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Embryo research to reduce the need for IVF raises ethical concerns

20 January 2020
Appeared in BioNews 1031

Researchers testing a new way to harvest embryos for genetic screening have been criticised for paying women in Mexico to be inseminated.

The study, published online in Human Reproduction, involved 81 women at a hospital near Puerto Vallarta, Mexico. Each participant was paid about $1400 to be artificially inseminated and subsequently to undergo a procedure where the embryos were flushed from the womb and analysed for research. 

Lead investigator Dr Santiago Munné suggests the new method could offer a simpler, less expensive way to assure a healthy child for couples with high risk for passing on genetic disease, such as beta-thalassemia or cystic fibrosis.

'The advantage is that these embryos are conceived naturally, so you don't need in vitro fertilisation (IVF) to do the genetic testing of the embryos. In theory, it should be much cheaper,' Dr Munné said.

As a first step, the participants received hormone injections to stimulate their ovaries' egg production – a standard way to increase the number of eggs obtained in fertility treatments.

Unlike IVF, the eggs weren't extracted before fertilisation in the lab, instead fertilisation was achieved in vivo by means of insemination with donor sperm. Four to six days later, the resulting embryos were flushed out using a mechanical procedure called 'lavage' and analysed, comparing them to embryos produced via IVF. 

The research has been called unethical by critics.

'What this essentially does is use a woman's body as a petri dish, and there's something about that that seems so profoundly disturbing,' Dr Laurie Zoloth, a bioethicist from the University of Chicago, told NPR.

Other issues include the payment participants received, equal to more than two month's average salary in the area, which might become coercive to participants living on the poverty line.

The study also posed health risks to the participating women, who received intensive hormone stimulation. In some cases the lavage did not remove all the embryos, making terminations necessary. 

Editor-in-chief of Human Reproduction, Professor Lambalk, told NPR that after verifying that the research had been thoroughly reviewed, they decided to publish the study along with an editorial and a commentary to draw attention to the ethical issues it raised. 

In response to the criticism, Dr Munné referred to the extensive review and subsequent approval by the Ministry of Health of the State of Nayarit, Mexico, and the Western Institutional Review Board in the United States. Furthermore, he noted that the women were fully informed of risks associated with participation.

Embryos produced in the study have been frozen to be used by couples experiencing infertility and have been used to produce at least five pregnancies and three, thus far, healthy babies.

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