MEDICAL research on the long term effects of children born using assisted reproduction t echniques have not yet

been undertaken, despite the fact that 170000 children have been born through such means. American Society for Reproductive Medicine press release, Highlights from ASRM 20 02: The 58th Annual Meeting of the American Society for Reproductive Medicine, O ctober 12-17, 2002 Seattle children conceived by assisted reproduction are twice as likely to suffer major birth defects as children conceived without such assistance - 47 The New England Journal of Medicine 346: 725 (2002). M hansen ICSI enables sperm that is 'otherwise incapable of insemination' to fertilize an ovum. in this way, men may pass on their defect, and additionally, studies have shown that two thirds of infertile men with a cogenital absense of the vas deferens also carry cystic fibrosis mutations. 53 Human Reproduction 16: 2093-2097 (2001) RN Josserand ETHICAL the emergence of new AR technologies could interfere with the natural order of h uman procreation. for example, cryopreservation may enable a child to be born from a deceased parent, or perhaps for a parent to remain anonymous a s a result of sperm donation. newer technologies such as the use of embryonic stem cells could result in a child being born from two parents of the same gender, or alternatively, from an aborted foetus. right of procreation vs right of child? delayed surrogacy, such as that of Ranjit Hayer, who gave birth to twins in a ca lgary hospital at the age of 60. gap of two generations, would it be best for a child to be born this way? when it is generaally accepted that a c hild born with parents at such an age would not have living parents for as long as a child born through natural means. http://www.cbc.ca/health/stor y/2009/02/05/f-reprotech.html unfortunately, more often than not AR technologies entail the abortion of human embryos. who is to decide at what stage life begins? PGD, may enable the selection of a healthy embryo, where otherwise a child could be born with a potentially threatening disease. also, a 'saviour sibling' [2] could be given birth to where its tissue could be used to cure an older sibling with a life-threatening disease - as was seen with molly nash born in 1994. [3] alongside the widespread use and implementation of pgd, tails the possible use o f PGD to select certain characteristics to pass on to the child, these may range from merely aesethic traits, to those such as creativity, or athletic ability. the possibility of a photoshopped gener ation as such, defies what it is to be human, and could misshape the blessing th at is human procreation. economic limitations in vitiro fertilisation, and ICSI are expensive procedures, and where assited re production units operate on a commericial basis. therefore, these are often only viable to parents that are able to bear the associated costs of AR. whether or not such procedures should be funded by the state is a fairly significant consideration that must be assesed. socio-religious issues

the advent of assisted reproduction is irrefutably a blessing to those that are unable to conceive through natural means. however it is important to consider th e social and religious implications that arise through the implementation of such technology. the scientist has not always been a shining beacon of public admiration. public mistrust in science, l argely stems from the lack of communication between the scientific world and society.'Scientists are suspected of trying to play God, and to mess in what has always been God s act: procreation' pg 26 Current Pra ctices and Controversies in Assisted Reproduction WHO (2002) most abrahamic faiths remain opposed to the destruction of the embryo. this indu ces the question - at what stage does life form exactly originate? is the destuc tion of a human embryo equivalent to killing a living human being? to the religious concerns that of man 'playing Go d', and making desicions that would otherwise be governed by nature the concept of 'reproduction without sexual intercourse' is also a fairly contro versial issue that stems from AR technologies. it entails the separation of two acts that have historically been intertwined fromt he advent of man. futhermore, the procreation of same-sex couples, and thr ough delayed surrogation brings about questions as to whether or not such means of birth would in fact be suited for the well being and healthy development of the child. it is possible to have 5 differ ent parents 'oocyte donor, sperm donor, surrogate mother, and social parents) the emergence of sex-selection, and whether or not it is a parents right to choo se the gender of their child. society works through the natural balance of gende rs, and disrupting this could lead the breakdown of society. in addition, this relates back to the religious concerns t hat of man 'playing God', and making desicions that would otherwise be governed by nature. globally it has been estimated that approximately 100 million women have 'died prematurely due to a variety of discriminations' [pg 227 WHO 2002]. imbalance in gender ratios is evident in som e parts of india and china, which is a key reminder of the dangers of sex-selection for non-medical purposes.Fathalla M . The one hundred million missing females are dead. Let it never happen again. International Journal of Obstetrics and Gynecology, 1994, 46:101 104. unfortunately, more often than not AR technologies entail the abortion of human embryos. who is to decide at what stage life begins? Regulatory mechanisms that have been enforced in different regions of the world can be seen to vary with effectiveness. sweden has two independant regulatory bodies to monitor assisted reproductive te chnology outcomes, as well as an annual summary of clinical ART treatments. 'inc reasing effectiveness reported as delivery rates per procedure' as well as a reduction in multiple pregnancies. there is also surveillance of children born after ivf has been conducted

for ending with so many unanswered questions, and in a field where people hold 'strong but incompatible views', it is absolutely rudimentary to enforce strict regulation o n ART practice. with any regulatory body in such a field it is essential to be progressive, and

adaptive to each individual case. Ruth deech, former chair of the hfea states the need for such, and the importance of making desicions that invol ve 'real indivudals and their health' regulation should ensure that users of ART should document their results with go vernments, and proffesional bodies in order to document results of infertility t reatment. new procedures should be heavily documented and followed by the thorough surveil lance of offspring and parents. 'strong but incompatible views' a dawson regulation should be carried out not only on a national scale, but this must be expanded to a continental and international system, in order to analyse ART outc omes, their effectiveness, and in order to enable the progression of newer technolgies.