4.3.2 Reproductive Health: Control and Use of Gametes and Embryos
Josephine Johnston, LLB, MBHL
- To understand ethical and legal issues that might arise when patients harvest gametes, receive gametes from donors and create embryos in the course of assisted reproduction.
Having tried unsuccessfully for 18 months to become pregnant, Mara (32) and Tony (37) have come to Dr. Garcia for in vitro fertilization (IVF) using Mara's eggs and Tony's sperm. Following the first egg retrieval, eight embryos are created. Dr. Garcia decides to transfer one and freeze the remaining seven. Before agreeing to the transfer, Mara and Tony ask Dr. Garcia whether they can have pre-implantation genetic diagnosis (PGD) performed on the embryo to determine whether it is male or female, since they would prefer for their first child to be a boy.
- Should Dr. Garcia order PGD to help Mara and Tony select the sex of their child?
Mara does not become pregnant following the first embryo transfer. The couple wants to try again, but this time they ask Dr. Garcia to transfer three embryos instead of only one to increase the chances of a pregnancy.
- Should Dr. Garcia transfer more than one embryo at one time? If so, is there a limit to how many embryos Dr. Garcia should transfer at one time?
Dr. Garcia thaws three embryos, of which only one survives to the blastocyst stage and is transferred to Mara's uterus. Unfortunately, Mara does not become pregnant. Mara and Tony ask Dr. Garcia to thaw the remaining four embryos, of which two survive to blastocyst stage. Mara and Tony reveal to Dr. Garcia that they are cousins. Since their first transfer, they have learned that some of their family members have albinism. Mara and Tony ask Dr. Garcia to order PGD on the embryos and to transfer only those that do not carry the genes for autosomal recessive oculocutaneous albinism.
- Should Dr. Garcia order PGD to test the embryos for the presence of albinism-causing genes?
Both remaining embryos test positive for the genetic mutation, and Mara and Tony decide to repeat the IVF process using donor sperm. Mara and Tony tell Dr. Garcia that they plan to recruit a sperm donor by advertising in a local university newspaper and offering $1,000 for a sperm sample.
- Should Dr. Garcia allow Mara and Tony to use a sperm donor to whom they are paying $1,000?
Using donor sperm, Dr. Garcia is able to create 10 embryos, of which she transfers two and freezes eight. Mara becomes pregnant with twin girls, who are born healthy. (The case continues in case 4.3.3, "Storage and Disposal of Gametes and Embryos.")
- Should Dr. Garcia maintain information about the circumstances of the twins' conception, including the identity of and health information about the sperm donor, in order to provide this information to the twins when they are older?
- Department of Justice Canada. Assisted human reproduction act, 2004 (c. 2). Available from: http://laws.justice.gc.ca/en/A-13.4/index.html.
Further Reading and Resources
- Ethics Committee of the American Society for Reproductive Medicine. Preconception gender selection for nonmedical reasons. Fertility and Sterility 2004; 82(Suppl. 1): S232-5.
- Health Canada. Assisted human reproduction website: https://www.canada.ca/en/health-canada/services/drugs-health-products/biologics-radiopharmaceuticals-genetic-therapies/legislation-guidelines/assisted-human-reproduction.html. (Includes information about any regulations made under the Act.)
- Health Canada. Assisted Human Reproduction Agency of Canada website: https://www.canada.ca/en/health-canada/services/drugs-health-products/biologics-radiopharmaceuticals-genetic-therapies/legislation-guidelines/assisted-human-reproduction.html.
- Johnston J. Mum's the word: Donor anonymity in assisted reproduction. Health Law Review 2002; 11: 51-5.
- Johnston J. Paying egg donors: Exploring the arguments. Hastings Center Report 2006; 36: 28-31.
- Min JK, Claman P, Hughes E; Society of Obstetricians and Gynecologists of Canada; Canadian Fertility and Andrology Society. Guidelines for the number of embryos to transfer following in vitro fertilization. Journal of Obstetrics and Gynaecology Canada 2006; 28: 799-813.
- Robertson JA. Extending preimplantation genetic diagnosis: the ethical debate. Human Reproduction 2005; 18: 465-71.
- Shanner L, Nisker J. Bioethics for clinicians: 26. Assisted reproductive technologies. CanadianMedical Association Journal 2001; 164: 1589-94.