In Vitro Fertilization

Running head: IN VITRO FERTILIZATION

Age and In Vitro Fertilization

Regis University

Health Care Ethics
HCE 430
June 21, 2006

Relevant Facts
Advances in medical sciences are helping the infertile have children. These developments open up new ethical dilemmas about reproductive rights, parenthood, and the equity in the allocation of expensive medical resources that are very limited (de Melo-Martin, 1998). “According to the National Center of Health Statistics and the World Health Organization (WHO) between 8-10% of couples in the industrialized countries have reproductive problems (de Melo-Martin, 1998).” Many factors can cause infertility in women including: ovulation disorders, blocked fallopian tubes, and endometriosis. In approximately one half of the couples with reproductive disorders there is a contributing male factor. Most causes of infertility in men are a result of too few or abnormal sperm.
In vitro fertilization (IVF) is attempted by 1.6% of couples seeking infertility treatment. In many cases the woman undergoing IVF provides her own eggs and her partner supplies the sperm. The process of IVF involves several stages. The first step consists of the stimulation of the woman’s ovaries with hormones to generate numerous oocytes. The second step involves removing the eggs form the woman’s ovaries. This can be done by laparoscopy or ultrasound-guided retrieval. Next, specialists fertilize the mature eggs with the sperm in a laboratory dish. If one or more normal looking embryos develop then the specialists place them in the woman’s womb to facilitate implantation and potential pregnancy. Usually between three and five embryos are placed to increase the chances of implantation and pregnancy (de Melo-Martin, 1998).
Human IVF is an established clinical procedure in many countries. Attitudes have changed as it has been found that the babies born by use of IVF are healthy and have brought happiness to many families, so that now it is also generally accepted as a legitimate medical treatment. Because of much publicity, the technique of IVF is well known and over 20,000 babies have been born as a result of it (Assisted Reproductive Technology, 2003).
ISSUE ONE: Consideration of the interests of the potential child Emerging advancements in fertility treatment hit the media in 1993, when a 59 year old gave birth to twins as a result of IVF. A concern with someone of that age giving birth is that she is likely to die while the children are still young. It would be preferable to have a mother that is still alive well into adulthood (Hope, Lockwood, & Lockwood, 2005).
ISSUE TWO: Interests of Society If it is not possible to offer in vitro fertilization to every couple who requests help because of limited resources then we should choose on the basis of the greater good. Success rates for IVF decline with age especially at age 40 and over. The rate for pregnancy is 23% for women age 40 with the live birth rate only at 16%. The live birth rate for women over 43 is only approximately 2% without the use of donor eggs. Miscarriage rates are 13% for women below the age of 34, 29% at age 40 and 48% at age 43 (Assisted Reproductive Technology, 2003). The risk of chromosomal abnormalities in babies also increases dramatically with age. With these success rates and limited resources more people would benefit to focus our resources on women 40 and under. If it is true that children born to younger parents experience a higher level of well being than those children born to older parents, then we are obligated to put the resources into helping younger couples.

Statement of the Practical Problem
Physicians are obligated to consider the welfare of any child. That is regardless of how the child was conceived. Consideration must be given to quality of life for the child when a couple is requesting IVF.
Primary Ethical Questions
1. Should there be an age limitation in couples undergoing in vitro fertilization?
Secondary Ethical Questions
1. Should youth be considered over financial resources when selecting participants for in vitro fertilization?
Arguments against putting an age limitation for IVF
The principle of liberty guarantees a right to freedom of choice, including the right to have access to health care services such as IVF. Catholic Moral Tradition rejects any technology that would replace the procreative and conjugal aspects between husband and wife. This may place increasing pressure on people to have children, whereas in the past they accepted their conditions.
Feminist ethics disagree with the reproductive technology that it reinforces social attitudes concerning the stereotype of women as child raisers, and it increases the possibility of exploitation of women.
Arguments in Favor of putting an age limitation for IVF
The physician has duties based on beneficence to the woman who wishes to become pregnant and the potential child who will result from the procedure. These obligations to the woman must balance the rates of success against the health-related risks of pregnancy and with the possibility of the risks with multiple gestations (Chervenak, McCullough, & Rosenwaks, 2003). The physician also has to respect patient’s autonomy in protecting and promoting the patient’s interests. “Although pregnancy and childbirth have health-related aspects the decisions to become pregnant, how aggressively to pursue treatment of infertility, and how many children should result from infertility treatment appeal predominantly to non-health-related values such as personal preference, family traditions and expectations, economics and social resources, and religious beliefs (Chervenak et al., 2003 p. 429).” Authoritative judgment cannot be made based on medical education or clinical expertise. These decisions fall under respect for the woman’s autonomy. In promoting the principle of autonomy, the physician has a responsibility to educate and inform the patient in ways to enhance the patient’s decision- making capability (Chervenak et al., 2003).
Other Considerations
The physician has the responsibility to promote the principle of justice in protecting and promoting the interests of health care organizations and society, especially economic interests and the distribution of resources that are limited.
My Position
The birth of a child to an infertile couple brings not only great human joy but a new human being. We should recognize the frustration of couples who desire to have a genetic family but are unable to achieve this on their own. All methods for procreation of children should always have the well being of the family in mind. We can’t reject these techniques an unnatural because we would then be rejecting modern medicine as a whole, as every medical treatment is aimed to resist disease and suffering. An overall, arbitrary age limit would not be possible as the facts for each patient would be different.

References
Assisted Reproductive Technology Success Rates National Summary and Fertility Clinic Reports. (2003). U.S Department of Health and Human Services Centers for Disease Control and Prevention.
Chervenak, F. A., McCullough, L. B., & Rosenwaks, Z. (2003, December). Ethical Considerations in Newer Reproductive Technologies. Seminars in Perinatology, 27(6), 427-434. de Melo-Martin, I. (Summer 1998). Ethics and Uncertainty: In Vitro Fertilization and Risks to Women's Health. Retrieved June 20, 2006, from http://www.piercelaw.edu/risk/vol9/summer/deMelo.pdf:
Hope, T., Lockwood, G., & Lockwood, M. (2005, January). An Ethical Debate Should Older Women Be Offered In Vitro Fertilisation? Retrieved June 21, 2006, from http://bmjjournals.com/archive/6992ed.htm