Algunos dilemas éticos presentes y futuros ante los avances en fecundación in vitro

Marta Reguera Cabezas

doi:10.18294/sc.2023.4462

Some present and future ethical dilemmas surrounding advancements in in vitro fertilization

Marta Reguera Cabezas Biologist, Master in Genetics and Assisted Human Reproduction, Assisted Reproduction Unit, member of the Ethics Committee, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain.

Received: 14 April 2023, Accepted: 26 October 2023, Published: 16 November 2023

https://doi.org/10.18294/sc.2023.4462 | PMID: 38000000

Abstract views

1190

Metrics Loading ...

PDF (Español)

Abstract

The growing field of assisted human reproduction has achieved unimaginable milestones. Its continuous development and the innovations it generates at times pose both ethical and legal dilemmas. This essay aims to elucidate the progressive changes occurring in the realm of the origin of life due to the development of new options and strategies in assisted human reproduction. First, it constructs an interdisciplinary reflection on human nature and the changes society faces from the perspectives of science, ethics, and law, particularly from the perspective of Spain. Second, it provides a brief overview of current or future biomedical techniques in the field of human reproduction. It concludes with a discussion of the need to reflect on the rapid advancement of science in assisted human reproduction.

Keywords: Fertilization in Vitro, Gene Editing, Ectogenesis, Reproductive Techniques, Bioethics

Categories: Bioethics

Full-text of the article is available for this language: Español.

References

1. Hall SS. Modificar nuestra herencia. Investigación y Ciencia. 2016;(482):52-60.

2. Singer P. De compras por el supermercado genético. Isegoría. 2002;(27):19-40.
Crossref

3. Savulescu J. Beneficencia procreativa: por qué debemos seleccionar los mejores niños. En: ¿Decisiones peligrosas? Una bioética desafiante. Madrid: Tecnos; 2012.

4. Harris J. The value of life: an introduction to medical ethics. London: Routledge; 2001.

5. Torres Quiroga MA. Maternidad y gestación en venta: fabricar bebés en la era neoliberal. Barcelona: Edicions de la Universitat de Barcelona; 2019.

6. European Parliament. Panel for the Future of Science and Technology (STOA). Human Enhancement [Internet]. 2009 [citado 25 mar 2023]. Disponible en: https://tinyurl.com/mrxh8r3s.

7. Machin R, Plaza CA. The Latin Network of Researchers in Reproductive Biotechnologies: scientific cooperation and social debate in a global era. JBRA Assisted Reproduction. 2023;27(2):339.
Crossref | PubMed

8. Cortina A, Serra MÀ. Humanidad infinita: Desafíos éticos de las tecnologías emergentes. Madrid: Ediciones Internacionales Universitarias; 2016.

9. Gracia D. Bioética mínima. España: TRIACASTELA; 2019. p. 37.

10. Gleicher N, Kushnir VA, Barad DH. Worldwide decline of IVF birth rates and its probable causes. Human Reproduction Open. 2019;2019(3):1-7.
Crossref | PubMed

11. Nuffield Council on Bioethics. What’s on the horizon for the Nuffield Council on Bioethics? [Internet]. 2023 [citado 9 nov 2023]. Disponible en: https://tinyurl.com/2bupcv8z.

12. Singer P, Wells D. In vitro fertilisation: the major issues. Journal of Medical Ethics. 1983;9(4):192-195.
Crossref | PubMed

13. Powell K. What’s next for lab-grown human embryos? Nature. 2021;597:22-24.
Crossref | PubMed

14. Esping-Andersen G, Arpino B, Baizán P, Bellani D, Castro-Martín T, Creighton MJ, et al. El déficit de natalidad en Europa. Barcelona: Fundación “la Caixa”; 2013.

15. Pérez Milán F, Weinig Mantorras R, Romeu Sarrió AR, Coroleu Lletget B, (eds,). Libro Blanco Sociosanitario de la Infertilidad en España. Madrid: Imago Concept & Image Development SL; 2011

16. Casabona R, Jiménez N, Malanda R, (eds,). Reproducción humana. En: Idiakez AI. Manual de Bioderecho. Madrid: Dykinson; 2022. p. 223-248.

17. Rubio Castro AM. Sujeto, cuerpo y mercado: Una relación compleja. En: Casado M, (ed,). De la solidad al mercado: el cuerpo humano y el comercio biotecnológico. Barcelona: Universidad de Barcelona; 2016. p. 65-96.

