Dr. Chris Willmott gave a presentation on the ethical issues associated with fertility treatment. He discussed various fertility procedures like IVF, egg/embryo donation, and surrogacy. He also outlined some of the debates around who should have access to treatment, how many embryos should be transferred, the fate of leftover embryos, genetic screening of embryos, and resource allocation issues. The talk examined arguments both for and against different procedures from various ethical perspectives.

1. Dr Chris Willmott Dept of Biochemistry, University of Leicester [email_address] Ethical issues associated with fertility treatment TSN Masterclass: “Reproductive Technologies” University of Leicester

2. Fertility treatment: What? non-IVF: Artificial Insemination - AIH - DI/AID G amete I ntra F allopian T ransfer N a P ro T echnology IVF: ‘standard’ IVF I ntra C ytoplasmic S perm I njection Z ygote I ntra F allopian T ransfer Egg donation  3-parent embryo Embryo donation Surrogacy P reimplantation G enetic D iagnosis

6. Fertility treatment: Who? Relationship status: Married couple? Unmarried couple? Single woman? Same-sex couple? Age: Too young? Too old? Pre-menopause? Post-menopause? Other restrictions: HIV+ ? Criminal record? Ability to pay? Existing family?

7. Fertility treatment: Who? Relationship status: Married couple? Unmarried couple? Single woman? Same-sex couple? Age: Too young? J Med Ethics 37 :201-204 (2011)

8. Fertility treatment: Who? Relationship status: Married couple? Unmarried couple? Single woman? Same-sex couple? Age: Too young? Too old? Pre-menopause? Post-menopause? Rajo Devi Mother at 70 Maria del Carmen Bousada Mother at 66 Died at 69

9. Fertility treatment: Who? Criminal record Existing family

18. Preimplantation Genetic Diagnosis Biopsy For single-gene disorders PCR-based amplification - multiplex PCR - fluorescent PCR For gender determination, aneuploidy, etc Fluorescence in situ hybridisation (FISH) Comparative genome hybridisation (CGH) Microarray-CGH

19. Preimplantation Genetic Diagnosis Arguments in favour Can eliminate a genetic condition e.g. Cystic fibrosis

20. Preimplantation Genetic Diagnosis Arguments in favour Can eliminate a genetic condition e.g. Cystic fibrosis Late-onset conditions? Incomplete penetrance?

21. Preimplantation Genetic Diagnosis Arguments in favour Can eliminate a genetic condition Can ‘tissue-match’ embryo with older sibling

22. Preimplantation Genetic Diagnosis Arguments in favour Can eliminate a genetic condition Can ‘tissue-match’ embryo with older sibling

23. Preimplantation Genetic Diagnosis Arguments in favour Can eliminate a genetic condition Can ‘tissue-match’ embryo with older sibling Sex selection - X-linked conditions - “Family balancing”

24. Preimplantation Genetic Diagnosis Arguments in favour Can eliminate a genetic condition Can ‘tissue-match’ embryo with older sibling Sex selection - X-linked conditions - “Family balancing”

25. Preimplantation Genetic Diagnosis Arguments in favour Can eliminate a genetic condition Can ‘tissue-match’ embryo with older sibling Sex selection - X-linked conditions - “Family balancing” In some parts of Asia ratio of boys to girls 130:100 But... Sex selection can be serious issue elsewhere WHO, 2011

26. Preimplantation Genetic Diagnosis Arguments against Not a ‘cure’, inappropriate embryos destroyed - healthy, but ‘wrong’ gender or tissue-type

27. Preimplantation Genetic Diagnosis Arguments against Not a ‘cure’, inappropriate embryos destroyed New genetics = new eugenics? Slippery slope to ‘designer babies’? “ At some point we will be intervening at the genetic level in the same way that we intervene in the dietary level now ” (Guardian G2, 10.10.05) “ Genetic selection is not cheating – it is one way to be a responsible and caring parent ” (THES, 5.11.04) Julian Savulescu (Oxford)

28. Preimplantation Genetic Diagnosis Arguments against Not a ‘cure’, inappropriate embryos destroyed New genetics = new eugenics? Slippery slope to ‘designer babies’? Attitude to disabled? e.g. Selection against deafness? Selection for deafness?

29. Preimplantation Genetic Diagnosis Arguments against Not a ‘cure’, inappropriate embryos destroyed New genetics = new eugenics? Slippery slope to ‘designer babies’? Attitude to disabled? e.g. Selection against deafness? Selection for deafness? Nature 431 :894-896 (October 2004)

30. Preimplantation Genetic Diagnosis Arguments against Not a ‘cure’, inappropriate embryos destroyed New genetics = new eugenics? Slippery slope to ‘designer babies’? Attitude to disabled? Attitude to children? Commodification “Not what I ordered”

31. Preimplantation Genetic Diagnosis Arguments against Not a ‘cure’, inappropriate embryos destroyed New genetics = new eugenics? Slippery slope to ‘designer babies’? Attitude to disabled? Attitude to children? Commodification “Not what I ordered”

35. Principlism  Ethical matrix Ben Mepham

36. Any Questions? E-mail : [email_address] Twitter : cjrw Slideshare : cjrw2 Delicious : chriswillmott Blogs : www.bioethicsbytes.wordpress.com www.biosciencecareers.wordpress.com www.lefthandedbiochemist.wordpress.com University of Leicester