A fertile couple in Anhui Province gave birth to a child through IVF in 2011, only to discover eight years later that the child was not biological.
This is a news event that has been making a lot of noise in recent days. The court found in the first instance that the hospital providing IVF technology had many problems in embryo cryopreservation, such as duplicate numbers, incomplete thawing records, missing verification processes, etc. In the end, the hospital took full responsibility and was awarded 640,000 yuan.
Assisted reproductive technology, including IVF technology, has catalyzed a revolution in the field of reproductive medicine after more than two hundred years of development and has become a "gospel" for couples suffering from infertility.
But while being regarded as the "gospel", the doubts surrounding assisted reproductive technology have never stopped. At many points in the evolution of technology, the pros and cons, scientific and ethical conflicts brought by it have been intuitively presented to people.
Assisted reproductive technology is like a knot - in it, "praise" and "doubt" are intertwined and difficult to separate.
Fertility is a universal human need. Since the beginning of mankind, fertility has been a major event, as the ancient Chinese said, "death and life are also great". Human beings have survived to this day by constantly reproducing their offspring.
But for people with fertility disorders, giving birth and raising the next generation was once an unattainable dream. Human assisted reproductive technology was born to meet this need.
The National Health Insurance Administration recently issued a letter saying that assisted reproductive technology will be gradually included in the scope of medical insurance payment. [1] As soon as the news came out, there was a heated discussion in the public opinion field. Because this means that the originally expensive assisted reproductive technology will benefit more couples who have fertility intentions but have fertility disorders.
There are reports that assisted reproductive technology is expensive, especially IVF technology, "some people spend 300,000 yuan before and after, and the financial burden is large." ”[2]
The so-called human assisted reproductive technology refers to the use of medical technology and methods to artificially manipulate gametes (sperm and eggs), zygotes (fertilized eggs), and embryos to achieve the purpose of conception. [3]
(Introduction to assisted reproductive technology in humans.) Source: Screenshot of the official website of the government)
Nowadays, it is mainly divided into two main categories.
The first type is artificial insemination technology, that is, artificial (non-sexual intercourse) is used to inject semen into the female reproductive tract to facilitate the natural combination of sperm and eggs, so as to achieve the purpose of pregnancy. According to the source of semen, it can be divided into artificial insemination of husband semen and artificial insemination of donor sperm.
The technique of artificial insemination can actually be traced back to the 18th century.
In 1790 in London, England, a man was unable to make his wife normally pregnant because of hypospadias, and the physician John Hunter used a syringe to inject his semen into his wife's vagina to give his wife a pregnancy. This is also the world's first successful case of artificial insemination. [4]
In 1844, in Philadelphia, USA, there was the first successful case of artificial insemination using donor semen.
In 1953, there was the first case of artificial insemination using frozen semen to obtain pregnancy, which laid the foundation for the cryopreservation of semen and the establishment of sperm banks.
Another large category of assisted reproductive technologies is in vitro fertilization-embryo transfer technology. When it comes to this technology, one person has to be mentioned - Louis Brown.
On July 25, 1978, in the delivery room of a general hospital in the small town of Oldham, England, with a cry, the baby girl Louise Brown came to life. [5]
(Baby girl Louise Brown with medical staff.) Source: BBC)
Unlike all previous babies, Louise Brown was conceived not in the mother's womb, but in a test tube in a laboratory. To be precise, an egg is taken from the mother, in a laboratory test tube, the egg and sperm are combined, and finally the fertilized egg is implanted into the mother's uterus and developed into an embryo.
This is the first time in human history. Louise Brown became the world's first IVF baby and announced the official birth of in vitro fertilization-embryo transfer technology.
Louise's birth was seen as a "miracle of life" and something that her parents, Mr. and Mrs. Brown, once dared not imagine.
Before Louise was born, the Browns struggled for 9 years, but never got a baby. The examination found that Mrs Brown's fallopian tubes were severely blocked and adhesions were developing with the ovaries – meaning she could not conceive naturally.
