Indications for the use of modern reproductive technologies. Bioethical aspects of new human reproductive technologies. Typically, egg donors are either
Pregnancy– a biological state caused by the conception of new individuals.
Infertility– the inability of persons of childbearing age to reproduce offspring. A marriage is considered infertile if a woman does not become pregnant within a year of regular sexual intercourse without the use of contraceptive means and methods.
Infertility is a fairly broad medical, psychosocial and ethical concept. If this happens, you need to go to the doctor and determine the reason for the lack of pregnancy.
The causes of female infertility are very diverse, there are 3 leading factors:
Uterine;
Tubal-peritoneal (obstruction of the fallopian tubes, adhesions);
Neuro-endocrine (ovulation disorders associated with polycystic ovary syndrome (PCOS) or hyperprolactinemia).
Immunological disorders are also noted, for example, the presence of antisperm antibodies and infertility of unknown origin, in which there is no visible cause.
The first stage of treatment for these forms of female infertility is therapeutic or surgical correction. If this does not bring results, the IVF and PE program may be a solution to the problem.
More complex conditions are:
Lack of own eggs in the ovaries;
Dysgenesis of the gonads, for example in Shereshevsky-Turner syndrome;
Chemotherapy for cancer;
Surgical removal of the ovaries;
Genetic abnormalities.
Among the causes of male infertility are the following:
Congenital anomalies of the development of the genital organs (cryptorchidism, etc.);
Influence of harmful environmental factors;
Allergization and weakening of the immune system;
Uncontrolled use of medications (including anabolic steroids and narcotics);
Sexually transmitted infections;
Stress factors;
Sedentary lifestyle;
Alcoholism and smoking;
Injuries to the genital organs;
Various hormonal disorders, for example, low FSH levels, hypo- and hyperplasia of the adrenal glands, diabetes, thyroid diseases, etc.;
Lack of spermatogenesis against the background of high FSH levels;
Congenital genetic abnormalities, such as Klinefelter syndrome (XXY karyotype);
Chemotherapy for cancer.
VRT- assisted reproductive technologies. Assisted reproductive technologies mean:
Intrauterine insemination with husband's sperm
In Vitro Fertilization
In vitro fertilization with micromanipulation ICSI (ICSI)
Use of donor sperm in ART.
List of abbreviations for the names of the main methods and programs of ART:
ECO- in vitro fertilization
PE- transfer of embryos into the uterine cavity
GIFT- transfer of gametes into the fallopian tube
ZIFT- transfer of zygotes into the fallopian tube
AI- artificial insemination
IISD- artificial insemination with donor sperm
IISM- artificial insemination with husband's sperm
ICSI- injection of sperm into the cytoplasm of the oocyte
ISO- induction of superovulation
MESA- aspiration of sperm from the epididymis
PEZA- percutaneous aspiration of sperm from the epididymis
THESIS- aspiration of sperm from testicular tissue
TESE- extraction of sperm from testicular tissue
EIFT- transfer of embryos into the fallopian tube.
Insemination with the sperm of the husband (donor) - ISM (ISD)). Artificial insemination is the oldest method of treating infertility. Frescoes have reached us that depict the process of introducing a seed. Artificial insemination is performed in some cases of endocrine, immunological and male infertility, in the presence of patent fallopian tubes. On a favorable day for pregnancy, the woman’s sperm is injected into the uterine cavity from her husband or donor.
The introduction of sperm directly into the uterine cavity involves the artificial passage of the cervix with sperm that could die due to cervical infertility when trying to conceive naturally. To carry out this procedure, a prerequisite is the presence of at least one patent fallopian tube.
Fertilization (in vitro in Latin) in vitro - The essence of the procedure is to obtain mature eggs from a woman’s ovaries, fertilize them with her husband’s sperm (or, at the request of both spouses, with donor sperm), grow the resulting embryos in an incubator for 48-72 hours, and transfer (replant) the embryos into the patient’s uterus.
The IVF procedure consists of the following stages:
Selection and examination of patients;
Induction of superovulation, including monitoring of folliculogenesis and endometrial development (monitoring follicle maturation and endometrial growth using ultrasound). The purpose of stimulation is to obtain a large number of mature eggs in both ovaries to increase the chance of pregnancy. SSO is carried out using various modern hormonal drugs, which are selected individually for each married couple, based on the results of a preliminary examination;
Puncture of ovarian follicles (puncture of follicles is performed under intravenous anesthesia and ultrasound control through the lateral fornix of the vagina). On this day, the patient’s husband donates sperm, which undergoes special treatment;
Insemination of oocytes and cultivation of embryos in vitro;
Transfer of embryos into the uterine cavity. Embryo transfer is carried out with a special catheter through the cervix on the 2nd, 3rd or 5th day after follicular puncture. As a rule, no special preparation is required for this. Usually 2 embryos are transferred. If the patient has had many attempts or the quality of the embryos is poor, transfer of more than 2 embryos is possible. The remaining good quality embryos are cryo-frozen. If the attempt fails, these embryos are used for subsequent transfer;
Supports the luteal phase of the stimulated menstrual cycle. After embryo transfer, medications to support pregnancy are prescribed for 2 weeks;
Diagnosis of early pregnancy. After 2 weeks, the woman donates blood for βhCG to determine whether she is pregnant. Depending on the results of the study, further tactics for managing the patient are determined.
