TWC: TWC Individual Report Draft 1

Executive Summary

Innovation for discussion : In Vitro Fertilization

What will be included in this paper :

· Background of IVF

· Historical perspective

· Current situation

· Future consideration

· Conclusion

Background/Introduction

The revolutionary innovation of the IVF has gone down into history. Never before man could artificially create a new life, never before there would be a solution to infertility. No one would have imagined the IVF made possible decades ago. This was certainly a big leap forward in technology and marks a great milestone for mankind. IVF rewrote the rules and has brought hope to millions of infertile couples and older women who have difficulties conceiving at their age. Biological deficiency is no longer an obstacle to having children unlike before. Before IVF was introduced, couples who were clinically diagnosed infertile could not start their families, let alone carry on their family’s lifeline. This is of a grave importance, especially to traditional Asian families where the males are expected to have off springs to carry on their family’s lifeline. Therefore, infertility is not an option in these families, if not consequences will dire. Therefore, the benefits that we can reap from IVF are unprecedented.

In Vitro Fertilization is a process by which egg cells are fertilized by the sperm outside the human body. The term “in vitro” originated from the Latin word “ in glass” as biological experiments in the past were carried out in glass containers. Mature eggs from the women’s ovary will be collected after being artificially stimulated to increase the numbers of mature eggs produced. After which, fertilization will take place when the eggs are placed together with the sperm. Embryos will be formed after 2 to 5 days and will be implanted back into the women’s uterus. However, before the actual process actually takes place, there is a long procedure to follow before this is made possible. The women will be given drugs to suppress the natural cycle and following this, fertility hormone drugs will be taken to increase the number of eggs produced. The IVF process is taxing on the woman’s emotional, physical body and require much determination and perseverance, therefore proper checkups will be facilitated by clinics before executing the process. (The issues will be explained further in detail.) Medicine is never absolute, so is IVF. After the implantation of embryos into the uterus, it does not guarantee a pregnancy. Therefore, couples have to be prepared for the outcome. Retrieved from : http://www.fertilityjourney.com.sg/therapyOptions/AssistedReproduction/IVF/TheIVFProcess/index.asp?C=41845408256931828704

Historical Perspective

Although the IVF made its grand entrance in the 20^th century, similar innovations and ideas that led to the development of it had begun decades before 1978 when the first successful “test-tube baby” was born. The concepts behind IVF then and now were also different. It was reported that the concept behind IVF begun in the 1981 when a professor and physicist named Walter Heape experimented to transfer the embryos of one pregnant rabbit to another. He inserted the embryos of a one breed (Angora) into the uterus of another recently mated breed (Belgian) and this resulted in 4 Belgians and 2 Angoras of rabbits being born. This was the first ever successful transfer of preimplantation embryos into a gestational carrier without affecting their development. (Randy S Morris M.D ) After the successful transferring of embryos, numerous of scientists became interested in this field of science. Subsequently, scientists like Gregory Pincus reported that human eggs would mature within 12 hours in a laboratory in 1939 and MC Chang reported the first unequivocal case of a live birth in 1959. The legacies of these great scientists were then carried on, with more and more breakthroughs in this area.

As we can see, the concept of IVF is not completely new. However, it was never thought of an infertility treatment before unlike now, where the similar concept is used to provide solutions for infertility. Research continued and it was not until the late 1960’s that it was made possible to fertilise a human egg outside the human body. The only possible alternative for infertile parents to have children at that time was to adopt, but numbers available for adoption were low. Then in July 1978, the world saw a medical breakthrough nevertheless in this field of science and marked the first successful birth of a “test-tube baby”. Years of failed attempts and medical research have finally introduced In vitro Fertilisation to the world and gave hope to millions of infertile couples. After the first successful birth however, success rates still remained low. Medical specialists and professionals continue to embark on their research based on the process to create the “test-tube baby”. As years past and technology became more advanced, success rates increased tremendously. In 1985, there was only 5% success rate of pregnancy for those who underwent the treatment. However, fast forward to today, that number had climbed up at a tremendous rate. The average success rate for women under the age of 35 is 44% and for women above 40 years of age range from 7% to 35%. (IVF success rates, 2011 ) These statistics are expected to rise even higher in the near future and this will definitely benefit more couples.

