Though the President's Council on Bioethics is just beginning to reevaluate infertility techniques in the United States, scientists and clerics in the Middle East have been on top of the issue ever since the first "test-tube" baby was born 25 years ago.
At the annual meeting for the American Association for the Advancement of Science in Seattle, Marcia Inhorn, a medical anthropologist from the University of Michigan, described how, in Middle Eastern countries, religious edicts (fatwas) rule the reproductive lives of Shiite and Sunni Muslim couples who, she said, literally want to make their "test-tube babies in a religiously correct fashion."
In the conference's topical lecture series, Inhorn, also the director of the Center for Middle Eastern and North African Studies, discussed how Islamic religious beliefs strictly outline reproductive dos and don'ts, especially when it comes to in vitro fertilization, or IVF.
Not long after the birth of Louise Brown, the first baby born using IVF technology, the Grand Sheikh of Egypt's Al-Azhar University issued the first fatwa concerning assisted reproductive technology. Inhorn said the fatwa issued in 1980 "has proved to be truly authoritative and enduring in all its main points for most of the Middle Eastern region."
Dr. Gamal Serour, joint founder of Egypt's first IVF clinic that opened in 1986, outlined the importance of infertility techniques in an e-mail. "This technology has been so integral in the Middle East," he wrote. "Procreation and continuity of human life is considered of great importance to the people living in the area."
However, the technology was strictly regulated. Essentially, Inhorn said in an interview, the fatwa stated: "IVF was OK to do as long as you were using gametes from husband and wife and the embryos were transferred back to the same wife."
Anything outside of using sperm or egg from an infertile couple, like surrogacy or sperm donation, said Inhorn is haram, or sinful, and tantamount to zina, or adultery, strictly forbidden in Islam.
"Though it's not the same as adultery per se, it's the same as entering upon the sacred dyad of marriage," Inhorn told Science & Theology News.
Even with embryos created within the boundaries of a marital relationship, restrictions on IVF occur, said Serour, also director of the International Islamic Center for Population Studies and Research at Al-Azhar University. "Cryopreserved gametes or embryos cannot be used if [the] marriage contract has broken, whether by divorce or death of one of the couple," Serour wrote, citing Sunnah, or the normative behavior as proscribed by Muhammad, as the primary Islamic tenet prohibiting this action.
Apart from adultery, IVF creates other problems for Muslims that would seek to use a donor or a surrogate mother.
"Islam privileges the notion of lineage - that each child should have a known father," Inhorn said. "The use of a donor confuses issues of lineage descent and inheritance." In her AAAS lecture, Inhorn said knowing a child's lineage is "not only an ideal in Islam, but a moral imperative."
Inhorn explained that an adopted child is "really like a stranger in your family; you can love it and treat it very well and the Qur'an encourages this," she said, but the scriptures don't allow legal adoption as it is practiced in the West. The child keeps its given name and does not inherit anything from the family.
More recently, however, the minority Shi'a sect of Islam broke away from the traditional party line of the dominant Sunni religion. Though they also conceive of adoption in the same terms as other Muslims, Shiites were given more options by a fatwa handed down in the late 1990s by Iran's Supreme Jurisprudent Ayatollah Ali Hussein Khamanei.
Khamanei effectively opened up the possibility for donors to be used in cases of extreme infertility, said Inhorn, as long as both parties "abide by the religious codes regarding parenting."
Despite the fact that there are many donation stipulations and that a child born from the gametes of both parents is the gold standard, Inhorn said in her lecture that Muslims often view donor technology as a "marriage savior, helping to avoid the marital and psychological disputes that may arise if the couple's case is otherwise untreatable."
Still, the most prominent hurdle to IVF and other fertility treatments is not necessarily religious guidelines, but the procedures' high costs. In fertility clinics in Egypt, a single IVF procedure can cost up to $3,000, making it difficult for even the wealthiest Middle Easterners to use the biotechnology.
New research in Science magazine that highlighted the potential for women to produce new eggs throughout their lifetime could, in the future, provide a low-cost alternative to IVF in the Middle East. Inhorn said that anything to avoid IVF would be "great."
Serour encouraged new technology providing that it results in "procreation within the frame of marriage."
Despite what some might view as constraints of Islam on reproduction, Inhorn said the Scriptures do encourage finding a solution to one's problems.
"Islam as a religion is very accommodating of science and biomedicine. There are certain mandates in the religion that say `Seek a solution to your suffering. Seek and I'll help you,'" Inhorn said. "In terms of infertility treatment, from the richest to the poorest, people will say `As a good Muslim, I'm encouraged to try.'"
