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MEDICALLY ASSISTED CONCEPTION
An Agenda for Research
Report of a Study by a Committee of the
INSTITUTE OF MEDI CINE
Division of Health Sciences Policy
NATIONAL RESEARCH COUNCIL
Board on Agriculture
National Academy Press
Washington D. C. 1989
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NICE: me project that is the subject of this report was approved by
me Ga~rerning Board of the National Pesear~ Cavil, whose ~ are
drawn frog the councils of me National Aca~ of Science, the National
Acaderry of Er~ineering, arm the Institute of Medicine. m e ~ rs of the
committee responsible for the report were chosen for their special
competencies and with regard for appropriate balance. This report has
been reviewed by a group other than the authors according to prCoeJur~-
approved by a Report Review Committee consisting of members of the
National Academy of sciences, the National Academy of Engineering, and the
Institute of Medicine.
The Institute of Medicine was chartered in 1970 by the National Academy of
Sciences to enlist distinguished members of the appropriate professions in
the examination of policy matters pertaining to the health of the public.
In this, the Institute acts under both the Academy's 1863 congressional
charger responsibility to be an advisor to the federal government and its
own initiative in identifying issue= of medical care, research, and
education.
The National Research Council was organized by the National Academy of
Sciences in 1916 to associate the broad community of science and
technology with the Academy's purposes of furthering knowledge and
advising the federal government. Functioning in accordance with general
policies determined by the Academy, the Council has become the pr ~ ipal
operating age ~ of both the National Academy of Sciences and the National
Academy of Engineering in providing services to the government, the
public, and the scientific and engineering communities. The Council is
administered jointly by both Academies and the Institute of Medicine.
This project received support from the National Academy of Sciences
Basic Science Fund and the U.S. Department of Agriculture (Contract
59-32U4-8-63/R).
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IN 89-08
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LIE OF MEDIATE
NIL REMET CECIL
~rd on Agriculture
ON 1~ BASIC SCENCE PWN~ONS OF
MEDIC ASSISTED ~PrION
J. RYAN,* (Taiwan), Professor and Chairman, Dot
of ~stetriceand~yr~ology, H~rvard~i~al School, Boston,
~ssac~husetts
JOT D. BIT, Professor of Physiology, Harvard Medico School,
in, Massachusetts
MARIAN D. D~MEWOOD, Assistant Professor, Department of Gynecology
and Obstetrics, me Johns Hopkins Mbdi~1 Institutions, Baltimore,
~y1and
CLAUDE DESJARDINS, Professor of Physiology, Department of Physiology,
University of Virginia School of Medicine, Charlottesville, Virginia
NEAL L. FIRST/** Professor of RQ pro ductive Physiology Meat and Animal
Science Department, University of Wisconsin' Madison/ Wisconsin
GARY D. HODGEN, Professor and Scientific Director, Eastern Virginia
Medical School, Norfolk, Virginia
ROEEh~ B. JAFFE,* Professor and Chairman, Department of Obstetrics,
Gynecology and Reproductive Science, School of Medicine, University of
California, San Francisco
HOWARD W. JONES, Jr., Professor of Obstetrics and Gynecology, Eastern
Virginia Medical School, Norfolk, Virginia
STANLEY P. LEIDD,*** Research Associate Professor, Departments of
Obstetrics, Gynecology and of Urology, Baylor College of Medicine,
Hcuston, Texas
.
*Member, Institube of Medicine
**Member, National Academy of Sciences
***During the study, Dr. Leibo was in the Research and Development
Division of Rio Vista International, Inc.
· . .
_ Ill _
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JCN~N VAN I, Professor of Mbl~llarl cellular, are Developmental
Biology, Depar~t of Molars Cellular and Devel~nt~ Biology,
University of Colorado at BaulHer, Baylor, Colorado
EI=RD E. ALPACA, Professor arm Chairman, ~a~t of Logy
The Johns Hc~?kins ~ic~1 Ir~i~ions, ~ltinr~re, Skylark
STUDY STAFF
Institute of Medicine
ET.TFN HER, Director, Division of Health Skiers Polity
JESSICA lOdNSEND, Study Director
CONSTANCE M. PLEURA, Meeting Ra~rteur
LACE K. ~ALL, Or,
B=rd on Ac~r~culture
Institute of Medicine
.
JAMES; =~;1 Associate Executive Direr
— 1V —
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HE OF is
DEFACE
SPRY
SCOPE OF TO STUDY . . . ~ . . ~ . ~ . e · · e ~ · · e e ~ · e -
I. ~ vr~ F~I]ZATION AND E2~0 ~NSt~X AND
S(XIAL C'ON=gNS · · e · · · · · · · · · · · e e e e —
Infertility
Contraception
Agriculture .
Biodiversit~
Primates for Search .