Current situation

Benefits

IVF has indeed revolutionized the medical arena in the area of child birth. In the world today, approximately 1 out of 7 couples have difficulties conceiving. As stress levels are rapidly rising around the world due to strive for efficiency and productivity, the numbers for infertility are also increasing rapidly around the world. Infertility could be due to either the men or women or due to unexplained causes. Therefore, the introduction of In Vitro Fertilization can offer hope to such parents. It also offers an opportunity for older women to conceive despite their age. As technology advances, success rates have seen a tremendous improvement. Success rate for women below 35 is now 47.6% and about 30% for those above 35 and these rates are unprecedented. (IVF success rates, 2011 ) Due to success of IVF, it is no longer the last option for infertile couples after every treatment have failed. It has become the first option as it maximizes the opportunity to conceive as soon as possible. The high success rates also boost the confidence of these couples.

Also, the selection of embryos allows the detecting of genetic abnormalities and avoiding of inheritable diseases before implanting the eggs into the patient. Though this is mentioned as a major ethical issue, it is undoubtedly beneficial for parents in terms of the financial and emotional aspect. This is also very beneficial since some women have a higher risk for having a child affected by various complications, and thus the selection of embryos will reduce the health risks of the mother.

Issues

As put forward aptly by George Bernard Shaw, co-founder of London School of Economics, “Technology does not solve a problem without creating 10 more” and IVF is no exception. Despite all the benefits we can reap from the invention, there are a whole lot of issues attached to it and many of which are controversial issues up till today. These are some issues and benefits that arise from the revolutionary innovation.

Ethical issues

Ethical issues are perhaps the most glaring issues with the advent of IVF. They have made headlines and sparked debates all over the world by many different groups of people. The IVF process require the fertilization of the sperm and the egg outside the human body, and only the best embryos will be transferred to the women’s uterus, while the rest of the unused embryos will be discarded. Ann, M. Some moral and ethical issues concerning IVF techniques. Retrieved April 15, 2009, from http://brendakaren.wordpress.com. As we read this simple description of the process, we can easily pinpoint the existing issues involved. Every single process in itself is an ethical issue.

Firstly, the first issue raised is the fact that human life is created outside the human body. This has been argued by many religious groups that life should only be created through the closest intimacy of the husband and wife. Also, proponents argue that children should be a gift from God rather than defying nature, creating them outside the human body. Scientists have been criticized again and again for playing “God” by using artificial contraception. Lehardy, C. ( 2007, November 10)

Adding on, embryos, to some people are human lives, but to some are not. This debate has been ongoing for as long as humans acquire the technology to extract embryos from the human body. Therefore, for those who believe that the embryo is a human life, are we freely discarding lives while discarding the embryos? Although one life is created through IVF, many are destroyed in the process. Is this the extent we take onto creating a life? Do we have the rights to do so? Can killing one embryo be justified to save another? It is almost impossible to have absolute answers to these questions. Depending on one’s belief, the answers will defer.

Another major ethical issue about IVF is that, as mentioned before, there is a careful selection of the embryos before transferring into the woman’s uterus. This is done to avoid inheritable diseases being passed on to the child. This is again argued by religious groups that scientists have no rights to alter genes as they are not “God”.

In a modern capitalist world we live in today, it should not come as a surprise that eggs are being commoditized. Women, especially those single and desperate to earn quick cash, are “donating” their eggs and receiving cash payments in return for it. https://www.eggdonor.com/ is one site that offers these incentives in exchange for eggs. One would not believe the extent these women will go to earn cash quickly, but this is an issue that arose.

In today’s day and age, it is evident that science and religion can never strike a compromise. Science has time and again dispelled religious beliefs but does this mean that science is always right and will always prevail? The question now is, where do we draw the line with regards to morality or what it means to be ethical, or is it even possible to do so? In my opinion, one should not be too caught up in religion if one wants to advance in the society. Since science and religion can never be on the same line, I believe that none should impede the progress of the other. Certainly, one can be a strong believer of his own religion and not commit anything against his values. However, they need to recognize everyone has their own set of beliefs and values and if an individual believes that IVF is suitable process to go through, no one should or has the right to criticize her for being unethical in her decision. Those who made the decision to undergo IVF should fully recognize the process they will be going through.

