From: Brett Paatsch (paatschb@ocean.com.au)
Date: Wed Jan 15 2003 - 22:32:57 MST
Hal Finney wrote:
> In some of our recent discussion on human cloning, it was suggested
> that the technology should not be implemented until safety concerns
> are addressed. Now it appears that IVF, which has been in common use
> for 20 years, also has safety issues.
Actually the success rates for IVF have always lower than that for
natural birth, I haven't got the figures on hand, but heard it from an
IVF expert testifying to the Senate Committee in relation to the Research
Involving Embryos and Prohibition of Human Cloning Bill (in Australia).
The comparitive figures have been converging however with improvements
in IVF techniques.
It actually stands to reason that in the aggregate folks that are having
fertility
problems are going to have more sperm and/or egg "quality" problems or
perhaps related problems with embryo implantation. After all these are
the very sorts of problems that can cause them to seek IVF treatment.
A fact often not considered by the general public in relation to IVF, (the
general public usually associates IVF with babies being made), is that quite
a bit of experimenting needs to be done to develop new cultural mediums
that may offer greater chances of success; to trail junior clinicians in
their
"trade"; to determine if say a woman's embryos have a particular easily
remediable condition that amounts to having too hard a membrane for
cell division to take place post fertilization. A woman could have this
problem and be infertile all her life if she did not go to an IVF clinic and
have a simple test done on one of her embryos. If the test shows the
embryos have a particular condition there is a readily available treatment
that neatly steps around it and the woman can be made fertile quite easily.
In practise most of the "destructive" testing that is done on embryos is
done on embryos that are *obviously* developing abnormally and could
never go on to produce a live child anyway.
Still, once these, little considered (by the public and politicians) facts
became more widely known in the context of the above legislation,
some folk who had previously been in favour of IVF having seen it as
an essentially life bringing process, actually started to be think they
should change their mind. This was because they started to hear that
"human beings" (ie. unviable embryos - but the public and many of the
pollies did not had science to see such distinctions or the patience or
interest to learn them) were actually being routinely "destroyed" as part
of standard IVF practice. This "destruction" of "human life" was oriented
towards improve IVF methods, diagnosis, training and testing new
processes but it came at a "cost".
The IVF lobby, led by the patient advocacy group ACCESS and the
IVF Clinical Directors groups became so concerned about the backlash
from the community and alledged radical catholic elements within the
Australian Health Ethics Committee that they actually started to petition
against the bill that would have facilitated ES research.
The religious conservatives and believers had frightened them so badly.
Fortunately, the IVF lobbys concerns were able to be addressed and
they found a more sensible strategic game plan. They stopped running
interference and fell back into line with the ES lobby. But for a while,
fear from the IVF lobby, that a strong community and political push,
based on increased but incomplete awareness of what had always
been happening in IVF clinics to little "human being" (ie.abnormal
embryos) nearly derailed the passing of the legislation. "Panic" nearly
split the IVF lobby from the ES cell and patient advocacy lobbies and
nearly handed the "luddites" a victory.
Other technical considerations with types of IVF procedure were also
raised.
For instance there seems to be evidence that a transfer of mitochondrial
DNA from younger women to older womens oocytes (eggs) can increase
the vitality of those eggs and the likelihood that the older woman will be
able to produce a child with her own nuclear DNA. But the spectre of
mixing DNA even mitochondrial DNA from two women into one child
caused considerable concern. Some concern came from a not completely
unreasonable fear that their might be an immune reaction to the donor
mitochondrial DNA from the host at some point. A bigger concern
seemed to be that many just felt uncomfortable about producing children
that would have DNA including mitochondrial DNA from three parents
(mum, dad and the other younger woman). The procedure of "cytoplasmic
transfer" was thus banned in Australian or at least placed under moratorium
for three years (which means we wait for other countries in the world to
test
it first and then maybe later we do it here too). From memory the technique
has been used in the US for a couple of years.
So technology is constantly changing, being revised and tweaked in IVF
clinics. As new things are learnt new possibilities for overcoming new
causes of infertility become possible. But they are only able to be proven
effective by first trying them. And they cannot always be tried only on
unviable embryos. Such is the price of IVF. Sometimes, some embryos
are expended to learn how to resolve infertility problems. Usually as much
testing as possible is done using only unviable embryos - but obviously
sooner or later some viable embryo has to be the first or the process
never gets tried for real. And so the risk is inherently higher for the that
first embryo (little "human being" or "human life" as some "think" it and
term it).
> How do we balance the risk to our children against our desire to
> reproduce? When is it OK to use a new technology to have a child that
> would not otherwise be possible, if that technology also carries an
> increased risk of birth defects?
>
> Hal
>
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