Assisted Reproductive Technology

Assisted Reproductive Technology
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Assisted Reproductive Technology: Does Ethics Play Role in Decision Making When it
Comes to Reproduction in Case of Infertility
Reem Ahmed Ali Al-Hada
HLTH 400 Contemporary Health Issues
Professor Mukaire
17 November 2015

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Abstract
Advancement in medical technology opened many opportunities for the infertile
couples to have children through the assisted reproductive technology. The intention of
this research is to overlook the decisions that couples make if they are given different
solutions of assisted reproduction technology and if their morality and belief play a role
in their decision.100 random Likert scale survey was sent to people with different
gender, religious background, and educational level. This forced choice survey contains
10 questions that included demographics and different scenarios about assisted
reproductive technology to examine what each individual would respond. In the result,
the majority of the respondent have some information about the different kind of
assisted reproductive technology such as artificial insemination, vitro fertilization, and
surrogacy, however, a 39% do not know the side effects behind assisted reproductive
technology. 81% agreed that it is ethical to use assisted reproductive technology in
some cases such as unable to reproduce. The results illustrate that religious values,
gender differences, or education level does not have an impact on couple’s decision
regarding to the assisted reproductive technology in case of infertility.
Key Words: assisted reproductive, insemination, vitro fertilization, surrogacy,
preimplantation genetic diagnosis, morals, religion, and education.

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Introduction
Assisted reproductive technology (ART) is a helpful procedure to help women get
pregnant. There are various types of ART and they are all work for the same purpose
and get the same results. The purpose of this research is to examine the knowledge of
the survey respondents of ART options and risks, and whether their moral values will
affect their decision in using it. I assumed that the religious background and culture
develops one’s moral values in which it will affect their decision on the usage of ART for
any reasons. The results of this study will either favors the assumption that has been
made or object it.
Since there are large amount of females and males that face the issue of
infertility, this study became very significant. According to the Women’s Health, there
are 6.1 million of women in the United States are infertile from age 15 to 44.2 Infertility
defined by CDC as the inability of getting pregnant after one year of sex.1 They went
farther explaining about how pregnancy happens and that’s when a women’s egg is
joined to the man’s sperm to get fertilized and attaches to the uterus. Any complication
between the steps from fertilization to implantation such as blocked fallopian tubes or
problems with the uterus can cause infertility. Men’s infertility is caused by enlargement
of the testicular veins and testicular problems. The risk factors that may increase
infertility are age, physical and emotional stress, exposure to trauma, radiations and
chemotherapy, and unhealthy habits and environmental toxics.1 However, medical
technology advancement became a solution to the infertility problem. In 1978, the first
procedure of vitro fertilization was conducted and from that point reproductive
technology grew fast leading an increase of usage.3 There were 190,773 assisted
reproductive technology performed by the year of 2013.4 Not all cases are successful
and yet, people will choose to go through this procedure. The most effective and
common type of ART is vitro fertilization in which the egg is fertilized out of the mother’s
womb in a lab and then it is implanted in the uterus.5 Second type is artificial
insemination, where the sperm is injected to the women’s uterus. Surrogacy is another
type of ART to which a surrogacy women become pregnant for another couple by using
the man’s sperm and her own eggs. Lastly, preimplantation genetic diagnosis is used in
vitro fertilization and it is used to screen any genetic defects and correct it before they
implant it in the uterus. This procedure also helps parents to select gender.6
Number of people looked at the ART as the hope for having children of their own.
Regardless to the adoption system, some women praise ART more than adoption
because they would be able to experience pregnancy and have a child of their own with
an adopted physical characteristics of their parents or family. Some people also use
ART to reduce the risk of communicable disease that maybe carried down to the child.
However, the risks of having an ART overcomes the benefits. For those who use
artificial insemination with a donor sperm, the risk of getting sexually transmitted
infections are very high.7 The risk factor for vitro fertilization is a congenital
abnormalities such as malformations in a child.8 The chance of getting malformations is
increased by 30% after the vitro insemination use. Additionally, it increases cancer risk
such as hepatoblastoma, retinoblastoma, neuroblastoma and leukaemia. Another risk
factor that was discovered is neurodevelopmental disease such as cerebral palsy, low
birth weight and delay of development in child. Finally, vitro fertilization can cause

