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Wednesday, 6 September 2017

Implications of Assisted Reproductive Technology

By Dr. Agbo (Volunteers for DHI)

“To be or Not to be, that is the question”

On Saturday 5 August this year, a gathering of distinguished experts under the umbrella of Association of Fertility and Reproductive Health (AFRH) discussed the Ethics of Assisted Reproductive Technology (ART) in Nigeria.

Advances in reproductive science and medicine have raised troubling questions over the past 40 years—what is the meaning and definition of parenthood? What is the significance of biological connection between a child and the parents? What is the definition of infertility, and to whom may it apply? And how far may we go to secure “children of our own”?

Couples declared to be infertile now have a range of reproductive options. Techniques such as in vitro fertilisation (IVF) and artificial insemination may be combined with the use of donor gametes and/or gestational surrogates in a variety of ways. Infertility websites advertise many methods by which couples can have children; one fertility clinic claims over 18 different options that couples can consider.

Countless legal and cultural issues have arisen with these technological and scientific advances, but as the technology progresses, the legal world is only beginning to address practices that will have significant consequences for generations. And above all, what are the ethical implications of these new advances?

These and more issues were discussed in the forum. In Nigeria, the reality is that the combination of the lack of law in this area and the desire of the ART industry to obtain ovarian eggs leads to the exploitation of women and many other unethical practises.

Should egg donors be paid?  If it is a donation, why do they have to be paid? The truth is that payment given for selling eggs unfairly motivates the poor and the desperate to give up their gametes.  Additionally, both the ART industry and researchers in the area of cloning have strong interests in obtaining eggs from willing women. Egg donation is a multi-million dollars business. Egg donors are disproportionately young women given extraordinary amounts of monetary compensation for a “donation.” Sometimes, they are not even paid the compensation that motivated them to donate, if insufficient numbers of eggs were harvested.

One of the panelists at the forum, Dr. Nkechi Asogwa, pointed out that donors are often taking upon themselves risks they wouldn’t otherwise take, but those risks have a strong possibility of materialising into health issues later in life. She said that it is unfair to involve the donors in bearing such risks which they undergo because they desperately are in need of money; if these donations are for altruistic reasons, she asked, “how many rich women donate their eggs”?

Young women, who donate their eggs, receive hormonal injections, causing them to super-ovulate, after which they are put under anaesthesia to undergo an invasive surgical procedure. Egg donors are not typically tracked, nor are they given routine follow-up medical care, despite the fact that many of them develop health complications later, ranging from Ovarian hyper-stimulation syndrome to reproductive cancers. This inadequate medical record tracking, - even in developed countries – has made it impossible to prove or disprove a significant relationship between egg donation and subsequent health complications. Without data, there is no way to provide true informed consent to prospective donors.   One can then conclude that the practice of egg donation is questionable and ethically unacceptable given the fact that the ethical principles of “Do No Harm” and “respect for autonomy and freedom” are not being respected. In addition, our culture and religions forbid such.

Young women are not commodities to be sold. The time has come for the law to catch up to the existent technology and practices in order to protect women and reduce exploitation.

In today’s increasingly narcissistic culture, the focus on the ego is overwhelmingly pervasive. And the greatest victim of the age of narcissism is the young woman in financial difficulties. Social engineering and western influence have made the average young Nigerian to question age old cultural and religious beliefs. In an age where everything goes as long as you can afford it; who will uphold the rights of the poor, of the unborn, of the disabled etc. if the very medical practitioners who have taken oaths to protect life are ready to forsake their oaths because of monetary incentive? What is the standard to decide who deserves to live and who should die in an IVF embryology laboratory? Are medical professionals gods; do they create?

As a people and as medical practitioners it pays us to understand and learn from the countries where ART has been practised for over 40 years; to weigh the moral implications of ART instead of sliding down the slippery slope of immorality where every imaginable  act – e.g.  surrogacy or the so called “rent a womb”; pre-implantation diagnosis used mainly to select “designer babies” and commit abortion of the unwanted embryos, technical infidelity where another person’s gametes and not the other spouse gametes are used for IVF; unmarried couples seeking IVF with subsequent litigations; use of IVF for homosexuals to have children, single women seeking IVF to have babies among others -is permissible. As medical professionals, what legacy will we be remembered for?

Given the fact there are now modern morally upright ways of solving infertility problems like Naprotechnology, FEMM and a host of other Fertility Awareness Based Methods, let us pause and think before it is too late