Nov 09, 2024
New Delhi: Many ethical concerns are raised when it comes to the In Vitro Fertilization (IVF). In vitro fertilization (IVF) is an innovative medical procedure that has transcended the boundaries of traditional conception methods, offering hope to countless couples who are battling infertility challenges.
It is one of the common alternatives chosen by couples to conceive, especially in cases of blocked fallopian tubes in females, male factor infertility, recurrent miscarriages, endometriosis, or diminished ovarian resewe. During this procedure, the eggs and sperms are combined outside the body in a controlled laborat01Y environment, and the resulting embryo is transferred back into the uterus with the aim of fulfilling the dream of having a baby.
When exploring the option of in vitro fertilization (IVF), one cannot overlook the ethical complexities that are linked to this popular technique and one such pertinent question which remains unanswered is— the optimum number of embryos to be transferred during IVF. More the number of embryos transferred, more are the chances of multiple pregnancies.
This is done to maximize pregnancy rates in order to sustain the competition between IVF units, and making the treatment more cost- effective.
The practice of multiple embryo transfer can pose serious risks to both the mother and the infants. Almost every obstetric complication happening in a singleton pregnancy is more common in multiple pregnancy and even routine life after delivery is more difficult for the parents with increased incidences of anxiety and depression. Risks to the children can be due to premature delivery, complications of intra- uterine growth retardation and all these can have short term and long term ill effects on the babies. Further, the health care costs related to the management of these complications increase and higher number of multiple pregnancies can be a public health issue.
However simply stating that multiple pregnancy has potential risks to both the mother and child doesn’t mean that multiple embryo transfer should be prohibited.
There is a need for proper legislation on the number of emblyos to be transferred to curtail both the parental and physician autonomy.
The parents have the right to decide as to how many children they want in their family and the IVF specialist has a moral obligation towards both the parents and the future child. Hence a conscious decision regarding the number of embryos to be transferred has to be made considering many factors because any risk to either the parent or the child may be morally and ethically unacceptable.
The key component of IVF treatment is informed consent.
In order to make decisions that are consistent with their beliefs and goals, couples must have a thorough understanding of the physical, emotional, financial, medical and ethical components of the procedure.
This covers the risks and benefits of single embryo transfer vs multiple embryo transfer and also their choices about cryopreservation, embryo selection and genetic testing. The decision regarding performance and possibility of multifetal reduction should also be discussed in length.
The ethical dilemmas of reduction is perceived as a problem of abortion. Regardless of the education provided before treatment, people may still consider decision to reduce the number of emblyos as psychologically demanding and it is better not to go to that stage where couples have to take certain decisions which may jeopardize their present pursuit. Hence prevention of multiple pregnancies should be preferred to multifetal reduction of pregnancy.
Age, parity, diagnostic criteria and co-existing medical conditions are examples of patient variables that affect the decision-making process. Couples should be informed about the potential dangers and how these factors may affect the treatment outcome, since they have an impact on the overall success of IVF.
Technological advancement such as pre — implantation genetic testing (PGT-A) offers the parents an opportunity to screen for aneuploidy or genetic disorders and provide optimal pregnancy rates after elective transfer of a single normal embryo.
Another factor to be considered is concerns of couples on cryopreservation of emblyos as many of them tend to experience emotional distress and this should be well addressed.
Finally—the—prognosis – patients need to know about their chances of success depending on their particular medical/ obstetrical background, their profile as a patient — poor responders or poor implanters, their infertility treatment history, the quality of the embryos and the clinic’s experience. This aids them in reaching practical decisions.
The treating physician and the couple reach an agreement on the modalities of treatment. Finally as adults, patients should have an ultimate say on the treatment that they would wish to receive within the framework of risks vs benefits and all the associated treatment alternatives prioritizing health outcomes.
This article is written by Dr. Vandana Bhatia, Fertility Specialist , Nova Southend Fertility and IVF, Vasant Vihar.
Source: Economic Times