Group 2

Issues on Artificial
Reproduction its Morality
and EthicoMoral
Responsibility of Nurses
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 ARTIFICIAL
REPRODUCTION

2
Objectives
 Discuss artificial reproduction, its processes and risks, as well as
its moral and ethical issues and considerations, and legality in
the Philippines.
 Identify the types of artificial reproduction
- Artificial Insemination
- In-Vitro Fertilization
- Surrogacy
 Appreciate the role of the nurse in his/her participation in the
delivery of safe, effective and efficient care to patients.

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 Artificial
Insemination
• Assisted Reproductive Technology

Methods used to achieve pregnancy through the use of artificial or

partially artificial means

Grossly used for infertility treatment

Defines as the act through which sperm is placed into a female’s uterus,
or the intrauterine method, or into the cervix, or the intracervical method

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TWO PROCESS THAT AI EMPLOYS:

• Homologous or Artificial Insemination from the Husband

(AIH) – sperm of the Husband of the Woman

•Heterologous or Artificial Insemination from a Donor (AID)

– sperm of a construed donor

It must be clear that in AIH or AID, it is the wife who is incapable of
reproduction and not the husband
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 RISKS of ARTIFICIAL INSEMINATION

• Multiple Delivery

• Preterm Delivery

• Birth – Weight Delivery

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Some Catholic Theolegians argue that the AIH is
acceptable while AID is not for it is equivalent to
‘‘permitted’’ adultery.

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AID carves out a lot of moral considerations like:

Does the true father have a right obligation to the conceive child?

Would the stepfather(husband of the infertile woman) offer or give

authentic love to the child conceived not from his sperm but from another
person?

Can the other members of the couples damily show true acceptance to the
child?

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Is it LEGAL here in
our country?

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According to EXECUTIVE ORDER NO. 209 or THE FAMILY CODE
OF THE PHILIPPINES under PATERNITY AND FILIATION

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CHAPTER 1. LEGITIMATE CHILDREN

Art. 164. Children conceived or born during the marriage of the parents
are legitimate.
Children conceived as a result of artificial insemination of the wife with
the sperm of the husband or that of a donor or both are likewise
legitimate children of the husband and his wife, provided, that both of
them authorized or ratified such insemination in a written instrument
executed and signed by them before the birth of the child. The
instrument shall be recorded in the civil registry together with the birth
certificate of the child. (Executive Order No. 209, s. 1987)

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 In-Vitro
Fertilization
Louise Brown
WHAT IS IVF?
is a procedure in which eggs are
removed from a woman and
fertilized in laboratory dish (either
husband or another man) embryos are
then implanted in a woman, where
egg may be brought to term. (Edge &
Groves, 2019)

REASON WHY IT’S DONE

•infertility
•desire to have a child without male
partner (Staff, 2019)
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BEFORE IVF:
-Fertility
-Semen Sample
-Donor sperm

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 STEPS:
Ovarian Stimulation
Egg Retrieval
Sperm Retrieval
Fertilization
Embryo transfer

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Ovulation Induction
If you're using your own eggs during IVF, at the start of a cycle you'll begin
treatment with synthetic hormones to stimulate your ovaries to produce multiple
eggs — rather than the single egg that normally develops each month. Multiple eggs
are needed because some eggs won't fertilize or develop normally after fertilization.

To determine when the eggs are ready for collection, your doctor will likely
perform:
• Vaginal ultrasound, an imaging exam of your ovaries to monitor the
development of follicles where eggs mature
• Blood tests, to measure your response to ovarian stimulation medications —
estrogen levels typically increase as follicles develop, and progesterone levels
remain low until after ovulation

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Egg Retrieval
• During egg retrieval, you'll be sedated and given pain medication.
• Transvaginal ultrasound aspiration is the usual retrieval method. An
ultrasound probe is inserted into your vagina to identify follicles. Then a thin
needle is inserted into an ultrasound guide to go through the vagina and into
the follicles to retrieve the eggs.
• If your ovaries aren't accessible through transvaginal ultrasound, an
abdominal ultrasound may be used to guide the needle.
• The eggs are removed from the follicles through a needle connected to a
suction device. Multiple eggs can be removed in about 20 minutes.
• After egg retrieval, you may experience cramping and feelings of fullness or
pressure.
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Egg Retrieval
• Mature eggs are placed in a nutritive liquid (culture medium) and incubated.
Eggs that appear healthy and mature will be mixed with sperm to attempt to
create embryos. However, not all eggs may be successfully fertilized.