18. Rivas AM. Incentivos sociales/laborales a la vitrificación de óvulos: ¿Mayor autonomía de las mujeres? Revista Jurídica Universidad Autónoma de Madrid. 2017;(35):291-306.

19. von Schondorf-Gleicher A, Mochizuki L, Orvieto R, Patrizio P, Caplan AS, Gleicher N. Revisiting selected ethical aspects of current clinical in vitro fertilization (IVF) practice. Journal of Assisted Reproduction and Genethics. 2022;39:591-604.
Crossref | PubMed

20. Gleicher N, Kushnir VA, Albertini DF, Barad DH. Improvements in IVF in women of advanced age. Journal of Endocrinology. 2016;230(1):1-6.
Crossref | PubMed

21. Asplund K. Assisterad befruktning - etiska aspekter. Estocolmo; Smer rapport 2013:1.

22. Alamillos Guardiola M. La maternidad tardía: Expresión contemporánea del patriarcado occidental. Revista de Antropología Experimental. 2016;(16):213-221.
Crossref

23. Hammarberg K, Kirkman M, Pritchard N, Hickey M, Peate M, McBain J, et al. Reproductive experiences of women who cryopreserved oocytes for non-medical reasons. Human Reproduction. 2017;32(3):575-581.
Crossref | PubMed

24. Goldman KN. Elective oocyte cryopreservation: an ounce of prevention? Fertility and Sterility. 2018;109(6):1014-1015.
Crossref | PubMed

25. Asplund K. Use of in vitro fertilization-ethical issues. Upsala Journal of Medical Science. 2020;125(2):192-199.
Crossref | PubMed

26. Lima NS, Martínez G. Ethical dilemmas posed by surplus frozen embryos in Argentinean fertility centers [Internet]. 2021 [citado 12 oct 2023]. Disponible en: https://tinyurl.com/466pbfax.

27. Caplan AL, Patrizio P. The beginning of the end of the embryo wars. The Lancet. 2009;373(9669):1074-1075.
Crossref | PubMed

28. Rivas A, Lores F, Jociles I. El anonimato y el altruismo en la donación de gametos: la producción de biocapital en la industria reproductiva. Política y Sociedad. 2019;56(3):623-644.
Crossref

29. Zegers-Hochschild F, Crosby JA, Salas SR. Fundamentos biomédicos y éticos de la criopreservación de embriones. Revista Médica de Chile. 2014;142(7):896-902.
Crossref | PubMed

30. Kingsberg SA, Applegarth LD, Janata JW. Embryo donation programs and policies in North America: survey results and implications for health and mental health professionals. Fertility and Sterility. 2000;73(2):215-220.
Crossref | PubMed

31. Gough F. Ireland and the frozen embryo:a slight thawing? Medical Law Review. 2010;18(2):239-247.
Crossref | PubMed

32. Lima NS, Botti G, Lancuba S, Martínez AG. Abandoned frozen embryos in Argentina: a committee opinion. JBRA Assisted Reproduction. 2019;23(2):165-168.
Crossref | PubMed

33. Reguera Cabezas M, Cayón J. Deseados pero abandonados: el incierto destino de los embriones criopreservados. Revista de Bioética y Derecho. 2021;53:139-157.
Crossref

34. Gosálbez PE, Fernández FR. Dilemas bioéticos y jurídicos de la reproducción asistida en la sociedad actual en España. Revista Latinoamericana Bioética. 2018;18(34-1):104-135.
Crossref

35. Department of Health & Social Security. Report of the Committee of Inquiry in to Human Fertilisation and Embryology: HM Stationery Office [Internet]. 1984 [citado 12 oct 2023]. Disponible en: https://tinyurl.com/4sppr2z4.

36. Hyun I, Wilkerson A, Johnston J. Embryology policy: Revisit the 14-day rule. Nature. 2016;533:169-171.
Crossref | PubMed

37. Clark AT, Brivanlou A, Fu J, Kato K, Mathews D, Niakan KK, et al. Human embryo research, stem cell-derived embryo models and in vitro gametogenesis: Considerations leading to the revised ISSCR guidelines. Stem Cell Report. 2021;16(6):1416-1424.
Crossref | PubMed

38. McCully S. The time has come to extend the 14-day limit. Journal of Medical Ethics. 2021;47(12):e66.
Crossref | PubMed

39. Redondo-García A. La regla de los 14 días a debate: un análisis crítico desde la bioética. Revista de Bioética y Derecho. 2022;(54):103-119.
Crossref

40. Harris J. It’s time to extend the 14-day limit for embryo research. The Guardian [Internet]. 2016 [citado 1 abr 2023]. Disponible en: https://tinyurl.com/yjk2kzyd.

