Reproductive medicine involving genome editing: clinical uncertainties and embryological needs.

Genome editing based on site-directed nucleases facilitated efficient and versatile genetic modifications in human cells. However, recent reports, demonstrating CRISPR/Cas9-mediated genome editing in human embryos have raised profound concerns worldwide. This commentary explores the clinical justification and feasibility of reproductive medicine using germline genome editing. Despite the perceived utility of reproductive medicine for treating intractable infertility, it is difficult to justify germline genome editing from the perspective of the prospective child. As suggested by the UK legalization regarding mitochondrial donation, the prevention of genetic disease in offspring by genome editing might be acceptable in limited cases of serious or life-threatening conditions, where no alternative medicine is available. Nonetheless, the mosaicism underlying human embryos as well as the off-target effect by artificial nucleases will likely hamper preimplantation genetic diagnosis prior to embryo transfer. Such considerations suggest that this type of reproductive medicine should not be developed toward a clinical application. However, the clinical uncertainties underscore the need for embryology that can address fundamental questions regarding germline aneuploidy and mosaicism using genome editing.

[Significance of reproductive medicine in regard to judicial and ethical concerns in Germany]. / Gesellschaftlicher Stellenwert und juristische Aspekte der Reproduktionsmedizin in Deutschland.

Reproductive medicine becomes more and more important due to demographic changes and an increased demand. Since the German "Embryonenschutzgesetz" was set in 1991 many medical improvements could be achieved which are not covered by law. Health can be improved avoiding multiple pregnancy rates. In Germany we are facing an insufficient law concerning reproductive medicine. Therefore, it is very important to renew the law in order to create a better health supply clearing crucial medical questions.

Ethical considerations in women's sexual and reproductive health care.

BACKGROUND: The concept of reproductive health, which adopts a holistic approach to the management of reproductive disorders, was developed in 1994 at the International Conference on Population and Development. This together with the adoption of a right-based approach to the relationship between reproductive health and population and development and the emergence of the concept of sexual and reproductive right marked a turning point in contemporary global health care initiative. Sexual and reproductive healthcare raises ethical questions that fall within the purview of bio-ethics. OBJECTIVE: To review ethical issues related to women's sexual and reproductive healthcare. METHODOLOGY: A critical review of available literature on the subject matter was conducted. FINDINGS: Four key principles form the basis of Bioethical analysis--respect for person, beneficence, non-maleficence, and justice, applicable at four different levels microethical, macroethical, mesoethical, and megaethical levels each of which can be employed in the ethical analysis of sexual and reproductive health care. Medical practitioners caring for women, for the fact that they work in areas of a woman's body that are of particular psychosocial sensitivity, are expected to adhere to strict ethical principles in their practice. The International Federation of Gynaecology and Obstetrics (FIGO) in collaboration with the Society of Gynaecology and Obstetrics of Nigeria (SOGON) has developed a human right based code of ethics related to sexual and reproductive health care to guide medical practitioners caring for women in their daily practice. CONCLUSION: An understanding and proper application of the ethical principles is expected to enable these medical practitioners to actualize the ultimate and desired goal of uplifting the sexual and reproductive healthcare and right of women.