It is to be hoped that the fertility wars are over for the time being. But there is a cloud hanging over us. The Birmingham woman who hopes to carry all of eight foetuses to term and who has made an arrangement with the News of the World to tell her tale in return for cash will reach a turning point sooner or later. Pregnancy does not go on forever, it is just that sometimes it seems like that.
The prospective octuplets overshadowed the story of how staff at Britain's fertility clinics were being compelled by the law to destroy embryos unclaimed after five years by those who had commissioned their creation. Anti-abortionists called it murder. A little earlier, they had been exercised by a report that a woman pregnant with twins might have one of them aborted because she would not be able to cope with two.
What has any of this to do with the lab? "Nothing," at least to a first approximation. Women and their partners are interested in producing babies; scientists, many of whom are women, have a long-standing interest in how it all happens. The second group's success-especially in understanding the role of natural hormones in the regulation of ovulation and implantation-has facilitated all kinds of procedures, from donor insemination to in vitro fertilization (IVF). (In vitro stands for "in glass," loosely translated as "in a test-tube.")
The revolution in fertility management has been deliberately delayed. It is more than three decades since Robert Edwards, then at the department of physiology at Cambridge, began assaulting Nature with learned articles on IVF in rats. Edwards has always been open about his intentions. His goal was to find a way of treating human infertility. From the beginning, Edwards and his colleague, the late Patrick Steptoe, also proclaimed that their proposals would raise novel ethical problems. Eventually the Warnock committee recommended the regulatory framework within which IVF clinics and others with an interest in human embryology must now function.
On balance, the statutory regulation of practice and research seems to be working well. So why all the fuss over the summer?
The case of the putative octuplets is not accidental. Stimulating ovulation by the use of hormones is now a common, and sensible, practice. On this occasion, the physicians concerned appear to have recognised that it had worked too well, with the result that they warned the woman against unprotected intercourse, advice which she declined to follow.
This is an ethical dilemma, but hardly one for science or medicine. There is ample cause to fear that an eightfold pregnancy will be dangerous for the mother, bad for the foetuses or both. But there is no way in which society can intervene to prevent an outcome likely to end in tears. It may be different in China, but the mother-foetus relationship has been almost sanctified in the west.
The business of unwanted embryos is different. They exist in the first place because the IVF procedure is not fully efficient. Doctors collect several ova, do their best to fertilize them and then attempt to implant in the uterus those in which fertilization has succeeded. Unused, viable, embryos are frozen.
Why destroy the unimplanted embryos? The formal origin of this statutory requirement is the wish to avoid some of the delayed conceptions that might otherwise be arranged, but the status of the embryos is contentious: the anti-abortionists say that their destruction is murder. It is also a waste.
Arguments about when life really begins are both endless and pointless. But it is a plain fact that a viable embryo stored in liquid nitrogen will never become a person unless it is implanted in a uterus by skilled human beings. If the original donors of the ovum and the sperm have no wish to use it, the embryo is orphaned before it has begun on any of the crucial cell divisions that turn DNA into people.
Whether there may be a case for using some of them to provide conceptions for people who are not their genetic mothers is a different question. No doubt that would require the consent of the genetic parents, but otherwise would be no different from surrogate pregnancy, which is legal.
A better use would be in research. As things are, all research projects with human embryos must be approved by the Human Embryology Authority under pain of criminal penalties. Most of the projects so far undertaken have been designed to improve the practice of IVF. Basic research on embryology in general can be more conveniently carried out with the embryos of other mammalian species, which is not regulated. There is an absolute ban on research with embryos older than 14 days-a limit (recommended by Warnock) to predate the first development of the nervous system at about 20 days.
Nevertheless, there are some human questions, for example whether the congenital condition of spina bifida is caused by a lack of folic acid, that would benefit from direct study. It would be wrong to suggest that any of these needs is urgent, but making use of unwanted embryos in research deserves a hearing, as does the question of whether 14 days is the right age-limit.