The desperate couple approached Patrick Steptoe, an obstetrician and gynaecologist Stepto is a collaborator of biologist Sir Robert Edwards, and the two have been exploring IVF technology together for more than a decade.
Beforehand, the two were still unsure, believing that the probability of success was "one in a million". Finally, in this delivery room, Louise was born by caesarean section, and the staff gave her more than 60 tests and finally determined that her condition was healthy.
Today, this in vitro fertilization-embryo transfer technique, as well as some derivative techniques, including gamete or zygotic intrafallopian tube transfer, intracytoplasmic sperm microinjection, preimplantation embryo genetic diagnosis, etc.
However, since the advent of assisted reproductive technology, skepticism has been like a ghost.
According to Xiong Yuegen, a professor in the Department of Sociology at Peking University, the introduction of reproductive technology is to help people with fertility needs get rid of troubles, but it also makes childbirth no longer an internal matter of individuals and families, but gradually evolves into a public ethical issue. [6]
Emerging technologies in reproductive medicine challenge bioethics, and tensions arise between the two.
The encounter between Louise and her parents' family is a typical case. In the eyes of the Catholic Church at that time, Louise was not born naturally, but artificially manufactured and produced, which broke the nature and sacredness of life. Some church leaders have accused the technology of "playing with life."
And at that time, in vitro fertilization-embryo transfer technology was just adventing, and some scientists were also worried about the health risks of IVF.
(Louise Brown as an adult.) Source: BBC)
Because Louise was the first IVF, the family was abused, insulted and even threatened, and received sacks of "hate letters".
Once Louise's mother received a jewelry box and opened it to see that it contained a broken test tube, a red liquid like blood, and an embryo made of plastic.
In addition, surrogacy due to human assisted reproductive technology has aroused more controversy.
Surrogacy has sparked many ethical debates. This is mainly focused on commercial surrogacy, especially the exploitation and coercion of surrogate mothers in poor countries in the transnational surrogacy intermediary service chain, as well as the commercialization of uterus and baby. [7]
At present, in major European countries such as Germany and France, surrogacy is illegal.
In 2018, Indian fertility expert Nayana Patel published a paper arguing that surrogacy has sparked a series of ethical controversies. [8]
Patel listed a series of problems:
How to define the relationship between a child born through surrogacy and his biological mother, gestational mother and social mother?
Can the laws and customs of society accept this "polymatriarchy" relationship?
Does the child have the right to know the identity of any or all of the parties involved in his or her birth?
Children born by surrogacy will also face unexpected troubles.
Shirley Cruise, who lives in Canada, whose mother underwent artificial insemination and gave birth to herself out of wedlock. Because the donor didn't leave a name, Shirley didn't know who her genetic father was, so she said she always felt "missing." She felt as if half of herself was hidden behind a veil, and there was an indescribable sense of burden. [9]
"I am very sad and sad. Anyone can trace it back to my grandfather and great-grandfather, but I can't. It was as if someone wouldn't allow me to do that. Shirley Cruise said.
Although most countries ban commercial surrogacy, it has always existed as a black industry. In the market, as long as you are willing to spend money, you can often customize the surrogate mother and the gender of the child.
According to comprehensive media reports, in 2014, an Australian couple asked for a surrogate in Thailand, and the surrogate mother gave birth to a pair of dragon and phoenix fetuses. As a result, one of the boys developed Down syndrome, so the Australian couple took the healthy baby girl and abandoned the sick baby boy to the surrogate mother.
The move drew strong moral condemnation and raised complex legal issues.
In 2010, Robert Edwards, who invented IVF technology, won the Nobel Prize in Medicine that year.