IVF is also possible in the natural menstrual cycle, without induction of superovulation.
Indications for IVF:
Infertility that cannot be treated or is more likely to be overcome with IVF than with other methods. In the absence of contraindications, IVF can be performed at the request of a married couple (unmarried woman) for any form of infertility.
Contraindications for IVF:
Somatic and mental illnesses that are contraindications for pregnancy and childbirth;
Congenital malformations or acquired deformations of the uterine cavity, in which implantation of embryos or pregnancy is impossible;
Ovarian tumors;
Benign tumors of the uterus requiring surgical treatment;
Acute inflammatory diseases of any localization;
Malignant neoplasms of any location, including a history.
Competent and effective treatment of infertile marriage is possible only with clear interaction between urologists, gynecologists and IVF specialists. It is mandatory to fully inform the patient about all possible methods of restoring fertility, indicating the percentage of successful measures and the risk of complications for himself and his wife.
Injection of sperm into the cytoplasm of the egg (ICSI). The ICSI program is carried out for severe forms of male infertility, as well as in some cases related to the individual characteristics of the reproductive health of a married couple. Fertilization of the eggs obtained from the wife is achieved by introducing a sperm into the cytoplasm of the egg.
If it is impossible to obtain fertilization of an egg using IVF, the micromanipulation method ICSI is used.
The essence of the Intracytoplasmic Sperm Injection (ICSI) technique is that under a microscope, using a fine microsurgical procedure, a single sperm is injected into the cytoplasm of a mature egg. This overcomes the barrier of the impossibility of natural fertilization, which is usually the reason for the absence of children in couples with severe forms of male infertility. Indications for the use of ICSI have recently expanded. This method is also used in the absence of fertilization in the previous IVF program, with a small number of oocytes, with a thick shell of the egg, etc.
ICSI is used for the following types of male pathology:
heavy oligozoospermia(the concentration of sperm in the ejaculate is less than 10 million per ml, i.e. so low that it practically excludes natural fertilization of the egg);
asthenozoospermia in all forms oligozoospermia(less than 30% of actively motile sperm against the background of a total sperm concentration in the ejaculate of less than 20 million per ml);
azoospermia(lack of mature sperm in the ejaculate) of various origins if motile sperm are detected during puncture of the testicle or epididymis.
World experience in using the ICSI technique in assisted reproductive technology programs shows that this procedure does not affect the health of born children. However, you need to keep in mind that if the causes of male infertility are associated with genetic disorders, then these disorders, if ICSI is used, will be inherited by your sons along with the sperm chromosomes. Preliminary examination of men with severe forms of spermatogenesis disorders will help to avoid the birth of offspring with congenital pathologies. ICIS - intracytoplasmic sperm injection.
Egg donation. The egg donation program allows women who do not have eggs in their ovaries, as well as those with a high risk of hereditary diseases in the fetus, to carry and give birth to a healthy child. In such cases, eggs are obtained from a healthy female donor.
Surrogacy. The “surrogacy” program gives a chance to have a child to women who, for various reasons, have had their uterus removed or who are contraindicated from carrying a pregnancy due to serious illnesses. In these cases, the eggs and sperm of an infertile couple are used. The resulting embryos are transferred into the uterine cavity of a healthy woman - a “surrogate mother”.
The onset of pregnancy and gestation of the fetus sometimes fade into the background due to the abundance of legal problems associated with the registration of a child born to a surrogate mother.
Not in all countries biological parents retain the rights to the child. And “surrogate mothers,” if the family is not protected by law, can resort to the so-called “surrogate” racket. After the birth of the child, they refuse to give him to his parents, forcing him to pay all expenses for his and her maintenance, etc.
Requirements for surrogate mothers:
Age from 20 to 35 years;
Having your own healthy child;
Mental and somatic health.
Freezing of embryos. This program is created for the storage and subsequent use of well-developing embryos in the IVF (in vitro fertilization) program. If necessary, these embryos are thawed and transferred into the uterine cavity without repeating the full IVF cycle.
Donor sperm bank. Donor sperm is used in cases of absolute male infertility or in the absence of a sexual partner.
Before a course of chemotherapy, cancer patients can freeze sperm samples, which can later be used to obtain pregnancy using the ICIS method.
General characteristics of new reproductive technologies (NRT).
1. Table 1.3 shows goods and services - economic benefits. Fill out the table to indicate which products and services you have: companions, spouses, and investors.
