WASHINGTON (INA) — Before 1980 ends, the first test-tube baby may be born in the United States. That baby’s birth will inspire -joy for some, and legal and ethical controversies for others.
Three recent successes of “in vitro fertilization” attempts in humans have given hope to many childless couples, but they’ve also given rise to many questions of a moral nature.
In vitro is Latin for “in glass” (thus the term “test-tube baby”). It is a surgical maneuver to bypass blocked or absent Fallopian tubes. It can potentially benefit the 2 million U.S. women who can’t become pregnant by other means.
The IVF procedure entails taking sperm from the man, retrieving a mature ovum (egg) from the woman and fertilizing it in a test tube in the laboratory. The resulting embryo is implanted into the uterus of the mother and pregnancy continues to term.
Because it is complex, tedious and expensive, and its safety and effectiveness are still unproven, it is a last-resort attempt at pregnancy for the 5 percent of all infertile couples who have exhausted other means and still remain childless.
Fertility experts Drs. Howard and Georgeanna Jones, who moved ahead with private funding, set up a clinic at the Eastern Virginia Medical School in Norfolk. Their work is based on the methods used by Drs. Patrick C. Steptoe and Robert G. Edwards, who managed the IVF conception of Britain’s celebrated “Brown Baby” Louise Joy Brown, daughter of Lesley and John Brown, the first known in vitro baby.
The Norfolk facility is the only one in operation in the United States, and the cost is high — a minimum of $4,000 per couple. One reason for the expense is that the woman requesting must be closely monitored for a minimum of three monthly cycles before the egg can be retrieved. Dr. Howard Jones says that government subsidy is necessary if the procedures is to become widely available.
The government subsidy question is one of priorities, says Dr. Charles McCarthy, staff director of the Health and Human Services Ethics Advisory Board and director of the Office for Protection from Research Risks at the National Institutes of Health.
“Is it more desirable to fund this kind of research than cancer research or heart research?” asks McCarthy. The Ethics Advisory Board has recommended to Health and Human Services Secretary Patricia Harris that it is ethically acceptable to fund research. The board suggested that she make a decision about services as well. She has not yet decided on either.
“My guess is that it will be settled on budgetary grounds, rather than ethical grounds,” says McCarthy, noting that many health service programs are being cut.
He contends that if private funds are “not catering to enough women who have this problem, or … catering only to women of a certain economic class … the government should seriously consider some sort of supplementary program.” But he wants more research done on the procedure’s safety and efficacy before he recommends government funding.
Leroy Walters, director of the Kennedy Institute Center for Bioethics at Georgetown University and a committee member, seems to agree, saying, “our society should be willing to support (the IFV research), even to the extent of providing financial assistance, assuming that the technique is proven to be safe and efficacious.”
Before the government-subsidy issue can be dealt with, three major issues must be resolved:
1. How safe is the procedure for the potential offspring? And who is responsible for this safety? (This is the primary medical concern. Risk to the woman is minimal). Although the risk of having an abnormal child hasn’t been evaluated completely, judging from animal experiments; it is low.”
Chromosomal difficulties would not be any higher than normal, assuming that the pregnancy went to term,” says Dr. Howard Jones. A natural screening process generally causes spontaneous abortion of chromosomally abnormal fetuses. Approximately 45 percent of all human conceptions end this way.
But the law of averages indicates that some abnormal children would result from the IVF procedure, and who would be responsible?
“I think the parents are responsible, unless it can be shown that the defects came because of a mistake that the scientist or physician made.” says John Fletcher, assistant for r bioethics at the NIHClinical Center. “The parents are giving informed consent.”
2. When does life begin? Is the early embryo a developing person, and therefore deserving’ of protection from harm or from being disregarded?
To avoid this issue, the Joneses fertilize a single egg rather than retrieving multiple eggs which must then be disregarded. The issue could arise if they detect abnormality in the early developing embryo and choose not to implant it.
Much can be learned about genetics and contraception by observing the embryo’s first 14 days, but an ethical surrounds this. If researchers can study this embryo in the laboratory, there is a possibility that genetic diseases could be corrected in vitro, and to some this is regarded as immoral. “The goal is to move ahead in a way to allow research to continue, but not at the expense of violating certain values,” says Fletcher.
3. If IVF became legal, who would be deemed eligible to secure IVF assistance? Where is the line drawn — and who should draw it in terms of restrictions? The Joneses say they limit the procedure to “stable couples.”
Technically, the IVF procedure can be conducted using donor sperm, much like artificial-insemination. “I would have no qualms about using donor sperm,” says Dr. Georgeanna Jones, if both the couple and the doctor approve.
What about surrogate mothers? The use of a surrogate mother to bear a child for another woman is not acceptable to most ethicists and physicians.
“In a pregnancy, a woman takes a very definite risk — I would feel differently about that,” says Dr. Georgeanna Jones.
Says Walters, “The main issue … is what the three people would do if- the woman carrying the child decided she did not want to give it up.
“And to what extent would the members of the couple have influence over the lifestyle of the surrogate mother during pregnancy?”
What if a surrogate mother wanted the child to be adopted? Existing laws ban the sale of a child, but none cover a surrogate mother’s legal right to voluntarily put the child up for adoption.
Finally, how about costs? Dr. Howard Jones predicts that within 10 years IVF will be a standard procedure for overcoming certain types of infertility. If it becomes routine, costs will decrease.
Joe Nagelschmidt, a Blue Cross-Blue Shield spokesman, predicts that the insurance firm will pay benefits for IVF as it now pays for other infertility services if the procedure is proven safe and medically necessary and if large experience is built up.
“We believe that not everybody has to have a child,” says Dr. Howard Jones, “this would …appeal to those who, for whatever reason, decide it has a very high priority in their lives.”
For those who give it that priority, but cannot afford it, the government must answer these questions: Is it safe? Is it right? Is it a luxury?
Copyright, 1980, Independent News Alliance