In Vitro Fertilization as a Solution to Infertility
In Vitro Fertilization Helps to Prevent Inherited Diseases
Being one of the methods of assisted reproductive technology, in vitro fertilization (IVF) offers solutions not only to infertility but also to hereditary diseases transmission, which either results in selective pregnancy termination or severely affects child’s health. Preimplantation genetic diagnosis is a screening procedure aimed at analyzing DNA to identify and eliminate the eggs or embryos bearing the risk of genetically determined diseases (Bouffard, Viville, & Knoppers, 2009). One of the greatest advantages of this procedure is the fact that the embryos are screened before the implantation; therefore, in case of hereditary disease identification, no controversial issue of pregnancy termination arises.
The transmission of a significant number of diseases and disorders from parents to their children threatens the health of future generations. While in certain cases the diseases can be effectively treated, there are also incurable illnesses, the incidence of which is highly undesirable. However, sometimes, even genetic consultation or prenatal screening cannot ensure the identification of these health-related issues. For instance, mitochondrial dysfunction is a severe condition, which can potentially cause multi-organ disorders. The breakthrough in handling mitochondrial dysfunction has been made recently: given the fact that mothers transmit this disease to their infants, the genome of a future mother is transferred to a donor zygote (Amato, Tachibana, Sparman, & Mitalipov, 2014). Therefore, the affected genes of a mother are replaced with the healthy genes of another person. Since mitochondrial dysfunction is inherited from mothers, in vitro fertilization becomes the method, which can help to avoid transmitting it to future generations. Even though there are certain ethical controversies concerning embryo extraction and storing as opposed to the natural processes, these concerns do not outweigh the benefits of preventing inherited diseases.
Hereditary Neurogenerative Diseases
It is important to note that in vitro fertilization with preimplantation genetic diagnosis can assist in solving the problem of hereditary neurogenerative diseases (Yu-Wai-Man, 2016). Neurological disorders set later, for example, Alzheimer’s and Parkinson’s diseases, cause significant suffering of both the patients and their surroundings. There is no effective treatment of these illnesses, and the drugs only maintain the status quo without providing actual relief. For this reason, the researchers highly welcome the possibility of eliminating pathological processes, which result in neuronal dysfunction soon after the conception. However, as Yu-Wai-Man (2016) states, the neurogenerative disorders may require mitochondrial replacement, which “carries important long-term implications as it involves germline manipulation transmissible to future generations” (p.1330). Despite these implications, the medical community considers the proposed procedure. However, it has to be conducted within the strictly regulated environment.
The advances in medical science allow the researchers to identify specific illnesses related to certain chromosomes. Thus, Turner’s syndrome, Marfan syndrome, Down’s syndrome as well as acute and chronic myeloid leukemia are among the hereditary diseases, the risks of which can be identified and eliminated before the actual pregnancy nowadays (Bouffard et al., 2009). Medical intervention into the chromosomal order raises certain ethical challenges including the “designer baby” issue (Bouffard et al., 2009, p.390) among others but the benefits of this intrusion outweigh the perceived disadvantages; thus, the scientists advocate for preimplantation genetic screening as a part of in vitro fertilization treatment to avoid chromosome-related disorders.
Therefore, in vitro fertilization as an assisted reproductive technology offers a chance for prospective parents with genetically determined illnesses to avoid passing particular genetic flaws to their children. Despite the cost of the procedure, perceived infant and maternal risks, and certain ethical concerns, preimplantation genetic diagnosis remains the solution for couples, which have hereditary diseases. Although there are specific ethical issues, strict scientific regulation and impossibility for parents to intrude in the procedure with the aim of “designing” a baby allow concentrating on the advantages of the manipulation.
Cryopreservation Can Positively Contribute to Family Planning
Cryopreservation is a method of storing an embryo left after an IVF cycle. The evident advantage of this procedure is the absence of the need for a patient to experience full IVF cycle again since the initial stage (embryo formation) has been already finalized. The embryos or reproductive materials such as oocytes and semen could be cryopreserved for the purposes of family planning and as a way to solve the problem of infertility after chemotherapy.
Cryopreservation for Family Planning
Despite high cost of the IVF procedure, its positive outcome cannot be guaranteed. For this reason, the couples can leave the embryos from the IVF cycles in case the current attempt to conceive fails. Conversely, if a pregnancy is successful, the patients can preserve embryos for the next time in case they decide upon another gestation. Another option of using cryopreservation for family planning is the possibility of preservation of an embryo for future if current pregnancy is unplanned. Minerva and Sandberg (2015) consider this option to be an alternative to abortion. According to the researchers, in case of pregnancy, currently, women have two choices: either to maintain gestation or terminate pregnancy. Thus, cryopreservation could offer the third alternative of extracting a fetus or embryo from an uterus and preserving it for the future. Although there are certain ethical issues related to embryo manipulations and interference with nature, they should not present usage of the technology and its potential benefits for patients.
