|
|
| Human
Reproduction: Changing Perspectives |
By Vinod Scaria
E-mail: vinodscaria@yahoo.co.in
[Respond
to this article]
"Change, like sunshine, can be a friend or
a foe,
blessing or a curse, a dawn or a dusk"
- William Arthur Ward
The birth of Louise Brown in
1978 marked the beginning of a new era – the era of Artificial
Reproduction, which radically changed human concepts of reproduction,
which was till then considered God’s domain and something beyond human
reach. This breakthrough in the art of 'making' children was of course
greeted with mixed feelings – of euphemism and apprehension. The
initial criticism ranged from scepticism to sheer outrage. While some
thought man was trying to play God, others thought it would cheapen
human life and lessen the sanctity of human reproduction. But to be
sure, that was the moment perhaps any man would rejoice – for he had
crossed one of the worst hurdles that nature had laid before his dreams
of having a child.
Time had proved its worth at
last. The initial waves of apprehension had weaned away soon and the
technique was introduced worldwide in the 80s, and today, a couple of
decades later, this unique technique of In-vitro-fertilization (IVF) has
created over a million children worldwide, and has emerged as one of the
most acknowledged techniques in the treatment of infertility. IVF per se
is just another technique in the whole spectrum of techniques that form
what is known as Artificial Reproductive Techniques (ARTs in short). In
fact, ARTs range from techniques like artificial insemination and
Gamete IntraFallopian Transfer (GIFT) to highly sophisticated techniques
like intracytoplasmic sperm injection (ICSI). The science of artificial
reproduction has
grown to such a magnitude that about one in every 100 children in the
developed countries are born through this technique.
The miracles of ARTs do not end there. The avenues
opened up by this science seems to be endless. Perhaps no other science
had kindled human imagination to such an extent. Just consider surrogate
motherhood and gamete donation, which were even beyond the wildest
dreams in the pre IVF era. Fertilisation outside the human body has its
own advantages – the most important being the opportunity to
manipulate them at our will. Screening of embryos before implantation,
which is virtually impossible in the classical method of reproduction is
now possible with this technology. Embryos can be screened for both
gross chromosomal abnormalities (like for trisomy of the 21st chromosome
in Down’s syndrome) and for molecular markers of genetic diseases –
what is known as the pre-implantation genetic screening (PIGS in short).
The advantages are two fold – that it allows only perfect embryos to
get implanted and that it can reduce the morbidity associated with
therapeutic amniocentesis and subsequent medical termination of
pregnancies for congenital abnormalities. The availability of embryos
outside the body also allows us to manipulate its genetic material by
introducing a 'healthy' gene in place of an abnormal one, or harvest
stem cells which would later be used in case a need for an organ
transplant arises. Though the sciences of gene therapy and stem cell
culture have a lot to go before they emerge as a fool proof techniques,
reviewing the pace at which new developments occur in these fields. I
personally feel, they would become a conventional therapeutic procedures
in less than a decade.
Artificial reproductive
techniques have gone a step beyond-by collecting germinal tissues and
cryopreserving it for later use (what is known as fertility insurance)
– which is certainly Godsend to patients who have to undergo extensive
chemo or radio therapies for malignancies, but have not yet formed their
families.
The Present scenario:
As I had mentioned before, ARTs have emerged as
widely acclaimed modalities in the treatment of infertility, and is
slowly replacing empirical endocrinological and surgical modalities of
treatment of infertility. It is roughly estimated that the total annual
number of IVF cycles is about half a million worldwide and is certainly
on the rise.
This upward trends means that more and more infertile
couples are opting for ARTs. There has been reports that even normal
couples are opting for ARTs out of the fact that embryos can be screened
before implantation and can ensure that they would have only
‘perfect’ children. The implications of these are yet to be
formulated.
Gamete donation is yet another reality, with most specialized centres
maintaining gamete banks where gametes are cryopreserved . This enables
gametes to be used very long after the donation and even probably after
one is dead. To be frank, gamete donation and its use in helping sterile
patients are slowly attaining social acceptance.
Another interesting field is
that of male pregnancy. Researches are going on around the world in this
field; and results would probably appear within a couple of years. Male
pregnancy if proved feasible for regular practice, would probably free
woman from her last natural constraint. The ethical and moral
implications of this should be well reviewed as this technology is in
itself a double edged sword. While helping males to attain
"motherhood" its implications on family set up and the gradual
extinction of females from this earth should be thoroughly considered.
Researchers are also
going on the possibility of rearing an embryo outside the human body
(gestation in vitro). Though the researches in this field, are at
present largely confined to animal models, this would become a reality
in a decade or so.
The Future:
The present trends show
that human concepts of reproduction would be totally uprooted in the
near future. But before it would happen, technological, ethical, moral
and legal hurdles have to be overcome.
It is foolish to think, man in his everlasting pursuit for perfection
would set aside just his ways of procreation. The demand for
"perfect" and only perfect children would some day spell the
death sentence to our natural ways of reproduction. With our ever
increasing knowledge on how to manipulate genes, the possibility of
"designer children" cannot be ruled out. With technology at
his disposal, I cannot think why one would settle with less. The future
would prove whether our genome and of course of our children would be
enhanced with genetic material from other organisms (transgenics), or
whether we would take control of our own evolution evolve into a
completely different species.
The next close possibility is that of human cloning. May be today it is
just the sheep, but tomorrow it is sure to be the shepherd. Many ethical
and technological constraints have to be overcome before it becomes a
reality. "If cloning (of a human) has not happened already, it is
going to happen soon, and the world ought to get over it", says
Brian Alexander, author of 'You Squared'.
Ethical Aspects:
The ethical formulations are
expressions of human thought and conscience, which has always changed
with time and tide. Ethics per se has never been able to hamper
scientific progress, but has been able only to restrict it for the human
well being. The use of technology in ways that harm human well being
should be restricted, but that does not mean banning the whole
technology, turning a blind eye to the benefits mankind could attain
from it would justify the purpose. The pictures of technology terror and
human benefits merge into one another and cannot be separated.
[Respond
to this article]
|
|
