1. "Unofficial" Discourses of Islam and IVF
1.1. In Egypt the last two decades have been a period of profound religions revitalization
1.1.1. Many Muslims have renewed their personal commitment to Islam, both outwardly in their adoption of Islamic dress and inwardly in their quests for a spiritual relationship with God
1.2. The infertile poor ultimate explanations for infertility implicated GOD'S WILL= "testing" women's and husband's religious faith and patience
1.2.1. Elites at Egyptian IVF centers = also concerned about religion, morality, GOD = more so than the poor
1.2.1.1. Egyptian Muslims heavily controlled by their religion
1.3. God is feared, God's will and control over test-tube baby making. his reasons for success or failure must not be questioned
1.3.1. “Good Muslims”must try and seek a solution to their suffering
1.3.1.1. BELIEVE IN GOD FIRST, THEN DOCTORS
1.4. Hajj [pilgrimage], muheggaba [veiled]
1.4.1. For those who have made it to EGYPTIAN IVF CENTERS = they are convinced God wants them to undertake IVF/ICSI = achieving God's will
1.4.1.1. Some consult spiritual leaders,local shaikhs, Coptic priests,mufti, and fatwas at Al-Azhar, most "official" & " correct" source)
1.5. Lots of prayers, special prayers, and " bargaining" among infertile couples = increase success of around medically assisted conception
1.5.1. IVF only permissible as long as sperm, egg is husband's and wife's (reoccurring theme) = donations are religiously unaccepted/ morally illicit
1.5.1.1. Majority of women are now veiled (covering their hair, neck, faces), Men's beard & callused "prayer spots" on their foreheads mark them as religious men
2. Discourses of Donation
2.1. Official religious discourse on NRT has been translated exactly into medical practice by IVF patients/doctors = seek "to do right" by Islam
2.1.1. Differing opinions on the use of contraception
2.1.1.1. Moral degradation of 3rd-party donations although it is considered a "medical treatment" in other countries
2.2. 3rd-party donations doesn't involve "sexual contact" of adulterous relations, nor desire to engage in "extramarital affair"
2.2.1. extramarital relations = "great sin"
2.2.1.1. Zina, means "adultery" and "prostitution"
2.2.1.2. Iqtilat in-nasab, or "mixing relations" = zina
2.2.1.3. Hadith on adultery = go to hell
2.3. 3rd-party donations ="Moral concerns" of potential for incest among offspring = "intermarrying" = "half-siblings"
2.3.1. Islam= privilege religion mandate biological inheritance
2.3.1.1. "Origin preservation" most essential objective Islamic law
2.3.1.2. The tie by nasab (lineage) = considered God's great gifts to his worshipers, morally significant
2.3.1.3. Adopted reasoning of IVF= iqtilat in-nasab, or "mixture of relations" = very dangerous
2.4. Islam = everybody must have nasab, relations who are "known"
2.4.1. For men very important = purity of lineage" through " known fathers"
2.4.1.1. Not being biological parent of a child =lack of appropriate parental sentiments
2.5. Foster parent/adoption = stigma (LEGALLY, RELIGIOUSLY, CULTURALLY)
2.5.1. Poor infertile women sometimes open to idea of "adoption" vs. Elite who dismissed this
2.5.1.1. Adoption = problematic "last resort" done only for the "sake of God"
3. Fatwas and "Official" Islam
3.1. Fatwa [nonbinding religious opinion] of religious scholar for the guidance of his followers
3.1.1. Islamic sharia [a law] to be the Qur'an (word of GOD)
3.1.1.1. Qur’an (the Muslim holy book)
3.2. Al-Azhar "one of the oldest university in the world" center of "Islamic education"
3.2.1. fatwas issued from Al-Azhar have great weight in Arab & non-Arab Muslim world
3.2.1.1. Al-Azhar fatwa on medically assisted reproduction have achieved wide acceptance in Arab-world among Muslim doctors who provide NRT
3.3. Growth of NRT = fatwas (official/non-official) = cover birth control, abortion, sterilization, female circumcision, surrogacy, treatment of AIDS
