Reproductive Technology

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Reproductive technology also known as Assisted reproductive technology (ART) is what encircles the majority of current use of technology in human and animal reproduction. This technology has made it possible for couples who suffer from the lack of conceiving children to have kids of their own due to its aid in conceiving children for infertile couples.[1] The first use of a technique considered reproductive technology was in 1978 and the first time ART became legalized in the United States was in 1981. It has been shown that this technology gives safe, healthy, and improved reproduction.[1] Anonymous donation is a significant part of reproductive technology; there are many donors who choose to stay unidentified, however, the system of keeping an anonymous identity varies in different parts of the world. Each country has its own system in how they legalize the anonymity of the donors.[1] Because in certain parts of the world it is hard to keep a hidden identity, this matter has raised many concerns on how ethical ART is in regards to personal and private information.[1] Not only that, but also the fact that online websites are widely available for conceived children to find out who their true parents are through a DNA or genetic test.[2] This has been one of the reasons why in the world donors' anonymity is being banned.

Petri-Dish with Oocytes [3]
DNA [4]

Overview

Reproductive technology is used to assist with infertility as well as low fertility. There are many different types of techniques associated with reproductive technology. The most common is in vitro fertilization.

In vitro fertilization

In vitro means outside the body, in which the technique of ART is being made outside a female's body.[5] In vitro fertilization is the combination of an egg and a sperm in a glass tube; this process is time consuming due to its complexity of how the egg is acquired and mixed [5]

Types of Reproductive Technology

Assisted Reproductive Technology (ART) uses medical procedure and involves in vitro fertilization (which is where a female’s egg is combined with a male’s sperm outside of the body). [6] Another type of reproductive technology is gamete intrafallopian transfer (GIFT), which is an in vivo process by obtaining an egg from an ovary and mixing it with sperm directly inside the body then reinserting it into the fallopian tube by GIFT. [6] A similar procedure is called Zygote intrafallopian transfer (ZIFT). The only difference between GIFT and ZIFT is that with ZIFT the egg and the sperm are mixed in a lab setting rather than in the body, hence in vitro. These techniques all aid with low fertility or no fertility at all and over the years the number of individuals who are utilizing reproductive technology has drastically increased to approximately 40% of Americans. [6]

Ethics

How Ethical is it to Release Private Embryo Donors' Information?[7]

Recipients

Recipients have the ability to choose their specific egg/sperm donors depending on various characteristics such as race, ethnicity, educational background, and/or religion. Recipients are required to undergo evaluations where the physician must obtain a full medical history from them and their partner, as well as a complete demanded physical exam including blood testing along with various gynecologic testings. They must also be screened for different disease such as syphilis, hepatitis B and C, HIV, West Nile and more.[8] Personal information on the recipients must also be obtained, such as, name, date of birth, address, and all of the medical history.[8] This process alters human enhancement and plays with bioethics. In the 1980's, there were many concerns regarding ART for its safety, its consistency of various data from clinics regarding pregnancy success rate, and its accessibility for different economic backgrounds.[9] Due to such concerns the government legislated the Fertility Clinic Success Rate and Certification Act in 1992 requiring all ART clinics to inform the CDC with all the data regarding performed procedures and success rates. The data transferred also included personal information of all recipients and donors.[9] These laws were made to ensure that patients are well informed of the different clinics’ success rates, however, this has taken a different route in which clinics started to indirectly manipulate their data. Clinics started to “cherry pick” their patients in order to increase their success rate.[8] This has led patients with a poor pregnancy prognosis to not have as much access to reproductive technology relative to those who have a higher chance of getting pregnant.[8] In order to avoid false optimism and unnecessary fears, patients value counseling and accurate information. Therefore, the inaccurate measurements that were being made using various computer systems have affected those who are using reproductive technology to have children, giving them false hope and fake optimism.[8] This eventually has led individuals' to distrust infertility clinics which skewed their data even more.[8]

Third party system

This term explains the idea that a third individual other than the two main couples will be assisting in giving either eggs or sperm for the couple’s use. This can be socially, legally, and ethically complex. There are many who perform anonymous donation which is donating without the reveal of their identity, some people, however, do choose to be known.[10]

Donors

All embryo donors are required to undergo intensive screening processes that include history and physical medical exams, as well as detailed genetic testings for diseases.[11] They also have to answer question regarding their sexual history, substance use, history of family disease and psychological history.[11] Such private information is mainly stored in computer system with access from the clinic, nevertheless, one mistake is able to reveal much information.[11]

