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Is there a right or wrong way of doing things in Reproductive Medicine?

Is there a right or wrong way of doing things in Reproductive Medicine?
Interesting and controversial questions discussed with Prof. Martin Johnson at Cambridge University – 2013.
By Dr. Lucy Coleman

lucy021. What do you think about fertility tourism and the implications of this? Does it have something to do with fertility regulations, or do you think that there are regulations affecting the vision of reproductive specialists?

There is a very good special issue1 of Reproductive BioMedicine (RBM) online which is devoted to this subject; you need to have a look at this. I think it is a very complicated issue, you have to build efficient trust in your own people. Because people move across boundaries for a number of reasons: there are regulatory, financial, cultural reasons, and that volume is substantial. That chapter in RBM online summarizes all this issues. I recommend you to read it

1 Introduction: travelling for conception and the global assisted reproduction market. Zeynep B. Gürtin, Marcia C. Inhorn. Reproductive BioMedicine Online. Volume 23, issue 5, pages 535-537, November 2011.

2. What is your vision regarding same sex couples and their future children? Would there be implications and changes in the family concept?

Yes, that is a very hot topic here, because things have moved massively in the UK, how much family structure changes through Assisted Reproductive Techniques (ART). I have no problems. Serious works have shown that children from lesbian couples or gay couples are normal, sometimes are even better. What is important is the environment the child is brought up, not whether it comes from a father or a mother. Most of the medical professionals are in favor of this, as well as governments; political parties and churches attitudes have relaxed around the subject in the last couple of years, although the catholic church is very against this. Gay marriage will be legal in the UK soon. It is legal in Argentina. I don’t know if it is legal in any other country in South America.

3. Are there any recommendations to specialists in reproductive medicine to expand in the way they decide to sell embryos, eggs or stored semen to their future parents?

You are asking me about sell for money. In principle I don’t like the moneyfication of potential people. I am against of selling or any attempt of it. It is totally fraud and has to be very carefully looked at. I think it is reasonable to cover cost and expenses but I don’t like the idea, it is like selling a kidney or a bone.
Lucy: So you think a donor should not be paid for that?
Martin: I think they should be giving compensation but ideally egg donors should be people who are going to be ovulated anyway for their own purpose, like egg sharing as long as is properly regulated.

4. When is an embryo considered legally a baby?

In UK law it is not a baby until it is outside the mother and have any legal rights until is born. From the moment it passes down the birth canal becomes a person. Although the abortion law here is reasonably strict, any woman can have an abortion right until the time she delivers the baby. For different causes, like a risk for her health or if the baby comes with defects. Here you have to protect the right of the mother until the baby is born to protect its own rights. But when we are dealing in IVF with embryos, we are so far from babies.
Lucy: Some people believe the embryo should have rights from the moment of the implantation or even before during fertilization.
Martin: We published a paper2 in Reproductive BioMedicine Online recently that states: The afterlife of embryonic persons: what a strange place heaven must be. Because what this author pointed out, if you accept that most embryos die naturally, even in vivo, so heaven must be populated by blastocysts, whereas they come back as people that never existed. So that is a rather extreme way of looking at it. You need to read that paper.

2 (Murphy T. 25, 684-688, 2012).

5. We use written consents for every procedure performed, do you think it would be beneficial if we could have a worldwide guideline for every consent in particular?

I think that would be quite difficult to do because of all the different laws. But the principle it should be the same. The patient needs to be informed. If the person is able to consent, they are free from pressures.

Lucy: It is also important to offer them counseling.
Martin: Yes, because it gives them a chance to explore the issues and ask questions.

6. What do you think would be the future for reproductive medicine?

I think we will have artificial cells into gametes. It is experimental now in mouse, but we will do that. Mitochondrial replacement. I don’t know if we will have eugenic genetic engineering, but that might be a possibility, I don’t think that is a high on the agenda because we will probably have stems cells to generate tissue replacement because that is already happening. The desire of having children will always be the driving force, and the due to possibilities of achieving it someone will try them.

7. What would be your advice for the new generation of specialist in reproductive medicine?

They should be clear where the responsibilities lie. Not just the mother, the father and the potential baby, but the whole society. To look all the responsibilities implicated. They should not be constrained by financial or religious beliefs. They need to look at the person in front and say: Is this person informed and autonomous? Are they able to make decisions for themselves? And you respect those decisions whether you act or not. You have to have moral integrity yourself; you have to trust your patients, and to test their autonomy in a compassionate way.

8. Do you consider yourself an innovative person?

I don’t think I am particularly innovative. I have the capacity of taking stuff, analyze them, present them reasonably well, but I don’t think I am particularly imaginative. I think I work quite hard, if I can see something worth doing I will go for it if is doable. I have done lots of things in my time. There is nothing I have done I am ashamed of in my work.

9. People think fertility specialists are going against nature and claim to be like God. What do you think about that?

My answer to that is: Nature is what we work with, and what is possible is natural. If we were going against nature why we believe in antibiotics? Because nature is to be infected and die. So we are part of nature and therefore we are natural. Playing God? That is an interesting question because I went to a meeting of Progress Organization a few years ago and invited representatives of diverse religions; there were a series of questions, and the Catholics and Protestants said we play to be God. But the non-orthodox Judaism said that in Judaism it is considered a complement, because if you are playing God you are getting as close to God as you can. So they consider it a complement. Similarly, when someone asked the questions about human embryos, there was horror from the Islam and the Christian people. You just realize there are different religious perspectives. That’s why I think you can’t be too cultural or religious in your ethics. When people come along and make suggestions to me about something they want to do I won’t say no, even if I find it distasteful, because that is just bringing out my own prejudice, my own culture, my own religious beliefs. I would say: why would you want to do this? How are you going to do this? What will the consequences be or not be? Who is going to benefit from it? Let’s explore it rather than dismiss it. And I think that is something I’ve got from Bob Edwards. Not disengaged, because every suggestion that came along made him play devil’s advocate sometimes, but he will always defend us from any position because he did that. He never closed his mind from things. He took many risks but he didn’t take them lightly, he engaged with all the students. He really was an amazing man.



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