Impact of Reproductive Technologies on Society
Melanie Pescud, Tammy Knox, Carly Malpass, Kellie Cue ??
‘Infertility is estimated to affect more than 80 million people worldwide, and while developments in reproductive technologies have evolved rapidly, so have the ethical, social and political controversies which surround nearly all aspects of their use’ (Vayena et al, 1997)

People have accepted the practice of various forms of fertility treatment for thousands of years. Despite this, controversy surrounds these new reproductive technologies because they challenge the traditional understanding of the relationship between sex and procreation. Consequentially, this also has the potential to challenge the structure of linage and kinship networks.

This report will investigate the reported and perceived social implications of some commonly used reproductive technologies currently used today; including contraception, in-vitro fertilisation, gamete intra-fallopian transfer, intra-cytoplasmic Sperm Injection, pre-implantation genetic diagnosis, gamete donation and abortion.

Equality of Access
Reproductive technologies have had a significant impact to the lives of many infertile and sub-fertile couples around the world. However, due to the high financial costs of these procedures, the access to these technologies is largely limited to Western society; particularly middle to high income earners. Consequentially, developing countries whom have the highest rates of infertility, have limited access to these technologies.

The use of these technologies is surrounded with controversy over the social implications involved. In the case of developing countries, some fear allowing access to these societies would lead to increased population growth in already overpopulated environments. A potential consequence of this would include further inequality to resource access, increased risk for the spread of disease, and subsequent extrapolation of financial costs.

However this ignites further controversy, as denying the access of these services is considered to violate a basic human right, established in the UN Declaration of Human Rights Article 16.1: Xvi, which states “men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family.’ (Vayena et al, 1997)

In-Vitro Fertilisation
In-Vitro Fertilisation (IVF) is an assisted reproductive technology that has been used since the 1950s in animal breeding, and successfully produced its first human child in 1978 with the birth of Louise Brown.

The technique requires ovarian hyperstimulation in order to extract a number of developed ova from the ovaries. These are then fertilised external to the body, and the resulting embryo is replaced in the uterus several days later for implantation.

IVF is considered to have a notable impact on society, mainly due to its risks and social-evils. The risks of IVF have been well documented, and include multiple pregnancy, ectopic pregnancy, and ovarian hyperstimulation syndrome (OHSS).

The major outcome of IVF is that it has provided a means for many infertile couples/individuals to have children. However in doing so, there are concerns regarding the fertilisation of oocytes outside of the body. Not only is this viewed as unnatural, but it also requires extensive laboratory work in order to retrieve, fertilize and replace the resulting embryo.

Additionally, as with many assisted reproductive procedures, success entails an increased risk of having a multiple pregnancy, which has considerable increased health risks for the mother and fetuses. This is because more than one oocyte is often transferred into the fallopian tubes, with the potential for fertilization. This procedure also increases the risk of an ectopic pregnancy, miscarriage, premature birth and other complications. Therefore, it has the potential to lead to significant emotional and financial costs for the family and wider society. ‘It has been reported that average, hospital charges for a twin delivery were four times higher than for a singleton, whereas charges for a triplet delivery were eleven times higher. Additionally, there are long term costs associated with complications; including mental retardation, cerebral palsy, chronic problems with lung development and learning disabilities, which increase in frequency with pre-maturity.’ (Kaz et al 2002)

Another controversial issue is associated with age. There is debate over what age is too old for a person to undergo IVF in order to have a child, with reports of women utilizing its services after the onset of menopause. This raises concern for the mothers’ health in surviving the pregnancy, as well as their ability to survive long enough to raise the child.

Intra-cytoplasmic Sperm Injection
ICSI was introduced in 1992 and is considered to overcome the obstacles that IVF cannot. It allows clinically infertile men to have children without the use of a donor.

The process involves removal of tissue from the testes; on which a biopsy is carried out and sperm is removed. The fertilisation and implantation process occurs as for IVF, however it involves the risk of possible developmental problems in the offspring, ectopic pregnancy, and OHSS

.

The major concern for the use of ICSI to treat male-factor infertility is the belief that these infertile men will pass on their infertility to their offspring (particularly males), perpetuating the cycle of ART dependency in order to reproduce. There is the belief that if a person cannot naturally reproduce, then they are not meant to. However, you would have to consider if there actually is a gene for infertility, and if so, what is the likelihood of such a gene being actively passed on through the use of ICSI?

