Befragung von Paaren während der IVF-Behandlung bezüglich Einstellung zur Ausweitung der Präimplantationsdiagnostik als Aneuploidiescreening im Rahmen der assistierten Reproduktion
Die Präimplantationsdiagnostik (PID, eng. Preimplantation Genetic Diagnostic, PGD) wurde 1990 zum ersten Mal von Handyside durchgeführt (Handyside 1990). Seither gab es gerade in Deutschland immer wieder Diskussionen, inwieweit dieses Verfahren zulässig sein sollte, ob alle seine Möglichkeiten ange...
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Table of Contents: The present work is a survey of 101 German couples undergoing IVF in the fertility centres of the university of Marburg and Gießen. The survey was carried out by using a qualitative and quantitative multi-method approach. The couples were asked about their attitudes towards different assisted reproductive technologies, primarily preimplantation genetic diagnosis and pre-implantation genetic screening. According to an ethical-coherence analytical and empirical-inductive approach we started with an analysis of current literature. Simultaneously a narrative qualitative interview was carried out. The couple was asked about its reproductive history, their attitudes towa-rds assisted reproductive technologies, genetic diseases and their present desire for a child. On the basis of the results of the literature analysis and this first interview a guideline was developed for the following seven qualitative interviews. According to the concepts, dimensions and categories found in the interviews com-plemented by core issues taken from the bioethical/ philosophical literature a stan-dardised questionnaire was constructed. For the quantitative part both gender were interviewed separately by a questionnaire to allow evaluation for gender differences. The survey deals with several topics. First of all the present desire of the couples for a child should be described. A detailed history of prior and present therapy was re-ported. We distinguished between objective parameters (such as the couples age, repeated implantation failure, duration of desire for a child) and subjective parameters of the desire for a child (such as strength of desire for a child, meaning of biological child-ren, imageability of a life without children). The next part concerns the assessment of various reproductive techniques, their risks and chances. We asked for possibilities following an unsuccessful IVF treatment, including adoption, polar body biopsy, PGD, counselling and abdication of children. There were also techniques mentioned, that were not available and actually illegal in Germany, such as PGD (until 2011) , embryo-and oocyte-donation and blastocyst transfer. The couples were invited to appraise which technique they would prefer most in case of an unsuccessful IVF treatment. They were also asked to tell whether the different procedures should be permitted and whether they would use these pro-cedures themselves. The status of the embryo is a main topic in the bioethical discourse in Germany on the implementation of PGD. Therefor we asked the couples about their concept of the embryo (more or clear „my child“ vs. more or clear „a cluster of cells“) and about the beginning of life. They also should decide, whether they would regard multiple pregnancy more as a risk or a chance. The results were evaluated in the context of the bioethical debate on the establish-ment of the PGD in Germany. Finally the findings were discussed within the context-sensitive bioethics perspective developed by Krones and Richter. The crucial factor for he couples is their desire for a biological child as reason for their acting during the IVF treatment. The couples are content with the IVF treatment regardless of success. Remarkable is the low utilisation of counselling, although the couples see a great necessity for it. There is a particular dissatisfaction of the couples concerning human genetic counselling. They describe it as neither useful nor comprehensible. There should be a reevaluation and change in counselling and human genetic counselling to meet the requirements of couples undergoing IVF treatment in a better way. Asked for the assessment of the risks and chances of the IVF treatment the couples overestimate the chances and underestimate the risks. They state an above-average baby-take-home-rate for their personal treatment. Otherwise they regard multiple pregnancies not as a risk but as an advantage. No influence of objective parameter concerning the desire for a child (like advanced reproductive age or repeated implantation failure) could be shown on the couple’s behaviour during the treatment. The main aspect determining the couple’s behaviour is the strength of the desire for a biological child. Those couples with the strongest desire state the greatest personal chance on childbearing. This view of „whishful thinking“ should be considered during counselling for artificial reproductive techno-logies. The surveyed couples are quite less restrictive towards the establishment of PGD in Germany compared to the current legislation. They show an altruistic motivation. They prefer the permission of reproductive techniques much more often than they presume to use these techniques. Likewise they would rather use egg/embryo donati-on to other couples than accept egg/embryo donation from them. Only few gender differences are statistically significant in the survey. There is a ten-dency that men are more permissive concerning the establishment of various repro-ductive technologies. They are also more willing to use these technologies. Asked for the status of the embryo the couples imagine the embryo “clearly or more as their child” (62%). Only a minority considers the embryo to be “clearly or more a cluster of cells” (38%). Most men and women describe an embryo in its eight cell stage as a „potential human being“ (31,2%) or a „cluster of cells, with a need for special protection“ (31,2%). The majority (64,4%) chose nidation, the implantation of the fertilized egg in the uterus, as the beginning of human life. The ethical perils of an establishment of PGD and PGS are seen by the couples, but especially social ethical problems are less considerable for them. Concerning the status of the embryo and the beginning of life the couples vote for special protection of the embryo and a relational understanding of human anthropology. The couples feel responsible for the embryos of their IVF treatment and are in a rela-tionship to them. Their attitudes should be much more considered during bioethical and political discussions. They should equally take part in decision making process about the establishment of further artificial reproductive technologies in Germany