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Many systems constitute the human body. Beside other systems, the reproductive system is of the key importance as it is directly concerned with the survival of species.
In present scientific era, latest reproductive techniques are introduced. Most of the cases of infertility (both in male and female) have been cured. Here we can't neglect the religious, moral and social problems which can arise by the artificial and scientific methods of reproduction.
Artificial insemination, test tube baby and cloning are such artificial and scientific techniques by which the hindrances in the natural fertilization are removed and success is assured for acquiring pregnancy.
Being Muslims, we should consider the limitations of Islamic teachings before availing such scientific methods.
Islam doesn't condemn any scientific invention or technique but implies some bindings and limitations while availing such facilities. For example, television, telephone, computer, fax, loud speaker and all such inventions are not forbidden in Islam but their usage and application is very well defined accordingly .Similarly the techniques like artificial insemination and test tube baby can never be restricted at once, but we have to analyze all the possibilities and probabilities which can arise by using such methods and techniques. Then the conditions which collide with Shariah are restricted or forbidden and the aspects which are allowed by the Shariah can be adopted.
NATURAL FERTILIZATION IN HUMAN BEINGS
Being mammals, internal fertilization takes place in human beings which occurs inside the female reproductive tract. Male are equipped with a pair of testes where male sex cells or sperms are produced while female has a pair of ovaries where ova or eggs are produced. During the sexual copulation, the male sprays the sperm inside the female reproductive tract. The sperms are million in number but only one fuses with the female's ovum and new cell "Zygote" is formed. This fusion is known as "Fertilization". Mitosis cell division starts in zygote and after app.9 months, a complete human being is reproduced. (1)
CAUSES OF INFERTILITY
CONDITIONS AFFECTING BOTH PARTNERS
AÂ numberÂ ofÂ factorsÂ that affect males and females alike can increase the risk of infertility. Perhaps the most common problem is age-the older a person is, the more difficult it is to become pregnant. Over the last 20 to 30 years there has been a trend to delay childbearing, often until women are in their 30s. A woman reaches her peak fertility at age 18 or 19, with little change until the mid-20s. As she approaches age 30, her hormone levels start to decline and her fertility also begins a slow decline, with a more rapid decline after age 35. Menopause, which occurs in the late 40s to early 50s in most women, marks the end of a woman's natural ability to bear children. A man's fertility decline is not as rapid and has no clear-cut end point, but a man of 50 has lower hormone levels and is likely less fertile than he was at age 25 or 30.
GeneticsÂ canÂ alsoÂ play a role in infertility. An irregular genetic makeup in one or both partners can prevent conception or result in a miscarriage, the spontaneous abortion of a fetus. Up to 60 percent of miscarriages that occur in the first three months of pregnancy result from genetic abnormalities.
Sexually transmitted infections (STIs) are a leading cause of infertility. In many cases, diseases such as gonorrhea and Chlamydia may have no symptoms. If left untreated, STIs can cause extensive and irreparable damage to reproductive organs. In women, untreated STIs can cause pelvic inflammatory disease (PID), a bacterial infection that damages the uterus, fallopian tubes, and ovaries. PID is one of the primary causes of ectopic pregnancy, a life-threatening condition in which the fetus begins to develop in the fallopian tube. In men, untreated STIs can result in sterility, an inability to conceive.
InÂ recentÂ yearsÂ fertility experts have determined that in some cases the immune system may play a role in preventing conception or interfering with embryo implantation in the uterus. Both men and women can develop an allergic reaction to sperm, causing their bodies to create antibodies that attack and kill sperm. These sperm antibodies may also bring about infertility by causing sperm to clump together, preventing them from fertilizing an egg. (2)
MALE INFERTILITY FACTORS
HistoricallyÂ menÂ were assumed to be fertile if they were capable of sexual intercourse. As a partial consequence of this attitude, research on fertility has traditionally emphasized problems in women. More recently, however, physicians have found that the male partner is the primary cause of infertility in about 30 percent of cases. Causes of male infertility can be categorized into sperm abnormalities, structural problems, or medical disorders
1) SPERM ABNORMALITIES
LowÂ spermÂ countÂ isÂ the most frequent cause of male infertility. Although ultimately only one sperm is required for fertilization, men whose semen (fluid produced during ejaculation) contains less than 20 million sperm per milliliter frequently have infertility problems.