41. Ball P. Cómo crear un ser humano. Madrid: Turner Publicaciones; 2020.

42. Lovell-Badge R, Anthony E, Barker RA, Bubela T, Brivanlou AH, Carpenter M, et al. ISSCR Guidelines for Stem Cell Research and Clinical Translation: The 2021 update. Stem Cell Reports. 2021;16(6):1398-1408.
Crossref | PubMed

43. Gracia D. Ética y Medicina: Problemas éticos del origen de la vida [Internet]. 1990 [citado 25 de marzo de 2023]. Disponible en: https://tinyurl.com/2n45ssvy.

44. Douglas T, Savulescu J. Destroying unwanted embryos in research: Talking Point on morality and human embryo research. EMBO Reports. 2009;10(4):307-312.
Crossref | PubMed

45. Morgan L. Icons of life: a cultural history of human embryos. Berkeley, California: Editorial de la Universidad de California; 2009.
Crossref

46. Germán Zurriaráin R. El utilitarismo ético en la investigación biomédica con embriones humanos. Persona Bioética. 2008;12(1):16-28.

47. Ledford H. CRISPR fixes disease gene in viable human embryos. Nature. 2017;548(7665):13-14.
Crossref | PubMed

48. Cressey D, Abbott A, Ledford H. UK scientists apply for licence to edit genes in human embryos. Nature [Internet]. 2015 [citado 2 sep 2022]. Disponible en: https://tinyurl.com/mwep2mhn.
Crossref

49. Savatier P, David L, Vos JD, Yates F, Tajbakhsh S, Martinat C. Des embryons chimères et des pseudo-embryons comme alternatives pour la recherche sur l’embryon humain. Médecine, Sciences. 2021;37:799-801.
Crossref | PubMed

50. Nicolas P, Etoc F, Brivanlou AH. The ethics of human-embryoids model: a call for consistency. Journal of Molecular Medicine. 2021;99:569-579.
Crossref | PubMed

51. Shahbazi MN, Siggia ED, Zernicka-Goetz M. Self-organization of stem cells into embryos: A window on early mammalian development. Science. 2019;364(6444):948-51.
Crossref | PubMed

52. Hyun I, Munsie M, Pera MF, Rivron NC, Rossant J. Toward Guidelines for Research on Human Embryo Models Formed from Stem Cells. Stem Cell Reports. 2020;14(2):169-174.
Crossref | PubMed

53. Sawai T, Minakawa T, Pugh J, Akatsuka K, Yamashita JK, Fujita M. The moral status of human embryo-like structures: potentiality matters?: The moral status of human synthetic embryos. EMBO Reports. 2020;21(8):e50984.
Crossref | PubMed

54. Chan S. How and Why to Replace the 14-Day Rule. Curr Stem Cell Rep. 2018;4(3):228-234.
Crossref | PubMed

55. Appleby JB, Bredenoord AL. Should the 14-day rule for embryo research become the 28-day rule? EMBO Molecular Medicine. 2018;10(9):e9437.
Crossref | PubMed

56. Braga DPAF, Setti AS, Borges E. Ethics and IVF add-ons: We need to talk about it. JBRA Assisted Reproduction. 2022;26(3):371-373.
Crossref | PubMed

57. Armstrong S, Atkinson M, MacKenzie J, Pacey A, Farquhar C. Add-ons in the laboratory: hopeful, but not always helpful. Fertility and Sterility. 2019;112(6):994-999.
Crossref | PubMed

58. Wilkinson J, Malpas P, Hammarberg K, Mahoney Tsigdinos P, Lensen S, Jackson E, et al. Do à la carte menus serve infertility patients? The ethics and regulation of in vitro fertility add-ons. Fertility and Sterility. 2019;112(6):973-977.
Crossref | PubMed

59. Hörbst V. ‘You cannot do IVF in Africa as in Europe’: the making of IVF in Mali and Uganda. Reproductive Biomedicine & Society Online. 2016;2:108-115.
Crossref | PubMed

60. Simpson B. IVF in Sri Lanka: A concise history of regulatory impasse. Reproductive Biomedicine & Society Online. 2016;2:8-15.
Crossref | PubMed

61. Nardo LG, El-Toukhy T, Stewart J, Balen AH, Potdar N. British Fertility Society Policy and Practice Committee: adjuvants in IVF: evidence for good clinical practice. Human Fertility (Cambridge, England). 2015;18(1):2-15.
Crossref | PubMed

62. Human Fertilisation & Embriology Authority. HFEA statement on fertility treatment ‘add-ons’ [Internet]. 2019 [citado 2 abril 2023]. Disponible en: https://tinyurl.com/3ndvfkf9.