ADVANCER IN IRE ~AC:11CE AND SCONCE BASE OF
MEDIC~LY ASSISTED ~J(:~;PI'ION e e e e e e e
Developments ~ n E~nan In Vitro Fertilization e ~ · e e
Develo~nts ~n Assisted Cor~tion ~n Fb~-~ucing
Arlilll~s e · e e · · · e · · · · · · · · · e e e e e -
Ga~togenesis and Ga~c . . e · · · e · · e e e e ·
Fertilization . . ~ . e · · · e · e · e · · e e e e e e
PreiTrplantation Development e · - - - - - e · · -
Implantation e e · ~ e · · e e e e e e e · e e e
III. ~ 1D }~ ItI IN VI~ I~LlL~ ON AND
=13RYO TEtANSt~ · · e · e · · · · · · · · · · · e e e
Ethira1 and Social Issues e · - e e e · - - - - - e e e
O~cher Barrier~; ~ Scientific ~s e e e e
RE~E~ A~ AND E~ONS
P~ Ag~ .
(::oncl~l~ions ar~ ~ations .
APE~NDIX A Papers E~es~ at Workshap e
II e
IV.
~ V ~
PAGE:
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The committee appreciates the generous contribution of time and knowledge
of those who presented papers at the oommittee's workshop at the Arnold
and Mabel Beckman Center, Irvine, California, August 21-23, 1988. The
thought-provoking papers Contributed to the workshop, and the presence of
exceptional scientists and clinicians Stimulated outstanding discussions.
The committee gained ~nval`=hle knowledge and insight into issues in
research in reproductive and developmental biology that provided the Basis
for its deliberations. ~ want to extend the gratitude of the committee to
all who attended the workshop. By offering those resources that we all
value -- time and knowledge -- the committ^-'s work was greatly
facilitated.
Kenneth J. Ryan
Chairman
Committee on the Basic Science Foundations
of Medically Assisted Conception
— V1. —
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ICE
This report is the ret of a sty by a amni~ee of the Aspire
of Medicine (IaM) art the National Prearm ills E~rd on
Agriculture. Ibe by its fauna 1984 meeting of an abhor grab
convent by the National Academy of sciences to di.~C-= ads of genetic
engineering of the human germline. It was nc*~ that because of a policy
that, ~ effect, pr ~ ibit ~ the ,~= of federal furls for r ~ rig
involving human embryos, the clinical practice of in vitro fertilization
and embryo transfer (IVFET) was in danger of outstripping its scientific
foundations. Moreover, the United States had not systematically reviewed
the recurrent state of knowledge and practice of IVFET. In 1986, the IoM's
bard on Health Sciences Policy convened a meeting of experts in the
fields of human and animal research, clinical practice, law, ethics, and
public policy to consider some of the inches raided at the earlier
meeting. This group was asked to advise the IBM on whether it should
pursue a spry in any of the areas in which difficult issues had been
raised by the practice of medically Misted conception namely,
professional, social, legal, and ethics issues, ~ addition to questions
of science policy. The group identified several topics to which the IaM
could make a substantial contribution. An important result of the meeting
of this group was to highlight the .=r-ientific contribution of research
relating to animal uses of medically assisted oonception, and the lack of
communication between those working to further human clinical [VFET and
those working ~ the animal sciences. This seedy of the basic science
fcundations of medially assisted conception results freon the
Rations made by this group of exerts.
SO of the Study
A committee was appointed whose membership included individu~ns with
expertise in the clinical practice of in vitro fertilization, research in
animal and human reproductive and developmental biology, and physiology.
The c ~ nits== was asked to examine Jche basic science foundations of
medically assisted conception, and develop an agenda for basic research An
reproductive and developmental biology that Could contribute to advances
in the clinical and agricultural practice of rVFET. This research would
also be applicable to other concerns in human and animal reproduction such
as mane and female infertility and contraception. Because of limitations
on research using human embryos, the committee was also asked to identify
animal systems that provide useful models for specific a ~ of
medically assisted conception. In addition, the committee was asked to
address ways of diminishing barriers to progress in reproductive research
and consider ways of fostering communication bean investigators
oriented to human clinical questions and those intern In studies of
animals.
c ~
— Vll —
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Although the barge ~ the catnip incline consideration of ways
of leering barriers to progress in carp, sane of which are cat her
legal art ethical cor~xrns, the canine was not ~i~ ~ resolve
or ~ ke r ~ erections on such issues. Rap er, it was to confine its
deliberations to consideration of ways that scientists ~ ght contribute to
the furtherance of the debate on legal and ethical issues related to
~lirO1 ly assisted ~l~ptioa,.
The commit ~ e held two meetings. At the first, a plan was developed
for a workshop that wound bring together clinicians and investigators to
review the status of racist c~ ion in animals and humans, and
suggest productive areas for future recur=. He committee carefully
reviewed curing Heart di~ct:iorm In repressive science, and select
retard areas and .ir~ve~igators to pry them at He workshop. He
commit ~ e was aware that it was neither feasible Thor desirable deco provide
a comprehensive view of reproductive research. Rather, the committee
selected areas of research that show particular promise or describe
particularly problematical areas in relation to rVFET. This workshop was
also conceived as a major effort in bringing together representatives from
the human and animal research worlds to enable them to exchange idea=,
enhance their understanding of ways in which they can contribute to each
other's work, and together participate in a joint activity that might
establish continuing ties.
· . . a
_ · . · ,
~ .
_ ~__~
The committees second meeting' after the workshop, was spent in
developing this report and its recommendations.
Vll' —