3.3.1. EGYPTIAN GOVERNMENT HAS NEVER HAD A VESTED INTEREST IN INFERTILITY
3.3.1.1. 5 categories in Islamic sharia:
3.3.1.1.1. Obligatory (wajib)
3.3.1.1.2. Recommended (sunna)
3.3.1.1.3. Permitted (mubah)
3.3.1.1.4. Undesirable but not forbidden (makruh)
3.3.1.1.5. Forbidden (haram)
3.4. Qias (analogy) involves intelligent reasoning on issues not mentioned in the Qur'an
3.4.1. Sunna and hadith = collection of traditions and sayings of the prophet Muhammad as authenticated by Islamic jurists; ijma
3.4.1.1. Religious judgment through interpretation, analogy, and personal reasoning known as "ijithad"
3.5. Official Islamic discourse on NRT has affected Middle Eastern reproductive medicine at level:
3.5.1. Discourse
3.5.1.1. Original Al-Azhar fatwa FIRST authoritative statement of Muslim view toward medically assisted conception
3.5.1.1.1. (Al-Azhar fatwa) and Qur’an and hadith believe marriage is sacred = procreation and motherhood= great importance
3.5.1.1.2. Prevention and treatment of infertility is encouraged = to preserve integrity of martial union
3.5.2. Practice
3.5.2.1. Al-Azhar fatwa spells which are hallal, and haram
3.5.2.1.1. Artificial insemination with husband's semen
3.5.2.1.2. Marriage is a contract: no third -party donor of any kind
3.5.2.1.3. Extracorporeal (in vitro): fertilized egg from (wife) sperm (husband), transfer to wife uterus
3.5.2.1.4. Adoption of child from an illegitimate form of medically assisted conception not allowed (if born = illegitimate child; child can’t inherit)
3.5.2.1.5. IVF should be done by an expert physician and for medical reasons
3.5.2.1.6. Establishments of sperm banks "selective" semen =threatens existence of race = prevention (adultery)
3.5.2.1.7. After divorce or death= IVF prohibited
3.5.2.1.8. Excess (pre-embryos) can be preserved, frozen eggs may be transferred to wife for duration of marriage contract
3.5.2.1.9. Mltifetal pregnancy reduction allowed if health of mother in jeopardy or if realizing full term is not possible (selective abortion)
3.5.2.1.10. All forms of surrogacy are forbidden
3.6. Israel (Jews) IVF, NRT, surrogacy, sperm banks are permitted
3.6.1. Roman-Catholic countries IVF, AID, NRT are prohibited, fundamentally wrong
3.6.1.1. Most Christian countries medical legislation and regulations are liberated from religious influence therefore semen donations are permitted
3.6.1.1.1. In the world of IVF the Sunni Muslim Middle-East with its strict, religiously derived prohibitions against third-party donation and surrogacy, which are followed by patients and doctors
4. The "Americans"
4.1. Uses case of Dalia and Galal (first cousins) wealthy internationally sophisticated Egyptian elites who are able to purchase the fruits of globalization
4.1.1. Galal (male infertility) = a cluster of veins in his testicles = very poor sperm count
4.1.1.1. Her family was deeply opposed to her marrying an infertile man
4.2. Previously attempted IVF in Los Angeles
4.2.1. Told by doctors given his poor semen profile, they should undergo artificial -insemination using donor semen from sperm bank
4.3. Their trial of IVF did not succeed in the USA to morality= lead to immoral and genealogically bewildering mixture of relations
4.3.1. Coming of ICSI in Egypt a place where science is constantly advancing= decided to undergo
4.3.1.1. Very concern with ability of Egyptian doctors to carry out IVF with any hope of success
4.4. Under the care of GOD and Dr. Yehia became a mother of IVF test-tube baby girl Deena and of healthy ICSI son Mohammad
4.4.1. Their story is a morality tale
4.4.1.1. Muslims accept and comply to all rules of their religion = moral obligation
5. Reproductive Medicine and Religious Morality
5.1. Egyptian Muslims must confront what they believe to be the "IMMORALITY OF TEST-TUBE BABY MAKING" in a technologically advanced but morally wayward Western Christian Society.
