Infertility Ethics
It is estimated that fertility issues occurs in 1/5th of all heterosexual couples in the UK.

  • IVF (In-vitro fertilisation) is a procedure that attempts to replicate what occurs naturally, with fertilisation happening in vitro rather than in a woman's body.

    Oocytes (eggs) are recovered from the female via hormonal stimulation, and are mixed with sperm in the laboratory. The resultant embryos are then implanted into the female uterus allowing them to gestate.

  • ICSI (Intracytoplasmic sperm injection) involves the injection of single spermatozoa into the cytoplasm of the oocyte, and thus allowing more control over which sperm fertilizes which oocyte. The fertilised egg is then transferred into the woman as in traditional IVF techniques. ICSI is used when sperm quality/quantity is low thus decreasing IVF chances.

IVF/ICSI can be used with egg donation or surrogacy (where the woman providing the donated egg) isn't the birth mother. IVF can also the combined with PGD (pre-implantation genetic diagnosis) to rule out genetic disorders.

Legal issues
Human Fertilisation and Embryology Act 2008
  • All human embryos outside the body - whatever the process used in their creation are subject to regulation.
  • Regulates "human-admixed" embryos created from a combination of human and animal genetic material for research.
  • Ban sex selection of offspring for non-medical reasons. (Sex selection is allowed for medical reasons - for example to avoid a serious disease that affects only males)
  • Same-sex couples as legal parents of children conceived through the use of donated sperm, eggs or embryos. These provisions enable, for example, the civil partner of a woman who carries a child via IVF to be recognised as the child's legal parent.
  • Retain a duty to take account of the welfare of the child in providing fertility treatment. "The need for supportive parenting" - hence valuing the role of all parents.
  • Storage of an embryo requires consent from both parties whose gametes will be used in the formation of the embryo, in writing. The consent must also include specific remits, e.g. the maximum period of time for which embryos or gametes can be stored.
  • At any point before the embryo is used, consent may be withdrawn by either party.
  • If consent is withdrawn from either party, then the embryo should be destroyed.

When disagreement is reached on the future of the stored embryos, the government has proposed (Department of Health review of HFEA act, 2006) the introduction of a 'cooling off' period, of a period of 1 year, to allow time in which the parties involved can reach a decision on the future of the stored embryos.

Ethical issues
  • Previous to the 2008 HFEA Act, civil partners were not allowed to have IVF, but now with the updated provision, there would be non-discrimination against married individuals or people in civil partnerships.
  • Should lesbian couple be allowed to have IVF where childlessness is not an absence of fertility on the NHS? There is a resource allocation issue.
  • Beneficence: Is it better to be born than not be?
  • Pregnancy past menopause: The uterus is capable of carrying out a pregnancy after menopause; and IVF allows menopause not to be a barrier. However it may also be less clinically effective, and may not be justified in limited resource situations.
  • Implantation of an embryo without consent of both parties involved would be unethical.
  • Children born as a result of gamete donations when they reach 18 years old, are able to have basic identifying information about the donor (name, date of birth and last known address). This raises ethical concerns of anonymity to reciepients.
  • The financial and legal issues of the father are unclear in the circumstances of IVF. If the embryo were implanted, the child may claim financial inheritance from the father, who may have other commitments, so this may become financially and psychologically traumatic for the partner.
  • By bringing children into the world, doctors should have a duty to ensure that the welfare of the children should be adequate. i.e. Nadya Suleman in the US had IVF, which resulted in the birth of 8 babies adding to her existing 6 member family.
Clinical issues
  • If the embryo is unable to be implanted, the patient will be unable to have children that are genetically hers. Therefore it is vital that support and advice are provided about the situation and the options available to her.
  • There is no right of access to fertility treatment (like all other medical treatments).
  • NICE is in the current process of revaluating the NICE 2004 guidelines for the assessment and treatment of people with fertility problems. The new guidelines are expected to be published in 2012.
  • The NICE 2004 document are not binding, and there are regional variations in the numbers of IVF cycles offered. NICE suggests 3 IVF cycles be offered on the NHS.
  • The number of sperm donation is limited, to reduce risk of children of same donor meeting and unknowingly considering marriage
  • Human Fertilisation and Embryology Act 2008
  • The Parental Orders (Human Fertilisation and Embryology) Regulations 2010
  • Surrogacy Arrangements Act 1985 (c.49)
  • Bromham DR, Journal of Assisted Reproduction and Genetics 12 (8) 1995 "Surrogacy: Ethical, Legal, and Social Aspects"
  • Royal College of Obstetricians and Gynaecologists: Male and Female sterilisation Guidelines 2004
  • Recommendations on Ethical Issues in Obstetrics and Gynaecology (FIGO 2000)