Gamete Intrafallopian Transfer
GIFT is similar to that of IVF where the woman's ovaries are stimulated to produce multiple oocytes at one time and then collected. Spermatozoa are also collected from the male partner or donor. The difference however lies in the process of fertilization. GIFT involves transferring the collected gametes into the woman’s fallopian tubes; allowing fertilization to occur as it would ‘naturally’. Consequentially, GIFT is the only form of ART that is supported by the Catholic Church; provided the spermatozoa is collected during intercourse.

The probability of a successful pregnancy using this method is not any better than with conventional IVF, and is not suitable for many causes of infertility; including blocked fallopian tubes, pelvic adhesions or server forms of male infertility. Nevertheless, this has a profound impact for infertile couples who want children, but who are unwilling to defy their beliefs. This is particularly the case for members of the Catholic faith, which was estimated to have a total worldwide population of 1.06 billion in 2001.

Although this procedure is reported to only have a 20% success rate, and is consequently responsible for substantial disappointment for many couples; its positive outcomes are argued to outweigh this issue. According to Wickipedia (2005), the inability to conceive often bears a stigma in many cultures around the world. Additionally, the anxiety and disappointment of having this knowledge often leads to marital discord. Therefore, this technology is believed to provide these couples with hope; which is argued to improve marital stability, resulting in a number of favourable social implications.

However, there is argument that this technology will provide an incentive for couples in western societies to prolong age of first conception, which is already an observed trend. This has the potential to slow population growth, and possibly hinder the populations progress and productivity in the future. However, the success of this procedure becomes significantly less effective with increasing age of the female. Providing this information becomes public knowledge, it is unlikely to cause a significant effect on wider society.

This procedure also involves an increased risk multiple pregnancy and complications; including ectopic pregnancy, miscarriage and premature birth. As mentioned previously, this can entail significant individual and social implications.

Donars
The donation of gametes and embryos to infertile couples has proved to have significant success rates in obtaining a successful pregnancy. However, there are a number of concerns associated with its use.

‘By tradition, parents create children. However, this technology has challenged this belief by redefining the concept; that it is children who create parents.’(Edwards et al 1993) As a result, the use of donors challenges many social concepts associated with kinship and lineage.

Some religions, such as the Catholic faith, consider the donation of gametes to constitute the interference of a third party in the ‘holiness’ of marriage. Therefore, ‘a couple confronted with the possibility of a sperm or oocyte donation must overcome a symbolic barrier of adultery.’ (Englert et al 2004) Additionally, this removes a partner’s biological interest in the child, and has created instances of custody debate between the genetic parent and birth parent.

This has ignited debate over the issue of anonymity. Some believe it is up to the parents who raise the child to decide whether or not to disclose the information. However, according to Englert et al (2004), ‘non-anonymity is gaining grounds, mainly because (true or not), in a society that gives more and more space to genetics, it is believed that knowing your genetic origin is an important part of knowing who you are, and that knowing the identity of her or his donor is part of your wellbeing.’

Additionally, according to Edwards et al (1993), the use of this technology instigates the controversial issue of virgin births, where women who do not want to have sexual relations, can have the option of having children. This opens the ethical debate over same sex parenting.

Couples generally prefer to be a relation of the donar. This reflects the importance societies have placed on genetic heritability. However, there are differing opinions associated with what is acceptable for each sex gamete. Some consider oocyte donation more acceptable, as it is considered an asexual process; therefore avoiding the perception of adultery. In addition, ‘one study found that 86% of the women and 66% of their partners in recipient couples favored using a sister for oocyte donation, but 9% of the women and 14% of the men expressed the same preference using a brother for sperm donation.’ (Englert et al 2004) Edwards et al (1993) found similar results, they contributed it to sexual competition; where it was considered to create a closer bond between sisters, but conflict between brothers.

Another issue is associated with selling gametes as commodities. Oocytes are reported to be most highly paid for, largely because it requires more effort from the female donor, and incurs some potential health risks. However, this has resulted in placing a premium on women who are in good health, and who appear to be a ‘good investment’. As a result, this has increased the risk of donars to hide possible health problems, which has potentially detrimental health effects for the couple, and resultant child.

There is also concern about consanguinity between offspring of recipients from the same donor. According to Borrero, C (2003) ‘this is a problem in small communities in which a very limited supply of donors is available. It has been suggested that in a population of 800 000, limiting a single donor to no more than 25 pregnancies would avoid inadvertent consanguineous conception.’