5.1.1. REPRODUCTIVE MEDICINE & RELIGION form important Nexus in Egypt.
5.2. Clash of Moral Worlds in God-fearing Muslim Egypt:
5.2.1. Leading Egyptian religious authorities completely "BANNED" reproductive donations on the basis of its inherent immorality
5.2.2. Secular U.S: organized religion country where (Civil law has replaced religion)
5.2.2.1. "Moral decline" of American IVF practices = frequent donation of sperm, ova, & embryos from 3rd-parties
5.3. RELIGION restricts how test-tube babies are to be made LOCALLY
5.3.1. Reduction in # of technological options avalibale
5.3.2. Reduction in # of infertile couples willing to use available NRT
5.3.3. LOCAL RESTRICTIONS OF IVF/ICSI = SEEN AS A MORALLY "GOOD & DISCIPLINE"
5.3.4. Religious proclamations are taken very seriously by doctors /patients at IVF centers
5.4. Over the last 100 years = Islamic religiosity = increasing in the Muslim world among many social strata
5.4.1. Adoption, surrogacy, eggs or sperm donation is haram, or sinful = strictly prohibited
5.4.1.1. After divorce/death= IVF prohibited
5.5. Sperm bank = not supported
5.5.1. 3rd-party donations = confusion of lineage = children unaware of biological parents
5.5.1.1. Infertile Muslims undergo IVF = in a religiously-correct way
5.6. IVF is allowed within Islam/Coptic Christianity = using both sperm-eggs from couple
5.6.1. Freezing eggs/sperm and preservation of per-embryos/embryos = only permitted under marriage contact
6. Contemplating Immoralities
6.1. Egyptians, both Muslim and Coptic Christian, perceive themselves as morally superior to the Christian West
6.1.1. West/Europe has lost moral compass in pursuit of NRT
6.2. Egyptians question = presence of sperm banks and racial implications of sperm donation, surrogacy and disputes over surrogate offspring
6.2.1. There is "anti abortion groups" protesting the disposal of unclaimed embryos = in US/EUROPE = Not in Egypt
6.3. Egyptians question IVF treatments abroad due to media exposure :
6.3.1. 1)Doctor who used his own sperm to impregnate patients
6.3.2. 2) Postmenopausal grandmother had acted as a surrogate for her own daughter
6.3.3. 3) Dutch white woman bore IVF twin sons, one "white" and one "black" actually biracial, due to a careless admixture of semen in IVF lab
6.4. Egyptians are shock by Western sperm donation practices and FEAR THEM
6.4.1. Egyptian-Muslim doctors religion prevents them from considering emigration to Western donation practices
6.4.1.1. At least some Muslim patients are moving outside their country,their own branch of Islam, to overcome infertility
6.5. Common belief that unintentional or illegal "mixing" may occur in Egyptian IVF labs = contributed to public disapproval
6.5.1. Both feared by poor and elite Egyptians
6.5.1.1. Their moral uncertainties anxieties associated with fear of "mixing = major arena of constraint on acceptance
6.5.1.2. Husbands inability to know of their sperm has being "mixed" with of an another man = prevents acceptance of treatment
6.6. To reassure patients = Egyptian IVF centers constituting some form of "proof that doctors aren't trying to increase success rates via tempering patients eggs, sperm
6.6.1. Dr. Yehia clinic instigated a unique method of " witnessing" through videotaping = it did work, but it does not constitute irrefutable evidence
6.6.1.1. Ultimately patients must on individual doctors to be trustworthy = believe Muslim doctor will fear punishment from God
6.7. Other patients put trust in their country "I am Muslim" and " My doctor is Muslim"
6.7.1. There has never been a case of accidental sperm mixing in Egypt
6.7.1.1. Some suspicious that doctors from other religion will not provide them with "honest care"
6.7.1.2. Some infertile Coptic couples are force to seek out Muslim doctors = Christian patients happy with Dr. Yehia
6.7.1.3. Ultimately put faith in each other and in God, the ultimate witness