InÂ additionÂ toÂ theÂ quantity of sperm, the quality of sperm may affect male fertility. Physicians determine sperm quality according to its motility (ability to move) and its physical structure. Poor motility will prevent sperm from swimming the long distance from the woman's vagina to the fallopian tubes to fertilize an egg. Sperm that have structural problems will also have problems penetrating an egg. Other conditions that can compromise sperm quality include genetic impairments such as damaged deoxyribonucleic acid (DNA), the genetic information critical in the development of a fertilized egg; or degradation that may result if sperm
2) STRUCTURAL ABNORMALITIES
SomeÂ menÂ haveÂ anatomical abnormalities that impair or prevent fertility. The most common structural problem affecting male sperm levels is a varicocele, a tangle of swollen veins surrounding the testis. Other testicular problems include torsion, in which one testis is twisted, or undescended testicles, in which the testes are located in the abdomen instead of in the scrotum, the external pouch of skin that normally holds the testes. The vas deferens (tubes that carry sperm from the testes to the penis) may be blocked because of a past infection or injury, or may be absent altogether due to a congenital abnormality. Other structural problems may prevent a man from ejaculating or cause his ejaculation to propel the sperm backward into his bladder rather than out through the penis
3) MEDICAL DISORDERS
AÂ numberÂ ofÂ medicalÂ disorders may cause male infertility. Infections such as sexually transmitted infections, prostatitis (infection of the prostate gland), and mumps contracted as an adult may lead to scarring and obstruction of the reproductive organs. Certain medications, including some prescribed to control high blood pressure (calcium channel blockers and beta blockers), ulcers, and depression, can impair testicular function. Exposure to high levels of environmental toxins, including lead, mercury, and certain pesticides, may also affect male fertility. Some men have insufficient hormone levels, resulting in low sperm count or improper testicular function.
FEMALE INFERTILITY FACTORS
ManyÂ factorsÂ canÂ affect a woman's ability to ovulate (monthly release of an egg from the ovaries), conceive, or carry a pregnancy to term. Female infertility factors are commonly grouped in two categories: structural abnormalities and hormonal imbalances.(3)
SomeÂ womenÂ areÂ bornÂ with reproductive systems that have anatomical irregularities, or infection or injuries may damage certain reproductive organs. Blocked fallopian tubes are a frequent cause of female infertility, accounting for up to 35 percent of cases among females. Scar tissue that blocks the fallopian tubes-caused by infection, inflammation, or a condition called endometriosis-prevents eggs from meeting sperm.
SometimesÂ aÂ womanÂ isÂ born with a malformed cervical canal. An impaired cervical canal can prevent passage of sperm from the vagina to the uterus as the sperm travel toward the fallopian tubes. If a woman is able to conceive, problems with the cervical canal can lead to miscarriage. In the uterus, no cancerous growths, such as fibroid tumors and polyps, can prevent a fertilized egg from implanting in the uterine wall
AÂ frequentÂ causeÂ ofÂ infertility in women is abnormal ovulation. Normally one egg will be released each month about midway through the menstrual cycle, under the direction of several hormones. If any of these hormones are not functioning, ovulation will occur irregularly or perhaps not at all. This condition accounts for about 25 percent of cases of female infertility.
AbnormalÂ ovulationÂ can be caused by a number of disorders of the endocrine system, including thyroid disease, diabetes mellitus, and polycystic ovarian syndrome. Certain chemicals can affect hormonal levels and adversely affect fertility. For instance, marijuana use can shorten the menstrual cycle. Cigarette smoking reduces some types of hormone production and may deplete egg supply.
AÂ numberÂ ofÂ otherÂ factors also may contribute to female infertility. Once inside the female's cervix, sperm may encounter obstacles. The cervical mucus (thick fluid that protects the cervix and uterus from infection) may be too thick for the sperm to penetrate, or it may be chemically hostile to the sperm. A fertilized egg may become stuck in the fallopian tube and result in an ectopic pregnancy.
It is, originally, the process in which male gametes, the spermatozoa, are collected and introduced artificially into the female genital tract for the purpose of fertilization Other artificial methods for achieving fertilization have since been devised. Artificial insemination was first developed for breeding cattle and horses. Spermatozoa are collected from a chosen male and frozen, then thawed and used to impregnate females.
Frozen human spermatozoa are now also used for insemination-most often from an anonymous male donor when a couple wishes to have a child but the husband is infertile. Use of frozen spermatozoa leads to pregnancy about 60 percent of the time, whereas freshly collected semen has a much higher success rate of about 90 percent. Neither method is known to result in an increase in birth defects, but frozen semen often becomes unusable after a long time.