Pre-Implantation Genetic Diagnosis
Pre-Implantation Genetic Diagnosis (PGD) “provides the opportunity for couples at risk of having a child with a serious genetic condition, to start a pregnancy with the knowledge their embryos will not be affected with the indicated disease” (Cram and de Kretser 2002, pg. 194).

While this is the major focus of PGD, fears are held that it will be used to make ‘designer babies’; whom adhere to certain requirements desired by the parents (ie IQ, hair and eye colour, athletic ability, etc). Currently, this is not possible, but debate over the societal impact of such a prospect has been overwhelming.

However, PGD does have the ability to determine the sex of the embryo; well before it develops into a fetus and gender testing can be carried out via ultra-sound. This leaves open the way for people to choose the sex of their child, and dispose of embryos that are not of the desired sex. Allowing couples to determine the make up of their family through PGD and IVF is currently prevented in Australia through legislation; but sex-selection on the basis of a sex-linked chromosomal disorder has been allowed.

Biased sex-selection could have considerable implications to society, through Altering population demographics and sex ratios. There could also be consequences for the family unit, as the technology is not 100% accurate. Parents holding high expectations of having a certain sex offspring would be emotionally affected by having a child of the other sex, not to mention the parental investment issues the child would subsequently face.

Contraception
Contraception has allowed people to have control over their own fertility. Therefore, people are able to make an attempt to avoid pregnancy at times when they do not plan to have children; or to plan and choose the number of children they wish to have (IPPF, p17). There are many different techniques encompassed by the term contraception.

Natural Family Planning Techniques are methods of contraception which the Catholic Church strongly promotes; they do not require synthetic measures rather they focus on periods of abstinence (IPPF, 148).

One such technique is the basal body temperature method; this is where females record their temperature immediately after waking each morning. Throughout the early phase of the cycle just following menstruation the temperature will be low. Ovulation is indicated by an increase of 0.2-0.4C rise in temperature, the female then abstains from intercourse for 3 consecutive days of high temperature (IPPF, p149).

Another technique practiced is the cervical mucus method; this involves monitoring the vaginal and cervical mucus. At ovulation when oestrogen levels are raised the mucus is thick, sticky and opaque looking, women must abstain from intercourse until their mucus returns to a thin, clear and slippery consistency (IPPF, p151).

Family planning methods have allowed women that are not prohibited by culture to use barrier or oral contraceptives to control their fertility and plan their families. Such methods require dedication to be effective as they require long periods without intercourse. They have impacted society by decreasing the average sizes of families.

Barrier methods of contraception such as condoms are a common form contraception. They are widely available at a low cost throughout the world; this has resulted in their wide use amongst males and females. When used correctly the latex rubber condoms are effective at preventing pregnancy and sexually transmitted infections. Condom use has an effectiveness rate of around 95% with pregnancies per 100 women varying between 2 and 15 (Everitt & Johnson, p256).

Diaphragms, cervical caps and spermicides are other forms of barriers that act to prevent the passage of sperm entering the female reproductive tract during intercourse (Everitt & Johnson, p258).

The development of the female contraceptive pill has allowed the suppression of ovulation through a combination of oestrogen and progesterone or progesterone only doses. This has a high effectiveness when taken correctly and is economical at a cost of around $5 a month (Everitt & Johnson, p259). Pill use is associated with an effectiveness rate of around 98% with pregnancies per 100 women varying between 1 and 3 (Everitt & Johnson, p256). There is also a combination of three pills that can be taken up to 72hrs after unprotected intercourse that prevent fertilisation as a result of their high levels of oestrogen and progesterone.

Another contraceptive that is available for women is the intrauterine device. This is made of copper and is inserted in the uterus to produce a uterine environment that does not allow the sperm to transport through and prevents fertilization. (Everitt & Johnson, p263). This form of contraception is considered to be as effective as the combined oral pill (Everitt & Johnson, p263).

Another modern contraceptive measure is the Implanon implant, this works to prevent pregnancy for a period of three years. It is a small plastic rod that is implanted under the skin of the upper arm. The rod releases slowly a low dose of progesterone into the bloodstream. When inserted by a doctor Implanon is highly effective preventing pregnancy in over 99% of cases (FPWA, 2005).

