본문 바로가기
KERD
논문KCI 등재

보조생식술 규제 입법에 대한 각국의 현황과 그 영향: 기록부와 이식 배아 수를 중심으로

The Effects of Legislation on the Regulation of ART: Focusing on the Establishment of a Registry and Reducing the Number of Embryos Transferred

하정옥
생명의료법연구소 (Ewha Institute for Biomedical Law & Ethics)|2016.06|생명윤리정책연구 (Asia Pacific Journal of Health Law & Ethics)|제9권 제3호|pp. 103-131|DOI 10.38046/apjhle.2016.9.3.004

0

조회

0

다운로드

4

인용

0

참고문헌

키워드

보조생식술assisted reproductive technologyregistry이식 배아 수number of embryos transferred체외수정(시험관아기)in vitro fertilization (test-tube baby)기록부다태 임신 및 출생multiple pregnancy and birth

초록

이 논문은 체외수정 시술을 비롯한 보조생식술의 규제에 입법이 미치는 영향을 기록부의 확립과 이식 배아 수에 초점을 맞추어 분석한다. 그동안 국내에서 보조생식술 관련 입법 논의는 특정 시술이나 기법의 허용 여부에 초점이 맞춰져 있었을 뿐 기록부나 이식 배아 수에 대해서는 거의 논의된 바 없다. 기록부는 보조생식술의 기본 현황을 파악하는 출발점이며, 이식 배아 수는 보조생식술의 대표적인 부작용인 다태 임신과 출산을 제어할 수 있는 가장 효과적인 정책 개입 지점이다. 유럽과 북미의 여러 국가는 보조생식술의 시행과 함께 일찌감치 기록부를 확립하고 이식 배아 수를 줄이는 규제를 도입한 바 있다. 이와 대조적으로, 한국을 비롯한 아시아의 여러 국가는, 일본을 제외하고는, 기록부가 확립되어 있지 못하고, 특히 한국과 대만은 세계 기록 수합에서 가장 많은 배아를 이식하는 국가라는 불명예를 안고 있다. 분석 결과는 다음과 같다. 기록부의 확립과 이식 배아 수의 감소는 입법으로 규제될 때 가장 확실한 효과를 가져왔다. 그리고 이것이 전문가 단체의 자율 규제 및 보험 보장 확대와 연동될 때 시술을 시행하는 전문가들이나 당사자들의 동의를 이끌어 낼 수 있었다. 한국의 보조생식술의 역사가 30년이 된 지금 보조생식술의 취약한 거버넌스를 보완하는 데 이러한 선례가 시사하는 바가 클 것으로 기대한다.

Abstract

This article examines the effects of legislation on the regulation of assisted reproductive technologies (ART) including in vitro fertilization (IVF). It especially focuses on issues regarding the establishment of an IVF registry and reducing the number of embryos transferred. Most research articles about legislation dealing with ART in South Korea have reviewed whether there is a case for permitting or banning some treatments and techniques (e.g. pre-implantation genetic diagnosis, somatic cell nuclear transfer, surrogacy, etc.) related to ART, while there has been little interest in the notion of a registry or the number of embryos transferred. A registry is a starting point for identifying the basic status of ART procedures and the number of embryos transferred could be a successful and effective intervention, which formed part of a process where policies are used to control multiple pregnancies and childbirth, the most adverse effects of ART. Many countries in Europe and North America have established an IVF registry, some did so as early as in the 1980s or 1990s when they began to offer IVF treatment and reduce the number of embryos transferred. However, most of the countries in Asia, except for Japan, do not have an IVF registry and show the largest number of embryos being transferred. The research conducted here has led to the discovery that legislation has been the most powerful and effective form of intervention among other forms of regulation. Furthermore, when legislation is coupled with the self-regulation of expert organizations and the enlarging of insurance coverage, the effects of legislation could see a continuation based on the agreement of experts and infertile couples. There is the expectation that this review could be helpful in improving the weak governance of ART in Korea that has occurred throughout ART’s 30 years of history in the nation.

참고문헌 (57)

