Islamset - What to do with Surplus Fertilized Ova?

Medical Jurisprudence
Third Symposium
on

"The Islamic Vision of Some Medical Practices"
Held from 18-21 April, 1987 A.D.

WHAT TO DO WITH SURPLUS FERTILIZED OVA?
- by Dr. Ma,mun Al-Haj Ali Ibrahim
Associate Professor, Gynaecology &
Obstetrics Dept., Faculty of Medicine,
University of Kuwait

This subject is, no doubt, extremely important and has become a medical reality in this age. A Muslim doctor should embrace all the medical and legal jurisprudence aspects of this issue in order to have clarity of vision.

The subject under discussion is new in the world of medicine: approving the modern medical procedure followed in the treatment of certain cases of infertility - fertilization outside the body known as in vitro fertilization or «test tube baby». The procedure is to suck ova from the wife's ovary using an laparoscopy or ultrasonic visualization. The ova are then fertilized with the husband's sperm in a test tube. When fertilization has happened and the ova have started to grow and divide, they are put back into the wife's uterus via the vagina and the uterine cervix. If, by God's will, an ovum is attached to the endometrium, the embryo will then grow as in natural pregnancy. In the beginning, this procedure was only used in cases of infertility caused by blockage of the fallopian tubes but its use has now widened to include cases of partial infertility in men as well as infertility of unknown cause.

The rate of success of fertilized ova getting embedded in the endometrium is in direct proportion with the number of fertilized ova returned into the uterus. When only one fertilized ovum is returned the ratio is 15%, and rises to 23% if two ova are returned, and it goes up to 30.2% when the returned ova are increased to three, If more ova are returned into the uterus the ratio of success does not become any higher, instead, the ratio of possible multiple pregnancy, with all its dangers, rises. Thus, the best results are to be achieved by returning three fertilized ova into the cavity of the uterus. In order to get three ova fertilized and good, a greater number of ova, probably double this figure, needs to be collected from the mother's ovary because the fertilization ratio in the best centers is 95% in cases of fallopian tubes blockage and only 58% in cases of male partial infertility. In addition, a great part of the fertilized ova would be unfit to be returned, e.g. fragmented or fertilized by more than one spermato- zoon; for these too are spoiled, if returned into the uterus they would not result in normal pregnancy but a vesicular mole or even a malignant tumor inside the uterus.

In order to get a large number of ova, hormones activating the ovaries are adminstered to the wife and in many cases the resulting ova are eight and sometimes as many as ten. Consequently, there is a good chance of having a surplus of fertilized ova - so what do we do with them?

The available alternatives are:

1. To be thrown away and washed away when test tubes are washed.

2. To be left in a test tube to grow, and in this case their fate is also extermination, since the longest period of growth for such ova, so far recorded, is 16 days; after which the ovum breaks out of its membrane and stops growing. At this stage the ovum will not get embedded in the endometrium if returned into the uterus.

3. To be given to another woman who needs them, e.g. one who lost her ovaries, but as we have come to know this will be illegitimate because of the involvement of a third party from outside the legitimate marriage contract.

4. To be preserved by chilling and freezing to be used in another menstrual cycle if no ova got embedded, the first time, as long as the marriage contract is valid. But if the contract is terminated whether by divorce or death of husband or. wife, what shall we do with the preserved ova? And who has the right to decide: the doctor or the legal heir(s) or any of the two parties?

5. To be used for purposes of scientific research which is always compelled by necessity and, as it is well known, we could have never reached this great achievement nor could we succeed in treating these serious cases of infertility were it not for the continuous research in science. Through the application of this modern procedure 2000 babies were born around the world up till November, 1986. The two scientists: Robert Edwards and Patrick Steptoe of Oldham, England, have done numerous researches on fertilized ova to ensure safety of the procedure and for fear of occurrence of malformations, and only when they were sure, the trials of returning ova into the uterus started. They followed up the first woman who got pregnant by in vitro fertilization and delivered her baby in 1978. What is the scientific importance of continuing research on fertilized ova, which, as above mentioned, are of two types: one is spoiled and can not be returned into the uterus and the other is good but superfluous?

First: Research on cases of infertility and its causes.