Special Case

Two couples, A and B, A the donors and B the recipients did not know each other. Couple A donated eggs to couple B and B left the country. As couple A wanted to have children they found out that she cannot have kids anymore due to health reasons and now she was seeking to find couple B and ask if she is able to use some of the oocytes that she has donated before.[12] Moreover, as couple A gets in contact with the clinic, the clinic makes an error and wife A learns the names of couple B. She also learns that husband B is suffering from drug addiction withdrawal. Couple A also learns that couple B is international now. This information was meant to be super private for couple B as that is what was communicated to them when they agreed to go on this journey with couple A. The level of anonymity couple B was promised was not true as when the clinic made one mistake of giving away the names of couple B there was a lot found out due to some internet search.[12]

Hidden Identity

There has been many controversies regarding the choice of a donor remaining anonymous. Many donor conceived adults have reported that they are using a combination of techniques where they are able to eventually find their original parents.[2] Many countries have abolished the anonymity of donors at a certain age for the conceived children.[2] There are many online utilities where with genetic/blood testing the donor’s identity could be easily found.[2] The use of ancestry registries is also beneficial in finding donor’s information.[2] Moreover, there are many online websites that are being developed and are already made and filled with a bunch of personal information of different individuals that could be found by doing a simple genetic test.[2] Websites such as donorconeption.com, which help donors and the conceived children to find each other by combining various information.[2] This incredible use of technology decreases the likelihood of the donor’s identity to stay anonymous regardless of whether or not they wish to do so.[2] websites such as ancestry.com with family testa and register could easily find the donors.[2] Therefore, the offering of being an anonymous donor is not fully true in this day and age due to the developed online websites and technology that could find related individuals.[2] Therefore, donors as well as recipients have to understand that even though the law allows anonymity is it subject to change any time and there is no full guarantee.[2] Many countries have already stopped providing anonymous donation duo to various reasons that mainly impact the donor’s conceived child.[2]

Issues

An experiment was conducted to measure how accurate the information the donors received prior to performing the procedure and how much they have suffered from long term side effects. A small majority of donors said that their experiences aligned with what they were told regarding the process, but about 30% of donors disagreed and stated that their experiences did not match the expectations.[13] Over 55% of the participants indicated that they did not receive accurate information about the long and short term effects of egg donations.[13] About 60% reported that they did had immediate medication side effects while approximately 40% stated that they have suffered prolonged side effects and were misinformed of such details.[13] These issues affect the trust and reliability of fertility clinics when it comes to donating eggs/sperms.[13] Misinformation regarding individual’s health is crucial and could eventually lead to death.[2] There are also religious, cultural, and political factors that play a role in egg donation which could cause various issues. For example, donors from different countries face many challenges due to home countries prohibiting egg or sperm donation.[2] The restrictions and illegalization is mainly due to religious factors which have impacted how these countries view egg/sperm donation.[2] However, countries like Germany, rather than religion, they are concerned with ethical identity factors of the mother who will be giving her own egg to someone else.[2] The embryo Protection Act of 1990 in German illegalizes embryo transfer due to the threat to the legal definition of the mother and motherhood arising from genetic, gestational, and social mothers.[13]

UK System

The UK has a different law regarding egg/sperm donors and their anonymity. According to the UK law, egg or sperm donor’s conceived children have the right to full exposure of their genetic parent once they reach 18.[14] However, the donor has no right over the child once they donate their egg/sperm and the child is conceived.[14] Therefore, the UK has recommended that those who want to stay anonymous for the time being must be open to the fact that their identity will eventually be “unhidden” and their donated egg/sperm conceived children will have the ability to find them and retain personal donor’s information such as: Name, physical description (height, weight, eye and hair color), the year they were born as well the country of their birth, their ethnicity, whether or not they had kids during the time of the procedure, their gender, their marital status, and medical history. Much of the private information will be revealed thru the use of computer system to the conceived children only.[14] The reason to this law is due to the fact that some children who grow-up knowing that they are conceived thru egg/sperm donation lose a sense to their identity which could have a long term side effect on them psychologically as well as mentally.[14] However, thought the law of the UK does not entirely allow anonymity of donors it still handles the given information with sensitivity in assurance that it is being reached to the conceived child only.[14] There is a certain long process that the child themselves have to go through before they are allowed access to the donor’s private information.[14] Nevertheless, the law still warns regarding the fact that even though information is being handled with sensitivity, it is inevitable that home DNA testing and matching services that are available online can easily identify the hidden donors regardless.[14] This system was developed due to the belief that conceived children have the rights to acquire critical knowledge regarding their genetic parents.[14] It has been controversial in terms of how the information of the anonymous egg/sperm donors is easily released to those who ask for it although they do have a long process to go through themselves.[14]

