Effects resulting from modifying, selecting, or manipulating

The modification, selection and manipulation of gametes and embryos often involve the use of genetic knowledge to choose the genes or genomes of children. Robertson distinguishes four uses of genetic knowledge, namely the screening of prospective offspring for susceptibility or late-onset medical conditions; screening for gender and other non-medical characteristics involving selecting or choosing certain aspects of the genetic makeup of children by excluding negative aspects; reproductive cloning; and positive genetic alteration of offspring genomes, which involve positive selection or alteration of genes of offspring.293

Most uses of genomic knowledge in reproduction will involve preimplantation screening or screening before birth to prevent the birth of children with genetic disease or predisposition to disease. The presence of family diseases in some groups of the population is often considered as the reason for screening.294 A history of family or autosomal diseases, such as cystic fibrosis, sickle cell anemia, and Tay Sachs,295 also constitutes a justification for screening. Through screening, carriers of autosomal mutations may also learn whether their reproductive partners are also carriers. If so, they can decide to risk having children with disease, adopt, be without children, use donor gametes, or conceive and screen at the embryonic or fetal stage, and then decide not to start or not to continue a pregnancy.296 Embryo or prenatal screening might also occur when the determination of dominant or X linked diseases, such as Huntington’s disease, hemophilia, or Duchenne’s muscular dystrophy is needed.297

292 _{Walmsley 2014 OBF 34.} 293

Robertson “Procreative liberty in the era of genomics” 2003 AJLM 456.

294

Robertson 2003 AJLM 456

295

Robertson “Liberty, identity, and human cloning” 1998 TLR 1407.

296

Elsas “Medical genetics: present and future benefits” 2000 ELJ 814-815

297

84 Although these procedures seem to benefit parents in their endeavour to ensure a healthy child, they have a serious negative impact on resulting children. The first negative impact is the fact that these procedures seem to send the message that the life of children is not desired and valued or that it would be better for them that they had not been born.298

The manipulation of embryos and gametes also involve non-medical selection, such as “for gender, sexual orientation, hearing, perfect pitch, hair or eye color, intelligence, size, strength, memory, beauty, or other traits, which parents might find desirable”.299

Screening of embryos to determine sex is more accurate than sperm separation, but requires an expensive and intrusive cycle of IVF and the willingness to discard embryos.300

Wertz distinguishes two different groups of people who request for preimplantation genetic diagnosis for non-medical gender selection. The first group consists of persons who wish their first born child to be of a particular sex. According to Wertz most of people prefer their first born child to be male because their culture values males more than females.301 In the second group there are people who already have a child of one gender and wish to have a child of the opposite gender. In many cases, the requests are made by people who already have two or more children of the same gender, with no greater preference for males than for females.302

The risks of IVF and ICSI which arise from the manipulation of gametes, embryos, and the conditions of conception and implantation, are inevitable when attempting to enable infertile couples to conceive or become pregnant. Additionally, there is another set of risks that originates from manipulations done to determine the quality or make-up of gametes or embryos, or to modify, transfer, or remove genetic

298

Field “Killing ‘the handicapped’ – Before and after birth” 1993 HWLJ 123-124.

299

Robertson 2003 AJLM 460.

300

Robertson 2003 AJLM 460

301

Wertz “International perspectives on ethics and human genetics” 1993 SULR 1430-1432.

302 _{Ethics Committee of the American Society of Reproductive Medicine “Preconception gender}

85 material.303 Preimplantation genetic diagnosis to screen embryos, for example, carries some risk that embryo biopsies might affect the physical well-being of resulting children.304 Similarly, flow cytometry to select male or female bearing sperm for preconception sex selection subjects sperm to a fluorescent dye and laser energy with still unknown effects on sperm, embryos, and offspring.305

Children born through assisted reproductive technologies are not the only children to experience health problems. There is evidence that children conceived naturally can also experience such problems. However, it is important to note that in most cases, health problems experienced by children conceived naturally have their origin in the parents’ genetic or health state, and almost all these problems, if detected early, can be successfully managed. Generally, if one of the parents, in particular the pregnant mother, is infected by a virus, there is a chance that the virus will be transmitted to the child who is conceived while the mother is infected. A more recent study reported in this regard that a number of viruses responsible for various health problems can be transmitted from an infected mother to the foestus she is bearing. In fact, Seopela reported that the cytomegalo virus, the genital herpes simplex virus, and the rubella virus can be transmitted transplacently or during the passage of the newborn through the birth canal by contact with genital lesion.306 The cytomegalo virus is responsible for sensorineural hearing loss and mental retardartion,307 the genital herpes simplex virus causes microcephaly and hepatosplenomegaly,308 and the rubella virus is responsible for severe birth defects, known as the rubella syndrome. Its congenital and late manifestations include sensorineural deafness, cardiac defects, ophthalmic defects, rethinopathy and cataracts, central nervous system defects, mental retardation, and microcephally.309 All these infections are manageable during pregnancy.310 303 Robertson 2004 AJLM 12. 304 Robertson 2004 AJLM 12 305

Human Fertilisation and Embryology Authority “Sex selection: Options for regulation” (2003), available at http://www.hfea.gov.uk/AboutHFEA/Consultations (date of use 26 March 2015).

306

Seopela “Congenital and neonatal infections” 2015 OGF 27-29.

307 Seopela 2015 OGF 28. 308 Seopela 2015 OGF 28. 309 Seopela 2015 OGF 29. 310 Seopela 2015 OGF 28.

86 It should be noted that in addition to the physical effects of ARTs on children, most children born as a result of the use of these procedures are also exposed to psychological effects.