The rate of infertility in both husbands and wives may reach 12%, and the areas of research here are:

a. Research on male infertility: which is the main cause in about 40% of all infertility cases in husbands and wives. The available data of this type of infertility are inaccurate. We need to know the capability of the spermatozoon on penetration. What causes some sperm to lose this capability? What causes an ovum to be penetrable by more than one spermatozoon so that it becomes spoiled and if it grows the pregnancy becomes a vesicular - mole or turns into a life - threatening malignant tumor.

b. To achieve a higher ratio of success rate of in vitro fertilization; for the highest ratio of pregnancy in the best centers after returning 3 good fertilized ova does not exceed 25%, taking into consideration that a lot of ova do not get fertilized and some of them become spoiled and consequently, if we take the number of patients being treated into account, the ratio of success then becomes 15% only. This ratio needs to be raised a matter achievable only through scientific research, particularly to find out the causes of fertilized ova failing to get attached to the endometrium when returned into the uterus.

c. To study ways of preserving ova or fertilized ova to be used in a later menstrual cycle and to ensure that such a long period of chilling then heating does not cause any disorder in the preserved ova that could result in malformations - taking into consideration that researches on laboratory animals showed that the ratio of fertilization with more than one spermatozoon increases when ova have been preserved for a long period of time.

Second: Studying cases of habitual abortion and implantation failure.

I would like to mention here that about 60% of ova fertilized naturally in the fallopian tubes do not get implanted. This is known by studying the ratio of hormones secreted by fertilized ova in women during the last week of the menstrual cycle. Consequently, blood shedding signifies the occurrence of unnoticed abortion. Habitual abortion is still an enigmatic problem for doctors. Scientific research is urgently needed to relate the causes of fertilized ova not growing and failing to get implanted. This may be achieved through the study of genes which control the factors affecting growth, particularly in the fertilized ova that grow abnormally. Study of these genes is now being conducted on abortion products. Other studies are also carried out on ova of female laboratory animals. It is preferred, however, to make these studies on ova of the human female, especially when such ova are superfluous.

Third: Studying nucleic acid in the fertilized ovum to diagnose inherited diseases and probably treat them in the future.

What is done now is to take some of the placental cell during the first few weeks of pregnancy for testing, and if the results show the presence of an inherited disease abortion is induced, if allowed. A better procedure would be to take a specimen from the fertilized ovum and when an inherited disease is detected such an ovum should not be returned into the uterus. This is a sophisticated technology that science has not yet achieved, since the number of cells in a fertilized ovum is so small, but will hopefully be achieved, by God's will, through the improvement of cell implantation methods used in laboratories. There is also a great future hope in getting to recognize the gene causing each of the hereditary diseases and to deal with such genes using the so called genetic engineering, the future of which, I believe, lies in conducting research on fertilized ova before implanting them into the uterus.

Fourth: Studying malformations resulting from environmental factors.

The ratio of embryonic malformations reaches, in some regions, 3% , in some cases due to hereditary factors while in others as a result of environmental factors like exposure to chemical substances. Research on fertilized ova may lead to the identification of environmental causes of the various malformations, and consequently doctors will become able to advise the expectant mother to avoid such environments.

Fifth: Research on family planning

Various researches are now being conducted to develop methods or devices that would prevent the fertilized ovum from growing or getting attached to the endometrium like the intrauterine contraceptive device (IUD). However, most of these researches are experiments on laboratory animals. What I have mentioned clarifies the existing medical need for research conducted on fertilized ova, and I would like to point out that a fertilized ovum is different cellwise from an embryo already implanted in the uterus wall. The egg cells divide and multiply, but only in part of it appears the primary protrusion of which the embryo starts forming after the ovum gets implanted in the uterus wall. This protrusion might not appear at all, in which case the result would be a blighted ovum or it could develop into a vesicular mole or uterine cancer. A fertilized ovum is partially alive, and therefore respected, so are the sperm and unfertilized ova; they too are equally respected for the partial life they carry.

However, when necessary we conduct scientific research on both sperm and unfertilized ova; and I believe that the existing scientific necessity justifies carrying out research on fertilized ova especially when superfluous.

And praise is first and last unto Allah.