Does Arab world have unique ethics in assisted conception? Is there any law covering this field? This talk may help to illustrate this

1. 1
In the Name of Allah the
Most Gracious
The Most Merciful

2. 2
Ethical aspects of ART in
the Arabic-speaking world
Professor Hesham Al-Inany, M.D, Ph.D.
Professor of Obstetrics & Gynecology
Faculty of Medicine , Cairo University

3. 3
Please note:
• The population diversity of more than
300 millions from 22 Arab countries is
not easy to demonstrate.
• At certain points one or more countries
are selected as representatives or used
as examples.

4. 4
Introduction
• The ability to reproduce is a basic
element of reproductive health.
• Infertility, in itself, may not threaten
physical health, but it can certainly
have a serious impact on mental and
social health.

5. 5
ART
• IUI, IVF, ICSI, and recently PGS,
PGD have offered solutions to
subfertile couple to achieve their
parenthood dreams.
• More than 3 million babies have
been delivered by ART till now
allover the world

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Arab World
• The ethical aspects of ART are very
important in determining the degree
of acceptability of such programs in
Arab world
• the conservative culture of Arab
world is governed by strong religious
sentiments

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Arab World
• More than 90% of arab are muslims
• The basic concept of Islam is to
avoid mixing genes,
• As Islam enjoys the purity of genes
and heredity, It deems that each child
should relate to a known father and
mother.

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Not only patients
• The physician is also concerned
about the legal basis of acts
undertaken on the basis of ethical
precepts

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LAW
• In all arab countries, there is no official
legislation to control assisted
reproduction, with the exception of
Tunisia
• Although most Western countries have
adopted legislation to govern ARTs,
Canada to date has not.

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Isitloose!!!
• however, ART in arab world is strictly
regulated by two factors:-
Religious laws
guidelines

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Religious
• Since marriage is a contract between
the wife and husband during the span
of their marriage, no third party can
intrude into the marital functions of sex
and procreation.
• A third party is not acceptable whether
he or she is providing a sperm, an egg,
an embryo or a uterus (Serour and
Omran, 1992).

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Fatwa
• So long as these procedures are
carried out by expert scientists
• and are clearly indicated for the
couple, and so long as the sperm
cell is from the husband and the egg
is from the wife with no mixing with
other cells from other couples or
other species,

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Fatwa (cont.)
• and that the conceptus is implanted in
the uterus of the same wife from
whom the ova were taken, then IVF is
an acceptable line of treatment (al-
Azhar Fatwa, 1980).

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Christianpointofview
• About seven million Egyptians are
Christians (Copts). Christian minorities
are also present in almost all Arab
countries. They follow the Alexandria
Orthodox Church, the Catholic Church
and a smaller number follow the
Protestant church.

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• The pope of Alexandria, who is the
spiritual leader of the Orthodox
Church, clearly stated that Christian
beliefs are identical to Muslim beliefs
concerning assisted reproduction.
(Aboulghar et al, 2007)

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• These religious regulations for both
Muslims and Christians are followed
strictly by all IVF centres in the Arab
world with the exception of Lebanon.

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Guidelines
• The Ministry of Health, the doctors’
syndicate, the Egyptian Fertility
Society and the Middle East Fertility
Society all issued guidelines which
conform with the religious regulations.
• In addition there are detailed
specifications for an IVF centre and
description of inspection and quality
control procedures

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However
• IVF centres in general do not conform
to recommendations concerning the
number of embryos transferred

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Guidelines
• A November 2000 workshop
organized by the International Islamic
Center for Population Studies and
Research, Al-Azhar University, Cairo,
considered use of assisted
reproduction technologies (ART) in
the Islamic world.

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Tunisian law
• Tunisia is the only Arabic-speaking
country which has a law to regulate IVF.
• The law states that ARTshould be
performed with gametes of a married
couple, and frozen gametes or embryos
are only to be used if the couple is alive
and the marriage contract is valid and
with valid consent.

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• The law provides specifications for IVF
centres and regulations to maintain
standards and it ensures regular
inspections and confidentiality for all
patients.
• All centres should keep a complete and
detailed register of all procedures.
There are different levels of penalties
for centres violating the law.

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Lebanon: anexception
• The presence of so many ethnic
groups in Lebanon and several
religions allow more freedom in family
and heredity laws. Each sect can use
the regulations of his or her ethnic or
religious background.

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For example
• According to the Druze religion (a
minority group), donation of oocytes
between sisters may be permitted.

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Specific conditions

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Cryopreservation
• According to Islamic Sharia or law
there has been no definite clear
opinion regarding cryopreservation.
In Egypt cryopreservation is done
under strict conditions after couples
have signed a consent for the wife
who is still legally married to the
same husband

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• Transfer of frozen-thawed embryos, or
using frozen-thawed sperm after
termination of the marriage contract
by divorce or death of the husband is
also forbidden.

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In Tunisia
• Cryopreservation is allowed for five
years, but it can be extended with a
written consent signed by the couple for
another period of five years.

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PGD
• It is accepted to use preimplantation
genetic diagnosis to prevent
hereditary diseases
• sex selection has been permitted for
family balancing.
• Certain precautions and restriction
were suggested to be applied to
avoid its abuse

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Cloning
• human reproductive cloning is
condemned, but cloning human
embryos for stem cell research is
considered acceptable Serour &
Dickens , 2001
• The majority of Muslim jurists
distinguish between reproductive
and therapeutic cloning (Larijani ,
Zahedi F.,2004)

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Surrogate Mother
• surrogate motherhood is not allowed
because of the legal position of the
mother in Islamic shari'a and
consequent inheritance rights on the
one hand and sociological
significance of motherhood on the
other. (Arbach , 2002)

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Multifetal pregnancy reduction
• According to Islamic view, MFPR is
only allowed if the prospect of
carrying the pregnancy to viability is
very small.
• It is also allowed if the life or health of
the mother is in jeopardy.
• Every attempt should be made to
prevent the incidence of multiple
pregnancy, especially high-order
multiple pregnancy.

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• When MFPR is performed, it is not
performed with the objective of inducing
abortion. MFPR is performed with the
objective of increasing the chances of
continuation of the pregnancy and the
chances of survival of the remaining
fetus or fetuses (al-Shazil, 1995).

33. Pregnancy in the
postmenopause

34. ART allow postmenopausal women to
become pregnant. The physiological
process occuring with pregnancy no
doubt task and exhaust the health
reserves of the woman.
Pregnancy in the postmenopause,
involves egg donation, accordingly,
using donated eggs is ethically
unacceptable in the Muslim World

35. Pregnancy in the postmenopausal using
couple’s frozen embryos is associated
with increased maternal risks and need
further evaluation.

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Embryo research
• According to religious
recommendations, research would
occur only on spare embryos
created as by-products of IVF
treatment for infertility.
• However, the wide use of
cryopreservation of extra embryos
has limited the number of embryos
donated for research

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• Cryopreserved pre-embryos may be
used for research purposes with the
free and informed consent of the
couple.
• These pre-embryos are not to be
transferred to the uterus of the wife
or that of any other woman

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Summary
 In the Arabic-speaking countries, assisted
reproduction treatment is strictly controlled
by religious rules that basically do not allow
involvement of a third party in the procedure.

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• Egg donation, sperm donation and
surrogacy are not allowed.
• Assisted reproduction treatment should
only be performed in the presence of a
valid marriage contract

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not to mingle genealogical lines
The concept