63. Human Fertilisation & Embriology Authority. The responsible use of treatment add-ons in fertility services: a consensus statement [Internet]. 2019. Disponible en: https://tinyurl.com/rn8me8jv.

64. Human Fertilisation & Embriology Authority. Treatment add-ons with limited evidence [Internet]. 2019 [citado 2 abr 2023]. Disponible en: https://tinyurl.com/42cbwju7.

65. Harper J, Magli MC, Lundin K, Barratt CLR, Brison D. When and how should new technology be introduced into the IVF laboratory? Human Reproduction (Oxford, England). 2012;27(2):303-313.
Crossref | PubMed

66. Sfakianoudis K, Simopoulou M, Grigoriadis S, Pantou A, Tsioulou P, Maziotis E, et al. Reactivating Ovarian Function through Autologous Platelet-Rich Plasma Intraovarian Infusion: Pilot Data on Premature Ovarian Insufficiency, Perimenopausal, Menopausal, and Poor Responder Women. Journal of Clinical Medicine. 2020;9(6):1809.
Crossref | PubMed

67. Provoost V, Tilleman K, D’Angelo A, De Sutter P, de Wert G, Nelen W, et al. Beyond the dichotomy: a tool for distinguishing between experimental, innovative and established treatment. Human Reproduction (Oxfordm England). 2014;29(3):413-417.
Crossref | PubMed

68. Madeira JL, Coyne K, Jaeger AS, Parry JP, Lindheim SR. Inform and consent: more than just “sign here”. Fertility and Sterility. 2017;108(1):40-41.
Crossref | PubMed

69. Dondorp W, de Wert G. Innovative reproductive technologies: risks and responsibilities. Human Reproduction (Oxford, England). 2011;26(7):1604-1608.
Crossref | PubMed

70. Zemyarska MS. Is it ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it? Journal of Medical Ethics. 2019;45(5):346-350.
Crossref | PubMed

71. Lensen S, Hammarberg K, Polyakov A, Wilkinson J, Whyte S, Peate M, et al. How common is add-on use and how do patients decide whether to use them? A national survey of IVF patients. Human Reproduction (Oxford, England). 21;36(7):1854-1861.
Crossref | PubMed

72. Brännström M, Johannesson L, Dahm-Kähler P, Enskog A, Mölne J, Kvarnström N, et al. First clinical uterus transplantation trial: a six-month report. Fertility and Sterility. 2014;101(5):1228-1236.
Crossref | PubMed

73. Williams NJ, Scott R, Wilkinson S. The ethics of uterus transplantation. Bioethics. 2018;32(8):478-480.
Crossref | PubMed

74. Casabona RCM. La persona entre la biotecnología, la bioética y el Derecho: el paradigma de los trasplantes de órganos. Revista de Derecho y Genoma Humano. 2021;(55):15-53.

75. Del Rio A, Negro F, Piersanti V, Tini A. Uterus transplant update: innovative fertility solutions and the widening horizons of bioengineering. European Review for Medical and Pharmacological Science. 2021;25(9):3405-3410.

76. Ronchi UF, Napoletano G. Uterus Transplantation and the redefinition of core bioethics precepts. Acta Bio-Medica. 2021;92(5):e2021435.

77. Crespo AA, Estrems JE, Bueno LP, Redondo MJQ, García CD. El trasplante de útero: una puerta abierta a la posibilidad de tener hijos. Revista Jurídica Universidad Autónoma de Madrid. 2017;(35):215-233.