US System

The US is one of the few countries that still gives hidden donors the opportunity to stay hidden as long as they wish to. It is inevitable that there are also genetic service and ancestry websites that donors’ conceived children could utilize to obtain information regarding their donors.[15] Nevertheless, there is not a specific law that allows the conceived child to access private information of the egg/sperm donor. Yet, to prevent the fact staying anonymous is a bit difficult with all the developed technology and computer online services/systems the US used a special technique where they made their donors choose to be known.[15] This technique was through money incentives, where in 2006 anonymous donors were paid $65 through the bank, yet known donors were given up to $100 per donation.[15] They want individuals to choose for themselves rather than be forced to reveal identity, however, with such a strong tactic how ethical this process is still unknown.[15] Additionally, similar to the UK, the donor has no right over the conceived child once eggs/sperms are donated. The hidden donors do not have much say in whether or not they could be found.[15] With the advanced development of many new information websites, any individual is certainly found with some genetic or blood testing.[15] The websites that provide such critical information are well protected to have the information be given out only to those who are considered "related" according to the website.[15]

South Africa System

South Africa follows a similar law with the UK in the terms of donor’s anonymity.[16] Their SA’s Children Act provides the conceived children all the information necessary and needed to know regarding their genetic parents.[16] This have caused some sensitivity to some donors when it came to identity release due to them hoping to stay anonymous.[16] A 150 egg donors participated in an online survey regarding their egg donation experience in SA.[16] Some participants spoke regarding the want to staying anonymous, however, anonymity in SA is prohibited after a certain age of the conceived child. Nevertheless, many of the donors stated that they do not regret donating their eggs regardless if their information was going to be public.[16] The act of identity release has instead helped out young adults to find their genetic parents and communicate with them for more advantages than disadvantages.[16] In addition, individual's taking the survey expressed that they were misinformed regarding how their health was going to be impacted due to egg donation as well as how the whole process was supposed to happen.[16] 7% expressed negativity as they wished they were given more accurate information regarding the side effects as well as the whole process since they were not given proper informed connect and were not exactly told of the long lasting side effects their health could suffer.[16] Such miscommunication of information for an important matter displays that information exposure might be biased and that is shown through the fact the those who were not informed with the proper process were from the lower class of the population.[16]

Legal Issues

With such a complex process of egg/sperm donation legal issues are inevitable. Written consents are required for all procedures, incase where situations such as the donors or the recipients have a change of mind last minute or when the procedure is already done. Recipients and donors both are advised to obtain a lawyer and sign a legal contact regarding the financial obligations and right of the donor with respect to the donated gamete as well as the rights of the recipients.[1]

Future: AI and Reproductive Technology

There has been a connection with reproductive technology and artificial intelligence. The role of AI in ART has big data that include electronic medical records and other data.[17] The electronic medical records can acquire data from many different ways in which it is analyzed using artificial intelligence as machine learning and language processing.[17] Machine learning has improved ART due to its ability of allowing computers to detect patterns from a large database and use this information to make predictions regarding the performance of ART.[17] AI can become an enhancement to physician’s knowledge regarding better embryos and sperms for ART.[17] This technology will give doctors greater in depth data that is more significant in creating high quality ART procedures.[17] An important aspect to a successful embryo transfer is the quality of the embryo itself and due to the fact that has been difficult to judge regardless of the increasing success rate of ART. Therefore, the chance of artificial intelligence being used to solve such a dilemma is expectable with the use of complex diagnostic and therapeutic modalities.[17] This data collection is said to start with medical records data and hospital data and data could sharing.[17] Data is said to be collected through an interconnected network of patient from across the world and in addition to medical records, medical imaging, laboratory exams, genetic information, and health records are also processed through AI; this process can save doctors a lot of time and give more precise and accurate results that is statistically measured.[17]

Ethical Issues with AI

The data collected must be kept confidential and does not get easily leaked out. The clinics and those involved in the creating must be fully responsible to the algorithm of machine learning outcome.[17] How well AI would be for ART depends on the performance of machine learning which includes the quantity and accuracy of the data.[17] It is possible that selection bias from sample collection could occur an result in poor data quality which leads to poor performance of machine learning algorithms in the clinical systems. The utilization of such private information as well as its collection is important and must be handled with full care.[17]

Risks of ART

There are some potential risks that are associated with ART, which include multifetal gestation, prematurity, low birth weight, perinatal mortality, and many other birth defects.[17] However, with the use of modern technology, and also as predicted with artificial intelligence such events could be highly prevented with the use of machine learning.[17]