Table 1.3 – Products and services (table for inventory)
2. From your point of view, the pace of development of some areas - the production of material goods and the provision of services - is growing at a faster pace and why? Give reasons for your position. Support your arguments with statistical data. Conduct a comprehensive analysis of the pet industry in the nursery industry of Ukraine and other countries.
3. Analyze the minds in which entrepreneurial risks can be formulated and developed.
4. Analyze the importance of such a factor as the provision of resources to the region for the level of living of the population of the region of Ukraine.
GBOU VPO Chita State Medical Academy
Department of Forensic Medicine
Essay
“Ethical problems of new reproductive technologies”
Completed by a student
207 group Dashiev B.L.
Checked by: Doctor of Medical Sciences, Professor
Avkhodiev G.I.
Chita, 2012
I. Introduction.
II. Main part.
1. General characteristics of new reproductive technologies (NRT).
History of the issue.
2. Methods of artificial insemination.
a) Artificial insemination.
b) In vitro fertilization (IVF).
3. Moral and ethical assessment of NRT (using the example of the positions of Christianity and Islam).
4. Experiments on embryos.
5. Complications.
6. Surrogacy.
7. Ethical and legal aspect (NRT). Order No. 301.
III. Conclusion.
I. Introduction.
The 21st century is rightly called the century of biotechnology. However, already in the 20th century. Advances in the field of medicine and biology have greatly changed human life and society.
Modern biomedical knowledge allows us to penetrate so deeply into human nature that man himself becomes its “creator” and “producer”. This is especially evident in reproductive technologies and genetic engineering. The uncontrolled use of new technologies can affect not only the people to whom they are used and their offspring, but also social relations and, above all, the state of the traditional family.
Because of this, according to some forecasts, this will certainly affect demographic processes in Russia. With good reason we can say that new technologies of artificial reproduction, freed in their application from any ethical and legal restrictions, can become a real factor in the destruction of traditional social foundations.
II. Main part.
General characteristics of new reproductive technologies (NRT).
History of the issue.
Even at the beginning of the 20th century, the origin of human life was considered a great mystery. Today it is turning into a technical manipulation called “new reproductive technologies.”
Man has been trying to find a solution to the problem of infertility since ancient times.
The first experiments in artificial insemination of women suffering from infertility were undertaken in England at the end of the 17th century. However, only towards the end of the twentieth century, in general, medical science mastered human reproductive physiology.
The world's first artificially conceived person appeared in England in 1978. It was a girl - Louise Brown. A few years later her sister Natalie was born. In Russia, the first test-tube baby (a girl, Lena) was born in 1986 in Moscow. Today Lena lives in Ukraine. A little later, in Leningrad in the same 1986, a boy, Kirill, was born.
These events were preceded by serious research, which has been purposefully carried out in Russia since 1965. At this time, a group of early embryogenesis was created, which in 1973 grew into a laboratory of experimental embryology (headed by Prof. B. Leonov). As of 1994, more than 1.5 thousand children were born in this laboratory.
In 1990, there were over 20 thousand children conceived “in vitro” on our planet. Let us note the dynamics: back in 1982 there were only 74 of them. Estimates of the effectiveness of this method among different specialists in different countries do not coincide. Our experts are inclined to figure 10-18%.
What are new reproductive technologies?
Assisted reproductive technologies (aka ART) are a set of medical treatment measures that help achieve pregnancy in a woman, with some of the stages of conception occurring outside the female body.
What types of reproductive technologies are there?
The section new reproductive technologies includes:
- In vitro fertilization (IVF).
- Artificial insemination.
- Use of donor embryos.
- Cryopreservation of germ cells or embryos.
- Use of donor sperm.
- Injection of sperm into the cytoplasm of the oocyte.
- Preimplantation genetic correction.
- Use of donor oocytes.
- Postmortem reproduction.
- In vitro fertilization.
ECO
IVF is a technology for fertilizing an egg outside the female body. The technology is not the newest by modern standards, but since its inception it has been greatly modernized and changed, as a result of which colossal numbers are now achieved in the number of use and the number of successfully born children.
The woman's egg is placed on a nutrient medium or in a test tube containing a special liquid, the man's seminal fluid is added to it, and all this is placed in an incubator for two to five days, where fertilization occurs. Afterwards, the successfully fertilized egg is placed in the uterine cavity. At the same time, at least 2 eggs are implanted into the woman’s uterus.
For this procedure, your own egg and sperm, or donor ones, can be used. Various combinations are possible depending on which spouse has reproductive problems. This technology is used not only by women who cannot give birth to a child themselves, but also by women who are in adulthood and even have children of their own.
In adulthood, IVF with a donor egg is used due to the fact that a woman’s own eggs are subject to various negative influences over the course of her life, which leads to mutations in the chromosomes of the egg. Egg donors are young, healthy women. Also, donor sperm or eggs are used by married couples whose risk of having a child with a genetic disease is very high. Currently, almost any center for new reproductive technologies can offer its services for this procedure.
