The Effects of Assisted Reproductive Technologies on Children

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CHAPTER THREE THE EFFECTS OF ASSISTED REPRODUCTIVE TECHNOLOGIES ON CHILDREN

INTRODUCTION

Children born as a result of ARTs can be born to heterosexual and homosexual individuals and couples. Irrespective of the family type into which they are born, they all experience the same physical adverse effects due to their mode of birth or conception. However, psychological adverse effects might to some extent differ based on the type of family in which these children will grow up. It is important to note that psychological effects of ARTs on children might be worsened in some countries by the legislation regulating ARTs within the jurisdictions of those countries.
This chapter will analyse the potential effects that ARTs may have on resulting children. The chapter begins with a brief overview of ARTs before discussing the ARTs in South Africa. The chapter will then discuss the effects of those procedures on children

ASSISTED REPRODUCTIVE TECHNOLOGIES – A BRIEF OVERVIEW

Assisted reproductive technologies have enabled millions of people in the world who otherwise would not have been able to do so, to have children. Assisted reproductive technologies were from the start meant to initiate pregnancy without sexual intercourse, and allow infertile heterosexual couples to have children. In this regard, Golombok, MacCallum and Rutter noted that donor insemination, which is one of the variances of ARTs, has been successfully used as an alternative for couples with an infertile male partner to have children.213
It was not conceivable for a woman to fall pregnant without sexual intercourse with a man until 1978 when Steptoe and Edwards made possible the fertilisation of an egg in a test tube and the transfer of the embryo into a woman’s body in order to initiate pregnancy in the absence of sexual intercourse. 1978 marked the dawn of a new era in medical technology. The achievement of Steptoe and Edwards opened the way to a new technology of reproduction, which has a range of techniques and is referred to as ARTs.214
Assisted reproductive technologies are therefore the use of non-coital technologies to conceive and initiate pregnancy.215 They consist of an array of techniques enabling people to reproduce without engaging in sexual activity at all. Some techniques are used to initiate pregnancy and others more specifically used to increase the possibility of pregnancy and/or to test for the presence of certain genes, so that prospective parents can choose which embryo to implant after in vitro fertilisation.216
There are three principal ways of initiating pregnancy: Alternative insemination, the prescription of fertility-enhancing drugs, and in vitro fertilisation. Alternative insemination (AI) is also known as artificial insemination. It refers to several procedures, all of which involve inserting sperm into a woman’s body. The sperm is placed in the woman’s vagina, cervix or fallopian tubes.217
Fertility enhancing drugs, as suggested by their name, are drugs that can be taken orally or through injection. The most common drug used is Clomiphene Citrate (brand name Clomid or Serophene), which is taken through the mouth to enable women who are not ovulating or are ovulating irregularly to produce one or more mature eggs. Gonadotropins are the drugs that can be taken through injection. They have the ability of stimulating the ovary for the production of more follicles in one cycle.218
Although there are many techniques used in ARTs, in vitro fertilisation and related procedures (gamete intra fallopian transfer (GIFT) and zygote intra fallopian transfer (ZIFT)) are the most invasive ARTs used. GIFT and ZIFT are variations of in vitro fertilisation (IVF).219 Sperm donation, donation of eggs and embryo donation also fall under GIFT and ZIFT.220
Surrogacy, a procedure in which a woman is recruited for the purpose of bearing and giving birth to a child that she agrees to hand over to individuals or couples she contracted with,221 is also a variety of ARTs. Golombok et al have described two types of surrogacy: Partial or genetic surrogacy, in which the surrogate mother and the commissioning father are the genetic parents of the child; and full surrogacy or non-genetic surrogacy, in which the commissioning parents (mother and father), or only one of them, are the genetic parents of the child.222 In other words, in genetic surrogacy the surrogate mother is inseminated with the sperm of the commissioning father. This would suggest that her egg was used in the procedures through which she will become pregnant. However, in non-genetic surrogacy, the egg and the sperm respectively of the commissioning mother and father or a donor are used and the embryo is transferred in the surrogate mother’s womb.
It is worth noting that with partial surrogacy conception happens through artificial insemination, and in the case of full surrogacy conception is achieved through IVF. Artificial insemination, fertility enhancing drugs, in vitro fertilisation and its related procedures, as well as surrogacy as described above are not the only ARTs that are used to treat infertility, genetic screening techniques also form part of ARTs.223
In summary, ARTs include the fairly simple procedure of artificial insemination, the use of an artificial instrument to inject sperm into the uterus of a woman who will carry and eventually give birth to the child.224 It also includes more complex procedures which manipulate both eggs and sperm outside of a woman’s body before inserting them, or the resulting zygotes or embryos, into her fallopian tubes or cervix respectively.225
As a result, children who are born through ARTs are born to parents who sometimes do not share all the traditional factors of marriage, genetics, gestation, and intended parenthood. In the case of homosexual marriage, the intended parents can be two mothers or two fathers, who may or may not include a genetic parent, a gestational mother or both.22

