**3. Ethical assessment of ARTs**

Nevertheless, regardless of the medical and social benefits they offer, it is also a reality that ARTs may present bioethical issues that are worth considering. These may be moral or ethical. Moral implications are related with the fact that they involve the instrumental manipulation of fertilisation, disregarding its natural environment, the sexual act, and the implications that may arise from this. Ethical implications entail the bioethical problems related to the medical aspects of these techniques, which are the concerns that we shall analyse in this chapter.

These ethical concerns include those related to:


### **4. Medical problems in children born by ART**

Children born by ART have a higher percentage of adverse medical effects than those conceived naturally [21–29], which gives rise to unanswered bioethical questions.

**199**

*Bioethics of Assisted Reproductive Technology DOI: http://dx.doi.org/10.5772/intechopen.90727*

compared to IVF [25].

[21, 23, 28, 47, 56].

ment [21, 22, 28, 30, 57, 58].

conceived singleton pregnancies [60].

**5. Medical problems in mothers who use ART**

that these abnormalities are not detected in adulthood [39].

development, cerebral palsy, autism and even asthma [38, 40, 41].

Thus, these children have higher rates of prematurity and low birth weight [30] as well as an increased risk of birth defects [31–33], especially cardiac malformations [34, 35] and chromosomal abnormalities [36], than children conceived naturally. Another study nonetheless failed to confirm these differences when children were stratified according to the age of their mothers, parity and gestational age [37]. Although some evidence has suggested that these types of medical disorders extend to early childhood [38] and even longer term [30], a recent article assessing whether the negative side effects are maintained until 25–30 years after birth found

In addition to the disorders mentioned above, children born by ART may also show an increase in acquired medical problems, such as: impaired psychomotor

Another issue that has also arisen is whether the increased risk of these negative side effects occurs equally in children born by IVF or by ICSI. Most researchers' opinions are that there seem to be no differences between both techniques [42–45], although others have found a greater number of problems when ICSI is used as

With respect to the cause of the problems in children born by ART, this seems

It has recently been suggested that the medical problems found in children born by ART could also be related to epigenetic modifications, which may occur during maturation of the gametes, fertilisation or in the early stages of embryonic develop-

A majority of adverse medical events that occur in women who use ART seem due to the greater number of multiple pregnancies that occur in them [49–52, 59] since, as has already been mentioned, obstetric problems are known to be more

Nevertheless, ART-conceived singleton pregnancies also present a higher risk of adverse events in mothers, such as antepartum haemorrhage, hypertension during pregnancy, premature rupture of membranes or gestational diabetes, than naturally

As already mentioned, the efficacy of IVF is low. In order to improve this, a large number of embryos are typically produced, usually between 10 and 12, of which 1 or 2 are transferred and the rest frozen. This practice inevitably means that the

Knowing what to do with these frozen embryos raises objective bioethical problems. In our view, there are four solutions for these embryos: (a) leave them frozen

**6. Ethical problems related to frozen surplus embryos from ART and** 

common in multiple compared to singleton pregnancies [49, 53–55].

**how their untoward situation can be resolved**

number of frozen human embryos is gradually increasing.

to be multifactorial, and it may basically be due to the technique itself (the manipulation of gametes, the practice of PGD, the culture medium and the time that embryos have been frozen), ovarian hyperstimulation of the mother [46, 47] and also due to paternal subfertility [21]. In particular, it may be related to the greater number of multiple pregnancies that occur in ART [48–52], since multiple pregnancies are known to be accompanied by more foetal congenital abnormalities [49, 53–55], although these are also found in singleton pregnancies using ART

### *Bioethics of Assisted Reproductive Technology DOI: http://dx.doi.org/10.5772/intechopen.90727*

*Innovations in Assisted Reproduction Technology*

18.81%.

mean rate of 18.31% [6].

**3. Ethical assessment of ARTs**

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

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

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],

Nevertheless, regardless of the medical and social benefits they offer, it is also a reality that ARTs may present bioethical issues that are worth considering. These may be moral or ethical. Moral implications are related with the fact that they involve the instrumental manipulation of fertilisation, disregarding its natural environment, the sexual act, and the implications that may arise from this. Ethical implications entail the bioethical problems related to the medical aspects of these

3.The surplus human embryos that are frozen, as well as the problems that may

5.The embryo selection that is carried out using preimplantation genetic diagno-

6.Gamete donation, especially the right to privacy of donors and of children to

8.The possible use of these techniques for social purposes, unrelated to the woman's own fertility, such as 'gestational surrogacy' and 'social freezing'.

Children born by ART have a higher percentage of adverse medical effects than those conceived naturally [21–29], which gives rise to unanswered bioethical

9.The possible hyperinflated success rates in advertisement of assisted reproduc-

with the total number of births estimated at over 5 million [20].

techniques, which are the concerns that we shall analyse in this chapter.

These ethical concerns include those related to:

arise from the treatment given to such embryos.

sis (PGD) to transfer only the best quality embryos.

1.Children born by these techniques.

4.The loss of embryos that occurs in IVF.

7.The production of saviour siblings.

tion clinics may present to attract customers.

**4. Medical problems in children born by ART**

2.Couples who use IVF.

know their parents.

**198**

questions.

Thus, these children have higher rates of prematurity and low birth weight [30] as well as an increased risk of birth defects [31–33], especially cardiac malformations [34, 35] and chromosomal abnormalities [36], than children conceived naturally. Another study nonetheless failed to confirm these differences when children were stratified according to the age of their mothers, parity and gestational age [37].

Although some evidence has suggested that these types of medical disorders extend to early childhood [38] and even longer term [30], a recent article assessing whether the negative side effects are maintained until 25–30 years after birth found that these abnormalities are not detected in adulthood [39].

In addition to the disorders mentioned above, children born by ART may also show an increase in acquired medical problems, such as: impaired psychomotor development, cerebral palsy, autism and even asthma [38, 40, 41].

Another issue that has also arisen is whether the increased risk of these negative side effects occurs equally in children born by IVF or by ICSI. Most researchers' opinions are that there seem to be no differences between both techniques [42–45], although others have found a greater number of problems when ICSI is used as compared to IVF [25].

With respect to the cause of the problems in children born by ART, this seems to be multifactorial, and it may basically be due to the technique itself (the manipulation of gametes, the practice of PGD, the culture medium and the time that embryos have been frozen), ovarian hyperstimulation of the mother [46, 47] and also due to paternal subfertility [21]. In particular, it may be related to the greater number of multiple pregnancies that occur in ART [48–52], since multiple pregnancies are known to be accompanied by more foetal congenital abnormalities [49, 53–55], although these are also found in singleton pregnancies using ART [21, 23, 28, 47, 56].

It has recently been suggested that the medical problems found in children born by ART could also be related to epigenetic modifications, which may occur during maturation of the gametes, fertilisation or in the early stages of embryonic development [21, 22, 28, 30, 57, 58].

### **5. Medical problems in mothers who use ART**

A majority of adverse medical events that occur in women who use ART seem due to the greater number of multiple pregnancies that occur in them [49–52, 59] since, as has already been mentioned, obstetric problems are known to be more common in multiple compared to singleton pregnancies [49, 53–55].

Nevertheless, ART-conceived singleton pregnancies also present a higher risk of adverse events in mothers, such as antepartum haemorrhage, hypertension during pregnancy, premature rupture of membranes or gestational diabetes, than naturally conceived singleton pregnancies [60].