Artificial insemination
Artificial insemination is a procedure for introducing seminal fluid into the uterine cavity using a special syringe. This procedure is not the newest, but even today it is quite popular. More than 100,000 intrauterine inseminations are performed annually in Europe, and the technology is constantly improving. It became widespread after the advent of sperm cryopreservation technology. Men at a young age donate seminal fluid to a sperm bank, after which, at a more mature age, a child can be born from their own seed.
Also, the technology is useful for HIV-positive women whose partner is HIV-negative. This method eliminates the risk of infection of the partner and allows you to have a child together. Nowadays, any center for new reproductive technologies and most private gynecologists can perform this procedure.
Injection of sperm into the cytoplasm of the oocyte (ICSI)
Injection of sperm into the cytoplasm of the oocyte (ICSI) is one of the modifications of IVF, carried out in cases where there is any pathology of sperm or spermatogenesis in a man.
When performing ICSI, the most mobile and morphologically healthy sperm is selected from the male seminal fluid, it is immobilized by breaking the tail with a microneedle, and using a microneedle it is inserted into the egg. After this, the egg, just as with conventional IVF, is sent to an incubator for two to five days, and then implanted in the woman’s uterine cavity. This procedure is also necessary for those couples in which the man is HIV positive. Before the selection and injection of sperm, the sperm is “washed” of elements containing HIV.
Preimplantation genetic correction of the embryo
Preimplantation genetic correction of the embryo is the newest reproductive technology. The purpose of this technology is to eliminate possible genetic pathologies of the unborn child. Necessary for those couples who have a very high risk of having a child with a genetic disease. The technology is so new that there are only a little more than a dozen children in the world on whom it has been tested.
To carry out the procedure itself, ICSI is first performed, after which the fertilized egg is placed in an incubator for 3 days. Afterwards, the zygote is placed on a special nutrient medium, and with the help of a gene gun, the genetic information of the unborn child is corrected. Of course, the technology was planned only to prevent congenital anomalies and diseases, but according to the creators of this technology, it is already possible to change the color of a child’s hair, eyes, skin and other cosmetic parameters.
Postmortem reproduction
Postmortem reproduction is a procedure for the birth of a child after the death of one or both parents. Nowadays, it is possible to use not only previously cryopreserved germ cells, but also to obtain germ cells from the body of a deceased person.
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State educational institution of higher professional education "Voronezh State Medical Academy
them. N.N. Burdenko Roszdrav"
Department of Philosophy
Abstract on the course “Bioethics”
"Bioethics and new reproductive technologies"
Completed by: 1st year student
Institute of Nursing Education
ZVSO 106 group
Peshkova Irina Alekseevna
Scientific supervisor: Markova S.V.
What is bioethics?
Bioethics is a complex cultural phenomenon that arose as a response to threats to human moral and physical well-being generated by the rapid progress of biomedical science and practice. Protecting the fundamental moral values that define human existence is a condition for the survival of humanity in the modern situation. In 1971, in the book “Bioethics: A Bridge to the Future,” American oncologist Van Rensselaer Potter wrote: “The science of survival must be not just science, but a new wisdom that would combine the two most important and urgently needed elements - biological knowledge and universal human values. Based on this, I propose the term “Bioethics” to denote it.”
Modern bioethics includes a number of closely related forms of activity.
Firstly, it is a multidisciplinary field of study of the conditions and consequences of scientific and technological progress in biomedicine. The problems facing humanity are studied by doctors, biologists, philosophers, theologians, lawyers, psychologists, political scientists and representatives of other disciplines.
Secondly, this is the sphere of academic and educational activities. Various bioethics courses are taught in kindergartens, schools and lyceums, universities (in medical, biological, philosophical, theological and other faculties).
Thirdly, it is a rapidly developing social institution. Bioethics in some respects is part of the human rights movement in the field of health.
The main problems in bioethics include the following:
- protecting the rights of patients (including HIV-infected people, psychiatric patients, children and other patients with limited competence);
- equity in health care;
- relationships with living nature (ecological aspects of the development of biomedical technologies);
- abortion, contraception and new reproductive technologies (artificial insemination, in vitro fertilization with subsequent implantation of the embryo into the uterus, surrogacy);
- conducting experiments on humans and animals;
- developing criteria for diagnosing death;
- transplantology;
- modern genetics (gene diagnostics, gene therapy and engineering);
- manipulations with stem cells;
- cloning (therapeutic and reproductive);
- providing care to dying patients (hospice and palliative care organizations);
- suicide and euthanasia (passive or active, voluntary or forced).
Let's consider the problem of new reproductive technologies.
The development (since the mid-1970s) of artificial human reproduction technologies has become another source of moral dilemmas. Such technologies often involve manipulation of human embryos, which are doomed to death. As a result, the problem of establishing criteria for accurately determining the beginning of human life as the moment at which the developing organism is considered by both doctors and future parents as a moral subject also becomes relevant and far from a generally accepted solution.