See Also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Brezina, P. R., & Zhao, Y. (2012). The ethical, legal, and social issues impacted by modern assisted Reproductive Technologies. Obstetrics and gynecology international. Retrieved February 11, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3261493/ .
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 Cohen, I. G. (2015, May 1). Sperm and egg donor anonymity: Legal and Ethical Issues. SSRN. Retrieved February 11, 2022, from https://deliverypdf.ssrn.com/delivery.php?ID=081001096020076069083119003071114086033075065035019070107070098030004089065003086118056100018023015058017100113101007007126010021
  3. ↑ Assisted Reproductive Technology. Sutter Health. (n.d.). Retrieved February 11, 2022, from https://www.sutterhealth.org/services/fertility/assisted-reproductive-technologies
  4. ↑ SART. Sutter Health. (n.d.). Retrieved February 11, 2022, from https://www.sutterhealth.org/services/fertility/assisted-reproductive-technologies
  5. ↑ 5.0 5.1 J. (n.d.). Application of computer technology to Reproductive Endocrinology. Clinical obstetrics and gynecology. Retrieved February 11, 2022, from https://pubmed.ncbi.nlm.nih.gov/2776380/
  6. ↑ 6.0 6.1 6.2 WebMD. (n.d.). Gift and Zift treatments for infertility. WebMD. Retrieved February 11, 2022, from https://www.webmd.com/infertility-and-reproduction/gift-and-zift/.
  7. ↑ https://cdn.theatlantic.com/thumbor/F20DkzjkjnnbUN6Eb8FS8XHrGeE=/0x0:2500x1406/1952x1098/media/img/mt/2021/10/Atlantic/original.jpg
  8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 International, E., 2022. Embryo Recipient Q & A | Embryo Donation International (EDI). [online] Embryodonation.com. Available at: <https://www.embryodonation.com/questions-and-answers.php#screening/> [Accessed 11 February 2022].
  9. ↑ 9.0 9.1 Cdc.gov. 2022. Policy Document | Assisted Reproductive Technology (ART) | Reproductive Health | CDC. [online] Available at: <https://www.cdc.gov/art/nass/policy.html#:~:text=In%20response%20to%20concerns%20about,government%20in%20a%20standardized%20manner> [Accessed 11 February 2022].
  10. ↑ “Reproductivefacts.org. 2022. Third-party Reproduction: Sperm, egg, and embryo donation and surrogacy. [online] Available at: <https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/third-party-reproduction-sperm-egg-and-embryo-donation-and-surrogacy/> [Accessed 11 February 2022].
  11. ↑ 11.0 11.1 11.2 “Donors.” 2022. Available at: <https://www.dovepress.com/getfile.php?fileID=21784/> [Accessed 11 February 2022].
  12. ↑ 12.0 12.1 Rizk, Marianne, and Stacey Pawlak. “A Case Report of Embryo Donation: Ethical and Clinical Implications for Psychologists.” Journal of Medical Ethics, vol. 42, no. 10, BMJ, 2016, pp. 659–64, http://www.jstor.org/stable/44014448.
  13. ↑ 13.0 13.1 13.2 13.3 13.4 Readings, J., Blake, L., Casey, P., Jadva, V., & Golombok, S. (2011, May). Secrecy, disclosure and everything in-between: Decisions of parents of children conceived by donor insemination, egg donation and surrogacy. Reproductive biomedicine online. Retrieved February 11, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155651/
  14. ↑ 14.0 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 Egg Donation in the UK. Academic.oup.com. (n.d.). Retrieved February 11, 2022, from https://academic.oup.com/humrep/article-pdf/14/7/1912/11496611/141912.pdf/
  15. ↑ 15.0 15.1 15.2 15.3 15.4 15.5 15.6 Center, P.-F. (2015, April 28). Sperm and egg donor anonymity: Legal and ethical issues: Re. The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. Retrieved February 11, 2022, from https://petrieflom.law.harvard.edu/resources/article/sperm-and-egg-donor-anonymity-legal-and-ethical-issues/
  16. ↑ 16.0 16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8 Thaldar, D. (n.d.). Egg donors' motivations, experiences, and opinions: A survey of egg donors in South Africa. PLOS ONE. Retrieved February 11, 2022, from https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0226603
  17. ↑ 17.00 17.01 17.02 17.03 17.04 17.05 17.06 17.07 17.08 17.09 17.10 17.11 17.12 Wang, R., Pan, W., Jin, L., Li, Y., Geng, Y., Gao, C., Chen, G., Wang, H., Ma, D., & Liao, S. (2019, October). Artificial Intelligence in reproductive medicine. Reproduction (Cambridge, England). Retrieved February 11, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733338
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