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Middle East Fertility Society Journal, Vol. 10, No. 3, 2005, pp. 190-192 OPINION Religious perspectives of ethical issues in ART: 2. The views of the Coptic Orthodox Church on the treatment of infertility, assisted reproduction and cloning Botros Rizk, M.R.C.O.G., M.D. Division of reproductive endocrinology, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, USA Code Number: mf05031 Related articles: Coptic The word "copt" derives from the Greek Aigyptios "Egyptian" via Coptic kyptaios and Arabic Qibti. Aigyptios derives from hikaptah, house of the Ka (spirit) of Ptah one of the names for Memphis, the first capital of Ancient Egypt (1). The Arabs, upon arriving to Egypt in AD 640, called Egypt dar al Qibt (home of the Egyptians) and since Christianity was the official religion of Egypt, the word Qibt came to refer to the practitioners of Christianity as well as to the inhabitants of the Nile Valley (1). The First Book on In Vitro Fertilization The first book on the opinion of the Coptic Orthodox Church on In Vitro Fertilization and transfer of embryos was published by His Grace, the late Bishop Gregorios, the Bishop of theological studies, Coptic culture and scientific research (7). His book was based on a lecture that he had delivered the year before at the 10th Annual Conference of the College of Medicine, at AinShamsUniversity in Cairo in March, 1987. The author could personally testify that HG Bishop Gregorios was a scholar in different fields of Theology and Science and represented the ultimate in dedication and purity that could ever be achieved. His book was given to me more than 15 years ago by Professor Aboulghar who started in vitro fertilization in Egypt and sought the opinion of the Coptic Orthodox community as well as the Islamic community. The introduction of his lecture and book starts by ascertaining that the success of in vitro fertilization represents a great success for Science by alleviating a great obstacle for married couples wishing to conceive a child. Although having children is not the only reason for marriage, it represents nature's first goal of marriage in all beings including humans. He fully acknowledges that motherhood is the strongest instinct that a woman could have and that having children is the first wish for any mother and certainly infertile women are among the unhappiest people even if they were married to the richest, wealthiest and most famous. He also acknowledges that the success of in vitro fertilization has brought happiness to thousands of married couples and settled lives among many families. He quoted examples from the Old Testament painting a picture of how such tragedy could affect family life such as Sara who asked Abraham to marry her maidservant and Rachel and Jacob. He cited Rachel's statement asking Jacob to give her children or she would rather die. The second chapter focuses on the pitfalls of in vitro fertilization and assisted conception. He emphasized that a key issue is the fertilization of a woman's oocyte by her husband's sperm and extreme accuracy should be exercised in this important issue. He stresses the role of the treating physician in honesty so that there is no question that fertilization has occurred between the husband and wife and not any third party. He acknowledges that in certain situations fertilization might not occur but does not accept that fertilization should be attempted between the wife's oocyte and any other man's spermatozoa, whether it is from a known or unknown donor. HG Bishop Gregorios calls this fertilization incomplete ethically or legally from all aspects because the fruit of the relation between a man and a woman should be from a holy relation. Another issue that he does not accept is the establishment of embryo banks and the buying and selling of gametes with money. This is fully unacceptable because it brings down the relation of the value of marriage and conception and having children to a low level. He then discusses the difficult issue of surrogate pregnancy and believes that this is an area with serious consequences. One of those consequences is that the infant may inherit some different psychological or physiological traits of the carrier. He acknowledges that in the past, a mother who died had her child nursed by another woman who could do so and that was a legitimate option in the absence of facilities for feeding. In a later discussion, HG Bishop Gregorios denounces surrogacy (8). In summary, HG Bishop Gregorios welcomes and accepts in vitro fertilization only under the circumstances where the oocyte and sperm are taken from the husband and wife and fertilization occurred in vitro with no doubt about gamete mixing. Embryo transfer must be performed to the mother who is the source of the oocytes. All the steps of in vitro fertilization should occur with the approval of the husband and wife and the treating physician should be alert to the fact that no mixing of gametes should occur and there should be no doubt in anyone's mind regarding the source of the gametes. He accepted in this lecture that surrogacy is an option when the sperm and oocyte are obtained from the married couple when the wife has lost or does not have the ability to carry a pregnancy as in the case of a woman who has had her uterus removed because of bleeding or cancer. In a later communication, he closed the door on surrogacy even under those rare circumstances (8). In the details of his lecture, he goes through the clinical indications for in vitro fertilization and the steps that should be adhered to from the retrieval of the oocytes until the embryos are transferred to insure the extreme caution that should be exercised by the couple and the treating physician. In 1998, HG Bishop Serapion of Los Angeles published a series of articles in the El Kiraza journal of which HH Pope Shenouda is the editor in chief (9). HG Bishop Serapion who is a physician by background acknowledges that in vitro fertilization is a legitimate option for couples who cannot achieve a pregnancy by normal means including medical and surgical options. In vitro fertilization is acceptable only if the gametes are from husband and wife. No donor oocyte or spermatozoa should ever be used under any circumstances. Surrogacy is fully unacceptable. In a small number of other publications of other Bishops in Egypt, in vitro fertilization remains an acceptable option, gamete donation is not. Sex Selection Ethicists are divided in two camps: those who feel that sex selection is a choice of couples and those who believe that this would be a biased intervention with negative consequences (10). The Coptic Orthodox Church has not specifically addressed this issue to my knowledge. Cloning or Somatic Cell Nuclear Transfer Somatic cell nuclear transfer or cloning is an issue that has divided more ethicists in the Western world (11, 12). Cloning could be performed for reproductive reasons. This type of cloning is known as reproductive cloning. To our knowledge, no human beings have been successfully cloned. Although it is not impossible, it is extremely difficult to do so. Most medical societies including the American Society for Reproductive Medicine does not accept cloning from an ethical point of view even if it becomes technically possible. Cloning for the production of stem cells is known as therapeutic cloning which is acceptable to some medical societies (12). The Coptic Church does not accept reproductive or therapeutic cloning. REFERENCES
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