Yardımcı Üreme Teknikleri ve Etik
Özet
Üreme teknolojilerindeki hızlı ilerlemeler, çocuk sahibi olma sürecinde bireylerin seçeneklerini artırırken beraberinde birçok etik ve hukuki sorunu da getirmiştir. Bu bölümde, günümüzde yaygın olarak kullanılan yardımcı üreme teknikleri (YÜT) kapsamındaki uygulamalar ve bu uygulamaların doğurduğu etik ikilemler ele alınmaktadır. Preimplantasyon genetik testler, gamet ve embriyo bağışı, kriyoprezervasyon, taşıyıcı annelik ve fetal redüksiyon gibi başlıklar, bireylerin özerkliği, toplumsal değerler ve çocuk hakları ekseninde tartışılmaktadır. Cinsiyet seçimi, kurtarıcı kardeşlerin oluşturulması, biyolojik materyalin ticarileştirilmesi gibi hassas konulara da yer verilerek etik açıdan değerlendirme yapılmıştır. Sağlık profesyonellerinin yalnızca teknik bilgiyle değil, etik ilkelere dayalı bir bilinçle hareket etmeleri gerektiği vurgulanmaktadır.
Referanslar
Njagi P, Groot W, Arsenijevic J, Dyer S, Mburu G, Kiarie J. Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review. Hum Reprod Open. 2023;(2):hoad007. doi:10.1093/hropen/hoad007.
Sciorio R, El Hajj N. Epigenetic Risks of Medically Assisted Reproduction. J Clin Med. 2022;11(8):2151. doi:10.3390/jcm11082151.
Londra L, Wallach E, Zhao Y. Assisted reproduction: Ethical and legal issues. Semin Fetal Neonatal Med. 2014;19(5):264-271. doi:10.1016/j.siny.2014.07.003.
Zhang J, Pastore LM, Sarwana M, Klein S, Lobel M, Rubin LR. Ethical and moral perspectives of individuals who considered/used preimplantation (embryo) genetic testing. J Genet Couns. 2022;31(1):176-187. doi:10.1002/jgc4.1471
Leaver M, Wells D. Non-invasive preimplantation genetic testing (niPGT): the next revolution in reproductive genetics?. Hum Reprod Update. 2020;26(1):16-42. doi:10.1093/humupd/dmz033
Robertson JA. Extending preimplantation genetic diagnosis: the ethical debate. Ethical issues in new uses of preimplantation genetic diagnosis. Hum Reprod. 2003;18(3):465-471. doi:10.1093/humrep/deg100
Atar S, Şahinoğlu S. Tıbbi olmayan cinsiyet seçimi: yeni teknolojiler–teknolojik gelişmeler ve etik tartışmalar. Türkiye Biyoetik Dergisi. 2023;10(2):68-78.
Kushnir VA, Adashi EY, Cohen IG. Preimplantation sex selection via in vitro fertilization: time for a reappraisal. F S Rep. 2023;4(3):241-243. doi:10.1016/j.xfre.2023.05.006
Ethics Committee of the American Society of Reproductive Medicine. Sex selection and preimplantation genetic diagnosis. Fertil Steril. 1999;72(4):595-598.
T.C. Sağlık Bakanlığı. Üremeye Yardımcı Tedavi Uygulamaları ve Üremeye Yardımcı Tedavi Merkezleri Hakkında Yönetmelik. Resmî Gazete. 30.09.2014;29135.
Zúñiga-Fajuri A. Born to donate: proposals for "savior sibling" regulation in Latin America. Colomb Med (Cali). 2018;49(3):228-235. doi:10.25100/cm.v49i2.3619
Human Fertilisation & Embryology Authority. Trends in egg, sperm and embryo donation 2020. [Online] https://www.hfea.gov.uk/about-us/publications/research-and-data/trends-in-egg-sperm-and-embryo-donation-2020/ [Accessed: 3rd June 2024].
De Melo-Martín I. The ethics of anonymous gamete donation: is there a right to know one's genetic origins?. Hastings Cent Rep. 2014;44(2):28-35. doi:10.1002/hast.285
Larijani B, Zahedi F. Ethical and religious aspects of gamete and embryo donation and legislation in Iran. Journal of Religion and Health. 2007;46: 399-408.
