ART: controversies surrounding an activist and deceptive article

In an article published in Le Monde on March 17, 2016, 130 doctors and reproduction biologists explain having transgressed French law and request extending Assisted Reproductive Technology (ART), notably to single women and homosexual couples.

Willing to imitate the manifesto “Yes, we have carried out abortions” by doctors in 1973 by co-signing this article with the provocative title (“We, doctors, have helped homosexual couples have a child even if the law forbids it“), these doctors are led by gynecologist, René Frydman, who participated in the birth of the first “test-tube baby” in 1982. Among those signing is also gynecologist, Israël Nisand.

The article formulates several specific demands on current regulations concerning medical aid for reproduction:

1) Developing oocyte donation in France, since the current offer does not meet couples’ needs;

2) Genetically analyzing embryos before being transferred to the uterus by expanding the opportunity for pre-implantation diagnosis (PID) for all in-vitro fertilizations;

3) Allowing women to keep their oocytes without any restrictions;

4) Authorizing sperm donation for single women (“without prejudice of her relational mode weather current or future, gay or heterosexual“).

Besides these four demands, the signatories propose creating a plan to fight against infertility, comparable to national plans against cancer or Alzheimer’s disease. This prevention plan would aim at informing people about the inexorable effects of age and the consequences of certain eating habits, addictions (tobacco, alcohol, drugs) or pollution. In conclusion the signatories call for the respect of “two fundamental ethical principles”: “the non-commercialization of the human body and refusing the risk of using or alienating another person for ones profit“.

Several reactions appeared the very next day in counterpoint to these standpoints, such as that of the biologist Jacques Testart or that of the law professor, Jean-René Binet, to recall some fundamental realities and the ethical principles which establish rules which apply in France. Jean-François Mattei, former Health Minister, analyzes the article with severity: “I do not see any particular courage in their initiative. The signatories transgressed the law in order to demand a legislative evolution. Indeed, they are exposing themselves to being sanctioned by the doctors’ order, and to legal penalties. But that is their responsibility. For my part, even if I respect their opinion, I observe that they do not respect democracy. In 1994 the bioethics Law was adopted by a large majority around the principle of restricting medical aid for reproduction to medical indications. This principle has never been modified since then, even though this Law was revised twice, in 2004 and 2011“.

For Alliance VITA, such a militant article by professionals, who are simultaneously judge and jury, raises questions about the underlying reasons of such pressure. The necessity of preventing infertility and performing studies on causes of infertility constitutes a major medical priority requested by VITA since 1994. However, it is shocking to use this as a secondary measure to justify, in parallel, a headlong rush which does not concern the reality of medical infertility. Especially since half the couples who turn to Assisted Reproductive Technology, which is in itself only a palliative, will have no child in the outcome.

Furthermore, the authors of the article highlight certain ethical principles, while carefully putting others aside. A recent Senate information report underlined, in fact, that extending ART to same-sex couples leads to eliminating the requirement of medical infertility and sexual difference, which would alter “the French conception of ART, and pave the way to the “right to a child” and to surrogacy for convenience”. Already in 2009, a notice from the State Council underlined that the idea was not to align with the less demanding from an ethical viewpoint, in order not to deliberately deprive a child from his father. It is surprising that such specialists do not want to recognize the specific status of gametes – masculine or feminine-, as supplying children’s genetic heritage.

Concerning the request of developing egg donation, including the end of free access and legalizing “financial compensation”, examples abroad prove that such a shift in practice automatically leads to different manners of marketing a woman’s body. The authors do not mention that this type of treatment is not without danger for the health of women donors or that acts connected to artificial reproduction constitute a harsh reality for couples to live with. Furthermore, this technique raises serious ethical questions, especially for those who are confronted with genuine medical infertility whose deepest wish is to procreate naturally and be cured of infertility. Finally, the possibility for every woman to keep her own oocytes is far from achieving unanimity, as confirmed by a recent poll.

As for the embryo genetic analysis prior to uterine transfer, it would constitute an additional pressure towards a eugenic attitude, which is already present in France, specifically regarding the diagnosis of Down’s syndrome.