Inm-5: Consultation and Ethic Points in ART

Background: Infertility is a complicated and psychologically threatening and challenging crisis. The rapid development of ART has raised many ethical and legal issues and lead to various emotional changes (anxiety, depression, stress, aggressiveness, etc.) as it may involve considerable time, expense, and loss of privacy. It can be both dangerous and expensive to enter the world of assisted reproduction without an experienced guide to lead the couple through not only the complex technology, but also a whole host of consumer issues. Materials and Methods: Articles were obtained from PubMed and Google databases and other relevant journals and reference lists. Results: There are different kinds of attitude regarding donation for helping another couple or research issues(such as deciding the fate of unused or freeze eggs, sperm, and embryos) even using ART(including all ART options, PGD, sex selection, abortion and reduction in multiple pregnancy) or adaption among people by different religion, culture and their law which make it difficult to prepare an international or even national agreement and guideline for ethical and moral problems in ART as well as principles of selection for key decisions to provide a fair and suitable procedure for infertile patients. Iran is the only Muslim country in which gamete and embryo donation is practiced. Although embryo donation is accepted by law and gamete donation by clergy leaders, there are difficulties in acceptability of these procedures by this nation. It is widely accepted that if IVF is to be developed, ongoing embryo research is inevitable. In so far as human embryos cannot themselves consent to be the subjects of research, no research of any kind may be carried out without the consent of parents or legal guardians. In many jurisdictions, subsequent to IVF or ICSI, it is common practice for surplus embryos to be used, with the consent of the natural parents, to provide children for other infertile couples. The Guide to Ethical Conduct and Behavior specifically requires that “any fertilized ovum must be used for normal implantation and must not be deliberately destroyed.”Fertility clinics should address the psycho-social and emotional needs along with ethical, legal and moral issues of infertile couples as well as their medical needs. The content of counseling may differ depending on the concerned couple and the existing treatment options. Many physicians would hesitate to provide infertility treatments to women with drug addiction, serious developmental delay, or severe psychiatric illness because they believe the woman would not be a good parent. It usually involves treatment implication counseling, emotional support counseling, and therapeutic counseling. Different studies have shown the beneficial effects of psychiatric and psychological treatments not only in adapting to unsuccessful treatments but also in reducing stress and bringing about successful pregnancy. Conclusion: The woman should be given sufficient time to process information about the pros and cons of the procedure, and given time to ask questions before arriving at a decision to accept or refuse planned care. Patient information is generally held under legal and ethical obligations of confidentiality. Information provided in confidence should not be used or disclosed in a manner that might identify a patient/client without her consent. Clinicians and Infertility specialists should assess level of grief and adjust counseling accordingly, Counsel how to tell family and friends of their problem, include the patient’s partner in psychological care, Provide comfort, empathy, and ongoing support, acknowledge and reassure about the future. Psycho-cognitive teachings such as opening the situation for infertile couples can probably help them in overcoming and controlling the natural emotional distress brought about by treatment failure and acceptance of the probability of being left childless.