In a first-of-its-kind twist, a mother is donating her frozen eggs in the hopes that they may one day help her daughter give birth.
Because the eggs belong to the mother, though, the possibility exists that the girl could someday give birth to her biological half-brother or half-sister.
Some doctors say such a prospect is an unsettling one.
"I have great concerns about this development," said Dr. Jeffrey L. Deaton, a reproductive endocrinologist and medical director of Premier Fertility Center in High Point, N.C.
"If the goal is to provide her with a family, why not make it less ethically challenging and consider either donor eggs or adoption? Our technology is progressing more rapidly than our ability to understand the social, ethical and religious ramifications."
While some are bothered by the development, most ethicists and fertility experts say such concerns are largely unwarranted.
"The dilemma of giving birth to one's genetic sister I think is overdone," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia.
"I suspect parents will adapt quickly, as do adoptive parents who raise their sister's kids, or even a younger sibling."
"Those who object would probably have objected to the invention of fire by mankind hundreds of thousands of years ago, and they definitely would have had moral problems … with [in-vitro fertilization] in general when these shocking new ideas first came upon the scene," said Dr. Sherman Silber, the medical director of the Infertility Center of St. Louis at St. Luke's Hospital.
The donation by Melanie Boivin, 35, from Montreal, was prompted by the fact that her 7-year-old daughter, Flavie, has Turner's syndrome -- a genetic condition that carries an almost certain chance of infertility.
The idea is that one or more of the 21 eggs harvested from Melanie could be fertilized and implanted into Flavie if and when she decides she wants to have a child. The plan offers what could be a more reliable approach than relying on an unrelated donor, which could entail several years on a waiting list for eggs.
Ethicist Bill Allen, director of the Program in Bioethics at the University of Florida College of Medicine, says that he sees no inherent ethical problem in such a situation.
"The language critics use to make this sound as if something terrible is going on," said Allen. "The notion that if Flavie Boivin uses her mother's donated eggs to bear a child, that child will be her offspring and her 'half' sibling at the same time, distorts the issue in a way that is sensational and mostly irrelevant."
"If Flavie were to use her mother's eggs, the child that would be born to her would be her son or daughter and would have a child-mother relationship with Flavie. The child would not relate to its mother, Flavie, as a half-sibling, but as a mother," he said.
Other ethicists say that the case at hand presents a far lesser set of ethical considerations than other reproductive technology advances that have garnered attention in the past.
"Personally, I find this act less worrisome than egg selling at exorbitant prices, or many other moral practices that cause immediate harm to women and to children," said Laurie Zoloth, director of the Center for Bioethics, Science and Society at the Northwestern University Feinberg School of Medicine in Chicago.
"This case is less distressing than some situations involving assisted reproductive technology," said Kathleen Powderly, acting director of the Division of Humanities in Medicine at SUNY Downstate Medical Center. "This one is not going to push as many buttons as some others -- like the mother who wanted to harvest the sperm from her brain-dead son to either have a baby herself or hire a surrogate."
Predicting a Stir
Still, the unusual nature of the situation prompted the team performing the donation procedure to refer the case to an independent ethics committee before going through with it.
"It was approved because she was doing it out of love for her daughter," said Dr. Seang Lin Tan, a professor of obstetrics and gynecology at McGill University in Montreal. Tan led the team that extracted and froze Melanie's eggs and reported the procedure at the European Society of Human Reproduction and Embryology conference in France this week.
There is no guarantee that the eggs will ever be used by Flavie, however. If Flavie decides that she wants to use her mother's eggs in the future, Tan says she must appear before yet another ethics committee.
Alternatively, according to Canadian regulations, she can choose to exchange the eggs with those donated by other women to get an egg that bears no genetic similarities to those of her mother. Women receiving Melanie's eggs would not be at increased risk of having a child with Turner's syndrome, fertility experts say.
But if Flavie decides to use her mother's eggs and if she manages to give birth, will the fact that the child is her own genetic half-sibling run counter to societal norms?
"That, obviously, is the important point in all of this," Tan said. "I don't think anyone has the 'right' answer to this."
He notes, however, that societal values and norms will change over time -- meaning that interpretation of the procedure 20 years from now could be much different than that of today.
"After all, it was only 20 years ago that homosexuality was illegal in Canada. Ethical norms evolve with time and change as time goes on."
Dr. Tommaso Falcone, the director of the Cleveland Clinic's Reproductive Endocrinology Research Laboratory, says moral concerns should be at least partially assuaged by the fact that many women have already donated their eggs to their sisters without ill social effect.
"Scientifically, this is simply [a] donor egg [procedure]. There is no scientific novelty. It is the ethical novelty -- somewhat -- in that the mother gave the eggs," he said.
Doctors Debate Viability
But Falcone adds that the logistics of using an egg that has been frozen for 20 years or more may prove to be a difficult hurdle.
"What is not stated is the very low pregnancy rate from this procedure," Falcone said. "Even in the best hands … it is probably no better than 5 [percent] to 6 percent."
Tan notes, however, that his lab can ensure a frozen egg survival rate of more than 85 percent -- pregnancy rates from similar procedures have approached 40 percent, making the option nearly as viable as natural pregnancy.
But only time will tell whether the eggs will still be viable after 20 or more years of cold storage.
"Obviously we don't know for certain," Tan said.
It is this variable of the equation that ethicists say may present the most significant ethical consideration.
"Egg freezing also is so new that the implications for creating healthy offspring from such eggs are also unknown," Caplan said.
"This is a very uncertain idea, and therefore is not a therapy, it is an experiment," said Zoloth. "We really do not know the implications for pregnancies conceived with these eggs, should it even work."
He added, "I am concerned about the possibility that this is not clear to the parents. What was the nature of the promises and claims made?"
But fertility expert Silber says the technique offers a solid chance of conception.
"We are planning on doing the same thing very soon for a mother and daughter with the very same indication," he said. "There will be no problem with cryopreservation for a long time, like 20 or 40 years."