Ethics should guide our steps in reproduction otherwise science would have unlimited ambition

1. Ethics & Reproductive
Technology
Hesham Al-Inany, M.D, PhD

2. TESE
• Before OPU !!!!
• If –ve , cryo oocytes?????
• Who decide?

3. Outline
• What is clear?
• What is not clear?

4. What is clear?
• Is infertility a disease?
• Can ART be applied?
• Is donor gamete forbidden?
• PGD
• Postmenopausal pregnancy
• Surrogate mother

5. Unclear
• cryopreservation
• sex selection?
• Mitochondria transfer
• Is stem cells a valid option?
• SER
• cloning
• Embryo research
• Sporadic models

6. Is infertility a disease?
• Many countries allover the world including USA consider fertility a
complimentary to life (welfare)
• Most insurance companies refuse infertility treatment

7. This has been solved
• the World Health Organization (WHO)
acknowledged that infertility should be
considered a disease to all intents and purposes,
as it diminishes the health and wellbeing of the
individuals who suffers from it.
• Accordingly it is a human right to get infertility
treatment

8. Is donor insemination or oocytes allowed?
• As Islam enjoys the purity of genes and heredity, It deems that each
child should relate to a known father and mother.
• A third party is not acceptable whether he or she is providing a
sperm, an egg, an embryo or a uterus (Serour and Omran, 1992).

9. Is assisted reproduction valid?
• A November 2000 workshop organized by the International Islamic
Center for Population Studies and Research, Al-Azhar University,
Cairo, considered use of assisted reproduction technologies (ART) in
the Islamic world.

10. 10
PGD
• It is accepted to use preimplantation genetic
diagnosis to prevent hereditary diseases
• sex selection has been permitted for family
balancing.
• Certain precautions and restriction were
suggested to be applied to avoid its abuse

11. What about Stem cells: In POF?
• AFSCs were transplanted into the ovaries of mice with POF six weeks
post induction using chemotherapeutic drugs.
• the transplanted AFSCs did not differentiate into germ line cells in
vivo.

12. Stem cells types References
Stem cells and
germ cells
markers
Chemotherapy
Morphologically
of ovary after
stem cells
transplanted
Hormone or cytokines profile
changes
Tracking of stem cells
Bone marrow
transplantation
Lee et al.43 / / /
BMP15, FMR1, FSHR, INHA, AMH,
NOBOX, FOXO3, EIF2B, FIGLA and
GDF9
Reactivate host oogenesis; not
generate oocytes
CD44 +/CD105 +
human amniotic
fluid
mesenchymal
stem cells
Liu et al.73
CD29, CD44,
CD73, CD90,
CD105 and CD166
Intraperitoneal
injection of
cyclophosphamide
/ / /
Adipose-derived
stem cells
Sun et al.63 /
Intraperitoneal
injection of
cyclophosphamide
Follicle number ,
ovulation number
and apoptotic
GCs¯
HGF , VEGF, PGF and TGF-β
Not participate in follicle
regeneration
Umbilical cord
mesenchymal
stem cells
Wang et al.64
CD29, CD44,CD90
and CD105
Intraperitoneal
injection of
cyclophosphamide
Apoptosis of GC¯,
number of
folliclesand oocyte
containing follicles
E2 Not develop into follicles
Human amniotic
fluid cells
Lai et al.72
Intraperitoneal
injection of
cyclophosphamide
and busulphan
Oocytes at all
stages
AMH and FSHR
Differentiated into GCs; not germ
cell

13. Summary of results
• No evidence of differentiation into oocytes
• But risk of developing GC tumour is potential (Botman , 2014)
• So till now, use of stem cells for POF in human is not valid

16. What is unclear?
• Cryo preservation !!!!!!
• Models of individual practice?

17. 17
Cloning
• human reproductive cloning is condemned,
but cloning human embryos for stem cell
research is considered acceptable Serour &
Dickens , 2001
• The majority of Muslim jurists distinguish
between reproductive and therapeutic cloning
(Larijani , Zahedi F.,2004)

18. 18
Multifetal pregnancy reduction
• According to Islamic view, MFPR is only allowed
if the prospect of carrying the pregnancy to
viability is very small.
• It is also allowed if the life or health of the
mother is in jeopardy.
• Every attempt should be made to prevent the
incidence of multiple pregnancy, especially
high-order multiple pregnancy.

19. 19
• When MFPR is performed, it is not performed with
the objective of inducing abortion. MFPR is
performed with the objective of increasing the
chances of continuation of the pregnancy and the
chances of survival of the remaining fetus or
fetuses (al-Shazil, 1995).

20. Pregnancy in the
postmenopause

21. • ART allow postmenopausal women to become
pregnant. The physiological process occuring
with pregnancy no doubt task and exhaust the
health reserves of the woman.
Pregnancy in the postmenopause, involves egg
donation, accordingly, using donated eggs is
ethically unacceptable in the Muslim World

22. Pregnancy in the postmenopausal using couple’s
frozen embryos is associated with increased
maternal risks and need further evaluation.

23. 23
Embryo research
• According to religious recommendations,
research would occur only on spare embryos
created as by-products of IVF treatment for
infertility.
• However, the wide use of cryopreservation of
extra embryos has limited the number of
embryos donated for research

24. 24
Embryo Research
• Cryopreserved pre-embryos may be used for
research purposes with the free and informed
consent of the couple.
• These pre-embryos are not to be transferred
to the uterus of the wife or that of any other
woman

25. Mitochondrial transfer ?
• use of mitochondrial donation in carefully selected women to
improve their chances of having children free of inherited
mitochondrial diseases

26. THANK YOU