IVF: what’s the next step?

It has been stated (The Times, June 25) that 750 women in Malta achieved pregnancy through in vitro fertilisation (IVF). The IVF technique is likely to become law in Malta very soon, allowing it to be performed in public as well as private hospitals.

This removes one problem relating to accessibility: there will be no distinction on economic grounds on who will be able to take advantage of the procedure. So far so good.

Without going into details, this technique allows for the fertilisation of an ovum outside the body and thus enables pregnancy to occur in situations where this is not possible naturally.

This technique, which has been successfully performed overseas for more than a generation and has resulted in many thousands of babies, will give those couples who currently cannot conceive the chance to have a normal pregnancy – and it cannot be denied this is an extremely urgent biological imperative for some couples.

There have been many ethical objections raised against this technique on ethical grounds, but it appears to be the consensus now that as long as the sperm and egg are obtained from the potential parents and not from third parties, and as long as embryos are not destroyed in the process, this technique is acceptable to most religious denominations.

One such concern has been the idea of a ‘slippery slope’ effect: once one has accepted the first step, the next step would be more easy to digest.

One current use of IVF overseas is its use for selection of embryos to prevent the emergence of hereditary disease or for other less worthwhile purposes, such as the selection of characteristics like physical or intellectual prowess.

The use of IVF to detect (and eliminate) hereditary abnormalities has been practised for several years.

More recently, techniques are being used to select embryos from women who have a genetic abnormality, making them more susceptible to develop breast cancer.

Embryos carrying these genes (so called BRCA1 and BRCA2) can be detected after a few days of in vitro (in-glass) growth and not used for implantation.

As we are all aware, breast cancer is one of commonest cancers in the community. Hereditary breast cancer carrying these specific genes accounts for about 10 per cent of cases of breast cancer.

The biggest ethical problem relates as to whether such techniques involve the destruction of an embryo, which of course is an unacceptable procedure. IVF as such does not involve the selection of already-formed embryos and therefore does not fall under such a category.

Another ethical problem relates to modifying the gene pool. Any genetic procedure which involves the reproductive cells (as opposed to the other body cells) has the possibility of spreading into the general population with unknown future effects. This was condemned by the Council of Europe’s Convention on Bioethics several years ago.

This is one issue which the average person finds very difficult to understand. Ask 100 people whether they believe that removing or changing the genes for a disease process is a good thing or not, and chances are they will all agree that this is something worthwhile.

There seems to be a complete discrepancy between bioethical thinking and acceptance by the general public on this issue.

Unless we can convince one and all that bioethical considerations should trump public opinion, it is very likely that the next step will be a request for the introduction of genetic manipulation techniques to deal with hereditary disorders, as has happened elsewhere.

While we cannot stop the advance of science and its application to urgent medical problems, it is incumbent on us to ensure that the general public is adequately educated, to ensure informed discussions about issues which are bound to arise in the not-too-distant future.

Professor Maurice Cauchi is former chairman of the Bioethics Consultative Committee.