Afshar L, Bagheri A. Embryo donation in Iran: an ethical review. Dev World Bioeth. 2013;13(3):119-124. doi:10.1111/j.1471-8847.2012.00334.x
Nahata L, Stanley N, Quinn G. Gamete donation: current practices, public opinion, and unanswered questions. Fertil Steril. 2017;107(6):1298-1299. doi:10.1016/j.fertnstert.2017.04.001
World Health Organization. WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation. Cell Tissue Bank. 2010;11:413–419. doi:10.1007/s10561-010-9226-0.
Klitzman R, Sauer MV. Creating and selling embryos for "donation": ethical challenges. Am J Obstet Gynecol. 2015;212(2):167-70.e1. doi:10.1016/j.ajog.2014.10.1094
Abreu CWDPA, Abreu MLA, Abreu MMA, et al. Final destination of surplus cryopreserved embryos. What decision should be made?. JBRA Assist Reprod. 2021;25(2):276-281. doi:10.5935/1518-0557.20200085
Dudzinski DM. Ethical issues in fertility preservation for adolescent cancer survivors: oocyte and ovarian tissue cryopreservation. J Pediatr Adolesc Gynecol. 2004;17(2):97-102. doi:10.1016/j.jpag.2004.01.004
21.Ethics Committee of the American Society for Reproductive Medicine. Planned oocyte cryopreservation to preserve future reproductive potential: an Ethics Committee opinion. Fertility and Sterility. 2024;121(4):604-612.
Asplund K. Use of in vitro fertilization—ethical issues. Upsala journal of medical sciences. 2020;125(2): 192-199.
Attawet J, Alsharaydeh E, Brady M. Commercial surrogacy: Landscapes of empowerment or oppression explored through integrative review. Health Care Women Int. 2024. doi:10.1080/07399332.2024.2303520
Gunputh RP, Choong KA. Surrogacy tourism: the ethical and legal challenges. International Journal of Tourism Sciences. 2015;15(1-2): 16-21.
Brandão P, Garrido N. Commercial surrogacy: an overview. Revista Brasileira de ginecologia e obstetrícia. 2023;44: 1141-1158.
Dickenson D, van Beers B. Surrogacy: New challenges to law and ethics. The new bioethics. 2020;26(4): 293-297.
American College of Obstetricians and Gynecologists. Family Building Through Gestational Surrogacy. Committee Opinion No. 660. Obs Gynecol. 2016;127(3); e97-103.
American College of Obstetricians and Gynecologists. Obstet Gynecol. Multifetal pregnancy reduction. Committee Opinion No. 719. Obs Gynecol. 2017;130:e158–63.
Piersanti V, Consalvo F, Signore F, Del Rio A, Zaami S. Surrogacy and "Procreative Tourism". What Does the Future Hold from the Ethical and Legal Perspectives?. Medicina (Kaunas). 2021;57(1):47. doi:10.3390/medicina57010047
Evans MI, Andriole S, Britt DW. Fetal reduction: 25 years' experience. Fetal Diagn Ther. 2014;35(2):69-82. doi:10.1159/000357974
Santana DS, Silveira C, Costa ML, et al. Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health. BMC Pregnancy Childbirth. 2018;18(1):449. doi:10.1186/s12884-018-2082-9
Santana DS, Cecatti JG, Surita FG, et al. Twin Pregnancy and Severe Maternal Outcomes: The World Health Organization Multicountry Survey on Maternal and Newborn Health. Obstet Gynecol. 2016;127(4):631-641. doi:10.1097/AOG.0000000000001338
Sebghati M, Khalil A. Reduction of multiple pregnancy: Counselling and techniques. Best Pract Res Clin Obstet Gynaecol. 2021;70:112-122. doi:10.1016/j.bpobgyn.2020.06.013
Zipori Y, Haas J, Berger H, Barzilay E. Multifetal pregnancy reduction of triplets to twins compared with non-reduced triplets: a meta-analysis. Reprod Biomed Online. 2017;35(3):296-304. doi:10.1016/j.rbmo.2017.05.012
Kuhn-Beck F, Moutel G, Weingertner AS, et al. Fetal reduction of triplet pregnancy: one or two?. Prenat Diagn. 2012;32(2):122-126. doi:10.1002/pd.2906
Dodd JM, Dowswell T, Crowther CA. Reduction of the number of fetuses for women with a multiple pregnancy. Cochrane Database Syst Rev. 2015;2015(11):CD003932. doi:10.1002/14651858.CD003932.pub3
Cheong MA, Tay SK. Application of legal principles and medical ethics: multifetal pregnancy and fetal reduction. Singapore Med J. 2014;55(6):298-301. doi:10.11622/smedj.2014077
FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health. Ethical recommendations on multiple pregnancy and multifetal reduction. International Federation of Gynaecology and Obstetrics. 2006;92(3):331-332.