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miscarriages, multiple pregnancy, premature delivery, ectopic pregnancies (when the
egg is implanted outside the uterus), and ovarian cancer.9
It is very important to look at the religious perspective that relates to health
because religion influence the ethics when it comes to health practices specifically
anything related to human life. Jewish law permit the assisted reproductive technology
because ART fulfills the first three commandments of the Torah. The first
commandment is to be fruitful and multiply, second is the loving kindness and lastly is
the family integrity.10(314-315) As for the Roman Catholic church, the assisted reproductive
system in all its forms is forbidden because they argued that the act of ART and
creation an artificial human being is absolutely immoral and procreation is deprived
when it is not a unification between a husband and wife through intercourse.10(315)
However, the Orthodox Church have an opposite view on assisted reproductive
technology.10(315) They support assisted reproductive system but they do not allow the
donation of the gametes. In the other hand, The Islamic Sharia did not mention the
assisted reproductive technology but promotes the use of ART when procreation fails
since adoption is not acceptable. However, this act is acceptable only for a married
couple. Using a third party sperm, eggs or uterus is also prohibited and it will be
consider as an act of adultery.10(315) Christianity did not specifically mention assisted
reproductive system, therefore, it is allowed to get infertility treatments. For that being
said, not all of assisted reproductive technologies are ethical particularly when the
treatment hinders the sanctity and dignity of human life.
Although, many religions and cultures try to justify the assisted reproductive
technology for some cases, the question that has to be asked is the act considered right
or wrong? Is it moral? Several couples want to enjoy the feeling of being parents but is
the assisted reproductive technology is the only solution for conceiving children? Some
of the reproductive technologies cross the gray area of morality such as vitro
fertilization. Occasionally, vitro fertilization causes multiple pregnancies and will lead
into health risks for the mother and child as it mentioned above. Second issue in vitro
fertilization as an article mentioned that some fertilize eggs to create embryos and
freeze it then use it for the sake of scientific research.11 Morality is defined according to
an individual view of the quality of life.
Gestational surrogacy is another moral dilemma. Since the surrogate mother is
the one who carries the baby, she have to detach herself emotionally and physically
from the baby after it’s born. This might affect the child’s self-identity when he is
informed about his surrogate mother.12 Financially, the surrogacy is very expensive
because the surrogate mother get paid for food , clothing , hospital expanses, and even
a fee for her service. This leaves people questioning their moral judgment and if the act
of the surrogate mother selling her own baby is right or wrong.
Another ethical issue is the preimplantation genetic diagnosis PGD. This
technology is preformed to form a perfect child. Either perfect from a genetic defects or
perfect on sex selection. However, it cost many human lives to form only one child. As
the Journal of the American Medical Association reported in 2001 that 29 lives were
destroyed to create one through the vitro fertilization.13 Again, morality is questioned on
using PGD to weed out the undesired genetic defected offspring.

