Personal Choices in Infertility Treatments

By Paul W. Zarutskie, M.D.

As new infertility treatments and technologies have emerged, so have ethical concerns about the status of the embryos that result from medical intervention. The debate is centered on the different points of view on when life actually begins: does it begin at conception, or at a later point in gestation?

Until the late 19th Century, the Catholic Church, for instance, followed THE BREATH of LIFE Doctrine in which the Soul goes through developmental stages from “nutritive”(as the unformed embryo), to a  “sensitive” (development of physical form) to “rational” (recognizable human). The rule was that the fetus has no soul until “animation,” which typically occurs 4o days post-conception.

However, that view has changed in that scientists are using conception as the landmark for the beginning of life. This in turn could explain the condemnation of the creation of embryos, ART technologies, and stem cell research. One area of treatment in which these issues must be addressed is Preimplantation Genetic Diagnosis (PGD). Use of this scientific advancement---PGD—has brought the “beginning of life” issue to the forefront.

Arguments for PGD focus on the usefulness of PGD as a diagnostic tool for patients with poor ART outcomes (advancing maternal age, prior failed IVF, habitual miscarriages, male factor). PGD increase implantation rates and decreases incidence of spontaneous abortions. It also lowers the risk for delivery of a child affected by genetic abnormality

Arguments against PGD focus on the limitations of technology that lead to errors in defining abnormalities. There is also a risk of damage to biopsied embryos, as well as the fear that selection of embryos leads to a concept of “designer genes.”

Conclusions
The development of PGD technologies is spawning a moral debate on the role of technology in providing improved health care. It is the responsibility of the physician counseling patients to be a moral agent providing informed consent on the cost/benefit ratio, outcomes, and expectations of using a specific treatment modality. In addition, healthcare professionals, patients,and society in general must  make decisions that promote the health and well-being of the patient and that honor the integrity of all participants in the decision making process.