ESHRE Task Force on Ethics and Law. 6. Ethical issues related to multiple pregnancies in medically assisted procreation. Human Reproduction. 2003;18(9):1976-1979. doi:10.1093/humrep/deg357
Referanslar
Njagi P, Groot W, Arsenijevic J, Dyer S, Mburu G, Kiarie J. Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review. Hum Reprod Open. 2023;(2):hoad007. doi:10.1093/hropen/hoad007.
Sciorio R, El Hajj N. Epigenetic Risks of Medically Assisted Reproduction. J Clin Med. 2022;11(8):2151. doi:10.3390/jcm11082151.
Londra L, Wallach E, Zhao Y. Assisted reproduction: Ethical and legal issues. Semin Fetal Neonatal Med. 2014;19(5):264-271. doi:10.1016/j.siny.2014.07.003.
Zhang J, Pastore LM, Sarwana M, Klein S, Lobel M, Rubin LR. Ethical and moral perspectives of individuals who considered/used preimplantation (embryo) genetic testing. J Genet Couns. 2022;31(1):176-187. doi:10.1002/jgc4.1471
Leaver M, Wells D. Non-invasive preimplantation genetic testing (niPGT): the next revolution in reproductive genetics?. Hum Reprod Update. 2020;26(1):16-42. doi:10.1093/humupd/dmz033
Robertson JA. Extending preimplantation genetic diagnosis: the ethical debate. Ethical issues in new uses of preimplantation genetic diagnosis. Hum Reprod. 2003;18(3):465-471. doi:10.1093/humrep/deg100
Atar S, Şahinoğlu S. Tıbbi olmayan cinsiyet seçimi: yeni teknolojiler–teknolojik gelişmeler ve etik tartışmalar. Türkiye Biyoetik Dergisi. 2023;10(2):68-78.
Kushnir VA, Adashi EY, Cohen IG. Preimplantation sex selection via in vitro fertilization: time for a reappraisal. F S Rep. 2023;4(3):241-243. doi:10.1016/j.xfre.2023.05.006
Ethics Committee of the American Society of Reproductive Medicine. Sex selection and preimplantation genetic diagnosis. Fertil Steril. 1999;72(4):595-598.
T.C. Sağlık Bakanlığı. Üremeye Yardımcı Tedavi Uygulamaları ve Üremeye Yardımcı Tedavi Merkezleri Hakkında Yönetmelik. Resmî Gazete. 30.09.2014;29135.
Zúñiga-Fajuri A. Born to donate: proposals for "savior sibling" regulation in Latin America. Colomb Med (Cali). 2018;49(3):228-235. doi:10.25100/cm.v49i2.3619
Human Fertilisation & Embryology Authority. Trends in egg, sperm and embryo donation 2020. [Online] https://www.hfea.gov.uk/about-us/publications/research-and-data/trends-in-egg-sperm-and-embryo-donation-2020/ [Accessed: 3rd June 2024].
De Melo-Martín I. The ethics of anonymous gamete donation: is there a right to know one's genetic origins?. Hastings Cent Rep. 2014;44(2):28-35. doi:10.1002/hast.285
Larijani B, Zahedi F. Ethical and religious aspects of gamete and embryo donation and legislation in Iran. Journal of Religion and Health. 2007;46: 399-408.
Afshar L, Bagheri A. Embryo donation in Iran: an ethical review. Dev World Bioeth. 2013;13(3):119-124. doi:10.1111/j.1471-8847.2012.00334.x
Nahata L, Stanley N, Quinn G. Gamete donation: current practices, public opinion, and unanswered questions. Fertil Steril. 2017;107(6):1298-1299. doi:10.1016/j.fertnstert.2017.04.001
World Health Organization. WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation. Cell Tissue Bank. 2010;11:413–419. doi:10.1007/s10561-010-9226-0.