The Orthodox Church has an ambivalent attitude towards this problem.
The intensive development of biomedical technologies, which are actively interfering in the life of a modern person from birth to death, is of serious concern to the general public, including representatives of religion. The Russian Orthodox Church has developed a social concept that provides a moral assessment of the problems generated by the development of modern science and medicine. Biomedical knowledge allows us to penetrate so deeply into human nature that man himself becomes its “creator” and “producer”. This is especially evident in reproductive technologies. The uncontrolled use of new technologies can affect not only the people to whom they are used and their offspring, but also social relations and, above all, the state of the traditional family. People's attempts to put themselves in God's place can bring new hardships and suffering to humanity.
The use of new biomedical methods in many cases makes it possible to overcome the disease of infertility. However, expanding technological interference in the process of the origin of human life poses a threat to the spiritual integrity and physical health of the individual. The Orthodox Church traditionally has high respect for the medical profession. This attitude is based on the idea of synergy, co-creation of God and man in the transformation of the world. At the same time, the Church rejects any claim of man to replace the Creator. It should also be noted that the possibilities of medicine will never become limitless. With good reason we can say that new technologies of artificial reproduction, freed in their application from any ethical and legal restrictions, can become a real factor in the destruction of traditional social foundations. Back at the beginning of the 20th century. the origin of human life was considered a great mystery. Today it is turning into a technical manipulation called “new reproductive technologies.” A simplified approach to artificial insemination entails a simplified approach to the human embryo, as well as the ability to choose the right time to have a child. This method also offers the chance to practice eugenics. Finally, today, in our industrial world, artificial insemination is an event of economic interest to medical practitioners. A person's life tends to depreciate when material wealth is on the other side of the scale.
Artificial insemination.
In some forms of infertility, the husband's or donor's semen is introduced into the woman's genital tract, bypassing barriers that are harmful to it. The method is used for both female and male reproductive pathologies. In general, this method does not contain any contraindications or moral difficulties, since we are talking about medical assistance to ensure that the marital act of procreation is preserved. The Orthodox Church classifies the method of artificial insemination with the husband's reproductive cells as an acceptable means of medical care, since it does not violate the integrity of the marital union, and does not differ fundamentally from natural conception and occurs in the context of marital relations. The ethics of donor artificial insemination of an unmarried woman, without the consent and cooperation of her husband, is questioned in all religions and is interpreted as a form of adultery and infidelity. Manipulations associated with the donation of germ cells violate the integrity of marital relations, allowing the intrusion of a third party into them. The use of donor material undermines the foundations of family relationships.
In vitro fertilization.
A typical IVF cycle involves ovarian hyperstimulation, egg retrieval, sperm collection, fertilization, embryo culture and subsequent embryo transfer. An essential point of IVF is the fact that after a successful procedure, 85-90% of viable embryos remain “unused”. Such embryos are either destroyed or used in experiments or bioproduction. This is precisely what gives grounds for representatives of religious denominations to claim that the use of IVF reflects parents’ failure to understand that 7–9 of their young children will die. In the fundamentals of the social concept, the Orthodox Church draws attention to the fact that “all types of in vitro fertilization that involve the procurement, conservation and deliberate destruction of “excess” embryos are morally unacceptable. Thus, IVF from the very beginning carries within itself an abortifacient ideology. As a result, the “price” of the life of an unborn child is a chain of deaths, physical and psychological complications in biological and genetic parents.
Surrogacy.
The essence of the method is that a woman, using artificial insemination, agrees to bear and give birth to a child for a married couple who cannot have children for health reasons. The method allows you to take the egg of a woman who has ovaries, but no uterus, and transplant it into another woman - the recipient, i.e. it gives hope for motherhood to a woman who is physically incapable of it. Surrogacy is unnatural and morally unacceptable even in cases when it is carried out on a non-commercial basis. This technique involves the destruction of the deep emotional and spiritual closeness established between mother and baby already during pregnancy. “Surrogacy is traumatic for both the carrying woman and the child, who may subsequently experience an identity crisis.” The Orthodox Church recognizes surrogacy as unnatural and immoral, because it contradicts the unity of marriage and the dignity of human procreation. Moreover, not only marital unity is affected here, but also parental unity, the close bond between parents and children. One of the negative consequences is the suffering of the child, who may subsequently experience a crisis of self-awareness and extremely severe psychological trauma.
The common denominator of all the issues discussed above is the Church's care and attention to human life as a gift from God. That is why the Church cannot consider paths to childbearing that do not agree with the plan of the Creator of life to be morally justified. If a husband or wife is unable to conceive a child, and therapeutic and surgical methods of treating infertility do not help the spouses, they should humbly accept their childlessness as a special calling in life.
But this issue can also be considered from the ethical and legal side, solving the problems of the demographic situation in our country.