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Method
This research involved 100 random participants who answered 10 survey
questions about assisted reproductive technology. The survey questions was Likert
scale created in Survey Monkey and was sent through Facebook and Emails to
relatives and friends. It was specifically sent through emails to those who have different
religious and cultural background to decrease the amount of bias since most of the
respondents are Christians. The survey was sent to people from different countries such
as Cambodia, Yemen, Egypt, Jordan, and Pakistan. It was taken between October 10th
and November 11th of 2015 which provided time for the respondents to take the survey.
The survey contains demographical questions and different scenarios on
assisted reproductive technology. Demographical questions was based on gender,
religious status and educational level. Religious status is very crucial part in this study
because moral and ethical values are delivered through their religious belief. Some of
colleges’ especially medical school will cover topics such as infertility and the solutions
to that issue. They survey asked the participants about educational level to confirm
whether or not they know the benefits and risks about assisted reproductive technology.
The question of gender is also important to obtain different answers from the opposite
sex and how artificial reproductive technology affect them individually.
There are 7 questions designed with a variety of direct answers, from strongly
agree to strongly disagree, to narrow down the respondents opinion on the specific
scenario. They were asked on their knowledge about the different kinds of assisted
reproductive technology such as artificial insemination, vitro fertilization, or surrogacy.
In addition, they were also asked about the risk factors to discover the actual amount of
people that are aware of this issue. The third question was asked if the individual thinks
that the assisted reproductive technology is ethical in some cases for instance unable to
reproduce, used for genetic reasons, reducing the risk of communicable disease,
unhealthy eggs reproduction, or the man does not produce sperm. The last four
questions was a follow questioner where they are put in a position to think about what
would they do if they were not able to bare a child, males asked to donate sperm,
females are verging to menopause, or couples could not have a specific gender. These
questions will examine their decisions and moral values.
Results
The study was on a diverse population with a different religious background, and
educational level. Although, 65 of the respondents are claimed to be Christians, there
are 21 Muslims, 2 Atheists, and 12 other religions. The ratio between male and female
respondent are not relatively equal. Out of a 100 respondents, 27% are males and 73%
are females. As far as the participant’s college level, 31% of the participants have a
graduate degree, 62 % have undergrad and 7% have not gone to college or they still in
high school.

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Figure 1. Knowledge of assisted reproductive technology and their risk factors.
The results are a reflective response from the participants to their knowledge of assisted
reproductive technology and the risk factors. Around 42% of the respondents have a
knowledge about the assisted reproductive technology, however, 33% does not have
any information about the risk factors.
Figure 2. Usage of assisted reproductive technology.
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Artificial
insemination
Vitro Fertilization Surrogacy Risk Factor
Percentageofrespondants Assisted Reproductive Technology and Risk Factors
Strongly Agree Agree Neutral Disagree Strongly Disagree

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The bar graph indicates the respondents opinion whether the usage of assisted
reproductive technology is ethical or not based on the cases that are given. It shows
that almost 82% agreed that it is ethical to use assisted reproductive technology when
the couples are unable to reproduce.
Figure 3. Religion and the usage of assisted reproductive technology (Unable to
reproduce).
This figure shows the result of the participants opinion on a specific reason of assisted
reproductive technology which is unable to reproduce compared to their religion
background. Around 58% Christians, 40% Muslims, 50% Atheist and 50% of other
religion think that assisted reproductive technology is ethical when couples are unable
to reproduce.
Figure 4. Personal choice for reproduction.
0
5
10
15
20
25
30
35
Sperm donor Artificial insemination and vetro fertilization
Numberofrespondents
PersonalChoicefor Reproduction
Strongly Agree Agree Neutral Disagree Strongly Disagree

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In this figure, it shows how many males will support the sperm bank by donating their
sperm. For females, it shows how many will use an artificial insemination and vitro
fertilization if they are unable to reproduce or reached the menopause. The results
shows that the majority of the respondents are not going to donate their sperm or use
artificial insemination and vitro fertilization.
Figure 5. Preimplantation genetic diagnosis
This figure presents the answers to the questions that regards preimplantation genetic
diagnosis for those who wants a female child rather than a male or vice versa. The
figure is followed by a table to show the exact percentage and number of respondents.