Abortion
This can be a legitimate choice for couples or women that are faced with pregnancy that could result in abnormal outcomes and that could harm the mother. We view this as a reproductive technology and method of contraception as it is an approach to fertility control that all communities use. The procedure usually occurs during the first trimester of pregnancy using either the dilation of the cervix by metal sounds or scraping of the conceptus with a curette or vacuum aspiration. However, the procedure does entail the risk of future infertility as the result of infections that could arise (Everitt & Johnson, p264).

This use of this procedure is highly controversial, and often sparks debate which is emotionally charged. Debate surrounds the concept of human rights, with one argument insisting it is the mother’s right to choose, and another who argue for the child’s right to survive.

In China, women and their families are pressured by population-control officials who are criticized for having no regard for human rights. Unmarried couples in China are not considered ‘allowed’ to have children.
Nine studies were carried out in seven urban areas and two rural areas to uncover information about the sexual activity and contraceptive use amongst these populations. It was found that there is an unmet need for temporary methods of contraception in the urban areas of China (Garner et al 2004). Unmarried women had typically experienced sexual activity and up to one-third in some areas had had a previous pregnancy. A striking majority of those women who had become pregnant had an induced abortion. Inducted abortions occurred in 86% to 96% of women across the regions (Garner et al 2004).
Abortion clinics in Beijing, Changsha, and Dalian were surveyed from January to September in 2002 using self-administered questionnaires to determine the rates of repeated abortion and contraceptive use among unmarried young women seeking abortion in China (Cheng et al 2004). Over this time 4547 unmarried women came to the clinics seeking an abortion. Of these women, 33% reported having had one previous induced abortion. Of those who had had more than one abortion only one-third used contraception at their first sexual intercourse following the procedure. Of the 446 women who did use contraception 41.3% used the withdrawal or rhythm methods. Condom use was characteristic of 65% of the sample, although only 9.6% did so correctly and as a consistent contraceptive choice. Of the pregnancies 47.7% were the result of not using contraception and the remaining 52.3% were related to contraceptive failure (Cheng et al 2004). Similar studies have found that failure of contraceptive methods and unprotected intercourse greatly contributes to the high incidence of abortions (Xiao and Zhao 1997).

Sex ratios in China
Current practice of family planning in China is based on the population policy and strategy of the country (Xiao and Zhao 1997). Historically there has been a tendency to actively shown a preference for sons in China and a subsequent sex ratio inequality has resulted. In the Yunnan Province in China abortion patterns and reported sex ratios at birth of a random sample of 1,336 women aged 15 to 64 were analysed for a 20 year period from 1980 to 2000 in relation to parity sex of previous children (Johansson et al 2004). There was a male bias in the abortion pattern during the 1980s, but by the end of the 1990s most pregnancies of women with two children were being terminated. In this time the sex ratio at birth increased from 107 males to 100 females from 1984 to 1987 to 110 males to every hundred females across 1988 to the year 2000 (Johansson et al 2004). Many women’s reproductive choices were influenced by son preference in accordance with the particular family planning policies in place. Assumptions that discrimination against girls would reduce as economic development progressed and the increasing rates of educated females.

In accordance with China’s official news agency 119 boys are born for every 100 girls in China, elsewhere in the world the ratio is still in favour of boys but to the ratios are more equitable, that is 103 to 107 boys to every 100 girls (McElroy 2004). The unevenness of the sex bias leads to an excess of males and a deficit of available female partners.

Social engineering has resulted in the continuation of induced abortions as a result of the one child policy imposed in the 1980s to control the population growth. If people can choose the sex of their one and only child then they often prefer males for various economic and social reasons. The latest Chinese census shows that the rural provinces of Hainan and Guangdong have sex ratios at birth of 135.6 and 130.3 boys to 100 girls respectively (McElroy 2004). Every time an abortion is performed to be rid of a girl in favour of a boy, the ratio becomes increasingly biased towards males. This is a serious impacting feature of this form of contraception.

Conclusion
Serour, G (1996) stated:

“Though reproductive choice is basically a personal decision, it is not totally so. This is because reproduction is a process which involves not only the person who makes the choice, but it also involves the other partner, the family, society and the world at large. It is therefore not surprising that reproductive choice is affected by the diverse contexts, sexual morals, cultures and religions, as well as the official stance of different societies.

When considering these issues it is important to remember the reality of the abilities and limitations of these technologies. Although their have been sizable developments in the field, those who successfully utilize these services currently represent a minority of the population.

There is general agreement however that there will be considerable future development in this discipline; that will encompass both forseen and unforeseen implications for society. Nonetheless, the impact and extent of these implications remains under deliberation.

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