It is due to a significant deterioration in the reproduction of the population of our country, both as a result of a decrease in the birth rate, on the one hand, and as a result of a deterioration in reproductive health, on the other. Today in Russia the problem of childless marriage is extremely acute: according to official statistics, almost 13% of married couples do not have children, and only the achievements of modern science can help these people continue in their offspring.
The successes of biomedical technologies in the field of reproduction are enormous, and they all serve humane purposes: the treatment of infertility, both male and female; the birth of a child, when all other possibilities, both natural and therapeutic, have been exhausted. The established practice of reproductive technologies is developing in three main directions, as mentioned above: artificial insemination of a woman with the sperm of her husband or donor, IVF-TE methods (extracorporeal “in vitro”) and carrying the embryo by a “surrogate mother”.
Artificial insemination. This is the only chance to get a child from your husband when the results of his spermogram are not normal. In cases of complete absence of mature germ cells in the husband, donor sperm is used as a “therapy of despair”, of course with the voluntary and conscious, even hard-won, consent of the spouses. This method, despite its denial by religious morality, has the right to life as a way to preserve a family in the event of childlessness “through the fault” of the husband, and this is more than 1/3 of childless families.
The IVF-TE method - in vitro fertilization and embryo transplantation - has been available abroad since 1978, in our country - since 1986. The method allows you to take the egg of a woman who has ovaries, but no uterus, and transplant it into another woman - a recipient, i.e. .e. gives hope for motherhood to a woman who is physically incapable of it (“surrogacy”). In addition, thanks to the IVF-TE method, the possibilities of pre-implantation diagnostics are increased, because When a genetic disease is detected, fertilized eggs are not transferred to the uterus, which opens up the possibility of childbearing for persons at risk of developing genetic diseases in their offspring. The improvement of the technique of freezing (cryopreservation) of genetic material has also indicated new horizons - now a woman can hope for a second and even third pregnancy without repeated egg retrieval surgery, if her “extra” reproductive cells were saved for such a case, and they can be used for ten years . At the same time, interference in the process of childbirth, the possibility of culling genetically defective fertilized eggs, and the danger of manipulating germ cells have outlined the range of legal and moral issues associated with new reproductive technologies.
Currently, in international law there are no rules prohibiting either artificial insemination or the placement of an egg fertilized with the sperm of a husband or donor into the uterus of a “carrying mother.” In domestic legislation, this issue is reflected in Art. 35 “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens”: “Every adult woman of childbearing age has the right to artificial insemination and embryo implantation, which is carried out in institutions that have received a license for this type of activity, with the written consent of the spouses (single woman). Information about artificial insemination and embryo implantation, as well as the identity of the donor, constitutes a medical secret. A woman has the right to information about the procedure of artificial insemination and embryo implantation, about the medical and legal aspects of its consequences, about the data of a medical genetic examination, external data and the nationality of the donor, presented by the doctor performing the medical intervention. Illegal artificial insemination and embryo implantation entails criminal liability established by the criminal legislation of the Russian Federation.”
The World Medical Association (WMA) had a positive attitude towards new reproductive technologies, because they serve a noble purpose - treating infertility and providing the right to spouses who are deprived of the opportunity to produce offspring to have children.
“Surrogacy” occupies a special place in issues of new reproductive technologies - the topic is the most poorly developed, both in legal and ethical terms. “Surrogacy” refers to a situation where voluntarily, but usually for a fee, a recipient woman carries a child, either as a result of the transplantation of an embryo obtained in a test tube, or after artificial insemination with her own egg. In conditions where a marriage is hopelessly infertile due to incompatibility or the absence of a uterus, this method of childbirth, according to many researchers, has a right to exist, although the ethics of surrogacy are questioned. The need for control, legal and ethical regulation of each stage is dictated by the danger of the commercialization of childbirth. There is no such legal regulation of the issue of “surrogacy” in domestic legislation.
The attitude of the majority of Russian doctors towards these technologies is friendly. How else can a specialist feel about a method that allows a childless couple, in the absence of a uterus or a serious pathology of it, obstruction of the fallopian tubes or their absence, to experience the happiness of motherhood, to get genetically “their” child?
As we see, an ambiguous opinion on issues of new reproductive technologies is emerging in society. Everyone has the right to choose.
Literature
1. Katkovskaya M.Ya. New reproductive technologies and axiological guidelines of Orthodoxy.// Medicine and Christianity: materials of the Republic. scientific-practical conf. students and young scientists / edited by. ed. S. D. Denisova. – Minsk: BSMU, 2007.
2. Bartko A.N., Mikhailova E.P. Biomedical ethics: theory, principles and problems. Part 1. M. 1995.
3. Siluyanova I.V. Ethics of healing / I.V. Siluyanova. M. 2000.
4. Orthodoxy and problems of bioethics. M. 2001.
5. Bioethics requirements. Kyiv. 1999.
1. General characteristics of new reproductive technologies.
2. The main moral and legal problems of new reproductive technologies.
3. The problem of the legal and ethical status of the donor in reproductive technologies.
4. The problem of the moral justification of “surrogacy”.
Even at the beginning of the 20th century, the origin of human life was considered a great mystery. Today it is turning into a technical manipulation called “new reproductive technologies.”