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Discussion
The problem of assisted reproductive system is the morality of an individual and
whether or not other factors will be a major contributor to the decisions that an individual
make. The assumption that is made previously in the introduction that culture and
religious belief forms the moral values of an individual. However, the findings from this
study did not support the assumption.
Demographics are a vital survey questioners for the study because it creates a
connection between a certain populations to generate a study that explains why people
are doing what they do. Their religion background was asked because it is a key factor
to determine their position in responding to an ethical issue such as assisted
reproductive technology. Figure 2, 82% of the respondents agree that assisted
reproductive technology should be used when couples are infertile. Around 8% disagree
and thinks that using assisted reproductive technology is immoral. While 10% feels
neutral about using ART for those who are unable to reproduce. Nevertheless, figure 3
shows that 82% of Christians, 75% of Muslims, 100% of Atheists and 72% of other
religion agreed reproductive technology should when couples are unable to bare
children. These numbers reflects to the religion morality which it is permitted to use
reproductive technology.
In this study it is asked of the participant to identify their level of education and it
is found that 62% are undergrad where are as 7% have no college degree. Educational
level helps to know if the respondents are educated about the topic before answering
the survey questions which may help me receive a good results because of their honest
responds. For example, in figure 1, there are more than 50% agreed that they have
some information about artificial insemination which we assume that they have some
education and been taught that in school.
Gender is another key factor in this study. The majority of males in figure 4
disagreed to donate a perm when its need in the sperm bank. 53 out of 73 females will
not use artificial insemination or vitro fertilization when the verge to menopause. These
answers are a correlation to their own religion because some religion specify that using
someone’s sperm or even donating a sperm is not moral.
The preimplantation genetic diagnosis is one of the most doubtful topic when it
comes to morality. Figure 5 demonstrates that 71 % of people thinks it is immoral to use
preimplantation genetic diagnosis and 12% thinks it is reasonable to use this type of
ART to select the sex of the child.
The Scientific background that is introduced at the beginning illustrates that
importance of knowing the types of assisted reproductive technology and their risk
factors. Most of the assisted reproductive system cause a health issue such as
premature and low birth weight, or malformations of the child. As it shown in the study,
the majority of the people do not know the risk factors of assisted reproductive
technology which may be consider as a factor of the unexpected response. However,
most religion does not have a clear stand point on this issue. As it mentioned above in
the introduction, Judaism, Islam and Christianity allows the assisted reproductive,
nonetheless, there is restrictions on what type of assisted reproductive technology to
use. For this reason, most of the respondents who agreed with using Art in certain
cases such as unable to reproduce. In addition, the majority disagreed upon the use of

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preimplantation genetic diagnosis as many of the religious group consider this act as
immoral.
This valuable information is useful in a way that other people not only religious
group will recognize this not just as a moral issue but as a health issue. This valuable
information can clarify the confusion whether or not assisted reproductive technology is
ethical or not. This information can be applied to other fields of study such as
psychology, public law and religion. For psychology, a further research can be obtain to
determine the psychological and emotional effects for the surrogate mother and the
child and how this will affect their behaviors in the long term. The public law study can
use this research and build on it to find out the risk factor of a multiple usage of assisted
reproductive technology or who can use it. Then, they should construct a law to reduce
the number of usage. Lastly, the study of Religion should construct a similar study that
explores morality more on the religious factor and how that can affect their decision in
every aspect of their life. The general public and a scientific community will use this
information to start a new research to either adopt the assisted reproductive technology
or start a movement and educate people about the types and side effects of ART.
There are several problems in the data collection design. First, there is no
balance between the amount of female and male respondents. There are more females
than males which can throw off numbers because females have different view than
males and this topic effects females emotionally than males. Thus, the response will be
differ and results will not be accurate. I should have sent 50 surveys for females and 50
surveys for males. Secondly, in the last question the “preimplantation genetic diagnosis”
is not defined. Most of the respondents are from different country, this term is not
something everyone knows what it means and the respondents might chose a guessing
answer. I should have clarified the meaning of that term. Lastly, Level of education did
not include high school level. Because some of my Facebook friends are still in high
school. This may create an error in our study because the high school students
probably clicked on the no college choice and that choice is not meant for high school
student. I should have added a choice for high school students to click in.
There are many things that could be done to find out more about the topic. I
should have added more of the demographic questions such as race, ethnicity, age,
country of origin and what their major in college. These specific demographic questions,
could have helped me to obtain more precise and accurate results. I also should have
interviewed doctors that are specialized with assisted reproductive technology and ask
about the success rate of the procedure they have administered and they still think that
ART is moral. I could’ve learn more in details about the assistive reproductive
technology from them because it be a good source to add in the background
information. Lastly, an interview should be conducted for the infertile couples that used
the ART or are considering to have one because getting a personal story will support
this research. The interview will determine what the moral stance and why they chose
ART as a solution and not adoption. For those who used the gestational surrogate, the
questioner will be directed to the psychological response of the child when he/she
confronted about the surrogate mother. The surrogate mother will also be questioned
about her emotional response after she gave a way her child that grew in her and if it
was easy to detach emotionally and physically from her child. These personal questions
will definitely help to clarify the morality and support the research thesis.

