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To: Multiple recipients of list HUM-MOLGEN <HUM-MOLGEN@NIC.SURFNET.NL>
Subject: ETHI: Sperm injection ethics
From: Hans Goerl <GENETHICS@delphi.com>
Date: Tue, 23 May 1995 03:35:22 -0400

Subj:   RE: Treatment of infertile men by ICSI - genethic implications

From: Dr Jim Cummins <cummins@POSSUM.MURDOCH.EDU.AU>

Hi all.

Fertilization for  severely infertile men by intracytoplasmic sperm
microinjection of oocytes is rapidly taking over the more conventional
approaches of IVF.  So far the success rate is extremely good and all
offspring appear to be normal.  However,we've argued in a public paper
(Human Reproduction 1994 9: 1214-1219) that we need to be cautious about
applying these techniques without good andrological screening of the men
concerned.  ICSI is, of course, not a "cure" for infertility, but it does
offer a group of men their only chance of being a genetic father.

There are a number of features associated with severe male infertility that
give rise to concern: relatively high levels (tenfold increase) in gross
chromosomal anomalies; clear links in some cases with Cystic Fibrosis
carrier status; elevated levels of DNA strand breakage; genomic imprinting
etc.  One likely outcome is the transmission of infertility to male
offspring but of course this won't be known for another generation.  At
least one multi-centre group has pioneered the use of round spermatid
injection for men with partial spermatogenic arrest and claims to have
achieved pregnancies  - for further information follow the links on my WWW
Home Page on http://Numbat.murdoch.edu.au/spermatology/spermhp.html

A number of  ethical issues thus arise:
(1)     What level of genetic screening is appropriate for both husband and
wife (given that most cases of male infertility have no known cause)?
(2)     What level of follow-up of children is needed?
(3)     Who pays for the follow-up and who controls the information?
(4)     Do couples have the right to refuse follow-up (privacy is a major
issue for many infertile couples) ?
(5)`    Are clinics ethically and legally responsible for the transmission
of genetic conditions by ICSI?  If so, for how long?
(6)     If we insist on follow-up, how do we discriminate between these
cases and consorts of very infertile men who get pregnant spontaneously
(yes, it does happen)?
(7)     Should we indeed discriminate between the infertile and the rest of
society who don't necessarily need technology to have kids?

I am currently surveying all IVF clinics in Australia and NZ and will be
publishing the findings in a couple of conferences later this year.
However, I'd also like to get some feeling for the attitudes of the
HUM-MOLGEN audience.   I'd also be happy to email copies of the paper I
referred to to anyone who contacts me directly on
<cummins@possum.murdoch.edu.au>.


 I look forward to the discussion.


Jim "Spermatology rules o~ o~ o~ o~" Cummins

Associate Professor in Veterinary Anatomy
Murdoch University, Western Australia 6150
Tel +61-9-360 2668, Fax +61-9-310 4144
E mail <cummins@possum.murdoch.edu.au>
URL <http://Numbat.murdoch.edu.au/spermatology/spermhp.html>
"An inordinate fondness for Beetles" (Haldane on God).
                         *******

EDITOR'S NOTE: There are some profound questions contained within this post.
It is an exceptional example of how our new genetic knowledge informs both
new and old medical practices. I too look forward to the discussion.


   
 
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