WHERE IS WOMEN'S HEALTH IN THE DEBATE ON EMBRYO RESEARCH?

by Ruth Hubbard

President Bush’s recently appointed Council on Bioethics has begun to deliberate about human reproductive cloning and embryo stem cell research just as the US National Academy of Sciences has released its panel of experts’ report on these subjects. The Academy’s panel opposes reproductive cloning, that is, the production of babies who would be genetic copies of other people, and recommends that it be outlawed. It, however, endorses cloning embryos as tools for research into treating disease (therapeutic cloning). Judging from the composition of the President’s Bioethics Council and its initial public statements, that body is likely to end up opposing both types of cloning. I would guess that it is also likely to endorse President Bush’s decision of August 9, 2001 to forbid the further production of embryos for research and to thus limit the number of useable lines of embryo stem cells to those in existence on that date. Meanwhile, Congress is resuming its own debate on legislation regarding these matters, on hold since September.

Lost in most of these discussions, which tend to focus on matters of human dignity and the status of the embryo, is the fact that to produce human embryos outside a woman’s body requires not just human sperm, which apparently has been readily accessible since biblical times and, no doubt, long before. Producing embryos also requires human eggs, and getting at those is much more difficult. Granted, in vitro fertilization (IVF), which requires eggs, has become a standard part of reproductive medicine, but it requires relatively few eggs. Furthermore, these eggs are usually extracted from women willing to take risks to produce their own biological children. Even so, questions have been raised about possible negative consequences of IVF for women’s health.

Manipulating a woman’s physiology to make her produce large numbers of eggs for research, while encouraging her to do so by paying for them, raises questions of medical and scientific exploitation and ethics that have hardly been discussed. To stimulate a woman’s ovaries to release more than the usual single monthly egg she must receive hormones, first to suppress ovulation entirely and then to hyperstimulate it. The ripened eggs are then extracted surgically from the ovaries while inspecting them by ultrasound. None of this is fun and there is, as yet, no way to know about its safety. To date, we know that hyperstimulation can shut down a woman’s ovaries so that she experiences premature menopause with incumbent increased risks of osteoporosis and other symptoms of early aging. Some observations also suggest that the hormones may increase the incidence of ovarian and, perhaps, breast cancer, but there are not enough data to be sure.

Meanwhile, it is by no means clear that the therapeutic opportunities to be derived from embryo stem cells are superior to those of using stem cells isolated from the tissues of adults or from umbilical cord blood. As we go to press, a University of Minnesota scientist announced that she has discovered a new, versatile class of adult stem cells she calls “multipotent adult progenitor cells” that can grow into several types of body tissue. The rush to explore the potential of embryo stem cells appears to be based on the pursuit of patents and near-term profits. There are more acceptable alternatives likely to yield therapies and cures.

Ruth Hubbard is a CRG Board Member and a Professor Emerita at Harvard University.