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To recap the discussion, a Christian viewpoint on the assisted reproductive
technology is compared with science and society viewpoint. Science is constantly
developing and it is used health field. Their goal is to find solutions to every health
problem but the moral values became an issue since some aspects of science are
morally wrong. In science, if the end justifies the mean, then it is a good method to use
even if it is morally wrong. Therefore, Assisted reproductive technology does more
benefits to infertile couple even it is morally wrong for some types of ART. So, what
would be the society’s viewpoint on the reproductive technology? Society’s morals
differs between countries, religious and ethnic groups. Some countries, religious and
ethnic group will allow assisted reproductive system and some will forbid it such as the
Roman Catholic Church. Nevertheless, when it comes to Christianity, the sanctity of
human life is very important. The Bible have not mentioned the wronged idea of
assisted reproductive technology. Some types of the ART are morally wrong than
others. Although some types of ART is moral, couples should consider other options
such as adoption. In 1 Samuel 1: 5-6, it is clear that God has the open and close the
womb. So, whatever a couple try to use, it is God’s will to bring that child to earth
(Roman’s 12:2). Surrogacy is one of assisted reproductive technology that violates
God’s idea of family. In Ephesians 5:31 states that a man should be married to one
women and they should be one flesh. However, choosing the act of surrogacy the
husband is making a woman, other than his wife, pregnant which violates the His words.
Using other a donated sperm or eggs are also against the word of God. Lastly, God
reminds His people to be patient in every circumstances and that as proven in Psalms
37:7.
Summary and Conclusion
Medical technology has been a blessing for many health problems such as
cancer but also opened doors for morality to be questioned in others such as infertility.
Assisted reproductive technology is used by the infertile couple to get pregnant. The
question will be is it moral to use ART? Most of the people agreed that it is moral to use
assisted reproductive technology for some serious cases such as unable to reproduce,
however, they disagreed on using preimplantation genetic diagnosis because it is a
procedure that helps to make a child perfect or to select the child sex which makes it
immoral. Most religions authorize the use of some types of ART such as vitro
fertilization or artificial insemination, however, the reproductive gametes come from the
married couple. The Bible did not specifically introduce this issue but the infertile couple
ought to be careful and reconsider their choices. In most of assisted reproductive
technology, either the mother or the child get affected and may get harmed. For this
reason, couples should pray about their decision and try to find other solutions.

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Reference
1. Center for Disease Control and Prevention. Reproductive health. Center for Disease
Control and Prevention. http://www.cdc.gov/reproductivehealth/infertility/. Updated
September 16 2015. Accessed November 9 2015.
2. Women’s Health. Infertility fact sheet. Women’s Health.
https://www.womenshealth.gov/publications/our-publications/fact-
sheet/infertility.html#c. Updated July 16 2012. Accessed November 9 2015.