Man has been trying to find a solution to the problem of infertility since ancient times. The first experiments in artificial insemination of women suffering from infertility were undertaken in England at the end of the 17th century. However, only towards the end of the twentieth century, in general, medical science mastered human reproductive physiology.
The world's first artificially conceived person appeared in England in 1978. It was a girl - Louise Brown. A few years later her sister Natalie was born. In Russia, the first test-tube baby (a girl, Lena) was born in 1986 in Moscow. Today Lena lives in Ukraine. A little later, in Leningrad in the same 1986, a boy, Kirill, was born.
These events were preceded by serious research, which has been purposefully carried out in Russia since 1965. At this time, a group of early embryogenesis was created, which in 1973 grew into a laboratory of experimental embryology (headed by Prof. B. Leonov). As of 1994, more than 1.5 thousand children were born in this laboratory.
In 1990, there were over 20 thousand children conceived “in vitro” on our planet. Let us note the dynamics: back in 1982 there were only 74 of them. Estimates of the effectiveness of this method among different specialists in different countries do not coincide. Our experts are inclined to figure 10-18%.
The concept of “new reproductive technologies” (NRT) includes different types of artificial insemination.
The first method in a series of so-called new reproductive technologies (NRT) was artificial insemination. In some forms of infertility, the husband's or donor's semen is introduced into the woman's genital tract, bypassing barriers that are harmful to it. The method is used for both female and male reproductive pathologies. The problem of “extra” embryos and their deliberate destruction does not arise when using this method.
In general, this method of artificial insemination for a married couple does not contain contraindications and moral difficulties, since we are talking about medical assistance so that the marital act of procreation, integral in all its components (physical, mental, spiritual), is preserved.
The next type of artificial insemination is In vitro fertilization (IVF) and embryo transfer into the uterine cavity (ET).
The procedure has proven its effectiveness in infertility – both female and male. A typical IVF cycle involves ovarian hyperstimulation, egg retrieval, sperm collection, fertilization, embryo culture and subsequent embryo transfer.
An essential point of IVF is the fact that after a successful procedure, 85-90% of viable embryos remain “unused”. Such embryos are either destroyed, transferred for implantation into other women, or used in experiments or bioproduction. If during an abortion the life of one (rarely more) “random” children is destroyed, then the implementation of RT methods contributes to the birth of one child, the condition for which should be the destruction of approximately (+_) 10 children’s embryos. This is precisely what gives grounds for many scientists, especially representatives of religious denominations, to argue that the use of IVF reflects parents’ failure to understand that 7-9 of their young children will die.
In this regard, the problem associated with determining the legal status of embryos and their legal protection arises. It seems that the legal attitude towards the status of embryos in our country should be based on the recognition of the fact that the embryo is not part of the mother’s body, but the beginning of a new life, and this should determine approaches to the creation of appropriate legal regulation of NRT. Indeed, from the point of view of modern genetics, starting from the moment of fertilization, i.e. with the penetration of the sperm into the egg, the two gametes of the parents form a new biological formation, a zygote, which carries a new individualized genetic program, a new one.
It is hardly ethical to turn a blind eye to the fact that the number of individual lives destroyed during IVF goes beyond all limits. “The loss of embryos reaches 93-94%. This loss begins when many embryos are implanted at the same time in order to increase the likelihood of success. At best, out of several, one survives. Thus, IVF from the very beginning carries with it an abortifacient ideology: in order to implant one, 8-9 embryos are calmly and deliberately destroyed...”
As a result, the “price” of the life of an unborn child is a chain of deaths, physical and psychological complications in biological and genetic parents.
Experiments on embryos are very convenient for researchers for two reasons. First, a human embryo is a living human organism. In this regard, the conclusions drawn from experiments on embryos have greater scientific reliability compared to the results of experiments on animals and dead fetuses. Secondly, the constant implementation of operations to terminate pregnancy and artificial insemination ensures a constant replenishment of the source of biomaterial for research.
Nevertheless, the Parliamentary Assembly of the Council of Europe in the Convention on Human Rights and Biomedicine, adopted in 1997, devotes a separate article to the issue of research on human embryos. Article 18 consists of 2 points:
1st paragraph: “In those countries where research on embryos is permitted by law, it is necessary to ensure adequate protection of the embryo.”
2nd paragraph: “The creation of embryos for research purposes is prohibited.”
In Russia there is no special legislation to regulate experiments and research on embryos. However, methods of reproductive technologies are widely introduced into medical practice. And the use of tissues and organs of human fetuses is also expanding. The legislation of our country does not contain any indications about the possible fate of the so-called “extra” embryos developed as a result of IVF (and not implanted into the uterus).
