From: Amara Graps (agraps@amara.com)
Date: Sun Jan 05 2003 - 01:47:00 MST
>Didn't we have most of these arguements and fears when IVF first produced a
baby?
Yes:
Carl Djerassi
http://www.djerassi.com/index.html
Sex and Fertilization: Ready for Divorce?
http://www.djerassi.com/icsi2/index.html
If you are looking at cloning with a critical view, then
what
about ICSI? You would need to look at ICSI with a similar
analysis. ICSI--the acronym for "intracytoplasmic sperm injection" now has
become the most powerful tool for the treatment of the kind of male
infertility when the 'sperm can't swim'. In one case out of four, men
with "congenital bilateral absence of the vas deferens" (immobile
sperm) are also carriers of the gene for cystic fibrosis. Carl
Djerassi says in his essays that with ICSI, one can envisage a
scenario in which such men could pass on to their offspring both
infertility and cystic fibrosis, raising the specter of successive
generations requiring ICSI in order to perpetuate their genetic
immortality-an immortality compromised by a disease that brings a
slow, early death.
In the last part of his essay, he writes:
<begin quote>
ICSI raises many other ethical and social problems beyond those
mentioned in the Melanie/Felix dialog. For example, now that the
effective separation of Y- and X- chromosome-bearing sperm has been
perfected, ICSI will enable parents to choose the sex of their
offspring with 100% certainty. For a couple with three or four
daughters, who keep on breeding in order to have a son, the ability to
choose a child's sex may actually prove a benefit to society, but what
if practiced widely in cultures (such as China or India) that greatly
favor male children over girls?
Or consider the capability of preserving the sperm of a recently
deceased man (say 24 - 30 hours post mortem) in order to produce
(through ICSI) a live child months or even years later-a feat that has
already been accomplished. Here we have immortality with a
vengeance. But what of the product of such a technological tour de
force? Using the frozen sperm and egg of deceased parents would
generate instant orphans under the microscope. The prospect is
grotesque-yet does it take much imagination or compassion to conceive
of circumstances where a widow might use the sperm of a beloved
deceased husband so that she can have their only child? These issues
are intrinsically gray; the technology occupies an ambiguous position,
enabling us to enact our best and worst impulses, and the answers
cannot be provided by scientists or technologists. The ultimate
judgment must be society's, which, in the case of sex and
reproduction, really means the individual affected. Ultimately, that
individual is the child, yet the decision must be made before its
birth by the parents-or more often than we care to admit, by just one
parent.
It is the nature of such questions that they resist convenient
solutions, not least because of their tendency to proliferate faster
than we can solve them. Whereas reproduction has historically tended
to exemplify the law of unintended consequences, the addition of
technology has given that law added force. Consider: until very
recently, the onset of the menopause was welcomed by many women as the
release from continuous pregnancies caused by unprotected and
frequently unwanted intercourse. But the arrival of the Pill and other
effective contraceptives, coupled with the greatly increased number of
women entering demanding professions that cause them to delay
childbirth until their late thirties or early forties, now raises the
concern that the menopause may prevent them from becoming mothers
altogether. Whereas reproductive technology's focus during the latter
half of the 20th century was *contraception*, the technological
challenge of the new millennium may well be *conception* (or
*infection*, if one focuses on sexually transmitted diseases). In the
long run, if the cryopreservation of gametes followed by sterilization
becomes a common practice, contraception may even become
superfluous. Melanie and Felix in the above fictitious dialog were
hardly the first to express such speculation.
