Should cancer patients undergo IVF to store frozen embryos and later have children? It may be good therapy for the mother -- but what about the child who might be bereaved at an early age?
Why shouldn't embryos be cloned to produce two embryos and artificial twins or to implant one and keep the other frozen? It's cheaper, means fewer IVF treatments and the 'spare' embryo could be implanted later, become a donor embryo for an infertile couple or even be kept for future organ transplantation in the twin.
Why are lesbians often excluded from IVF treatment? Studies show that their children have turned out without any social or emotional handicaps and no predilection to homosexuality.
What's wrong with a woman having a child from sperm taken from her dead partner? Counselling may avoid an impulsive decision, but provided the mother is stable the child is unlikely to suffer.
And what about other single women? Reports on their children vary, being favourable only when the single parent has access to social, emotional and financial support.
These are just a few of the questions being posed by Australian fertility expert Professor Carl Wood on Tuesday 27 June at the European Society of Human Reproduction and Embryology conference in Bologna, Italy.
His talk -- in the conference section Controversies in ART (assisted reproductive technology) -- spelled out the pros and cons on a range of contentious topics from surrogacy to full-blown adult cloning*.
"I'm not giving the answers -- I'm just posing the questions. I like to get people thinking and these are issues we need to think about," said Professor Wood, who is Emeritus Professor of the Department of Obstetrics and Gynaecology at Monash University in Melbourne.
But he does have some very definite views on the more routine difficulties that doctors face in IVF clinics.
"IVF should be deferred if patients are smoking over 15 cigarettes a day, regularly drinking more than three glasses of beer a day, are habitual drug-users or have a criminal record of child abuse or violence. It should probably be deferred if there is a record of admission to hospital for a serious psychotic disorder. Grounds for short-term deferral include no vaccination against German measles and no use of folic acid," he said.
Serious contra-indications on health grounds included acute infections, uncontrolled thyroid malfunction, diabetes, hypertension and thrombophilia, all of which may affect the success of IVF and pregnancy. Severe health problems in the woman, such as heart, kidney or liver failure, acute psychosis and signs of virus in the blood of HIV patients are conditions which could all be made worse by IVF treatment. For patients with paranoid schizophrenia there might be a threat to both mother and child and in severe depression the mother could be a suicide risk.
However, Professor Wood has come out campaigning in favour of cloning embryos -- banned in his home state of Victoria and most other countries, though he says it may be possible to do this in some states of the USA.
"There are drawbacks -- twins may be a disadvantage -- we don't know for sure what the success rate would be and there are possible objections on the grounds of manipulation of human life, sale of embryos, or use for research.
"But there are advantages too. We know that technically it works in cattle and sheep -- you split the embryo at five days of development. For women it would involve less egg harvesting. You don't have to put both demi-embryos into the womb at the same time. If one fails to implant, you transfer the second. Or, if the first is successful the second can be used later. Even identical twins have some differences and in the case of Œtwins' born years apart the differences would be even greater -- a different uterine environment for a start."
Notes: Programme number: O-089
* ESHRE has a voluntary moratorium on cloning for reproductive purposes but supports cloning for research purposes.
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