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The Honolulu Advertiser
Posted on: Monday, June 23, 2003

The ethics of in-vitro

 •  Previous story: New techniques build hope, families for infertile couples
 •  What about surrogacy?

This is the second in a two-part series.

By Mary Kaye Ritz
Advertiser Religion & Ethics Writer

A Journal of Science photo shows human sperm, which may "sniff" their way to the egg during fertilization, a finding that may lead to better in-vitro techniques. A smell receptor was found on the surface of human sperm cells, similar to those in the nose.

Associated Press

Dot Shigemura was on a local TV talk show describing the pain of infertility when the comment came over from a viewer: "Tell that woman that God tied her tubes."

Luckily, the moderator didn't pass it along while Shigemura was on air, otherwise the founder of Resolve of Hawai'i, a fertility support organization, doesn't know what she might have done.

Shigemura, a cradle-to-grave Episcopalian, had friends and fellow members of St. Barnabus sending out choirfuls of prayers on her behalf.

She believes her two sons — one conceived naturally, the other through in-vitro fertilization — are God's answer to her prayers.

While society has yet to catch up to science in a host of "What is life?" questions, latest technologies for fertility treatments raise a fresh crop of new ones.

The old questions: What is considered acceptable lengths to go to to have a child in one's own image? Do we have a "right" to have children? Should embryos be accorded rights and privileges of human beings?

Theologians and moralists continue to struggle with those issues. But now comes a host of new ones:

Who "owns" frozen embryos in a divorce? What about genetic testing that filters out a girl embryo from a boy? Should egg and sperm donors have a chance to meet their genetic offspring someday?

Scientific advances answered some of the older questions for us: With better laboratory incubation, fewer embryos are being implanted via in-vitro fertilization. That peels the sticky problem of multiple pregnancies off the top of the heap, because selective abortion is no longer necessary.

Neonatalist Dr. Gardner Bemis, Kaiser hospital's Biomedical Ethics Committee co-chairman, is fascinated with the questions arising from frozen embryos and surrogacy.

"Whose property are they?" he asked. "What happens in the event of a divorce, or if the wife says later she wants a baby but the husband doesn't? There's a whole lot of issues that haven't been worked out."

Such as, in surrogacy, what happens if the gestational host refuses to take the baby to term? Or what about when scientists will be able to take DNA from one woman and implant it into another's egg?

"It should get even more messed up," Bemis said. "You're going to be hearing about it."

Society will struggle to catch up.

"The law hasn't even taken care of adoption very well, and now we're moving into a new area that opens up a whole new host of questions ... I just hope someone in the in-vitro fertilization field is willing to pay attention to legal issues, so we don't end up with destroyed families along the way," Bemis said.

Dr. Tom Huang says embryo selection — the ability to select a male or female embryo — is a sticky issue. "If (prospective parents) request, should you do it? ... Professionally, we're (looking to) set guidelines for what we ought to provide," he said.

Richard Ambo • The Honolulu Advertiser

Senior Family Court Judge Frances Wong said the legal community encourages people to "discuss the ramifications as much as possible before they come to us."

Frozen embryos have been considered property in divorces, though Hawai'i has no such case that has gone before its Supreme Court. Sometimes, though, Wong pines for the good old days.

"It's very difficult for judges, who are not and shouldn't be activists, but when you have this area where technology is outstripping the community's ability to legislate, the judges are being asked to make decisions where there are fewer parameters than we're used to."

The Rev. Mark Alexander, theologian for the Honolulu Diocese of the Roman Catholic Church, laughed when reached by phone.

"How come you never call for the easy ones?" he said.

For the record, the Catholic Church opposes in-vitro fertilization.

"We believe human procreation belongs in marriage and you need to maintain the unity of the marital act," Alexander said, adding that it's a "marital act, not a technical act." Procreating isn't manufacturing, said Alexander, for whom fertility is an issue that hits close to home: His sister discovered she is infertile.

Artificial insemination is different, Alexander said, providing the method "wouldn't involve compromise of the marital act — then it's allowed." The difference is a subtle one, between assistance and replacement: "We have no problem with assistance, like drug treatments," he said.

Alexander, pastor of the Manoa Punahou Catholic Community, remembers when the Legislature required that insurance cover a single in-vitro fertilization attempt in 1987, and the controversy swirling around that. The measure initially was vetoed.

When he hears of the Chuns, Catholics whose single embryo was implanted in a single in-vitro fertilization attempt that led to the birth of "miracle baby" Noah, he said he's heartened to hear they struggled with their decision. He notes that sometimes people of conscience make decisions that the church doesn't agree with, such as to use birth control or in-vitro fertilization.

Intracytoplasmic sperm injection takes place at Pacific In Vitro Fertilization Institute using a very fine-gauge needle. The result: an embryo.

Dr. Tom Huang • Pacific In Vitro Fertilization Institute

"It's not a process that we believe is morally illicit. You don't undergo it under pain of excommunication," said Alexander, who also knows he has baptized babies who were conceived through in-vitro fertilization.

The major stumbling block to IVF, in the church's viewpoint, is the question of extra embryos.

They are life, Alexander said, not "zygotes," not "biological matter."

"We believe they have the status of being persons, and so should be treated as persons," he said. "Sometimes, you freeze them indefinitely, sometimes they're destroyed, sometimes terminated at a later time in development" — all of which the church opposes.

Shigemura, daughter of an Episcopalian priest, said she knows of Catholics who ask that a fertility clinic create only a set number of embryos. Doctors counsel them on the percentage needed but try to honor their faith background.

She also knows about crises in faith by Resolve newcomers. When they ask about their religion's views, she has a 10-page fact sheet, "Collection of Religious Perspectives about Infertility," ready to put in their hands.

Resolve's position on embryos as life, Shigemura said, is: "We know that not all those embryos would become life, so we believe in the patient's ability to choose what to do with those embryos, free of any outside interference."

Even stickier wickets have to do with embryo selection and donor selection, when it's not nature vs. nurture, but nature vs. better nature.

Some technologies allow screening for certain genetic disorders that affect, say, only males. In those cases, families could request that only female embryos be implanted. But what if you want to "balance" your family, a boy for you, a girl for me?

Dr. Tom Huang, a fertility specialist with Pacific in Vitro Fertilization Institute, said he knows that has been done elsewhere, and adds that genetic testing adds another sticky element to the petri dish.

"If they request, should you do it? ... Professionally, we're (looking to) set guidelines for what we ought to provide," he said.

And what about those babies who grow up into children wanting to know their "genetic" parents? Will a groundswell of interest open doors, the way adoption did?

Currently, Hawai'i's only egg-donor agency does not have a registry for children and donors to meet later. And Ann Rust, founder of Pacific Connection Fertility Services, won't even pick a donor who would consider her donation to be "a future baby." Instead, she looks for young women who equate the process to donating blood.

• • •

Resolve of Hawai'i

This nonprofit corporation provides support, education and advocacy for people experiencing infertility. It conducts monthly educational meetings, has newsletters and a help line and is led by volunteers who have experienced infertility.

Meetings generally are the fourth Thursday of each month at Kapi'olani Medical Center for Women and Children, Conference Room A, second-floor cafeteria.

Contact: RESOLVE of Hawai'i, 528-8559; www.resolveofhawaii.org.