In 1994, in the scientific journal Nature, the cryobiologist Stanley
Leibo and I addressed the deplorable prognosis for a new male
contraceptive in the next few decades, given the total lack of
interest in that field by the large pharmaceutical companies without
whose participation such a "Pill for Men" could never be
introduced. This led us to propose an alternative approach, not
involving the drug industry, based on a few simple
assumptions. Millions of men-admittedly, most of them middle-aged
fathers rather than young men-have resorted to sterilization
(vasectomy) and continue to do so. The procedure is much simpler and
less invasive than tubal ligation in women. (Sterilization among both
sexes has become so prevalent that in the U.S., it is now the most
common method of birth control among married couples, even surpassing
the Pill). Artificial insemination is both simple and
cheap. Furthermore, among fertile couples, it has almost the same
success rate as ordinary sexual intercourse. But most important for
our argument, fertile male sperm has already been preserved
inexpensively for years at liquid nitrogen temperatures. Therefore,
provided one first demonstrated that such storage is possible for
several decades rather than just years, some young men might well
consider early vasectomy, coupled with cryopreservation of their
fertile sperm and subsequent artificial insemination, as a viable
alternative to effective birth control. Shifting more of that
responsibility to men, at least in monogamous, trusting relationships,
appeared to Leibo and me a socially responsible suggestion. I shall
spare the readers a record of the resulting outcry-both by media and
in personal correspondence-but a lot has happened in the intervening
few years to make it much more likely that such a prediction will
become fact within a few decades rather than dramatic license.
Although many may consider some of the scenarios raised in *AN
IMMACULATE MISCONCEPTION* as "unnatural" or worse, every one of them
has now been realized or is about to be implemented. Take the question
of post-menopausal pregnancies. In progressively more geriatric
societies (for example, in Japan or Western Europe), where 20 per cent
of the population is already or will soon be over the age of sixty,
and older people are increasingly healthier than they used to be, a
woman who becomes a mother at 45 could raise a child for a
considerably longer time than could a 20-year-old at the beginning of
this century. Of course, motherhood at an older age is physically,
psychologically, and economically suitable only for certain women, but
at least the choice is now available in wealthy countries. It must be
emphasized that this increased emphasis on artificial fertilization
techniques and even surrogate parentship is a characteristic of the
affluent, "geriatric" countries. Even within these countries, the cost
of such reproductive technologies (frequently not covered by
insurance) is such that only the more affluent citizens can afford
them. Three-fourths of the world's population are represented by the
"pediatric" countries of Africa, Asia and much of Latin America, where
over 40% of the population may be below the age of fifteen and where
the control of fertility rather than the treatment of infertility will
remain the catchword for decades to come.
I have deliberately refrained from considering the implications of
human cloning-the closest technological approach to immortality. But
to the extent that biological parenthood is a form of
immortality-admittedly one subject to mutational and hence
evolutionary adjustments-IVF tampers with that as well. In the excerpt
from my play, I allude to pre-implantation embryonic genetic
screening, again a procedure primarily available to the affluent in
the affluent countries. But soon, the entire human genome will be
elucidated. Given the many technically feasible methods of rapid
genetic screening, what will keep prospective IVF parents from
screening their own embryos so as to transfer only the "best" back
into the mother? Who will define "best"? Few people will argue that
prospective parents may wish to discard embryos that show the markers
for Down's or Huntington's Syndrome, or markers for genetically
transmitted cancers, but where will the line be drawn? Short stature?
Left-handedness? Big ears? As we move in the direction of tailor-made
progeny, the gulf between the haves and have-nots is widening
enormously.
The recent advances in contraceptive and reproductive technologies
have clearly raised a multitude of gray problems which many of us
would like to wish away. But that is not possible anymore - the genie
has escaped from the bottle. Legislation will not offer a solution,
unless it were global in nature. Otherwise, a committed couple-or
perhaps just the woman-will cross geographical borders in an attempt
to circumvent biological ones. The answer is intensive and continuous
debate, based on knowledge rather than myth, which is one of the
reasons why I, the scientist, have moved to fiction and drama as novel
ways to raise the intellectual level of public discourse of sex and
reproduction.
<end quote>
His "science-in-fiction play" on this topic:
An Immaculate Misconception
http://www.djerassi.com/icsi/immaculate.html
Amara Graps
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