HUM-MOLGEN archive: ETHI: Sperm injection ethics

Subj: RE: Treatment of infertile men by ICSI - genethic implications From: Dr Jim Cummins <cummins@POSSUM.MURDOCH.EDU.AU> Hi all. Fertilization for severely infertile men by intracytoplasmic sperm microinjection of oocytes is rapidly taking over the more conventional approaches of IVF. So far the success rate is extremely good and all offspring appear to be normal. However,we've argued in a public paper (Human Reproduction 1994 9: 1214-1219) that we need to be cautious about applying these techniques without good andrological screening of the men concerned. ICSI is, of course, not a "cure" for infertility, but it does offer a group of men their only chance of being a genetic father. There are a number of features associated with severe male infertility that give rise to concern: relatively high levels (tenfold increase) in gross chromosomal anomalies; clear links in some cases with Cystic Fibrosis carrier status; elevated levels of DNA strand breakage; genomic imprinting etc. One likely outcome is the transmission of infertility to male offspring but of course this won't be known for another generation. At least one multi-centre group has pioneered the use of round spermatid injection for men with partial spermatogenic arrest and claims to have achieved pregnancies - for further information follow the links on my WWW Home Page on http://Numbat.murdoch.edu.au/spermatology/spermhp.html A number of ethical issues thus arise: (1) What level of genetic screening is appropriate for both husband and wife (given that most cases of male infertility have no known cause)? (2) What level of follow-up of children is needed? (3) Who pays for the follow-up and who controls the information? (4) Do couples have the right to refuse follow-up (privacy is a major issue for many infertile couples) ? (5)` Are clinics ethically and legally responsible for the transmission of genetic conditions by ICSI? If so, for how long? (6) If we insist on follow-up, how do we discriminate between these cases and consorts of very infertile men who get pregnant spontaneously (yes, it does happen)? (7) Should we indeed discriminate between the infertile and the rest of society who don't necessarily need technology to have kids? I am currently surveying all IVF clinics in Australia and NZ and will be publishing the findings in a couple of conferences later this year. However, I'd also like to get some feeling for the attitudes of the HUM-MOLGEN audience. I'd also be happy to email copies of the paper I referred to to anyone who contacts me directly on <cummins@possum.murdoch.edu.au>. I look forward to the discussion. Jim "Spermatology rules o~ o~ o~ o~" Cummins Associate Professor in Veterinary Anatomy Murdoch University, Western Australia 6150 Tel +61-9-360 2668, Fax +61-9-310 4144 E mail <cummins@possum.murdoch.edu.au> URL <http://Numbat.murdoch.edu.au/spermatology/spermhp.html> "An inordinate fondness for Beetles" (Haldane on God). ******* EDITOR'S NOTE: There are some profound questions contained within this post. It is an exceptional example of how our new genetic knowledge informs both new and old medical practices. I too look forward to the discussion.