Making babies for love and profit!

Tough legal and ethical challenges face fertility treatment

By Lahiru Fernando

Assisted Reproduction Technology (ART) has now become a familiar practice in several private clinics in Sri Lanka to help infertile women and men to become biological parents despite problems they face with their reproductive organs and conception. This is essentially a medical and surgical procedure when fertilization takes place in a laboratory setting in a Petri dish or test tube with the egg surgically extracted from a woman and mixed with male sperm. After a few days, the fertilized egg is re-inserted into the woman’s reproductive tract through a surgical process called embryo transfer. This is the most common ART technique known as Invitro-Fertilization (IVF). Invitro is Latin for “in glass” and refers to events taking place outside the human body in an artificial environment   involving medical and scientific manipulation of human reproductive material as the female egg and the male sperm to produce a full term pregnancy. Such medical innovations have steadily gained ground the world over since the first IVF baby was produced in 1978.
We may pride ourselves with having acquired the new technologies of reproduction in IVF and other ART.  However the lack of regulatory measures and monitoring has left no room for considerations of our culture moral and societal values.  Parents desperate to have children become very vulnerable and susceptible to the promises of doctors and skilled clinicians who gushingly proclaim the joys of helping them to have their dreams come true! But it remains vital through   enacting mandatory laws and procedures to safeguard their interest as well as prevent exploitation of donors, women and the despoiling of our Sri Lankan culture, values and identity by wholly embracing new technologies without adapting these to our own home grown solutions.
It is a fact that at present Sri Lanka has no specific legislation to govern, monitor and regulate ART and IVF procedures. In contrast there are regulations in the Penal Code as well as in the Transplantation of Human Tissues Act  No: 48  of 1987 to prevent trafficking in unborn children and transplant rackets in trade in body parts. IVF Reproductive Centers generally purport to follow voluntary ethical guidelines and report to the Sri Lanka Medical Council in a leissez   faire environment where nothing is mandatory or served by legal enactments and implementation. Babies are made “mimicking nature” in a world of invisible trade and fluid boundaries! Internationally many countries have adopted legal measures to license IVF/Fertility clinics under terms of complying with high normative standards and practices. This is especially so since in many parts of the world fertility doctors have become millionaires with average cost of IVF cycle and hormonal treatment rising astronomically. Recent report of how a fertility doctor in UK delivered himself an $8million profit in IVF boom made media headlines.
 Therefore serious moral and ethical questions arise in a relatively uncharted terrain where many could abuse such opportunities for commercial gain and unethical business practices. When unfertilized eggs from a woman and sperm from a man are combined in a laboratory dish they result in a generation of embryos. However only one or/multiple healthy embryo would be surgically implanted in the prospective mother’s womb. What of the other healthy embryos left in the laboratory? Are not these the beginnings of human life? What is the state of these embryos? Are they spares? Don’t they have the right to live?  In a Buddhist country where people possess an inherent desire to protect all life and even disdain to consume or break eggs from free run poultry thinking that they could be fertilized, shouldn’t we be concerned what happens to these human embryos? The destruction of human embryos, the lack of property rights as to who owns them are issues that remain unresolved.
There are profounder ethical dilemmas and commercial prospects when we consider the further extensions of IVF practices such as donor eggs or embryos. By using a surgical procedure donor eggs are harvested from a fertile woman and undergoes invitro fertilization to generate donor embryos, which will be implanted in the infertile woman. Many Clinics in Sri Lanka now possess facilities for freezing human embryos and  maintaining Sperm Banks with freezing of  spermatozoa  which is made available at cost to interested parties. Prospective parents who sincerely desire a child of their own blood could be swindled by unscrupulous agents who may well implant material from Donor Banks and Sperm Banks which are more likely to germinate and lead to successful outcomes than that which is extracted from the actual clients. Further the existence of such Donor Banks for purpose of propagation could result in artificial selection of gender; some parents who want desired traits in their children could select sperm or egg from sources considered to have a high intelligent quota, or from  preferred racial or ethnic  backgrounds
In Sri Lanka surrogacy is currently practiced where a woman contributes eggs and or carries a pregnancy for another person or couple who want a child. Are we to encourage pregnancy for profit with surrogacy options? If one woman donates an egg, another carries a pregnancy as a surrogate mother and a third raises the child who will have the parenting rights? Women in their 60’s could become mothers like acquiring household toy pets without a care or responsibility about the future of such children as they go well into old age!
 Some reputed clinics in Colombo allow the parents to bring the donor for egg or sperm. A further question is what are the rights and responsibilities of sperm donors and children conceived through sperm donation?  In some countries with extremely flexible IVF regimes, lesbians and gay couples have entered the IVF process with single participation and donor sperm/egg bank assistance and become proud parents. Recently an Israeli gay couple came to India to have a baby through IVF.
The fact that IVF is performed in privately run centers for profit without national legislation in this area   is what compounds the problems of its possible abuse. National hospitals in Sri Lanka do not currently provide such services and it is the lot of the couples who desperately desire to have children to rely on the burgeoning trade of the private IVF clinics. Here they are often faced with lack of insurance cover rising costs of treatment that is often necessary to repeat of over half a million rupees.