78. O’Donovan L. Pushing the boundaries: Uterine transplantation and the limits of reproductive autonomy. Bioethics. 2018;32(8):489-498.
Crossref | PubMed

79. Thomson JA, Itskovitz-Eldor J, Shapiro SS, Waknitz MA, Swiergiel JJ, Marshall VS, et al. Embryonic stem cell lines derived from human blastocysts. Science. 1998;282(5391):1145-1147.
Crossref | PubMed

80. Cheng H, Shang D, Zhou R. Germline stem cells in human. Signal transduction and targeted theraphy. 2022;7:345.
Crossref | PubMed

81. Bhartiya D, Hinduja I, Patel H, Bhilawadikar R. Making gametes from pluripotent stem cells – a promising role for very small embryonic-like stem cells. Reproductive Biology and Endocrinology RBE. 2014;12:114.
Crossref | PubMed

82. Hayashi K, Ohta H, Kurimoto K, Aramaki S, Saitou M. Reconstitution of the mouse germ cell specification pathway in culture by pluripotent stem cells. Cell. 2011;146(4):519-532.
Crossref | PubMed

83. Hayashi K, Saitou M. Generation of eggs from mouse embryonic stem cells and induced pluripotent stem cells. Nature Protocols. 2013;8(8):1513-1524.
Crossref | PubMed

84. Hermann BP, Sukhwani M, Winkler F, Pascarella JN, Peters KA, Sheng Y, et al. Spermatogonial stem cell transplantation into rhesus testes regenerates spermatogenesis producing functional sperm. Cell Stem Cell. 2012;11(5):715-726.
Crossref | PubMed

85. Johnson J, Canning J, Kaneko T, Pru JK, Tilly JL. Germline stem cells and follicular renewal in the postnatal mammalian ovary. Nature. 2004;428(6979):145-50.
Crossref | PubMed

86. White YAR, Woods DC, Takai Y, Ishihara O, Seki H, Tilly JL. Oocyte formation by mitotically active germ cells purified from ovaries of reproductive-age women. Nature Medicine. 2012;18(3):413-421.
Crossref | PubMed

87. Ramathal C, Durruthy-Durruthy J, Sukhwani M, Arakaki JE, Turek PJ, Orwig KE, et al. Fate of iPSCs Derived from Azoospermic and Fertile Men following Xenotransplantation to Murine Seminiferous Tubules. Cell Reports. 2014;7(4):1284-1297.
Crossref | PubMed

88. Casado M. En torno a células madre, pre-embriones y pseudo-embriones: el impacto normativo de los Documentos del Observatorio de Bioética y Derecho de la UB. Revista Bioética y Derecho. 2010;(19):17-32.

89. Luo Y, Yu Y. Research Advances in Gametogenesis and Embryogenesis Using Pluripotent Stem Cells. Frontiers in cell and developmental biology. 2022;9:801468.
Crossref | PubMed

90. Hayashi K, Ogushi S, Kurimoto K, Shimamoto S, Ohta H, Saitou M. Offspring from oocytes derived from in vitro primordial germ cell-like cells in mice. Science. 2012;338(6109):971-975.
Crossref | PubMed

91. Petric P, Vrtacnik-Bokal E, Stimpfel M. Is It Possible to Treat Infertility with Stem Cells? Reproduction Science. 2021;28(6):1733-1745.
Crossref | PubMed

92. Adashi EY, Cohen IG, Hanna JH, Surani AM, Hayashi K. Stem Cell-Derived Human Gametes: The Public Engagement Imperative. Trends in molecular medicine. 2019;25(3):165-167.
Crossref | PubMed

93. Montoliu L. Editando genes: recorta, pega y colorea. 3a ed. Next Door Publishers; 2021.

94. Lima NS. CRISPR/Cas9: reflexiones bioéticas sobre las modificacion es genómicas. Journal of Basic and Applied Genetics. 2018;29(1):9-15.

95. Vidalis T. Genome Editing in Human Gametes and Embryos: The Legal Dimension in Europe. BioTech. 2022;12(1):1.
Crossref | PubMed

96. Savulescu J, Pugh J, Douglas T, Gyngell C. The moral imperative to continue gene editing research on human embryos. Protein & cell. 2015;6(7):476-479.
Crossref | PubMed

97. Bekaert B, Boel A, Cosemans G, De Witte L, Menten B, Heindryckx B. CRISPR/Cas gene editing in the human germline. Seminars in cell and developmental biology. 2022;131:93-107.
Crossref | PubMed

98. Li Y, Kang XJ, Pang JKS, Soh BS, Yu Y, Fan Y. Human germline editing: Insights to future clinical treatment of diseases. Protein & cell. 2019;10(7):470-475.
Crossref | PubMed

99. Savulescu J. Genetic interventions and the ethics of enhancement of human beings. Gazeta de Antropología. 2016;32(2).
Crossref

100. Labude MK, Xafis V, Lai PS, Mills C. Vulnerability and the Ethics of Human Germline Genome Editing. The CRISPR journal. 2022;5(3):358-363.
Crossref | PubMed

101. Nuffield Council on Bioethics. Genome editing and human reproduction: social and ethical issues [Internet]. 2018 [citado 10 sep 2022]. Disponible en: https://tinyurl.com/7sz538dx.