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Sperm Retrieval
If you're using your partner's sperm, he'll provide a semen sample
at your doctor's office or a clinic through masturbation the morning of
egg retrieval.

• Other methods, such as testicular aspiration — the use of a needle

or surgical procedure to extract sperm directly from the testicle —
are sometimes required.

• Donor sperm also can be used.

• Sperm are separated from the semen fluid in the lab.

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 FERTILIZATIO
N
Fertilization can be attempted using two common methods:

Conventional insemination healthy sperm and mature eggs

are mixed and incubated overnight.

Intracytoplasmic sperm injection (ICSI) In ICSI, a

single healthy sperm is injected directly into each mature egg. 

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 EMBRYO TRANSFER
Embryo transfer is done at your doctor's office or a clinic and usually takes
place two to five days after egg retrieval.
 You might be given a mild sedative. The procedure is usually painless,
although you might experience mild cramping.
 The doctor will insert a long, thin, flexible tube called a catheter into your
vagina, through your cervix and into your uterus.
 A syringe containing one or more embryos suspended in a small amount of
fluid is attached to the end of the catheter.
 Using the syringe, the doctor places the embryo or embryos into your uterus.
If successful, an embryo will implant in the lining of your uterus about six to
10 days after egg retrieval. (Staff, 2019)

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RISKS OF IVF

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 Multiple births
 Premature delivery and low birth weight
 Ovarian hyper stimulation syndrome
 Miscarriage
 Egg-retrieval procedure complications. 
 Ectopic pregnancy. (Staff, 2019)

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Ethical Issues

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 The process results in extra or “spare” embryos that may then be disposed of,
frozen, or experimented on, none of which is without its detractors.
 For those who believe human life is sacred from the moment of conception
then the process of IVF and what happens to excess embryo becomes a
moral dilemma.
 Although 90% success rate with thawed embryos may be acceptable to
laboratory animals, probably not acceptable with humans particularly if
failure or partial failure is not detectable in later life
 Once frozen, embryos may outlive the donor thus increase possibility of
postmortem conception and birth.
 Use of embryonic tissue in medical research with the aim to treat diseases
like Parkinson also for transplantation (Edge & Groves, 2019)
Is it LEGAL here in
our country?

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According to the Fourteenth Congress of the Philippines S.B. 1342, the
Constitution, Article II, Section 15 provides: the State shall protect and
promote the right to health of the people and instil health consciousness
among them. A fundamental part of human experience is fulfilling the
desire to reproduce.
Unfortunately, millions of Filipino women and men are suffering from
infertility. While recent improvements in therapy make pregnancy
possible for more couples now than in past years, the majority of group
health plans do not provide coverage for infertility therapy; thus making
it impossible for low and middle income families to avail of the
technology. This bill seeks to require coverage for the treatment of
infertility in any group health plan or individual health insurance
This act is an act requiring coverage for the treatment of infertility in
any group health plan or health insurance. This Act shall be known as
the “Family Build Act of 2007” which also has standards relating to
benefits for treatment of infertility. A group health plan and a health
insurance issuer, offering health insurance coverage for treatment of
infertility deemed appropriate by a participant or beneficiary and the
treating physician. Such treatment shall include ovulation induction,
artificial insemination, in vitro fertilization (IVF), gamete intrafallopian
transfer (GIFT), zygote intrafallopian transfer (ZIFT), intracytoplasmic
sperm injection (ICST), and may other treatment provided It has been
deemed as ‘non-experimental’ by the Secretary of Health
In case of assisted reproductive technology (ART) , coverage shall be
provided if the participant or beneficiary has been unable to bring a
pregnancy into a live birth through less costly medically appropriate
infertility treatments.The patient has not undergone four complete
oocyte retrievals. The ART include in vitro fertilization, gamete
intrafallopian, ZGIT, embryo cryopreservation, egg or embryo donation
and surrogate birth. A group health plan and a health insurance
coverage, in connection with a group health plan.
Any law, presidential decree or insurance, executive order, letter of
instruction, administrative order, rule or regulations contrary to or
inconsistent with, the provisions of this Act is hereby repealed modified
or amended accordingly. Nothing in this Section shall be construed to
require a participant or beneficiary to undergo infertility therapy
 Surrogate
Motherhood
What is Surrogate Motherhood?