By then, more than four million "test-tube babies" had been born worldwide. The award committee said his achievement provides a new avenue for treating infertility, affecting more than 10 percent of couples worldwide. [10]
(Robert Edwards. Source: Nobel Prize official website)
According to data released by the World Health Organization (WHO) in 2020, it is estimated that 48 million couples and 186 million people worldwide suffer from infertility. [11] On the mainland, the Progress and Outlook Report on China's Maternal and Child Health Undertakings released in 2019 pointed out that the infertility rate in the mainland is as high as 10%-15%.
Assisted reproductive technology is undoubtedly benefiting humanity, but it is not without hidden dangers.
A population-based analysis in Finland included singleton children born to assisted reproductive technologies with naturally conceived children in the general population and compared birth outcomes.
Results showed that children born to assisted reproductive technologies were at increased risk of adverse birth outcomes (lower birth weight and preterm birth) compared to naturally conceived children in the general population. [12]
And if technology is misused without regulation, the consequences can be unimaginable.
In the 1960s, Quincy Fortier, a well-loved obstetrician-gynecologist, did not use sperm provided by the patient's husband when treating infertility, but performed "unpacking" and implanted his sperm into the patient's egg for artificial insemination. [13]
At least 26 patients endured this "atypical sexual assault." The victim's children lived to be in their forties and fifties before they knew who their "father" was.
These victims are tormented, facing the heavy problem of family history reconstruction and inheritance, "there is no relief", "how painful, circuitous and endless these torments are for people who have suffered different forms of sexual violence".
In these victims, it is often the medical technology that brings the "gospel" that reveals its destructive side.
(Quincy Forty. Source: The Washington Post)
The mainland is one of the countries with the strictest regulation of assisted reproductive technology, and the barrier to entry is quite high. The National Assisted Reproductive Technology Management Expert Database, established in 2015, promotes the fairness and justice of the technical approval process in various places, and strengthens quality management and standardized services before, during and after the event.
Illegal acts such as illegal sperm collection, illegal egg collection and surrogacy have also been severely cracked down on in mainland China to promote the standardized use of assisted reproductive technology.
All in all, perhaps only by bold innovation, prudent application, and the reins of the law to tie it will medical technology not become an unrestrained, unbridled wild horse, but to benefit mankind to the greatest extent.
Reviewer: Teng Xiaoming
Director of the Department of Assisted Reproductive Medicine and Director of the Andrology Department of Shanghai First Maternal and Child Health Hospital
bibliography
[1]https://new.qq.com/rain/a/20230214A01U1500
[2]https://m.yicai.com/news/101507964.html
[3]http://www.nhc.gov.cn/fys/s6546/201302/0ddf1e86bc5a41908f1e6b4d6c4b5dd0.shtml
[4] Cao Zeyi. Chinese Obstetrics and Gynecology (3rd Edition)[M]. Beijing:People's Medical Publishing House,2014.
[5]https://www.bbc.com/ukchina/simp/cool_britannia/britain_focus/2015/07/150731_britain_focus_test_tube_baby
[6] Azuko Kobayashi. Reproductive Choices: Freedom and Boundaries of Fertility [M]. Cheng Lin, trans. Zhejiang People's Publishing House, 2023, 01:5-8
[7]https://www.bbc.com/zhongwen/trad/science-55757710
[8] Nayana Hitesh Patel, et al. Insight into Different Aspects of Surrogacy Practices【J】,J Hum Reprod Sci. 2018 Jul-Sep; 11(3): 212–218.
[9] Azuko Kobayashi. Reproductive Choices: Freedom and Boundaries of Fertility [M]. Cheng Lin, trans. Zhejiang People's Publishing House, 2023, 01: 68
[10]https://www.bbc.com/ukchina/simp/uk_life/2010/10/101004_nobel_prize
[11]https://www.who.int/zh/news-room/fact-sheets/detail/infertility
[12] Goisis A, Remes H, Martikainen P, et al. Medically assisted reproduction and birth outcomes: a within-family analysis using Finnish population registers【J】. Lancet 2019; 393:1225.
[13]https://www.storm.mg/article/3267611
*Produced by Tencent Medical Codex Content Team