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ASSISTED REPRODUCTIVE TECHNOLOGIES IN SOUTH AFRIC

Pretoria and Cape Town were the first cities that welcomed the first two tertiary ART institutions in South Africa. The first “test tube” babies were born in 1984. Different forms of ART services are provided in the country. These include public services with units based in academic-centres, private services with units based in their private offices headed by independent specialists using corporate pathology laboratories, and services provided in larger established ART associates, which consist of clinical and laboratory ART specialists.227
In South Africa, the number of providers of ARTs is limited compared to the huge number of people who may be in need of ART services. This raises concerns over the adequacy of the services provided. Huyser and Boyd express this issue in the following terms:
“It is questionable if the current (approximately) 28 national ART service providers are providing an adequate reproductive health service within a nation of 52 million people with a variety of cultures and languages”228
In other words, the limited number of ART service providers is an important factor to be taken into account when evaluating the quality of the service provided. It is important to note that all ART services pursue one ultimate goal, which is the achievement of one live and healthy baby.229
Huyser and Boyd are also of the view that the adequacy of ART interventions is dependent on many other factors such as the diagnostic tests and screening policies, the preparation methods, as well as the equipment or materials to be used. These factors can compromise the purpose of ARTs.230 In view of the fact in Sub-Saharan Africa in general and in South Africa in particular, the prevalence of HIV is very high; all patients who request ART services must undergo several blood tests, including screening for blood borne viruses (BBV), and bacteriological cultures and sensitivity tests for diagnostic purposes. All patients must further receive an appropriate treatment against prophylactic or empiric microbes.231 Given the cost of all these treatments, Huyser and Boyd maintain that the likelihood of achieving a healthy and live child is very limited. They also maintain that the South African structure of ART services (private versus public/tertiary) will have an impact on the quality of services provided.232 This is a serious alert when analysing the effects of ARTs on resulting children

