Bioethics of Assisted Reproductive Technology

*Justo Aznar and Julio Tudela*

### **Abstract**

There is no doubt that for a couple who are having difficulties in conceiving, having a child is an objective good. However, it is also indisputable that assisted reproduction techniques raise clear ethical issues. In order to begin this bioethical reflection, it should be clearly established that the early embryo, which can be manipulated or destroyed using these techniques, is a living being of our species. We believe this is unquestionable from a biological point of view, and it therefore deserves our full respect. The bioethical assessment of assisted reproduction techniques includes analysis of the embryo losses caused by their selection and manipulation through preimplantation genetic diagnosis, 'social freezing' or the possible lack of rigour in the information provided by the clinics involved, to which must be added the higher morbidity reported in babies born as a result of these procedures.

**Keywords:** assisted reproduction, in vitro fertilisation, ICSI, bioethical considerations, loss of human embryos

### **1. Introduction**

There is no doubt that for a couple who are having difficulties in conceiving, having a child is an objective boon. In an attempt to achieve this goal, many will avail assisted reproductive technology (ART) or natural family planning methods [1–3].

ART refers to a number of techniques, primarily: (a) in vitro fertilisation (IVF), in which the fertilisation of an egg by sperm takes place in a laboratory setting; (b) intracytoplasmic sperm injection (ICSI), in which a single sperm is introduced into the egg to be fertilised, also in a laboratory setting; (c) artificial insemination, which involves artificially delivering semen to the female genital tract—the semen may be from the woman's own partner or a donor; and (d) gamete intrafallopian tube transfer (GIFT), which involves removing eggs laparoscopically after controlled ovarian hyperstimulation, followed by introduction of the mixture of the couple's eggs and sperm into the fallopian tube so that fertilisation occurs in the body, unlike IVF and ICSI, in which it takes place 'in vitro' although several modifications of these techniques have been proposed [4].

### **2. Efficacy of ART**

One important aspect to consider is the efficacy of these techniques, which is generally calculated based on two parameters: the pregnancy rate (PR) and the live birth rate (LBR) per ovarian stimulation cycle.

Based on data published by the European Society of Human Reproduction and Embryology (ESHRE) in 2014 [5–18], the PR and LBR following IVF in Europe between 1997 and 2010 varied between 22.28 and 29.2% for the PR, with a mean rate of 26.41%, and between 13.07 and 22.4% for the LBR, with a mean rate of 18.81%.

When ICSI was used, these same rates varied between 23.37 and 29.9% for the PR, with a mean rate of 27.22%, and between 12.68 and 21.10% for the LBR, with a mean rate of 18.31% [6].

ARTs have wide social acceptance today. Following the birth of the first girl, Louise Brown, by IVF in 1978, more than 200,000 children are now born annually worldwide using these techniques [19], i.e. more than 3% of all children born [14], with the total number of births estimated at over 5 million [20].
