The Embryo - Human Life vs. Collection of Cells?

Welcome back! Hopefully we are now "learned" about savior siblings and upon being exposed to the "success" of PGD and IVF evidenced by the Trebing story, we are all ready to delve deeper into what some of the techniques like in vitro fertilization (IVF) and preimplantation genetic diagnosis (PGD) are.

If you don't have time to read what we wrote about IVF and PGD below, don't worry! The next two videos will inform you about the processes...trust us...you want to at least watch the second video below for some awesome background music :) Enjoy!



The 411 on IVF and PGD

We're sure most of you all are aware of what IVF entails but here's a little refresher for you to brush up your knowledge on the topic. IVF was primarily utilized for infertile couples. About 6.1 million people in the U.S. are unable to become pregnant by natural methods. IVF is an assisted reproductive method, that combines a man's sperm with a woman's egg in a laboratory dish for fertilization. Then the embryos (usually 2-4, but as we have all noticed sometimes a lot more, look at the recent controversy with the "Octuplet mom") are placed in the woman's uterus for implantation. Just FYI, the cost of one IVF cycle is about $12,400. Each cycle of IVF may result in a successful pregnancy about 10-35% of the time (depending on maternal factors). Also, there may be a slight increased risk of genetic defects in IVF children according to a study (1). So with all this new technology, what can be done to identify these genetic deformities?

If you were thinking PGD, you are correct! PGD is a costly technique (an additional $4,000-$7,500 to each IVF cycle) to detect defects in IVF embryos prior to uterine implantation (2). It is currently the only option to test your future child who may be at a high risk of carrying a genetic abnormality. PGD assists in eliminating genetic disease before implantation which would prevent the need of termination of the pregnancy upon the diagnosis of a prenatal disorder. This is accomplished by removing a single cell, taking a biopsy, of the developing IVF embryo. Then genetic testing is done on the biopsied tissue for certain sex-linked disorders, single gene defects, or chromosomal disorders (3). Most commonly PGD is used to prevent the transmission of chromosomal abnormalities onto one's child but since the first savior sibling case in 2000, IVF and PGD may be utilized to find a genetically perfect match for an ailing sibling, as the Trebings family did.

What happens to the left over embryos from IVF and PGD?

Many of you have been asking us via e-mail what happens to the embryos that are not used during the process of IVF/PGD. You guys raise a good question that is definitely a controversial issue. It is believed that about 12 embryos are created (give or take) during each IVF cycle and not all of them are used (3). According to a recent study by researchers at Yale University School of Medicine, results show that only 5 out of every 100 eggs fertilized by IVF will result in a live birth. So, 95% of IVF embryos are discarded, either die in the Petri dish or in the womb (4). For the embryos that are 'non-viable' by IVF standards or determined 'affected' by PGD standards the embryo is either discarded or donated for research. For the embryos that are viable and not used during the IVF/PGD process, the donor can choose from the following:

• Freeze the embryo for future use (in case the first round of IVF doesn't work or they want kids through IVF in the future). About 25% of the embryo's stored this way do not survive (5).


• Discard the embryos (flush the embryos down the sink or throw it away in the bio-hazard bin). Approximately 50% of donors choose this option if they do not freeze their embryo (6).


• Allow the embryos to become non-viable on its own in the petri dish in which they were created (usually takes 3-4 days). Roughly 46% of donors choose this option if they do not freeze their embryo (6).


• Donate embryos to research (possibly stem cell research)


• Donate embryos for training purposes (training those who work in the IVF/PGD field)


• Donate embryos to another person

Next question you may want to ask yourself is, what is an embryo to you? Is it a human being or just a collection of cells?
As with the topic of abortion, the fate of the discarded embryos during the process of IVF/PGD is a hot topic in the ethical realm. People who are pro-life view the discarded embryos in IVF/PGD as throwing away a life while others consider the discarded embryos as part of the process of creating life. The overarching moral/ethical question to ask ourselves when looking at IVF/PGD is 'do we believe an embryo is a human life?'

For those that believe life begins at conception, the embryo is a human being with a soul, and therefore has a right to live. Scientifically, the embryo has the genetic make-up to become a living, breathing human being. With this perspective in mind, discarding embryos would be morally wrong. The discarding of the embryos can even be considered murder to most people who believe in pro-life. Some believe that IVF/PGD may be worse than termination of a pregnancy due to the fact that more embryos are discarded and destroyed in the process of IVF/PGD than termination. These views are closely associated with the Christian faith regarding the sanctity of human life in which, "human life should be valued and protected from conception to natural death (7)." Another issue to be raised in this perspective is the ethical principle of nonmaleficence, "to do no harm." If an embryo is considered a human being at conception, the process of discarding the viable embryos is doing unnecessary harm to a life.

