Biological characteristics of the preembryo.
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Biomedical subjects
Publications and source records attributed to C Grobstein.
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The development of the human embryo from the time of fertilization through the eighth post-fertilization week is described for medical policy purposes. During pre-implantation stages, differentiation occurs between precursors of embryonic and extra-embryonic structures. During implantation formation of a fore-hind axis begins within the inner cell mass. By the end of the eighth week, head, face, hands, and feet are suggestive as to species-recognition but not yet definitive. Data from laboratory studies of non-human mammalian embryos elucidate important aspects of human embryonic development.
This article has briefly reviewed the range of public policy issues and ethical questions raised with respect to IVF. It then discussed selected issues that are now under policy debate and decision. Given the wide acceptance of IVF as a medical procedure for married couples, what variants might also be ethically defensible? IVF for unmarried couples appears defensible under specific conditions that are equally applicable to married couples. Involvement of third parties (gamete donation and gestational surrogacy) is more complex and needs case by case examination. Sperm donation appears to generate little that is ethically new when coupled with IVF but requires the same care and concern as AID. Egg or embryo donation, however, does raise new ethical questions that need close attention and continuing analysis. Freezing of human embryos also breaks new ethical ground, particularly in the options it generates beyond a narrowly defined medical domain. Certain of these options are better not undertaken without further public policy decision. Improvement of current procedures and techniques through effective clinical trials can be ethically carried out in terms of scientific and medical perspectives. However, efforts in this direction will be more effective if undertaken within a public policy framework that clearly defines acceptability during a transitional period of confidence-building.
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In vitro fertilization, in its first 5 years of use, has met minimum standards for efficacy and safety, as judged by published clinical reports. It is becoming more widely available as an approach for overcoming sterility in married couples and appears also to be gaining social acceptance in that context. Several technical options presented by the procedure, particularly storage of frozen embryos and embryo transfers involving third-party contributions, are less fully evaluated clinically and raise social, ethical, and legal questions that go beyond the original medical model for therapeutic intervention. The clinical success of in vitro fertilization and the options it affords call for careful policy consideration. Estimates of costs and of potential demand for and supply of services are provided and the current status of relevant policy in the United States and abroad is discussed.
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