Klitzman R, Sauer MV. Creating and selling embryos for "donation": ethical challenges. Am J Obstet Gynecol. 2015;212(2):167-70.e1. doi:10.1016/j.ajog.2014.10.1094
Abreu CWDPA, Abreu MLA, Abreu MMA, et al. Final destination of surplus cryopreserved embryos. What decision should be made?. JBRA Assist Reprod. 2021;25(2):276-281. doi:10.5935/1518-0557.20200085
Dudzinski DM. Ethical issues in fertility preservation for adolescent cancer survivors: oocyte and ovarian tissue cryopreservation. J Pediatr Adolesc Gynecol. 2004;17(2):97-102. doi:10.1016/j.jpag.2004.01.004
21.Ethics Committee of the American Society for Reproductive Medicine. Planned oocyte cryopreservation to preserve future reproductive potential: an Ethics Committee opinion. Fertility and Sterility. 2024;121(4):604-612.
Asplund K. Use of in vitro fertilization—ethical issues. Upsala journal of medical sciences. 2020;125(2): 192-199.
Attawet J, Alsharaydeh E, Brady M. Commercial surrogacy: Landscapes of empowerment or oppression explored through integrative review. Health Care Women Int. 2024. doi:10.1080/07399332.2024.2303520
Gunputh RP, Choong KA. Surrogacy tourism: the ethical and legal challenges. International Journal of Tourism Sciences. 2015;15(1-2): 16-21.
Brandão P, Garrido N. Commercial surrogacy: an overview. Revista Brasileira de ginecologia e obstetrícia. 2023;44: 1141-1158.
Dickenson D, van Beers B. Surrogacy: New challenges to law and ethics. The new bioethics. 2020;26(4): 293-297.
American College of Obstetricians and Gynecologists. Family Building Through Gestational Surrogacy. Committee Opinion No. 660. Obs Gynecol. 2016;127(3); e97-103.
American College of Obstetricians and Gynecologists. Obstet Gynecol. Multifetal pregnancy reduction. Committee Opinion No. 719. Obs Gynecol. 2017;130:e158–63.
Piersanti V, Consalvo F, Signore F, Del Rio A, Zaami S. Surrogacy and "Procreative Tourism". What Does the Future Hold from the Ethical and Legal Perspectives?. Medicina (Kaunas). 2021;57(1):47. doi:10.3390/medicina57010047
Evans MI, Andriole S, Britt DW. Fetal reduction: 25 years' experience. Fetal Diagn Ther. 2014;35(2):69-82. doi:10.1159/000357974
Santana DS, Silveira C, Costa ML, et al. Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health. BMC Pregnancy Childbirth. 2018;18(1):449. doi:10.1186/s12884-018-2082-9
Santana DS, Cecatti JG, Surita FG, et al. Twin Pregnancy and Severe Maternal Outcomes: The World Health Organization Multicountry Survey on Maternal and Newborn Health. Obstet Gynecol. 2016;127(4):631-641. doi:10.1097/AOG.0000000000001338
Sebghati M, Khalil A. Reduction of multiple pregnancy: Counselling and techniques. Best Pract Res Clin Obstet Gynaecol. 2021;70:112-122. doi:10.1016/j.bpobgyn.2020.06.013
Zipori Y, Haas J, Berger H, Barzilay E. Multifetal pregnancy reduction of triplets to twins compared with non-reduced triplets: a meta-analysis. Reprod Biomed Online. 2017;35(3):296-304. doi:10.1016/j.rbmo.2017.05.012
Kuhn-Beck F, Moutel G, Weingertner AS, et al. Fetal reduction of triplet pregnancy: one or two?. Prenat Diagn. 2012;32(2):122-126. doi:10.1002/pd.2906
Dodd JM, Dowswell T, Crowther CA. Reduction of the number of fetuses for women with a multiple pregnancy. Cochrane Database Syst Rev. 2015;2015(11):CD003932. doi:10.1002/14651858.CD003932.pub3
Cheong MA, Tay SK. Application of legal principles and medical ethics: multifetal pregnancy and fetal reduction. Singapore Med J. 2014;55(6):298-301. doi:10.11622/smedj.2014077
FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health. Ethical recommendations on multiple pregnancy and multifetal reduction. International Federation of Gynaecology and Obstetrics. 2006;92(3):331-332.
ESHRE Task Force on Ethics and Law. 6. Ethical issues related to multiple pregnancies in medically assisted procreation. Human Reproduction. 2003;18(9):1976-1979. doi:10.1093/humrep/deg357
