[Human in vitro fertilization: technics and ethics].

Abstract

IVF is certainly one of the new medical technologies where ethical debates are the most frequent and heavy. Three illustrations will be presented: The improvement of ovulation induction techniques have increased the number of supernumerary embryos. How to deal with these embryos, on which principles and what do the patients think about it? Introduction in the early 90' of assisted fertilization techniques (ICSI) have largely extended IVF indications and improved the success++ rate. Nevertheless, it will be demonstrated that it's implementation was a hard process for which the creation of embryos for research was a crucial step, opening another passionate ethical debate. Oocyte donation which came true thanks to IVF, will give the opportunity to illustrate an unusual consequence of ethics on technical aspect; due to an ethical choice (anonymous donation) we have been able to improve by a factor 3 the clinical efficiency of our oocyte donation program. An example of enhancement of the technique due to ethics, a very important fact in the situation of shortage of oocytes for donation. In conclusion, it appears that the ethical debate does not only focus on the legitimacy of this "medicine of desire" but also demonstrate that the development as well as the daily practice of IVF makes a clear vision of ethical choices mandatory and indissociable of technical aspects themselves.