102. Alghrani A. Yes, uterus transplants should be publicly funded!’. Journal of medical ethics. 2016;42(9):566-567.
Crossref | PubMed

103. Schultz JH. Development of Ectogenesis: How Will Artificial Wombs Affect the Legal Status of a Fetus or Embryo. Chicago-Kent Law Review. 2009;84(3):877.

104. Romanis EC. Artificial Womb Technology and the Choice to Gestate Ex Utero: Is Partial Ectogenesis the Business of the Criminal Law? Medicine Law Review. 2020;28(2):342-374.
Crossref | PubMed

105. Bulletti C, Palagiano A, Pace M, Cerni A, Borini A, Ziegler D. The Artificial Womb. Annals of the New Yorj Academy of Science. 2011;1221:124-128.
Crossref | PubMed

106. Davis N. Artificial womb: Dutch researchers given €2.9m to develop prototype. The Guardian [Internet]. 2019 [citado 2 abr 2023]. Disponible en: https://tinyurl.com/bdhhmnba.

107. Welin S. Reproductive ectogenesis: The third era of human reproduction and some moral consequences. Science and engineering ethics. 2004;10:615-626.
Crossref | PubMed

108. Rosen C. Why Not Artificial Wombs? [Internet]. The New Atlantis. [citado 2 abr 2023]. Disponible en: https://tinyurl.com/366syc72.

109. Rifkin J. The end of pregnancy. The Guardian [Internet]. 2002 [citado 2 abr 2023]. Disponible en: https://tinyurl.com/35mft7vt.

110. Solerte ML. Artificial uterus -research background to improve survival and outcome of extremely low birth weight newborns. Journal of gynecology research and obstetric. 2020;6(3):67-71.

111. Coutinho D. O “futuro” da tecnologia reprodutiva: o útero artificial. 5º Congresso Internacional Direito na Lusofonia: Direito e novas tecnologias. Portugal; Universidade do Minho-Escola de Direito (ED); 2018.

112. Gelfand S, Shook JR, (eds). Ectogenesis. En: Singer P, Wells D. Ectogenesis: artificial womb technology and the future of human reproduction. Amsterdam, New York: Editions Rodopi BV; 2006.
Crossref

113. Salam R. The End of Pregnancy. Slate [Internet]. 2014 [citado 2 abr 2023]. Disponible en: https://tinyurl.com/564a43b5.

114. Di Stefano L, Mills C, Watkins A, Wilkinson D. Ectogestation ethics: The implications of artificially extending gestation for viability, newborn resuscitation and abortion. Bioethics. 2020;34(4):371-384.
Crossref | PubMed

115. Kendal ES. Form, Function, Perception, and Reception: Visual Bioethics and the Artificial Womb. Yale Journal of Biology and Medicine. 2022;95(3):371-377.

116. Kendal ES. Unique benefits of ectogenesis outweigh potential harms. Emerging topics in life science. 2019;3(6):719-722.
Crossref | PubMed

117. Casabona R. El Convenio de Derechos Humanos y Biomedicina. Granada, España: Comares; 2002.

118. Kendal ES. The Perfect Womb: Promoting Equality of (Fetal) Opportunity. Journal of bioethical inquiry. 2017;14(2):185-194.
Crossref | PubMed

119. Smajdor A. In Defense of Ectogenesis. Cambridge quarterly of healthcare ethics. 2012;21(1):90-103.
Crossref | PubMed

120. Romanis EC. Abortion & ‘artificial wombs’: would ‘artificial womb’ technology legally empower non-gestating genetic progenitors to participate in decisions about how to terminate pregnancy in England and Wales? J Law Biosci. 2021;8(1):lsab011.
Crossref | PubMed

121. Cohen IG. Artificial Wombs and Abortion Rights. The Hastings Center report. 2017;47(4):2-11.
Crossref | PubMed

122. Izquierdo JM. Juan Luis Arsuaga: “Es pronto para desaparecer como especie”. El País [Internet]. 2015 [citado 25 mar 2023]. Disponible en: https://tinyurl.com/2urmua62.