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As first test-tube baby turns 20, ethical questions persist


By Rhonda Rowland
CNN Medical Correspondent

July 24, 1998
Web posted at: 12:14 p.m. EDT (1614 GMT)

In this story:
Embryos for in-vitro fertilization   

(CNN) -- It was 20 years ago Saturday that the world's first "test-tube baby" was born. Louise Brown's arrival in Bristol, England, changed not only her parents' lives, but all our lives as well.

Since then, in-vitro fertilization, the technology that helped bring Louise into the world, has helped countless infertile couples worldwide realize their dream of parenthood.

And ever since, though most of us will never use the technology, the medical answers to infertility problems for individual couples have raised ethical questions for society at large.

Fear of cloning continues

The news of Louise Brown's birth made headlines worldwide, but while scientists were excited, many of them doubted the "experiment" would become common practice.

The public was skeptical and worried. People feared what scientists would do next: Could this technology be used to clone humans?

As scientists now clone sheep and mice, the public's fear persists. Government leaders around the globe are uncertain how best to regulate the ever-advancing technology.

From some scientists' point of view, such fears hamper technology that could further help infertile couples. For example, an embryo could be split in the laboratory to create an identical twin. Twins develop the same way, though unaided, in nature.

The way scientists see it, splitting embryos in the lab is a way to increase the chances of achieving a pregnancy. But though it probably could be done, fertility centers avoid it because of possible negative perceptions.

Ethics, emotions and science

test tube babies
Frozen embryos   

The emotional conflicts that surround cloning reflect the broader public uncertainty about how to address the personal questions raised by technological advances.

For example, the use of donor sperm, eggs and embryos has helped thousands of infertile couples achieve pregnancy, even with women in menopause.

But with the news of women in their 50s and even 60s becoming mothers, we are faced with the question of how old is too old for a new mother to be.

Then there are ethical issues involving the children. If donor sperm or donor eggs or embryos are used, should the children be told about their true genetic origins?

Studies show most couples keep this information from the child. Psychologists and infertility experts are divided over whether telling or not telling is better for the child. And the practice is so new, there are no long-term studies.

Then, too, the personal and technological questions are intertwined.

This year, an embryo that had been frozen for seven years was born, and the baby was dubbed the "world's oldest newborn." But how long should embryos be frozen before they are used?

With the success of freezing embryos, fertility clinics face the dilemma of not knowing what to do with them when couples abandon unused embryos, forget about them or simply decide they have completed their family.

Are these embryos babies waiting to be born? Should they be donated to others? Discarded? Used for research? Some clinics now ask couples to decide the fate of the unused embryos before embarking on infertility treatments.

The big business of baby making

When Louise Brown was born, many doctors thought the success rates would be too low to make the procedure practical.

Ten years after her birth, infertile couples had a 1-in-10 chance of success. Today it's 1-in-5. At some large centers, success rates are as high as 40 percent in women under age 40.

In fact, in-vitro fertilization as now practiced is a victim of its own success. Infertility treatment is a competitive business.

To boost pregnancy rates, some centers have felt pressure to "put back" a large number of embryos into the woman's uterus after the eggs are fertilized in the lab. The result: a high number of multiple births; that is, twins or more.

According to the Centers for Disease Control and Prevention, women who get pregnant through infertility treatments have a 37 percent chance of a multiple birth, compared to 2 percent in the general population.

Such couples face a difficult choice: carry several fetuses and risk the health of both the mother and the babies, or use selective termination to abort some fetuses.

Clearly, for couples who have struggled to become pregnant at great expense, this is a grueling decision. Doctors in the field say multiple births are not how they define success.

An ever more fertile future?

With all the hype and headlines that surround reproductive technology, many couples assume they will succeed at getting pregnant. But while pregnancy rates are rising, statistics show infertility treatments fail for most couples.

What does the future hold? Scientists predict higher success rates. They are close to finding ways of limiting the number of multiple births. Women over 40 should have more luck.

For now, there's no question that thousands of couples have reason to celebrate Louise Brown's birthday.

But as the technological advances proceed at their rapid pace, it's also clear the related ethical issues cannot be rushed to resolution any more than pregnancy itself.

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