Also, since there is the technology and opportunity to prevent a defect baby, we should not disqualify but rather carry out with the process as we have agreed that science and religion can never come to an agreement. A non-defect child will not cause an additional burden to parents as defect children generally needs more attention and attentive care. Parents then need to dedicate lots of time to their children and by doing so, this will deny them of lots of opportunities. Financial wise, parents’ burden will not be too heavy as medical fees are hefty.

Moreover, religious groups should have seen this coming from the very start when the idea was first proposed to create life outside the human body. These arguments are not unfounded as no strong believer will ever support the idea at all.

Social issues

IVF was also in the limelight regarding several social issues. The most common issue raised by non -supporters is that there is growing use of IVF for lesbian and gay couples to conceive and they are no longer confined by the biological means of child-bearing. Lehardy, C. ( 2007, November 10). They are able to have genetically linked children of their own. This is a growing concern as not all countries are liberal to accept the lesbian gay bisexual transgender(LGBT) community, let alone them having children of their own.

Another social issue there is a possibility of IVF baby mix-up. Ann, M. Some moral and ethical issues concerning IVF techniques. Retrieved April 15, 2009, from http://brendakaren.wordpress.com. News of such cases has surfaced in the recent years and caused a major out roar on the incompetency of clinics. Imagine conceiving a child then realizing the baby’s is not your own due to the mix up of sperms or eggs. This scenario may seem to happen only in television dramas, but it exists today. This will cause an emotional trauma and have detrimental effects on the family. The parents, especially the father, will feel detached from the child, knowing he/she does not have his genes.

Of course, conceiving a baby comes with a price tag, a hefty one to be more exact. Although opportunities and hope are given to infertile couples, many are being left out due to the cost of the treatment. An average cost for treatment is about $12,000, and while this seems to be a reasonable price tag for a baby, the less affluent will not be able to afford. Skoch, I. ( 2010, July 21 ) Should IVF be affordable for all? Newsweek. Hence, while IVF hopes to help infertile couples to conceive, it only helps those affluent ones.

Lastly, the emotional trauma that parents could face if the treatment is not successful. Success rates differ from person to person. It is dependent on many factors like age, number of embryos inserted, health condition on the woman etc. Since IVF is the last resort for most infertile couples, if the treatment does not carry out smoothly and they are still unsuccessful in conceiving, the emotional impact on them will be dramatic. This may cause women to go into depression, or even strain relationships.

The price tag placed on the treatment may seem relatively expensive compared to other infertility treatments. However, the cost of the treatment in my opinion is nothing compared to the cost of not being able to have children of your own at all. The emotional torture and time spent worrying is also a form of cost that cannot be put into or compared to monetary terms. ( Dr Malpani ) Therefore to me, costs should not be a major deciding factor for those who can afford it. As for those who are less affluent, there are several schemes put in place to help these people afford for the treatment. For example in the case of Singapore, these parents are entitled to various medical schemes like the Medisave or Medishield so to help them afford for these treatments. Also, in the case of the US where IVF treatments costs are exorbitant, several private clinics charge only half the price of what the public hospitals are quoting. This is because they believe everyone should be given an equal opportunity to get access to the treatment and if there are more competitors in the field, prices will be brought down eventually. The clinics in the US have been aiming to bring the price down so that more people are given the opportunity to receive the treatment. Skoch, I. ( 2010, July 21 ) Should IVF be affordable for all? Newsweek

The issue on the mix up of babies has been under scrutiny and more regulations have been put in place so to ensure such cases are minimized or will not occur at all. Clinics are given huge fines and warnings when such cases occur and this has been an effective deterrent for such unforgiveable mistakes to occur.

Procedure issues

While IVF seems to be the extraordinary baby making technology, it is not all that mighty. It has flaws in its procedures too. Around 1 in every 4 couples will have twins for those who successfully conceived, in comparison with 1 in every 80 couples in population. Triplets are not surprising as well as not only one embryo would be implanted into the woman’s uterus but a few. While this may seem like a blessing to have more children, it increases the chances of miscarriage. (Tuohy. W, 2003) Also, parents may not be prepared or financially-abled to support more than one child.

