Medical, ethical and societal issues in reproduction
A couple in Galway have been trying for a baby for over two years without success. Their doctor mentions IVF. Should they try it? Who pays for it? What happens to any embryos that are not used? Science can explain how the technique works, but it cannot answer every one of these questions on its own. By the end of this page you will see why.
Infertility and IVF
Infertility means a couple cannot achieve a pregnancy after a year or more of trying. It is common, and it can affect men, women or both.
| Cause | Who | What goes wrong |
|---|---|---|
| Low sperm count or poorly moving sperm | Male | Too few sperm reach and fertilise the egg cell |
| Blocked sperm duct | Male | Sperm cannot leave the body |
| Blocked fallopian tubes | Female | Egg and sperm cannot meet |
| Ovulation problems | Female | No egg cell is released each month |
Many of these problems stop fertilisation happening inside the body. IVF (in vitro fertilisation) gets around this. In vitro means "in glass": fertilisation happens in a laboratory dish instead of in the fallopian tube.
Doctors usually create several embryos in one cycle, because not every embryo develops well or implants in the uterus lining. One or two healthy-looking embryos are placed in the uterus. Any others may be frozen for later use, donated, or discarded.
State what the letters IVF stand for and describe in one sentence what the technique involves.
State what the letters IVF stand for and describe in one sentence what the technique involves.
Name two causes of infertility, one in males and one in females.
Name two causes of infertility, one in males and one in females.
A couple in Galway are offered IVF. In one cycle, several embryos are created, and one or two are placed in the uterus. a) Describe where fertilisation takes place in…
A couple in Galway are offered IVF. In one cycle, several embryos are created, and one or two are placed in the uterus.
- a) Describe where fertilisation takes place in IVF.
- b) Explain why more than one embryo may be created.
- c) Identify one ethical question about what happens to unused embryos.
Success rates
IVF does not always work. The success rate is the percentage of treatment cycles that lead to a pregnancy. It falls as a woman gets older, because the number and quality of her egg cells decrease with age, and the uterus lining may be less ready for implantation. Other factors include general health, smoking and the cause of the infertility.
"Expected" means an average over many patients. It does not tell us what will happen to any one couple.
In a clinic, the success rate for IVF in women under $35$ is $32\%$. Out of $250$ women under $35$ who started treatment, calculate how many are expected to have a…
In a clinic, the success rate for IVF in women under $35$ is $32\%$. Out of $250$ women under $35$ who started treatment, calculate how many are expected to have a successful pregnancy, and suggest two reasons why the success rate is lower in older women.
Ethical issues
An ethical issue is a question about what is right or wrong, fair or unfair, where people may reasonably disagree. Science can tell us what can be done and what the risks are. Ethics asks whether we should do it.
Questions in reproductive medicine include:
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Unused embryos: should they be frozen, donated to research, or destroyed? People differ on when human life begins and what respect an early embryo deserves.
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Cost and fairness: IVF can cost thousands of euro per cycle. Should the State pay? For whom?
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Genetic screening: cells from an embryo can be tested for a serious inherited disorder such as cystic fibrosis before it is placed in the uterus. This can spare a family suffering, but raises concerns about which conditions count as "serious" and where to draw the line.
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Consent and rights: who decides, and whose voice counts?
Define the term "ethical issue" and give one example from reproductive medicine.
Define the term "ethical issue" and give one example from reproductive medicine.
Some couples use genetic screening of embryos to avoid passing on a serious inherited disorder such as cystic fibrosis. a) Explain one benefit of such screening. b)…
Some couples use genetic screening of embryos to avoid passing on a serious inherited disorder such as cystic fibrosis.
- a) Explain one benefit of such screening.
- b) Explain one concern about its use.
- c) State who you think should make decisions about the use of these techniques, and justify your answer.
Evaluate the following statement: "Because IVF is expensive, it should only be funded by the State for couples with the best chance of success." Present one argument for…
Evaluate the following statement: "Because IVF is expensive, it should only be funded by the State for couples with the best chance of success." Present one argument for and one argument against, and give your conclusion.
Stem cells and gene editing
A stem cell is an unspecialised cell that can divide and develop into many different types of cell. Cells from a very early embryo can become nerve, muscle, blood or skin cells. This makes them useful for repairing damaged tissue, for example in some blood disorders, and for studying diseases.
Ethical issues arise because obtaining embryonic stem cells usually destroys the embryo, and some embryos come from IVF. People disagree about the moral status of an embryo. There are alternatives:
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Adult stem cells, for example from bone marrow, which can make blood cells and do not need an embryo.
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Umbilical cord blood, collected at birth, which contains stem cells.
These avoid destroying an embryo, though they may be able to form fewer types of cell.
Gene editing is a newer technology that can change a gene, for example to remove an allele that causes a disease. Used on embryos, the change would be passed on to future generations.
| Possible benefits | Possible risks |
|---|---|
| Prevent serious inherited diseases | Unintended changes in the DNA, with unknown long-term effects |
| Reduce suffering in families | "Designer babies": choosing features such as height or eye colour |
| Fewer embryos discarded after screening | Unequal access, so only the wealthy benefit |
Why can't evidence alone decide? Evidence can show how safe and effective a technique is. It cannot tell us which values matter most: protecting early life, preventing suffering, fairness, or freedom of choice. Different people weigh these differently, so decisions need public debate, laws and ethical guidance as well as science.
Stem cells from early embryos can develop into many types of cell and may be used to treat diseases. a) Explain why stem cells are useful in medicine. b) Discuss two…
Stem cells from early embryos can develop into many types of cell and may be used to treat diseases.
- a) Explain why stem cells are useful in medicine.
- b) Discuss two ethical issues associated with obtaining stem cells from embryos.
- c) Describe an alternative source of stem cells and explain how it avoids one of these issues.
A new technique allows doctors to edit genes in human embryos to remove a disease-causing allele. a) Describe two potential medical benefits. b) Discuss two ethical or…
A new technique allows doctors to edit genes in human embryos to remove a disease-causing allele.
- a) Describe two potential medical benefits.
- b) Discuss two ethical or societal risks, including the concept of "designer babies".
- c) Explain why scientific evidence alone cannot decide whether a technology should be used.
Back to the start: the Galway couple can find out how IVF works and what the chances are. Whether to use it, how embryos should be treated and who should pay combine science with their own values and society's rules.