For those that believe that the embryo is not a human being, discarding the embryos in IVF/PGD is not a hard task to do. In this perspective, the embryo is not living because it "has no brain, central nervous system, mouth, heart, lungs, or other internal organs. It has no organs to see, hear, touch, taste; it lacks a body, head, arms, legs; it has no self awareness, memory, thought processes, or consciousness (6)." The embryo in this view is not considered a human being, but it has the potential to be one (8). The discarded embryos are therefore, a collection of cells that has a potential for life but is not living. Since the embryos are not regarded as living, IVF/PGD is not doing harm and is in line with the principle of nonmaleficence. Instead, IVF/PGD can be viewed as techniques used to increase the possibility of developing healthy human beings. In an article from the San Francisco Chronicle, fertility specialists point out that a small percentage of embryos survive the natural reproductive cycle, "out of all the embryos created by sexual intercourse, roughly 3 out of 4 do not last long enough to produce a baby. About half of the fertilized eggs are lost even before the woman misses her first period following conception (5)." Therefore, IVF/PGD is not doing anything different from the natural reproductive process other than taking part of the process out into the laboratory?

OUR THOUGHTS

Judy: So now we’re getting into nitty gritty of the ethics surrounding IVF/PGD and savior siblings. Try to contain your excitement and let us dive into my thoughts :) I would like to comment on how amazing it is to see the advancements in medicine and in technology in our society today. However, putting my nerdiness about medicine aside, I do have ethical concerns regarding IVF/PGD and savior siblings. Let me start by addressing our question to you all, “what an embryo is to me?” I do believe that life begins at conception and therefore, the embryo should be considered a human being from day 1. It may scientifically be described as a collection of cells with no vital organs at that time, but if we let nature take its course, then that collection of cells will eventually become a fetus…a human being, right? Then I feel like that leads into a discussion about how people are playing “creator.” With IVF and PGD, we are the ones creating these embryos, bringing them into the world and therefore we must feel entitled to have the right to take them out of it as well. It is easy to not think about the possible moral ramifications of our acts but to rather turn our attention to all the great things that may be accomplished with the use of IVF and PGD. Such as, the success stories of savior siblings, to assist in reproduction of infertile couples, to possibly eliminate genetic disorders to future generations, and the use of excess IVF embryos in research to assist in finding cures of diseases like Alzheimer’s and Diabetes. But, if our society continues to leave such procedures unregulated, as many fail to address the moral dilemmas associated with such practices, what do you all think may be the “slippery slopes” of PGD? If you’re drawing a blank…we’ll discuss this in future posts, so stay tuned!

Enough about that, another issue I wanted to discuss briefly is about the ethical principle of nonmaleficence, “ to do no harm.” I want to try to apply that principle to the savior siblings. In general, parents are solely responsible for making decisions for their children up to a certain age, as they are not competent to make decisions for themselves. That sounds about right for all of us but I believe predicaments arise in situations such as the Trebings and other cases of savior siblings. In such cases, the parents decide what “sacrifices” of one child must be made for the benefit of another. However, is that ethical? To have a child be put through procedures that may pose harm to a certain extent to them in order to possibly save the life of another child. I believe it is evident that the parents are unable to uphold the principle of nonmaleficence for the savior siblings. However, if the parents are unable to make the best decisions for these individuals and their wellbeing, who will?

Lili: I'm just gonna get right into it and say that I believe life begins at conception. The embryo has the genetic makeup to become a human being...it's dividing, growing, living. To put it into perspective in my mind...I remind myself that I was once an embryo. Does that mean that I'm considered a human being now, but not at the beginning? Who determines when life starts and who determines when you are officially a human being? If there is a clear beginning and an end, you can't really tag a place in between and call it the beginning, right? I know my thoughts sound psychedelic, but that's what I honestly think. People may say that during the natural reproductive cycle the woman looses many embryos anyway, so what is the harm in taking it to the laboratory? I think the harm is thinking that IVF/PGD mimics the natural reproductive cycle, because there is nothing that screams 'natural' to me about it. I believe that things happen for a reason and that we should let nature take it's course. Although IVF/PGD has given us success stories, such as the Trebings, there are documented stories about IVF/PGD gone wrong as well...we will discuss this in a later post, so stay with us :) Disclaimer: I would like to add that I am pro-life, but I respect the right that every person has to make their own decisions...so if you were wondering...no, I do not picket outside of fertility clinics ;)

WHAT DO YOU THINK?

CHECK OUT OUR VIDEO! We went out and asked random people their thoughts on issues we've been discussing on our blog.

Hope you guys learned something from this post and leave us a comment already!!! :)

References
1. Jairo E Garcia MD. In Vitro Fertilization. Available at: http://www.emedicinehealth.com/in_vitro_fertilization/article_em.htm
2. Reproductive Health Technologies Project. Preimplantation Genetic Diagnosis (PGD). Available at: http://www.rhtp.org/fertility/pgd/default.asp
3. Molina B Dayal MD, MPH and Shvetha M Zarek MD. Preimplantation Genetic Diagnosis. Available at: http://emedicine.medscape.com/article/273415-overview
4. Bioedge. How many embryos are destroyed in IVF? Available at: http://www.bioedge.org/index.php/bioethics/bioethics_article/8552/
5. Carl T. Hall. The Forgotten Embryo. Available at: http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2001/08/20/MN58092.DTL
6. B.A Robinson. Are Pro-Life Leaders Ignoring the Real Problem? Available at: http://www.religioustolerance.org/abo_inco.htm
7. Biblical Bioethics Advisor. Preimplantation Genetic Diagnosis: A Pro-Life Choice? Available at: http://www.bfl.org/documents/BibBiov11no1.pdf
8. Kathryn Ehrich. The Embryo as Moral Work Object: PGD/IVF staff views and experiences. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2592482