The main ethical principle of healing since the time of Hippocrates has been the principle of “do no harm.” Let's consider NRT from the point of view of possible and real complications that accompany them.
1). Objective medical facts show: “Pregnancies resulting from IVF are characterized by a high incidence of complications, bleeding in the first and second trimesters, toxicosis of pregnancy, fetal growth restriction and low birth weight. There are reports that the weight of newborns after IVF with one fetus and twins is significantly less than in the population. The cesarean section rate is significantly higher than in the population - about 40-50% (in the population the optimal cesarean section rate is considered to be 10%). Even in the case of successful fertilization and pregnancy, a woman receives a massive medicinal effect before and during pregnancy, which cannot have a harmful effect on herself or her offspring.”
2). To obtain the required number of eggs, natural regulatory systems are switched off, followed by artificial ovarian hyperstimulation. After such exposure to hormonal drugs, not one, but 4-6 eggs mature in a woman, this is necessary in order to carry out as many of them as possible at one time. But this is not only a labor-intensive and expensive process, but also a procedure fraught with side complications.
3). One cannot help but mention the effect of disappointment when choosing an “elite dad.”
But even more serious ethical concerns are caused by arbitrary manipulations in the field of surrogacy.
The problem of surrogacy has its own history, but it is very difficult to establish the first cases of the birth of a child through the use of the surrogacy method. The first case of surrogacy was registered in 1985 in America. An elderly woman carried her daughter's baby to term because the latter had inoperable tubal obstruction. And in Russia, the first child was born in 1991 in Kharkov, under the supervision of Professor V.I. Grishchenko. and Dakhno F.V. There, the mother gave birth to her own daughter, who had a congenital absence of the uterus.
According to statistics, there are about one and a half thousand such children in the world, and a little more than ten in our country. The essence of the method under consideration is that a woman, through artificial insemination, agrees to bear and give birth to a child for a married couple who is unable to have children due to health reasons.
The legal aspects of this method of reproduction are determined by Russian legislation. According to the Family Code of the Russian Federation, firstly, surrogacy is permitted in the Russian Federation, and secondly, the right to determine the fate of the child is given to the surrogate mother. According to Article 51 Part 4: “persons who are married to each other and have given their consent in writing to the implantation of an embryo into another woman for the purpose of carrying it, can be registered as the parents of the child only with the consent of the woman who gave birth to the child (surrogate mother)… Spouses who consented to the implantation of an embryo into another woman, as well as the surrogate mother, do not have the right to refer to these circumstances when challenging maternity and paternity after the parents have been recorded in the birth register” (Part 3, Article 52).
The moral inconsistency of “surrogacy” is that it inevitably introduces a third party into the reproductive process. It does not matter whether the “surrogate mother” directly became pregnant from the father’s sperm or simply accepted a zygote fertilized in a Petri dish. In any case, the popular expression “womb for hire” indicates the moral and ethical dubiousness of this procedure. (I. Brack).
Based on the above, we can draw some conclusions: /surrogacy destroys traditional ideas about social parents of mother, father, daughter, etc.;
/ the legal relationship between the biological mother (carrying one) and the genetic one (egg donor) turns out to be complex. This fully applies to artificial insemination with donor sperm;
/ new technologies call into question the age-old principle of parental responsibility for their children, the importance of the family in the life of an individual and the entire human society;
/ the possibility of legislative resolution of commercial surrogacy is causing heated debate. In this case, complex moral problems will arise in the event of the birth of a child “ordered” of “inadequate quality”, i.e. diseased or undesirable sex.
The phenomenon of surrogacy and the problem of the status of the embryo reveals that without clear and precise moral, ethical and legal regulation of their use, they can carry significant destructive potential. Nevertheless, NRTs exist and are gaining strength in Russia.
The development of biomedical technologies, which invade the life of modern man from birth to death, is of serious concern to society. Attempts by people to arbitrarily change and “improve” nature can bring new hardships and suffering to humanity. The development of biomedical technologies is significantly ahead of the understanding of the possible spiritual, moral and social consequences of their uncontrolled use.
The use of new biomedical technologies in many cases makes it possible to overcome the disease of infertility and it is absurd to neglect them. But at the same time, it is alarming that the development of the mentioned technologies is associated with the spread of the ideology of so-called reproductive rights. This system of views establishes the priority of the biological rights of the parent over the social ones, over the rights of the child to his spiritual and physical health, to moral stability. The ideology of reproductive rights is dominated by an attitude towards human life as a product that can be chosen according to one’s own inclinations and which can be disposed of on a par with material values.
A moral attitude towards human life is necessary to protect human life from attempts to arbitrarily manipulate it. Human life from the very moment of its conception depends on the help of the support of others. Life originates, develops and is realized precisely in a community of compassionate and participating people.
The trust that exists between people ensures well-being in society. It seems very important to further study the problem posed and create an appropriate regulatory system in the state. It should be taken into account that the affected area is an area of not only moral, ethical, legal, but also national and state interest.