New restrictions have been put in place to prevent this from occurring as this issue is of a significant risk to the mother. The number of embryos that can be transferred have been reduced so that there will also be reduced chances of multiple births from occurring. It is also made compulsory for doctors to advise and notify the risks of multiple births to their patients before carrying out the process. (2009, October 20) New IVF Guidelines Aim to Reduce Multiple Births. Healthday News. This is to educate the patients so that they would make more informed choices and would be mentally prepared if the situation were to occur. Issued guidelines over the years have reduced multiple births by 60%, and this has a tremendous positive impact on this issue. Thus, the new restrictions put in place will most likely further reduce the number of multiple births from occurring.

In all, although it seems like issues raised by IVF outweighs the benefits, and it is unethical to go forward with the invention, more and more countries are adopting and legalizing this artificial method of contraception. To date, close to four million healthy babies have been conceived through IVF. Melina, R. (2010, October 5) However, the less developed countries are still not able to get access to IVF.

Future considerations

The potential of IVF seems limitless as it is still a fairly young but impactful innovation.

Many couples in the developed countries are postponing marriages and this can be attributed by the following factors: expensive to have children due to rising standards of living, women pursuing their careers before starting a family due to higher education and the declining value of marriage. Therefore, IVF is projected to be widely used by not only infertile couples but also those fertile women who decide to give birth at a later age. Also, as technology advances, the success rates of IVF will too increase. This will then lead to about 30% of all couples might eventually be undergoing IVF to conceive in the future. Therefore, will IVF one day be one of the solutions to the declining population growth in developed countries? Infertile couples and older women can now conceive and this will contribute to the population numbers.

In addition to the point above, about 30% of all couples might eventually be undergoing IVF to conceive in the future is also due to efficiency. The word “efficiency” may sound a little crude to describe the child bearing process. However, it seems that couples will eventually view IVF as a shorter route to pregnancy. Blackburn-Starza, A. (2008, August 12) The future of IVF remains problematic. Bionews. As we live in a world where productivity and efficiency are of paramount importance, conceiving will not be of an exception. IVF’s success rate is projected to increase in the future and this will help couples conceive more conveniently and efficiently, thus attracting more couples to undergo IVF. Also, IVF has a higher percentage rate of being able to conceive twins as compared to natural contraception. This will in a way “entice” women to undergo IVF as they are able to have two children in one process.

One other future consideration is that IVF will be used more widespread than ever and there will lead to more IVF centres being set up due to lucrative profits. With increased competition, costs will then be kept at minimum level as prices will be competitive. In this way, people are able to afford and are given equal opportunities to receive these treatments. Also, advanced technology will perhaps increase the efficiency of the process and drive costs down. As mentioned in the above, since costs still remain as a deciding factor for infertile couples, it will less likely to be an issue in the future.

Another future consideration is perhaps a little controversial – designing our next generation. Since scientists can decide to select which embryos to insert into the uterus to avoid diseases, can they alter genes such that parents can choose the sex or a specific code of genes before inserting into the uterus? This issue may sound a little crazy, but as we all know that nothing is impossible to scientists. They are able to beat against all odds with their scientific research, thus, designing our next generation with IVF will remain as a future concern.

Lastly, single women or the gay community use donated sperms to conceive. The profiles of donors are not to be disclosed to prevent discrimination. This will lead to a serious issue when a few more millions of people will undergo IVF in the future – incest. When sperm donors donate their sperms, their sperms will be “distributed” to several women. This will mean that the children of this sperm donor share the same father. In the future when more children are conceived through IVF with donated sperms, we are not able to verify who their fathers are and will only be able to do so through DNA testing. This may lead to the issue of incest when the children of the same father marry and give birth.

Conclusion

I personally support IVF treatments. Although it may have raised certain controversial issues, it is undoubtedly a revolutionary breakthrough in the medical field and for mankind. It has changed the history of contraception. Children are our future and their innocence makes the world a better place to live in. Thus, since infertile parents are given an opportunity to conceive, why deny them of a chance to? Also, with the decline in population growth in developed countries, IVF will certainly encourage infertile parents to have children of their own.

However, despite how impactful IVF may seem, we must recognise that we should not abuse this treatment. It is a double aged sword. Millions of people will be able to reap the benefits from this invention if it is used with consideration. Many have treated the IVF as a money making invention whereby people can commoditized their sperms or eggs. This has led to an out roar from non -supporters as well as religious groups. To prevent similar allegations, people should not take advantage of the innovation.