A different method of artificial insemination is the mixing of sperm and ovum in a nutrient medium outside the woman's body, followed by implanting the fertilized egg into her uterus. This technique is used when a woman's fallopian tubes are blocked, and, as a result, the spermatozoa cannot reach the ovum. The first baby born as a result of such a procedure was the English "test-tube baby," Mary Louise Brown, in 1978. In 1984 a further advance in this procedure was reported from Australia, with the embryo first being frozen for two months before it was successfully implanted. Yet another method was used that same year, in which the ovum was first fertilized within one woman's uterus and then transferred to the body of another woman. Eggs can now also be removed from a woman's ovaries and placed in her fallopian tubes along with her husband's sperm; normal fertilization then follows. Controversies have arisen over the legal and ethical status of some of these procedures, which have been widely used.
IN VITRO FERTILIZATION (IVF) OR TEST TUBE METHOD
It is an Assisted Reproductive Technology (A.R.T.) in which one or more eggs are fertilized outside a female's body. This technique has been used extensively in animal embryological research for decades, but only since 1978 it has been successfully applied to human reproduction. In human reproduction the process involves stimulation of the growth of multiple eggs by the daily injection of hormone medications. (It is also possible to conduct IVF without the use of the hormone medications; a single egg would develop and be retrieved.) The eggs are recovered by one of two methods: sonographic egg recovery, the more common of the two, which uses ultrasound guidance to retrieve the eggs, or oocytes; or laparoscopic egg recovery, in which retrieval is made through a small incision in the abdomen.
Once the eggs are retrieved, they are placed in a special fluid medium, and then semen that has been washed and incubated is placed with the eggs and left for approximately 18 hours. The eggs are removed, passed into a special growth medium, and then examined about 40 hours later. If the eggs have been fertilized and developed normally, the embryos are transferred to the woman's (or a surrogate's) uterus. Typically, multiple embryos are transferred to increase the likelihood of pregnancy. If more than four eggs develop into embryos, the donor may have the option of cryopreserving the remaining embryos for thawing and replacement in a later IVF cycle. (Cryopreservation is used to minimize the risk of multiple gestations [twins, triplets, etc.] if more than four embryos are replaced.) Following egg transfer, progesterone injections may be administered daily to the recipient. The probability of viable pregnancy is approximately 20 percent with one IVF cycle .(4)
Similar techniques are also available. In gamete intrafallopian transfer (GIFT), the technique is similar to IVF, but the harvested eggs and sperm are placed directly into the fallopian tubes, with fertilization occurring in the woman's body. In zygote intrafallopian transfer (ZIFT), the procedure is similar to GIFT, but the beginning-stage embryos (zygotes) are placed directly in the fallopian tubes. With super ovulation uterine capacitating enhancement (SOURCE), the woman receives daily hormone medications to stimulate the growth of multiple eggs. Once the eggs have reached the right stage, intrauterine inseminations are done using the partner's specially treated sperm. Donor oocytes programs are available in some places; donated eggs are used by women unable to use their own eggs to achieve pregnancy. Assisted reproductive technology is used to retrieve eggs from donors and replace embryos in the recipient.
Infertility is inabilityÂ toÂ conceive or carry a child to term. According to the Centers for Disease Control and Prevention in America (CDC), infertility affects about 6 million American women and their partners. People who suffer from infertility can seek medical advice to identify the cause of infertility and undergo treatment. More than half of those who seek treatment eventually conceive and carry a pregnancy to full term (5)
ARTIFICIAL INSEMINATION AND TEST TUBE TECHNIQUES IN THE LIGHT OF ISLAM
1) Test tube technique is followed to overcome a disorder which prevents natural fertilization. It is a legitimate procedure in Islamic law, since the semen belongs to a husband and the ovum is produced by his own wife, so there is no involvement of any foreign party or the element that would affect the legality of marital relationship. Since sexual relationship is legitimate between husband and wife, the union of his spermatozoon with her ovum is lawful even an external medium is used first and then ovum is replanted in the genital tract, the procedure being followed for a medical reason. One condition, however, is that the procedure should take place while marriage is valid. No sin and no wrong are committed; the action being done within the bounds of legality and Islam doesn't oppose such a legitimate pursuit.(6)
2) The method where a sperm and ovum are taken from a married couple, fertilized externally in a test tube, and then implanted into the uterus of the same woman, is the principle acceptable in itself from the point of view of Islamic law. It is, however, not completely devoid of the possibilities of confusion in its requirements and the circumstances under which it is conducted. Therefore, it should be resorted to only in the cases of extreme necessity.
