of the human embryo in culture, p. 601. The researchers ended their published report with a statement of the need for further study.
/bid.
Ethics Committee, p. 63S.
Bonnicksen, Developments.
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Bonnicksen, A.L. (1991). The Embryo as Patient. In: Humber, J.M., Almeder, R.F. (eds) Bioethics and the Fetus. Biomedical Ethics Reviews. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-445-0_8
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