Wednesday, March 12, 2008

Deaf couple and IVF - angels on the head of a pin ?

It was good to see a very calm, sensitive and rational Jackie Ballard representing the Royal National Institute for the Deaf on BBC 1's Breakfast News. She was talking about the discussion of a deaf couple's potential choices over their IVF offspring.

As Jackie pointed out, we are talking about one couple out of a population of 60-odd million people in this country, so this is a very rare situation. The couple in question have yet to seek IVF treatment. So this really is a bit of a daft debate - premature, to put it charitably. They might choose not to have their embryos screened (as most IVF parents have done up until now anyway). And then they might produce all non-deaf embryos or all deaf embryos so the need for a decision would not arise.

Also, some basic knowledge of IVF and the screening process is required to understand this dilemma properly. Martin from London, commented as follows on BBC Online:

How would the child react when they found out that their parents actively sought to deprive them of a sense ?

Of course, that is not a valid comment. If a situation occurred where there were, say, two non-deaf embryos, A and B in the "petri dish", and one deaf embryo, C, in it, the couple in question want to be able to choose the deaf embryo, C. So they are not depriving the embryo C of a sense if and when it becomes a child. They are simply letting it have a chance to live and not implanting A and B embryos into the womb. You could say that decision is unfair on embryos A and B but quite the opposite for embryo C.

Even then, embryo C might not grow in the womb. Most IVF implantations involve three embryos and only one, if any, survives. Bear in mind that only about 17-20% of IVF attempts end in a live birth!

So, the chances of this decision having to be made and then producing a child are very slim anyway. Bear in mind that many couples try IVF and don't succeed. Many embryos are discarded or simply fail to grow anyway - for example in 1996 there was a legal deadline and any "unclaimed" embryos or eggs held in cold storage, in liquid nitrogen, had to be disposed of. Many were discarded.

So are we debating Angels on the head of a pin here ? We may well be doing so.

Having said all that, I tend to side with the deaf couple. They already have a deaf child and are deaf themselves, if they want to choose a deaf embryo over a non-deaf embryo in the highly hypothetical possible scenario where they could do this, then I would say "let them". I can quite understand that having another deaf child would be an attractive prospect for them, in terms of maintaining the culture and, perhaps closeness (or at least their perceived closeness), of their family.

One further background point. Any debate about this sort of thing tends to get emotionally charged when the word "embryo" is mentioned. People tend to think back to their biology lessons and pictures of large embryos forming in the womb. I am not certain at which stage any screening is done on embryos, but normally, after unfreezing, or after removal of the egg from the ovaries and fertilisation, the parents review the embryo under a microscope before implantation in the womb. I assume that is the stage at which screening is done. In which case, we are talking about an embryo which is only two or three cells big. You look through the microscope at it and all you see are two or three irregular, slightly translucent circular outlines. It is not an embryo in the highly advanced stages that we normally imagine one to be. That doesn't take away the fact that the embryo is a potential human life when implanted, if it successfully grows in the womb, but it ought to be borne in mind.

Of course, we wouldn't be having this discussion were it not for remarkable advances in science. Even a few years ago, routine screening of embryos prior to implantation was not available. Indeed, IVF itself is a relatively recent facility in terms of its availability to parents. Louise Brown, the first IVF baby, will be 30 years old this year. In many ways, things were far simpler in the "old days". You were simply "barren" and you got on with your life without the roller coaster ride of IVF. There were none of these moral dilemmas.

I'm reminded of the remark of Barbara Castle's husband, Ted. The Castles went through a primitive form of fertilisation treatment in the 1940s. After several attempts her husband, a bluff northerner, put his foot down saying with some feeling:

I'm not going to make love to another bloody jam jar as long as I live !

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