What are the ethics in assisted reproductive technologies? Well, when you think about ethics, think about a sword, a double-edged sword that cuts both ways because ethics cuts both ways. So, what are we talking about when we say ethics? Let’s define that term. Ethics are a set of guidelines or rules that define a person’s behaviour in a culture. Essentially, it’s what we think is right or wrong to do.

The tricky part when we’re talking about ethics is the question of, are ethics absolute or relative? Is there an absolute universal rule that governs certain things or is it relative to where you are, who you are, what you do, or who’s around you? When we’re talking about assisted reproductive technologies, really we have big ethical issues around two major points. That’s genetic material and money. So let’s jump into those two things and break it down and see what we can find regarding the ethics of assisted reproductive technologies.

When we’re talking about the genetic material, let’s just look at the embryos. We’re talking about the creation of embryos, the storage of embryos, and the disposition of embryos, where they go when we’re finished. And here are the varieties of how to make embryos in assisted reproduction. But legally, in assisted reproduction, the parent is the person who is intended or who the intent is to become the parent. And that’s why in assisted reproduction training, we often refer to the recipients of gametes, the recipients of donated eggs or sperm, and the parents who are going to be parents from a resulting surrogacy as intended parents. We call them intended parents because that’s the intent of the process. That even though they didn’t carry the child or even though they didn’t donate the sperm or egg that resulted in the child, they are intended to be the parent of the child that’s born. So how does this play out ethically?

The first and the foremost step is that every file we put in a checklist that is put in the… So, all the points are labelled there and our staff ensures that each point is, we are complying with each and every point as per the ART law and regulation and we check each point.

Then there are, we have designated specific people for the checking of the file and in spite of that we do audits, very regularly audits are being done in our unit so that we don’t miss on any important thing and everything is in place and legally sound. Say, informed consent is defined when a couple visits and you talk to them, you explain the whole procedure, like how and what you are going to do and what are the good effects and what are the bad effects because every medication, every procedure we are undergoing, it has a certain extent of some side effects which need to be explained in detail to the couple.

So, we explain each and everything and after that we ask both the partners if they are willing to take the procedure and if any queries they have and when after understanding each and everything they sign the documents that is known as the informed consent. So, implication of informed consent is that our couple knows exactly what is going with them, how they will proceed with the procedure, what are the treatment options they have and they sit with their doctor and they together as a team they select the best treatment and they go ahead with it. So, it is very important to do a detailed counselling and take the patient which includes both the partners as a couple into consideration.

See, when we make embryos, embryo is a genetic material so it’s very important and very like it’s a genetic material, it’s a thing which needs which we cannot just discard like that. So, once we transfer into a couple and they get pregnant and we have extra embryos, we inform them, we tell them to visit the hospital, we give them enough explanation whether they want to continue freezing those embryos or they want to discard. Then they as a couple, both husband and wife they have to give their written consent if they want to discard the embryos.

We cannot take decision on our own. Yes, definitely the ART law which has recently come up, it was everywhere in the newspaper, in the media. So, this law has given us guidelines, there are very strict criteria which we have to meet.

So, if a female is going for egg donation, her age limit has to be between 23 to 35 years of age. A man who is donating his sperm has to be around 21 to 55 years of age and a couple who is accepting egg donation or sperm donation as a IVF option treatment, the age of the female has to be less than 50 and age of the male for that matter has to be less than 55. So, we have to comply each and every law which comes under the ART rule by the Government of India.

We also have some ethical issues or concerns or question marks around the embryos and genetic material. When we talk about selection, one of the benefits that assisted reproduction affords is the option to choose which embryo to use in implanting for procreation. Another ethical issue around the genetic material is, of course, disposal or disposition of the genetic material. Disposition simply means how you want to use it. So, when we’re talking about disposition, a lot of times it results in the use of the embryo in IVF to transfer to the uterus of the mother or to a surrogate to carry to full term. Now, what do we do, though, with embryos that are unused when you finish growing your family? So, the question becomes, do you freeze those embryos for future use for a sibling journey down the road? Do you simply dispose of them? You thaw them and let them demise. Do you donate them to medical science? Do you donate them to another person or couple to help them grow their family? This is one of the most talked about ethical issues in assisted reproduction. And a lot of people point to a number of things. They point to the interests of the unborn embryo or resulting foetus that could be possible. And people point to a number of different issues on this topic. Some people look at the rights of the unborn embryo. Some people talk about the rights of the intended parents, and some people talk even about the rights of the donor.

From IVF to egg donation to surrogacy to all the assisted reproductive technologies, it costs. But are the costs justified? What is the price that you can put on when your body may say you can’t have a child, but science says, no, that’s not right. We can help you. You know, what is it to you?

At Dr. Kamini Rao Hospitals, patients come to us with a long list of queries, they have so many issues, what’s going to happen if we do this, if we do that, what like there are n number of questions and at our centre we try to help them, understand them and guide them as per the ART law. Most of the centres of course in and around Tri-City and this IVF centre in Bangalore being one of them, we are fully compliant with the ART rules and regulations and we help our patients keeping the law in mind 24×7.

There are definitely some risks to assisted reproduction. Now, whether you’re caring for yourself and only using IVF to help yourself get pregnant or you’re working with a surrogate, there’s definitely some risks involved in that. There’s risk dealing with everything involving medicine. There’re definitely some risks. And when you’re asking a woman to put herself in those kinds of risks, there’s often the question of is that an ethical thing to do? Money, compensation aside, is it ethical to ask someone to put themselves at that kind of risk for you? Another ethical issue that comes up around assisted reproduction is access to the science. Unfortunately, not everyone has access to assisted reproductive technologies. And this can be for a number of reasons. It could be cost prohibitive to some. Some could live in a location that doesn’t allow them to utilise these services.

In the field of Assisted Reproductive Technology, where ethical accountability and legal compliance are as important as technical expertise, academic training is the key. Medline Academics is committed to helping physicians attain evidence-based Fellowship in IVF and Reproductive Medicine, so that fertility experts are not only technically skilled but also knowledgeable about the legal aspects of ART, ethical considerations, informed consent issues, embryo handling guidelines, and compliance with the law. By combining academic training with hands-on experience, Medline Academics aims to develop responsible fertility experts who practice transparent, patient-centric, and compliant reproductive medicine.