Læknablaðið - 15.02.1987, Blaðsíða 31

LÆKNABLAÐIÐ
53
paid a sum of money per donation. This is now £
10 per donation.
We have had no trouble with donors and we have
been able, therefore, to inseminate about 90
women per month and achieve a pregnancy rate
of about 60% so one has to argue on the one hand
about the advantages of paying donors and
getting a good service going or not paying donors
and getting no service at all and this is a difficult
moral argument. The Warnock Committee
recommended that we should move towards a
society where donations were considered as gifts
and the only monetary reward should be
expenses. However, I would say that the French
system which is one of the best organised AID
services in the world on a central basis and who
obtain their donations from husbands of women
who have had babies; a couple who has had a
child being asked to make a gift to the couple who
require AID so that the barren couple may have
child, has been insufficient and although the
system works well there are not enough donors
for the requirements of the service and the French
are, in fact, paying some of the donors.
The problems here of course are that the donor
may conceal information about his medical or
genetic or social history which would preclude
him from giving seminal fluid. This has become
particularly important since discovery of AIDS
and the fact that it can be passed in seminal fluid
and of course we now have to check all our
donors for the AIDS virus. However, our patients
have encouraged us to continue with the service,
taking all the safety precautions we can and are
prepared to take the slight risk that is involved, so
I think that AID is here to stay and is in fact
making an important contribution to the
infertility services in the UK where between
2-3000 babies are born as a result of this
technique each year.
I would now like to turn to the question of in vitro
fertilisation. At the beginning this type of therapy
was used for women with damaged or disease
tubes, but, more recently, it has been used as a
treatment for oligospermia and unexplained
infertility. I do not want to go into the details of
this treatment here, as that is not the object of this
lecture.
Many people regard in vitro fertilisation as an
exciting new possibility for helping the childless.
That, indeed, is my own view but there are those
who are deeply worried by its development. These
people either feel that IVF is fundamentally
wrong or are worried about the consequences of
the practice of IVF. Those who feel that it is
fundamentally wrong say that this practice
represents a deviation from normal intercourse
and that the unitive and procreative aspects of
intercourse should not be separated. Those who
hold this view believe that this is an absolute
moral principle which must be upheld without
exception. Individually, there will be those who
would not wish to receive this form of treatment
and not participate in its practice but I do not
think that those arguments could be used for the
formulation of a public policy.
The arguments based on consideration of the
consequences are shghtly different. Their
reservations start when IVF results in more
embryos being brought into existence than will be
transferred to the mother’s uterus. This is not
always necessary now because embryos can be
frozen and used later. These people would argue,
however, that it is not acceptable to produce
embryos which have a potential for human life
when that potential will never be realised.
Another argument is the resource one which asks
whether the National Health Service can afford
such expensive treatment which benefits only a
few when the money might be spent more
beneficially elsewhere. The argument for use of
resources, of course, is a proper one but it relates
to the extent of provision of service and not to
whether there should be any service at all.
I, therefore, feel that IVF is a perfectly legitimate
way of helping infertile couples. I do not think we
were on very difficult ground in the Inquiry in
coming to that conclusion but it is when we come
to some of the other techniques for the alleviation
of infertility that the ethical problems become
more difficult.
Is it acceptable for one woman to donate an egg
to another? Some would object to the
introduction of a third party into the marriage
and are concerned about the possible impact on
the child and the possible harmful effects on
society in general. However, I do not see a great
difference between egg donation and AID and I
would therefore accept it as a method. It should
be borne in mind, of course, that at the present
time, eggs cannot be frozen satisfactorily so that
egg donation would have to be done with a live
egg which had not been frozen.
Another contentious issue is embryo donation.
With it being possible to freeze embryos, this is a