Eubios Journal of Asian and International Bioethics 13 (2003), 59-60.
The field of assisted reproduction is one of the fastest growing areas in medicine. The development of new and sophisticated techniques all aim to give reproductive technologists and scientists a better understanding of reproductive biology. The development of new techniques may also be able to improve the chances of an infertile couple towards achieving a pregnancy. However the ethics and legality of assisted reproductive technology must not be brushed aside. Islamic scholars whose reference basis resides in the Holy Quran and the Hadith have addressed different issues relating to assisted reproductive technology. Some of the issues remain controversial and need detailed discussion before it can be deemed as appropriate and legible for use as guidelines in the development of the processes involved.
Assisted reproduction relies on the use of technology to assist infertile couples to conceive a much longed for child. Infertility affects between 10 - 15% of couples (1) where the incidence of infertility in males and females are approximately the same.
The birth of the first IVF baby in 1978 has brought new hope for infertile couples as an alternative means of obtaining a child. Several techniques of assisted reproductive technology have been developed ever since. These include techniques such as gamete intra fallopian transfer (GIFT), intra uterine insemination and intracytoplasmic sperm injection (ICSI) to name a few. However in the light of many technological advances in reproductive technology that are taking place, this field has received strong feelings and often oppositions from religious groups or human right activists in terms of the legality and the morality of some aspects of assisted reproduction.
Infertility and Islamic Law (Shariah)
The issue of infertility has been addressed in the Quran, Surah 42: 49-50:' to God belongs the dominion of the heavens and the earth; He creates what He wills; He bestows male or female, according to his will; or He bestows both males and females and He leaves barren whom He will; for He is full of knowledge and power.'
Islam is not against treating infertility, it is not seen as a defiance of God's will but to discover the truth about the capability of a couple to achieve a child (2). Infertile couples seeking treatment for their infertility are not seen as going against Islamic laws (Shariah). Moreover seeking treatment for infertility is encouraged and is necessary as it involves the procreation in the couple (3).
The process that is involved in assisted reproduction techniques often raises controversy and debate. However any opposition must not be interpreted as relating to aspects where Islam is against technological advancement, rather it aims to look at any particular aspect so that they go according to the guidelines of the Shariah (Islamic laws). According to Serour (1998) the primary sources of Shariah come from the Holy Quran, followed by the Sunnah and Hadith. Sunnah and Hadith are traditions and sayings of the Prophet Muhammad (PBUH). This is followed by the opinions of Islamic scholars and Analogy, which is reasoning to rule on events that is not mentioned by the Quran and Sunnah with equivalent events that have been ruled upon (3).
Techniques in assisted reproductive technology
Assisted reproductive technology has gone from older tubal techniques such as GIFT, TET (Tubal Embryo Transfer and PROST (pronuclear stage transfer) to more widely used uterine transfer techniques such as IVF and ICSI (4). Other sophisticated techniques have also been developed in order to achieve better pregnancy rates such as culturing embryos to the blastocyst stage and the assisted hatching of embryos.
The steps involved in a cycle of treatment such as in an IVF cycle would initially be drug stimulation of the ovaries to produce multiple follicles. Follicular aspiration is done in order to collect the oocyte. The oocyte will then be inseminated with sperm and left to fertilise. The embryos will then be cultured for a period of 2-3 days after which they will be selected based on morphology and cell counts before being transferred back to the uterus of the mother.
Another technique in assisted reproduction is the ability to biopsy an embryo and carry out analysis in order to find out the genetic structure. This process is called Preimplantation Genetic Diagnosis (PGD). PGD involves sampling one of the blastomeres that is present in the cleaving 2-3 day embryo and screening for their genetic structure. The purpose is to screen for genetic defects that may be present in the embryo. Any embryo that does not carry genes for genetic diseases may be transferred back into the uterus.
Issues arising from assisted reproduction
In infertile couples whose cause of infertility relates to the husband's condition of being azoospermic (no sperm) or other male factor infertility, an alternative approach would be to inseminate the man's wife with the sperm from a donor. In this aspect, Islam prohibits the act of insemination between the egg of a woman and the sperm of another man who is not her lawful husband.
Yusuf Al-Qarawadi (1995) addressed the issue of using sperm donors to be classified as being the equal to committing adultery and is therefore is regarded as a grevious crime and a great sin. He also emphasises on the importance of safeguarding lineage in Islam. A former head of the Al-Azhar Mosque and University, Shaykh Mahmud Shaltut as cited by Abul Fadl Mohsin Ebrahim (1988) released a fatwa (religious decree) that condemns the act of donor sperm insemination and equates it to committing adultery.
Cryopreservation involves freezing of semen using a cryoprotectant and storing it at very low temperatures for later use. This technique may be used for patients that have been diagnosed as having a disease where treatment from the disease may result in infertility. The sperm is processed and is kept and thawed at a later date and with the patient's consent, is used to fertilise the oocyte from the wife. This technique is legal as long as the couple is still within the marriage contract, however, the storing of the husband's sperm for the purpose of impregnating the wife in the event of his death is regarded as illegitimate as under Islamic law the event of death render's the marriage union to be void (6). This is because Shariah laws takes into account of the rights of the child for it to be reared by two parents.
