Is having a child a right ?
For many of us, having children is above all a desire. Some go further, and speak about a need. We would need to make children, like we need to eat, to shelter, to rest. If having children is a need, so it is normal, when it is not satisfied, to look for help.
Medicine being today an important element of the occidental society, we more and more turn to it when a need is not satisfied.
However, talking in that way of a child is too fast and erase a part of the complexity of the phenomenon. We don't know exactly why at a time in our life, we feel the desire of having a child. Many factors step in, some being essentially cultural, others being much more personal. But we can perfectly live whithout making all those dream come true. That being said, not being able to have a child, while it's a strong desire, can have many important impacts on physical health and mental health. When this is the case, it is probably a duty of the medicine to answer to this anxiety.
Yet, medicine is not all powerful in terms of procreation as for other dysfunctions, and so it can only act in the limit of its skills. Hence, rather than speak about a right to a child, we should speak of a right to be helped, including medically speaking, when we can't have the child we want.
And what about the filiation links for the children conceived by MAP ?
The MAP techniques are often accused to dissociate the biological aspect of the paternity (or the maternity) of his social aspect, thus disrupting family balance. It's true that when we need to resort to a gamete donor (ovum or spermatozoon) outside the couple, in addition to the social parents (behind the parental project), the resort to the MAP with gamete donation introduce "biological parents".
These multiple parenting question our traditional system of filiation, some believe then that we don't know who are truly the parents of the child thus conceived. Can we base the filiation exclusively on the will of a person or a couple ? Must filiation be related to the birth or the decision behind the birth ? What place should be given to the "extra parents" ?
Multiple parenting generaly being perceived as unstable, many legislations try, in the case of MAP with donation, to privilege the social filiation to the biological filiation (by erasing all track of the gamete donors for instance). In the contrary, in the case of homosexual parentality, and co-parentality, they try to take account the only biological parentality (by not giving parental status to the non-genitor partner). In each case, the objectif seems to be that a child only has two parents, no more, no less.
What risks with the AMP ?
MAP shows risks for the woman, but also for the child, who can be subjet to an alteration of his genes expression. As of now, for the IVF child (who are now in the age of being parents), they can conceive without any medical help. For those born thanks to ISCI IVF, they are still young, so we need to wait a few years before knowing if they inherit their parents' problems.
There can also be mistakes related to the attribution of the embryos or the gamete.
What moral status for the embryos ?
Most of the time, 2 out of the 5 to 8 embryos conceived by the IVF techniques are transferred in the uterus of the patient. The others are frozen in order to transfer them later, which allows to avoid new ovarian stimulations that are gruelling for the woman. In France, it is mandatory to use the frozen embryos before any new IVF attempt. Each year, the couples have to decide of the embryos' future :
keep them for an ulterior parental plan, give them to an other couple, give them to research or destroy them.
Theoretically, if no answer is given to the medical staff after 5 years of reminders, the embryos are to be destroyed, but not many centers dare to, which leads to cumbersome stocks.
We can also wonder about the embryos' future, when the parents are deceased.
Finally, there exists a possibility of embryos trafic in the countries where regulation is not strict enough.
A custom made child with PIGD ? Step towards eugenics ?
- The preimplantation genetic diagnosis (PIGD) allows to avoid the birth of diseased children without having to go through an abortion. The amount of applications continues to grow, as the amount of genetics mutations that can be analysed. An other use of the PIGD, not allowed in France, is the research of abnormal numbers of chromosomes in cases where an embryo viability problem is suspected (repeated failure of IVF, miscarriage, maternal age, ...) without being connected to a specific disease.
- However, some MAP techniques can be twisted from their original goal in order to make a fantasy true : choose one's soon to be born baby. In the case of IVF with gamete donation, it is possible, in some countries (USA, Sweden, Denmark, Netherlands, UK...) or on the Internet, to select one's donor depending on its appearance, its level of education, or its religion. The recipients (in particular the single and the homosexual couples) would be more and more precise in their choice. Other practice possible : use the PIGD to select the embryos based on pure convenience creteria. Some american clinics have then proposed PIGD to "choose the gender, the eyes and hair color, and avoid predisposition to cancer" before taking back their offer that was more a communication gimmick than a reality : for now, it seems impossible to ensure, on the base of our genetic knowledge, the eyes or hair color of a child soon to be born. The custom embryo fall well and truly from fantasy.
A timeless and artificial procreation ?
If artificial insemination or IVF create an unprecedented separation of sex and reproduction, the freezing of gametes and embryos leads to more dizzying break yet : the break of time. The removal of gametes and fertilization can be decoupled. And between fertilization and birth, it can now pass much more than the "nine biological month."
Stem cells can develop into many types of body cells. So why not use it to produce gametes? This is the bet of dozens of scientific teams worldwide. In animals, sperm and egg cells have been obtained from embryonic stem cells. Artificial sperm have enabled the birth from mice, but they have been victims of several pathologies, including respiratory difficulties. Works have also shown that it was possible, with the mice, to obtain gametes from induced adult stem cells, but no birth could be obtained yet. In humans, things seem to be more complicated. In 2009, a team would nevertheless managed to evolve embryonic stem cells into spermatozoon. Works are underway to try to do the same with adult stem cells. In the opinion of many experts, the first banks of artificial gametes will emerge most likely in the next one to two decades.