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Chapter 1: General Introduction
1.1 INTRODUCTORY REMARKS
1.2 PROBLEM STATEMENT
1.3 THE RESEARCH QUESTIONS
1.4 THE AIM AND SIGNIFICANCE OF THE STUDY
1.5 RESEARCH METHODOLOGY
1.6 OVERVIEW OF STUDY
Chapter 2: Homosexual Families
2.1 INTRODUCTION
2.2 DEFINITION OF HOMOSEXUAL FAMILIES
2.3 SOCIAL CHANGES AND THE DECLINE OF THE NUCLEAR FAMILY
2.4 CHARACTERISTICS OF HOMOSEXUAL FAMILIES
2.5 THE FUNCTIONING OF HOMOSEXUAL FAMILIES
2.6 CHILDREN IN HOMOSEXUAL FAMILIES
2.7 INTERIM CONCLUSION
Chapter 3: The Effects of Assisted Reproductive Technologies on Children
3.1 INTRODUCTION
3.2 ASSISTED REPRODUCTIVE TECHNOLOGIES – A BRIEF OVERVIEW
3.3 ASSISTED REPRODUCTIVE TECHNOLOGIES IN SOUTH AFRICA
3.4 GAY AND LESBIAN REPRODUCTION IN SOUTH AFRICA
3.5 THE EFFECTS OF ASSISTED REPRODUCTIVE TECHNOLOGIES ON CHILDREN
3.6 INTERIM CONCLUSION
Chapter 4: International and South African Constitutional Perspectives
4.1 INTRODUCTION
4.2 INTERNATIONAL PERSPECTIVES ON THE PROTECTION OF THE FAMILY
4.3 THE SOUTH AFRICAN CONSTITUTIONAL PERSPECTIVE TO FAMILY AND FAMILY MEMBERS
4.4 INTERIM CONCLUSION
Chapter 5: Homosexual Families in South Africa
5.1 INTRODUCTION
5.2 THE EMERGENCE OF HOMOSEXUAL FAMILIES
5.3 THE HOMOSEXUAL LIBERATION STRUGGLE
5.4 THE LEGAL RECOGNITION OF HOMOSEXUAL MARRIAGE AND FAMILIES IN SOUTH AFRICA
5.5 MODELS OF RECOGNITION OF HOMOSEXUAL RELATIONSHIPS AND ISSUES RAISED BY THE LEGAL RECOGNITION OF HOMOSEXUAL RELATIONSHIPS
5.6 THE LEGAL STATUS OF A CHILD BORN TO HOMOSEXUAL PERSONS AS A RESULT OF ARTS IN SOUTH AFRICA
5.7 PARENTAL RESPONSIBILITIES AND RIGHTS IN HOMOSEXUAL FAMILIES
5.8 THE BEST INTERESTS OF THE ASSISTED REPRODUCTIVE TECHNOLOGIES-BORN CHILD IN THE HOMOSEXUAL FAMILY .
5.9 INTERIM CONCLUSION
Chapter 6: Homosexual Families in the United States of America
6.1 INTRODUCTION
6.2 THE LEGALISATION OF HOMOSEXUAL UNIONS IN THE UNITED STATES OF AMERICA
6.3 THE DEBATE OVER THE LEGALISATION OF HOMOSEXUAL UNIONS
6.4 FAMILIES CREATED THROUGH ASSISTED REPRODUCTIVE TECHNOLOGIES IN THE USA
6.5 IMPLICATIONS OF THE LEGALISATION OF HOMOSEXUAL UNIONS IN THE USA
6.6 THE BEST INTERESTS OF THE ASSISTED REPRODUCTIVE TECHNOLOGIES-BORNCHILD IN THE UNITED STATES OF AMERICA
6.7 INTERIM CONCLUSION
Chapter 7: Homosexual Families in Australia
7.1 INTRODUCTION
7.2 THE LEGAL RECOGNITION OF HOMOSEXUAL UNIONS IN AUSTRALIA
7.3 THE ISSUE OF THE CONSTITUTIONALITY OF HOMOSEXUAL MARRIAGE IN AUSTRALIA
7.4 ARTS AND RELATED ISSUES IN AUSTRALIA
7.5 PARENTAGE RECOGNITION AND RELATION BREAKDOWN IN AUSTRALIAN HOMOSEXUAL FAMILIES
7.6 THE BEST INTERESTS OF THE CHILD IN AUSTRALIA
7.7 INTERIM CONCLUSION
Chapter 8: Conclusion
8.1 INTRODUCTION
8.2 THE SOUTH AFRICAN APPROACH TO ASSISTED REPRODUCTIVE TECHNOLOGIES AND FAMILIES CREATED THROUGH ASSISTED REPRODUCTIVE TECHNOLOGIES
8.3 COMPARATIVE CONCLUSIONS
8.4 CONCLUDING REMARKS
8.5 PROPOSALS FOR LAW REFORM
BIBLIOGRAPHY
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