Professor John Burn provided an overview of the genetic principals of reproduction. The scientific basis of reproduction is the preservation of the genes that we carry in every cell in our body. The gametes are the specialised cells (sperm and egg) that are the means by which the male and female genes are introduced at fertilisation. There is thus no ethical or scientific reason to enshrine special status in the gamete as distinct from any other cell type. It is the consequence of fertilisation, the embryo and its potential to create a new individual, that needs to be given appropriate respect. There is a very high attrition rate following natural fertilisation in humans and even at birth, 2-3 per cent of all naturally conceived children carry severe congenital problems. This illustrates the frequency with which such faults occur naturally in humans. More faults (3-4 per cent) occur after assisted conception, illustrating the care that must be taken when considering the introduction of any new reproductive technology. Questions from the audience raised the issue as to why more research is not done to investigate these causes of infertility. Since most of these problems arise during the development of sperm and eggs and early post-fertilisation development, there are strong arguments to support further research on artificial gametes. Ultimately however, in relation to treatment, the welfare of any child conceived must be our prime concern. The inherent and inevitable risk to the child in conception and during birth must be minimised and must be balanced against the interests of the infertile couple.
Dr Donald Bruce presented ethical concerns about artificial gametes. These centre primarily on the creation and use of embryos to derive embryonic stem cell lines from which sperm could be derived. Thus, those who have ethical or religious objections to IVF are unhappy about the creation of artificial gametes. Since it is possible that sperm may also be made from other stem cells, this objection to the use of embryos may not be relevant. Sympathy was expressed for infertile men who may benefit from such scientific developments including those who have been left infertile after successful cancer treatment.
Media and political discussions have raised concerns that artificial gametes may be used to create children for lesbian couples using both their DNA by creating a sperm from one partner to fertilise the egg of the other. The use of donated sperm to allow lesbian women to be parents is now accepted practice. Artificial gametes might give lesbian couples the possibility of a child who would have a complete knowledge of their genetic origin. This must surely be in the best interest of the child. Scientists and clinicians do not define the meaning of parenting; they respond to the clinical needs of individuals. Reproductive choices are made by individuals framed by the values of the society in which they live. A progressive society protects these choices.
Realistically, this is still only theoretical. Much research is still needed to develop the necessary technology and address the safety issues related to the use of laboratory grown sperm. The prospect of growing functioning eggs is many years away. Artificial gametes are not yet ready for clinical use. But Professor Burn also illustrated the remarkable speed at which scientific developments can occur. The ability to read individual genomes as a routine procedure would never have been thought possible just a few years ago and now it is a feasible option. Sperm is likely to be ready to test in clinical studies within the lifetime of the Human Fertilisation and Embryology Bill currently being considered in Parliament. The UK is internationally recognised as having provided legislation that allows science to progress within a regulated framework. This has kept the UK at the forefront in this field. A clause in the current Bill intends to prohibit the use of laboratory derived sperm from ever being used for fertility treatment in the UK. An amendment has been tabled that would permit Parliament to reconsider the issue whenever appropriate. Regulations could be made to permit their use to treat infertile couples if new developments had successfully addressed the safety issues.
The meeting was open to the public and widely advertised. The attendees were non-selected and came from throughout the UK. After hearing the scientific and ethical discussion, a vote was taken by 86 attendees on this clause in the HFE Bill. Six per cent voted for the government's proposed complete ban in primary legislation on the use of artificial gametes for fertility treatment. 53 per cent preferred that it be banned now but that Parliament be given regulatory making powers to reconsider the issue at any appropriate time in the future. The remaining 41 per cent felt that there should be no specific ban and that the current regulations provided by the HFEA licensing procedure were sufficient. The proposed government ban on the use of artificial sperm for fertility treatment may not reflect the wishes of society, since 94 per cent of those at the meeting who took part in the vote reflected a desire for a more progressive approach.