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3. Brown R, Harper, J. The clinical benefit and safety of current and future assisted
reproductive technology. Reproductive BioMedicine Online. 2012;25(2):108-117.
doi:10.1016/j.rbmo.2012.04.009.
4. Center for Disease Control and Prevention. Assisted reproductive technology.
Center for Control and Prevention. http://www.cdc.gov/art/reports/. Update October
13 2015. Accessed November 9 2015.
5. Mayo Clinic. Tests and procedures in vitro fertilization. Mayo Clinic.
http://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/basics/definition/prc-
20018905. Published 1998. Updated June 27 2013. Accessed November 9 2015.
6. American Pregnancy Association. Preimplantation genetic diagnosis. Mayo Clinic.
http://americanpregnancy.org/infertility/preimplantation-genetic-diagnosis/. Published
2015. Updated September 2015. Accessed November 11 2015.
7. Ott KM. A time to be born: a faith-based guide to assisted reproductive technologies.
Academia. http://www.academia.edu/1109435/A_Time_to_Be_Born_A_Faith-
based_Guide_to_Assisted_Reproductive_Technologies. Published 2009. Accessed
November 11 2015.
8. Hyrapetian M, Loucaides EM, Sutcliffec AG. Health and disease in children born
after assistive reproductive therapies (ART). Journal of Reproductive Immunology.
2014;106:21-26. doi:10.1016/j.jri.2014.08.001.
9. Mayo Clinic. Test and procedures in vitro fertilization. Mayo Clinic.
http://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/basics/risks/prc-
20018905. Published 1998. Updated June 27 2013. Accessed November 11 2015.
10. Schenker JG. Assisted reproduction practice: religious perspective. Reproductive
BioMedicine Online. 2005;10(3):310-319. doi:10.1016/S1472-6483(10)61789-0.
11.Fransworth J. What are the moral issues related to in vitro fertilization? Enternal
Perspective Ministries. http://www.epm.org/resources/2010/Dec/7/what-are-moral-
issues-related-vitro-fertilization/. Published December 7 2010. Accessed November
11 2015.
12. Modern Family Surrogacy Center. The ethical issue of surrogacy. Modern Family
Surrocgacy. http://www.modernfamilysurrogacy.com/page/surrogacy_ethical_issues.
Accessed November 11 2015.
13. Action Life. Choosing the perfect child: what’s wrong with PGD. Action Life.
http://www.actionlife.org/index.php/life-issues/reproductive-technologies/pre-natal-
screening/item/172-choosing-the-qperfectq-child-whats-wrong-with-pgd. Published
2006. Accessed November 11 2015.

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Appendix
This survey contains 10 questions that examines an ethical issue of an assisted
reproductive technology. Check one answer that best fits you. For the Women Only
question, answer if you are a female and skip the question if you are a male and vice
versa.
1. Your Gender
a. Male b. Female

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2. Your Religion Background
a. Christian c. Muslim
b. Atheist d. Other
3. Your Level of education
a. No college d. Junior in College
b. Freshman in College e. Senior in College
c. Sophomore in college f. Graduate
4. I have information about artificial insemination, vitro fertilization, or surrogacy
(Artificial insemination is injection of sperm into woman’s uterus)
(Vitro fertilization is fertilizing a mature egg by a sperm in the lab)
(Surrogacy, when a woman bare a child and give birth by using assisted
reproduction technology for other couple)
Strongly
Agree
Agree Neutral Disagree Strongly
Disagree
a. Artificial
insemination
b. Vitro
fertilization
c. Surrogacy
5. I know the risks behind assisted reproductive technology
a. Strongly Agree d. Disagree
b. Agree e. Strongly Disagree
c. Neutral
6. If my partner and I unable to bare a child naturally, I would use assisted
reproductive technology as a solution
c. Neutral
7. I think using assisted reproductive technology to reproduce is ethical in some
cases such as
Strongly
Agree
Agree Neutral Disagree Strongly
Disagree
a. Unable to
reproduce
b. Used for
genetic
reasons

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c. To reduce
the risk of
communicable
disease that
might be
transferred to
the child
d. Unhealthy
eggs
reproduction
e. Man does
not produce
sperm
8. Women only: If I did not find a husband and I wanted a child before I verge
onto menopause, I would consider insemination or vitro fertilization
c. Neutral
9. Men only: If a sperm bank needed a donation, I would donate my sperm
willingly
c. Neutral
10.If my partner and I have four girls in our family and wanted a boy, we would
consider preimplantation genetic diagnosis
c. Neutral

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