Moral Exploration of Single Embryo Transfer

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Moral Exploration of Single Embryo Transfer

• Carolyn McLeod
• Samantha Brennan
• Department of Philosophy
• The University of Western Ontario

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Moral Exploration of Single Embryo Transfer
funded by a grant from
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Investigators Issues

• Carolyn McLeod, Philosophy UWO
• Patient Autonomy
• Samantha Brennan, Philosophy UWO
• Family Issues
• Jeff Nisker, Obstetrics and Gynaecology LHSC
• Social Justice Issues
• Françoise Baylis, Philosophy and Bioethics,
  Dalhousie
• Selection of Embryos

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Project Introduction

• While women or couples in infertility treatment
  may conceive successfully, they face a higher
  than normal chance of multiple pregnancy, which
  carries with it significant risks.
• Our study investigates the moral risks to
  mothers, children and families that accompany
  multiple embryo transfer in in vitro
  fertilization (IVF), as well as the potential
  alternative that is, single embryo transfer.

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Incidence of Multiple BirthsOn The Rise
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Causes of Multiple Pregnancy
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Multiple PregnancyMaternal Health Risks Include

• Miscarriage
• Hyperemesis Gravidarum (Morning Sickness)
• High Blood Pressure
• Gestational Diabetes
• Iron- and Folate-defficiency anemias
• Acute Polyhydramnios (accumulation of excessive
  amounts of amniotic fluid)
• Preterm Labour and Delivery
• Extended Hospitalization and Caesarian Delivery

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Multiple PregnancyFetal Health Risks Include

• Prenatal Mortality
• Low Birth Weight
• Birth Defects
• Infant Mortality
• Cerebral Palsy
• Multifetal Pregnancy Reduction

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Prenatal Mortality in Multiple Pregnancy
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Single Embryo Transfer as an Alternative
Fertility Treatment

• Scientific research in underway in Canada to
  optimize the chances of achieving a pregnancy
  through assisted reproduction while avoiding the
  creation of multiple pregnancies.
• One of the proposed strategies is to move away
  from multiple embryo transfer in IVF, to the
  transfer of a single healthy, fully competent
  embryo.

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Single Embryo TransferA Better Ethical Option?

• Despite the benefits of eliminating some of the
  risks associated with multiple pregnancy, the
  move to single embryo transfer is not
  unquestionably wise from an ethical perspective.
• Indeed, this procedure poses its own unique set
  of moral problems.

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Carolyns Sub-project Questions of Patient
Autonomy

• Would the strategy of single embryo transfer put
  patients in a better position to choose
  autonomously while pursuing IVF?
• In particular, which grim options would they
  avoid (e.g., selective termination) and which
  would they probably face (e.g., deciding what to
  do with left over precious embryos that they do
  not want implanted)?

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Samanthas Sub-Project Ethical Questions for the
Family

• With single embryo transfer, patients may feel
  pressured to choose the genetically perfect
  embryo. Will parents who make such a choice be
  more likely to view their children as
  commodities?
• Will they be less tolerant of physical or
  psychological problems that their children may
  develop, since great effort was taken in the
  embryo selection process to avoid imperfections?

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For More Information About This Project

• Contact
• Carolyn McLeod
• cmcleod2_at_uwo.ca
• Samantha Brennan
• sbrennan_at_uwo.ca
• Or visit
• http//publish.uwo.ca/cmcleod2/

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References

• Slide 5 Incidence of Multiple Births On The Rise
• www.multiplebirthscanada.org/
• Slide 6 Causes of Multiple Pregnancy
• Lipitz, s., Uval, J., Achiron, R., Schiff, E.,
  Lusky, A. and Reichman, B. (1996) Outcome of twin
  pregnancies reduced from triplets compared with
  nonreduced twin gestations. Obstet Gynecol, 87,
  511-514.Triplet data
• National Consultative Ethics Committee. (1991)
  Opinion on embryonic and fetal reduction.
  Opinion 024 June 24. http//www.ccne-ethique.org
  /english/start.htm
• Slide 7 Maternal Health Risks
• http//www.womenshealthchannel.com/multiplepregnan
  cies/risks_maternal.shtml
• Slide 8 Fetal Health Risks
• http//www.womenshealthchannel.com/multiplepregnan
  cies/risks_babies.shtml
• Slide 9 Prenatal Mortality in Multiple Pregnancy
• Gissler, M., Silverio, M.M. and Hemminki, E.
  (1995) In-vitro fertilization pregnancies and
  perinatal health in Finland 1991-1993. Human
  Reproduction, 10, 1856-1861.
• Lieberman, B. (1998) An embryo too many? Human
  Reproduction, 13, 2664-2666.
• Luke, B. and Kieth, L.G. (1992) The contribution
  of singletons, twins and triplets to low birth
  weight, infant mortality and handicap in the
  United States. Journal of Reproductive Medicine,
  37, 661-666.
• Tarin, J.J., and Cano, A. (1995) Effects of
  manipulations in vitro of human oocytes and
  embryos on the birthweight of the resultant
  babies. Human Reproduction, 10, 1322-1324.
• Lambert, R. (2003) Safety issues in assisted
  reproduction technology The children of assisted
  reproduction confront the responsible conduct of
  assisted reproductive technologies. Human
  Reproduction, 17, 3011-3015.