It occurs when a woman agrees to carry

a baby to term and give it up to another set
of parents to raise.

 The contracting couple may be unable to

contribute genetic material for some
reason or the female is unable to carry
baby to term

 sometimes done for money or favor

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Kinds of Surrogate
Motherhood

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Altruistic surrogacy
When a woman offers herself to carry the child of an infertile couple
— or of others — for philanthropic reason, not for money.

Commercial surrogacy
When it is carried out for financial gain, and is often called womb for
rent or womb for hire: “a woman offers herself to carry a pregnancy in
exchange for money.”

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Ethical Issues

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 Unethical for women to be used

 Economic opportunity for women who have few economic option

 Legitimacy of selling humans

 Pregnancy viewed as deeply personal experience that should never be

undergone for the sake of others

 What if birth mother changes her mind?

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 Kantians find practice of surrogacy problematic since birth mother is
clearly used as an incubator and not regarded as rational actor.
-Kantians in favor as long as long as there is no overt coercion and
if woman is paid and agrees to donate her body for selfless reasons
and is acting as rational; and autonomous individual
- Kantians disagree with it are more likely to compare the practice
to a clinical form of prostitution without the act of sex

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 Utilitarian argument against surrogacy could grant simple equation
which is the birth mother is given money and the contracting parents
get a child they could not otherwise have but then argue that the long
term consequences un one or more ways.
- another argument argues that pain of separation of birth mother
outweighs the happiness gained by the contracting parents. (Edge &
Groves, 2019)

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Is it LEGAL here in our
country?

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 According to the Thirteenth Congress of the Republic of the
Philippines Senate Bill No. 2344 introduced by Senator Manny Villar,
surrogate parenting is a concept that is relatively new in this country,
although for a long time it has been widely known in the U S . and in
other well- developed countries. Surrogate motherhood is nothing but
baby selling. It is similar to the generic experiments that are done with
animals who are bred for certain purposes. A woman becomes a
surrogate mother when she agrees to conceive a child in her womb only
to give away the child after birth to another person for a valuable
consideration. Babies are not products like microwave ovens and
automobiles.

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 Pregnancy should never be reduced to a commercial service. The
enclosed bill proposes to penalize not only surrogacy arrangement but
also the act of selling infants by their mothers. The practice of surrogacy
arrangement is morally and religiously wrong. We see no difference
between surrogate motherhood and black-market baby selling. Hence,
both practices are outlawed in this bill.

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Bibliography:
Babor, E. R. (2010). Bioethics: A Philosophical Journey and a Critical Analysis into the Life
Sciences -- A Guide to a Health Care Provider. Quezon City, Philippines: C & E
Publishing, Inc.
National Center for Chronic Disease Prevention and Health Promotion, Division of
Reproductive Health. (2019). What is Assisted Reproductive Technology?. Retrieved from
https://www.cdc.gov/art/whatis.html
Executive Order No. 209, s. 1987. (n.d.). Retrieved from 0fficialgazette.gov.ph:
http://www.officialgazette.gov.ph/1987/07/06/executive-order-no-209-s-1987/
 Edge, R. S., & Groves, J. R. (2019). Ethics for Healthcare: A Guide For Clinical Practice.
Quezon: C&E Publishing, Inc.
(2019). In-vitro Fertilization. In R. S. Edge, & J. R. GROVES, ETHICS FOR
HEALTHCARE: A GUIDE FOR CLINICAL PRACTICE (Pp. 201-203). Quezon: C&E
Publishing, Inc.
( Staff, M. C. (2019, June 22). Mayo Clinic. Retrieved from
https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716?
fbclid=IwAR3ix4vXo5gotjZZGlbqM4ABEzvCCWodd3xXDR7aJwKkptDOQMogl3JTUW0
(2019). Surrogacy. In R. S. Edge, & J. R. Groves, Ethics For Healthcare: A Guide For
Clinical Practice (Pp. 203-205). Quezon: C&E Publishing, Inc.

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