In vitro fertilisation (IVF)
IVF involves fertilisation of the gametes outside of a woman's body. It is the preferred option for patients that present with factors such as the damage of the fallopian tubes. IVF involves several stages such as stimulating the ovaries to produce multiple oocyte, inseminating the oocyte with sperm, culturing the embryos until they have divided and finally transferring the 2-3 day post insemination embryos back to the uterus. The embryos are selected based on their ability to survive culture conditions by looking at the cell numbers present at day 2-3 post insemination and their morphology.
Looking at IVF from the Islamic angle, it is a technique that if successful may result in pregnancy for the childless couple. However a debatable issue that arise would be in the selection of embryos for transfer and the fate of the other remaining embryos. Patients may consent to discard the spare embryos or consent to freezing or cryopreservation. The advantages of freezing embryos would be that the woman might not have to undergo the drug stimulation cycle again and also to prevent the woman from experiencing the side effects of the stimulant drugs that are used.
Moral status of the embryo
Assisted reproductive technology often results in the availability of numerous spare oocytes and embryos (7) that are not transferred into the uterus of the mother. Cyropreservation (freezing) techniques are able to store embryos up to a few years which can be thawed and returned to the uterus of the mother when she decides to have a child, this process is legitimate so long as the woman from whom the oocytes were obtained is still within the marriage contract with the husband whose sperm was used to fertilise her own oocytes.
The other option for spare embryos is to be donated for research purposes. The interests of embryo research include to further improve knowledge in assisted reproduction, the diagnosis and prevention of genetic disease and development of better contraception methods (8). Embryo research for therapeutic purposes are allowed with prior consent of the couple undergoing infertility treatment (3). The embryos that have been researched upon are not to be transferred to the uterus of the mother or to any other woman.
Imam Al Ghazali in his Ihy' Ulum al Din as cited by Abul Fadl Mohsin Ebrahim (1988) described human existence as occurring in stages and the first stage of existence begins with the settling of the semen in the womb and that its disturbance would be a crime. In this context, the settling of the semen in the womb can be taken as the fertilisation stage. The fertilised egg and the very early embryo are forms of life and therefore deserves to be treated with respect and as Imam Al Ghazali has stated, disturbing or in other words manipulating it can be regarded as a crime.
Another alternative for spare embryos could be to donate the spare embryos to a childless couple. Surogacy involves the implantation of an embryo originating from a couple into the womb of another woman. As Islamic jurists have already ruled that the fertilisation of gametes that are from a man and a woman who are not legally married as being illegitimate, consider a situation where a legally married couple were to fertilise their gametes in vitro but have any resulting embryo transferred into the uterus of another woman. This would be illegitimate because it involves a third party to which the husband was not legally married to and would be deemed as violating Islamic Laws (Shariah) (6). Some jurists permit invitro fertilisation between the sperm from a husband and an egg that is from a legally married wife and implanted into the legally married second wife.
It is common to have conflicting interests and viewpoints between individuals and between different cultural backgrounds. There still exist uncertainties in some aspects of assisted reproduction such as in the area of embryo manipulation and sex selection to name a few. Some of the issues that have been highlighted in this paper have no definite ruling and if there are, is still subject to discussion and criticism. However what stands true is that Islam is a flexible religion and takes into account of the need to accommodate the necessities of life, however in attempting to obtain these necessities one should not contradict with the guidelines according to Islamic laws (Shariah) when doing so. Deeper research which lead to better understanding may be required by Muslims in areas that have no definite answer, and may we have guidance from Allah the Allmighty.
1. Johnson, M.H. and Everitt, B.J. (2000) Essential Reproduction. Blackwell Science.
2. Eskandarani, H. (1996) Assisted Reproductive Technology: State of the ART. Publications of the Islamic Educational Scientific and Cultural Organisation (ISESCO). Al-Wafa Printing Press. Saudi Arabia.
3. Serour, G.I. (1998) Reproductive Choice; A Muslim Perspective. In: The future of human reproduction: ethics, choice and regulation (Eds.) Harris, J. and Holm, S. Caledonian Press.
4. Bongso, A and Ratnam, S (1999) Medically assisted conception: The new millennium. Brunei International Medical Journal, 1:75-84.
5. Yusuf Al-Qarawadi (1995) The Lawful and the prohibited in Islam, Al-Halal wal Haram fil Islam. Islamic Book Trust. Kuala Lumpur.
6. Abul Fadl Mohsin Ebrahim (1998) Biomedical Issues Islamic Perspective. A.S.Nordeen Malaysia.
7. Macer, D.R.J. (1990) Shaping Genes. Eubios Ethics Institute, 1990.
8. Abdelali Haoudi (2001) Human Embryo Experimentation: is it morally and ethically justifiable?. Al Jarida Al Maghribia Magazine.