3) When insemination has harmful effect on fetus, it is prohibited.
4) Artificial insemination should occur while couple's marriage is valid, as the fusion of their fluids is lawful and a compulsory part of sound marital life. If the tie of marriage is broken through divorce or death, lawful contact between the couples ceases and the fusion of the fluids of such couples is no longer lawful.
5) If a third party, male or female, is to get involved in the procedure, the insemination is unlawful, as it violates the condition of valid marriage.
6) Jurists are in agreement that it is not permissible to inseminate a widow with her dead husband's semen, collected and stored during his lifetime or to introduce into her uterus an ovum inseminated while he was alive. Death ends life and severs the relationship of marriage. Jurists are unanimous in holding that marriage ends and its tie is broken when either the husband or wife dies as "Death nullifies the rulings relevant to this world, because it is a state of total helplessness".
7) Private parts (a'wra) of a woman are exposed to the physician who replaces the inseminated ovum in her uterus. Originally, a woman's vagina and its neighboring areas are private parts that should be emphatically guarded. These areas could only be looked or touched by the woman's husband and prohibition to look or touch includes both male and female. Scholars, however, allow the exposure of private parts to a stranger for the purpose of medical examination, which has become a necessity. A rule of Islamic law is that, "Necessities render permissible what is normally forbidden". The exposure, should however, be within the appropriate limits, which means it has to be restricted to what is necessary.(7)
8) Surrogate uterus refers to the procedure of planting an ovum inseminated with the fluid of the legal husband into the uterus of a third party, a volunteer or hired woman. This is what some scholars refers as "embryo transplant." An ovum is sucked out of the ovary of a woman with the help of endoscope. This ovum is inseminated with the spermatozoa from her husband, and once the sperm unites with the ovum, the latter begins to multiply. The mass of cells is then implanted into another woman's genital tract, which has been prepared through the medium of hormones, to receive the transplant. The embryo continues to grow inside the host woman's womb until she delivers it and hands it over to its parents, who contributed the gametes. This procedure is prohibited in Islamic law, because the woman who receives the inseminated ovum is stranger. Jurists set it as a condition that any semen that a woman admits into her genital tract should be legitimate i.e. it should be her husband's and must be introduced while their marriage is valid. A woman is forbidden to introduce into her genital tract the spermatozoa of a stranger, because they are not legitimate. The action is unlawful because it may lead to a confusion of lineage, causes the loss of motherhood, and disturbs the balance of the delicate scale of marriage in Islam, with which Allah has honored the human race, making the marital relationship a means for them to enjoy affection, compassion, mutual trust and reproduction. Such a procedure means the deliberate implanting of a stranger's fluid into a "field of cultivation" which is not legitimately tied by a marriage contract under the law of nature and Islamic law. The question of transplant entails extremely serious matter, both human and ethical. If we seek to determine the religious legitimacy of this matter, Islamic jurisprudence does not welcome or trust this contrivance and is not satisfied with its outcomes and consequences. It rather strives to prevent it. It spoils the meaning of motherhood, as created by the Allah and known to the people. (8)
In the case of a surrogate uterus, even if the woman involved is another wife of the husband, the procedure is still unlawful, because of the consequent of social and legal considerations, as the woman who lends her womb, rather than woman who has produced the ovum, is regarded as the mother. Allah, the Most Exalted says, "Their mothers are only those who gave them birth".
â€¦â€¦â€¦â€¦and, .his mother bears him with much pain and delivers him with much pain.
The application and use of artificial insemination and test tube baby techniques is limited in the light of Islamic principles and the rules laid down by the Shariah, and its legality is very much restricted under the legitimate circumstances and its implementation or application can never be allowed to all the cases of infertility
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Jadeed Fiqhi Masail, Lahoree, Mubashir Hussain, p.43-70, Maktaba Quddosia, Lahore, 2005.
Fiqh e Islami Ka Tareekhi Pas Manzar, Ameeni, Muhammad Taqi, p.266, Qadeemi Kutub Khana, Karachi, Sep.1991.
Fikr O Nazar (Quarterly),(July-Sep 1989), p.65-76,Islamic Research Institute, Islamabad