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For Women who Want Children--Assisted Reproductive Medicine and Bioethics

In 2004, TV personality Aki Mukai and her husband, professional wrestler Nobuhiko Takada, applied to have their twin boys born in America to a surrogate mother entered in the family register. When their application was denied, they filed suit in court. Unfortunately, in 2007, the Supreme Court ruled that the surrogate mother should be registered as the twin's real mother. In this article, I would like to consider this issue.

Assisted reproductive medicine uses the most advanced technology currently available to help women who are unable to conceive a child naturally with their husband.

Assisted reproductive medicine began with the technique of artificial insemination, a method in which sperm is artificially introduced into the uterus. In Japan, the first artificial insemination took place in 1948, after the end of the war when the country had finally become peaceful and perhaps the future of Japanese society had last become bright. But because the process of conception is incredibly complicated and involves an indeterminate number of factors, this method was not readily successful.

To overcome some of these difficulties, in-vitro fertilization was introduced. This method calls for artificially fertilizing the egg with sperm outside the womb and then returning the fertilized egg to the uterus of the woman. In Japan, the first successful in-vitro fertilization was in 1983, some 35 years after the first artificial insemination. That much time was required to achieve the technological advances of this method of fertilizing human ova in a laboratory dish and transferring the embryos to the woman's uterus. Even with the use of technology, this method was still difficult--its success rate was about 20%.

In 2004, the number of children born with the help of assisted reproductive technology had reached in 18,000, a 150% increase over five years before. Children conceived in this manner do not seem to encounter any problems growing up. As for the women, however, they do experience difficulties during pregnancy, etc, particularly if they are older.

If a woman has undergone a hysterectomy due to some health condition, it is not possible to transfer an egg fertilized in-vitro. In this case, surrogate birth becomes the option, namely, a surrogate mother is asked to carry the child to term in her uterus. Aki Mukai chose to have her children by surrogate birth in a state in the United States where it is legal.

Advances in assisted reproductive medicine have been influenced by developments in animal husbandry. The theory and technologies developed through research on propagating and increasing livestock for certain purposes, such as cattle, sheep, and pigs that produce high-quality meat, sheep that produce high-quality wool, and fast horses for races, have also been applied to human beings. As a consequence, obstetricians in the UK and the US, two countries with a history and experience in this field, were the pioneers in assisted reproductive medicine. We can consider Dolly, the cloned sheep that was born in Scotland, to be an extension of this research, a topic that I will discuss on another occasion.

At this point, readers will, no doubt, be filled with many different reactions. Some will find these efforts extreme and others will hope for more and faster development. A number of issues confront us today at time when we can even use the sperm and eggs of a third party in in-vitro fertilization and surrogate birth.

Reflecting these developments, bioethics is a field that has received much attention. It drew active interest at the beginning of the 1970s as a way of dealing with the ethical problems in the biological sciences and medicine that had emerged in the 1960s. Its starting point was originally the notion of "survival sciences" which is concerned with the survival of humankind on what is our finite planet Earth. Bioethics brings together ethics, the biological sciences, and medical issues under one rubric to apply its insights to a number of issues. In addition to the issues of assisted reproductive medicine, and naturally, experiments on human beings, topics such as death with dignity, heart transplants, and genetic research are argued from the position of bioethics.

In 2000, the Ministry of Health, Labour and Welfare formed the Special Committee on Medical Technology for Reproductive Treatment to study the question of surrogate birth from the standpoint of bioethics. In 2003, although it recognized the donation of sperm, ova, and fertilized eggs and the right to know one's biological parents, it released a report prohibiting surrogate birth, which also received the backing of the Japan Society of Obstetrics and Gynecology. Meanwhile, the ethics committee is to continue considering the surrogate birth issue.

Today when the technology and methods are readily available, what is the right thing to do when a woman wishes to have a child and is willing to do so by some means or other? It's time for women to speak up. Isn't this is an issue that needs the voices of women to be heard?

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