As any other reproductive technology feature, cryopreservation is the subject to debates. The utilitarian nature of family planning with the help of embryo cryopreservation raises certain ethical issues. To demonstrate that cryopreservation is a medical procedure, which has to be considered from the healthcare perspective, Minerva and Sandberg (2015) compare and contrast cryopreservation and abortion. First, the researchers argue that as opposed to abortion, a fetus in cryopreservation is suspended and not killed. Second, given the unnatural delay in the development of a fetus, the opponents can raise the issue of immorality of cryopreservation as similar to abortion (Minerva & Sandberg, 2015). However, while abortion implies killing, cryopreservation offers the delayed development. The potential for further development of a fetus after cryopreservation would be the same as in conventional spontaneous gestation. Consequently, cryopreservation is not similar to abortion, and it can be used for effective family planning.
Cryopreservation against Chemotherapy-Induced Infertility
The increasing rates of cancer incidence leave a great number of people with the concern about family planning since chemotherapy is in certain cases irreversibly detrimental for human reproductive system. As Avensu-Coker, Essig, Breech, and Lindheim (2013) argue, “the increased efficacy of current therapies may unfortunately have profound toxic effects on gamete function in both adolescent and reproductive age groups, with infertility as an expected consequence of cancer therapy” (p.711). At the same time, effective therapy leads to greater life expectancy, and it encourages patients after successful procedures to start or expand their families. In this respect, the researchers suggest focusing on cryopreservation of oocytes, semen or embryos with the further aim of continuing the cycle of in vitro fertilization (Avensu-Coker et al., 2013).
Cryopreservation can be particularly useful in case of adolescent or youth oncology. Though teenagers and young people are not likely to think about family planning at such a young age and when facing such a serious diagnosis, healthcare providers should convince them in the existence of the need for reproductive materials (oocytes or semen) for cryopreservation to avoid the consequences of chemotherapy-induced infertility. Therefore, cryopreservation is able to contribute to family planning as part of in vitro fertilization treatment or as the solution to chemotherapy-induced infertility. This procedure can be regarded as an alternative to abortion as well as the option for young people to start their families after chemotherapies.
IVF Increases the Risk of Multiple Gestations
The cases of multiple gestations are essentially related to the in vitro fertilization technology. According to Knopman et al. (2014), “the past 30 years has witnessed a 100-fold increase in multiple gestations” (p.82). To the great extent, this growth of multiple births is attributed to the assisted reproductive technologies, for example, in vitro fertilization. There exists a concern that multiple gestations bear the increased risk of adverse consequences for fetuses, mothers, and infants.
Multiple Pregnancy Risks
The researchers indicate that multiple pregnancy increases the risk of preterm delivery, hypertension, anemia, and gestational diabetes (Vogel et al., 2013). At the same time, Vogel et al. (2013) state that these issues are critical to the developing countries where healthcare resources are scarce. Thus, it can be concluded that safe access to quality cesarean section, which is available in developed countries, can resolve the potential complications of multiple birth.
There is another issue related to twin pregnancies as a result of IVF. Reynolds Schieve, Jeng, Peterson, and Wilcox (2001) indicate that the incidence of multiple birth is lower in women of greater age. However, since IVF technique sometimes involves the use of donor eggs, the non-compliance of the age of a donor and a recipient can lead to the increased possibility of multiparity. This fact should be taken into account as the potential danger factor for those who want to avoid multiple pregnancy at any cost.
Comparison of IVF-Conceived and Spontaneously Conceived Twins and Singletons
Despite the existing opinion in the medical community that multiple gestations represent higher risk than the singleton ones, certain researchers prove the invalidity of this evidence. Thus, the study by Gleicher, Kushnir, and Barad (2016) demonstrates that when comparing IVF and spontaneous gestations, the outcomes for IVF-conceived singletons are worse than those for spontaneously conceived ones. However, IVF twins show better results than the spontaneously conceived twins (Gleicher et al., 2016). These results disprove the unanimous perspective of the researchers that multiple gestations always represent higher risks and more complications. What is more, Mohammed and Abdel-Maaboud (2012) indicate that although traditionally, twin pregnancies are considered more complicated and bearing greater risks, the outcomes of research concerning the dangers of IVF-multiple gestations are rather inconsistent. As Mohammed and Abdel-Maaboud (2012) claim, they found “no significant differences in the incidence of either maternal or neonatal complications when twin pregnancies obtained by IVF or by SC are compared” (p.234). The outcomes of this research demonstrate that even in case of IVF-conceived twins, corresponding maternal or neonatal issues are similar to those of spontaneously conceived ones.
Consequently, certain conditions for conceiving twins through in vitro fertilization are needed. If the specialists consider the quality of an embryo and the age of a donor whose eggs are taken for the procedure, the incidence of multiple birth can potentially be reduced. Thus, the potential adverse outcomes of increased complications for mothers and infants may be eliminated. Even if the risk of multiple birth increases as a result of in vitro fertilization, the actual hazard of this incidence should be questioned. The rebuttal of the perceived hazards of multiple gestations and the adverse perinatal outcomes in case of IVF-conceived twins should be taken into account. As mentioned above, the risks are often exaggerated especially when the emphasis is on IVF technology while actually, spontaneous twin pregnancies present the same rate of complications.