  1. 배병주, "체외수정&배이식의 윤리고", 대한산부인과학회잡지, 30(2) (1987)
  2. 보건복지부, "2014-2018 건강보험중기보장성강화계획", ~ (2015)
  3. 하정옥, "재생산의 문화변동과 국가의 개입: <난임부부 시술비 지원사업>을 통해 본 인구정책의 한계", 한국여성학, 31(2), pp.257~297 (2015), 한국여성학회
  4. Allan Templeton, "Reducing the Risk of Multiple Births by Transfer of Two Embryos After IVF", New England Journal of Medicine, 339(9) (1998)
  5. Allan Templeton, "William Parslow, Factors that Affect Outcome of IVF Treatment", Lancet, 348(9093) (1996)
  6. "High Incidence of Preterm Births and Early Losses in Pregnancy after IVF", British Medical Journal, 291(6503) (1985)
  7. Bo Strömberg, "Neurological Sequelae in Children Born After IVF : A Population-Based Study", Lancet, 359(9305) (2002)
  8. David Adamson, "Regulation of ARTs in the United States", Fertility and Sterility, 78(5) (2002)
  9. David H. Barlow, "The Debate on Single Embryo Transfer in IVF. How Will Today’s Arguments Be Viewed from the Perspective of 2020?", Human Reproduction, 20(1) (2005)
  10. E. A. Sullivan, "ICMART World Report: ART 2004", Human Reproduction, 28(5) (2013)
  11. Elizabeth A. Sullivan, "Single Embryo Transfer Reduces the Risk of Perinatal Mortality, a Population Study", Human Reproduction, 27(12) (2012)
  12. Ester Maman, "Obstetric Outcome of Singleton Pregnancies Conceived by In Vitro Fertilization and Ovulation Induction Compared with Those Conceived Spontaneously", Fertility and Sterility, 70(2) (1998)
  13. Fernando Zegers-Hochschild, "ICMART: World Report on ART 2005", Fertility and Sterility, 101(2) (2014)
  14. "Pregnancies and Births Resulting from IVF: French National Registry", Analysis of Data 1986 to 1990, 64(4) (1995), Fertility and Sterility
  15. G. D. Adamson, "The Number of Babies Born Globally after Treatment with the ARTs", Fertility and Sterility, 100(3) (2013)
  16. H. B. Westergaard, "Danish National IVF Registry 1994 and 1995: A Controlled Study of Births, Malformations and Cytogenetic Findings", Human Reproduction, 14(7) (1999)
  17. H. Minakami, "Lower Risks of Adverse Outcome in Twins Conceived by Artificial Reproductive Techniques Compared with Spontaneously Conceived Twins", Human Reproduction, 13(7) (1998)
  18. Human Fertilisation, "Code of Practice (HFEA, 제1판)" (1991)
  19. Human Fertilisation, "Tenth Annual Reprot and Accounts 2001 (HFEA)" (2002)
  20. , 1998
  21. D. L. Healy, "Reproductive Medicine in the Twenty-First Century", Proceedings of the 17th World Congress on Fertility and Sterility (Parthenon Publishing Group) (2002)
  22. , World Collaborative Report on IVF, 2000, 2006, pp.85(6), ~
  23. CMART, "World Collaborative Report on ART 2002", Human Reproduction, 24(9) (2009)
  24. Jason K. Min et al., "Live Birth Rate per Cycle Initiated : The BESST Endpoint for Assisted Reproduction", Human Reproduction, 19(1) (2004)
  25. J. de Mouzon, "World Collaborative Report on IVF Preliminary Data for 1995", Journal of Assisted Reproduction and Genetics, 14(5) (1997)
  26. Johannes L. H. Evers, "Female Subfertility", Lancet, 360(9327) (2002)
  27. Karl G, "ICMART World Report: ART 2003", Fertility and Sterility, 95(7) (2011)
  28. Karl Nygren, "Current Practices and Controversies in Assisted Reproduction", pp.351~354 (2002), World Health Organization
  29. Kazumi Takeshima, "Efficacy, Safety, and Trends in ART in Japan:Analysis of Four-year Data from the National Registry System", Journal of Assisted Reproduction and Genetics, 31(4) (2014)
  30. Kazumi Takeshima, "Impact of Single Embryo Transfer Policy on Perinatal Outcomes in Fresh and Frozen Cycles: Analysis of the Japanese ART Registry between 2007 and 2012", Fertility and Sterility, 105(2) (2016)
  31. L. A. Schieve, "Live-Birth Rates and Multiple-Birth Risk Using IVF", Journal of the American Medical Association, 282(19) (1999)
  32. Laura A. Schieve, "Current Practices and Controversies in Assisted Reproduction" (2002), World Health Organization
  33. L. Garceau, "Economic Implications of Assisted Reproductive Techniques:A Systematic Review", Human Reproduction, 17(12) (2002)
  34. L. S. Wilcox, "ART: Estimates of Their Contribution to Multiple Births and Newborn Hospital Days in the United States", Fertility and Sterility, 65(2) (1996)
  35. , IVF, "ET in the U.S.: 1987 Results from the National IVF-ET Registry", Fertility and Sterility, 51(1) (1989)
  36. Medical Research International, "IVF-ET in the U.S.: 1988 Results from the IVF-ET Registry", Fertility and Sterility, 53(1) (1990)
  37. Medical Research International, "IVF-ET in the U.S.: 1989 Results from the IVF-ET Registry", Fertility and Sterility, 55(1) (1991)
  38. Medical Research International, "IVF-ET in the U.S.: 1990 Results from the IVF-ET Registry", Fertility and Sterility, 57(1) (1992)
  39. Medical Research International, "In Vitro Fertilization (IVF)", Embryo Transfer (ET) in the U.S.: 1985 and 1986 Results from the National IVF, Fertility and Sterility, pp.1988, 49(2)[DOI]
  40. Meredith A. Reynolds, "Does Insurance Coverage Decrease the Risk for Multiple Births Associated with ART?", Fertility and Sterility, 80(1) (2003)
  41. Mika Gissler, "IVF Pregnancies and Perinatal Health in Finland 1991-1993", Human Reproduction, 10(7) (1995)
  42. Osamu Ishihara, "International Committee for Monitoring Assisted Reproductive Technologies: World Report on ARTs 2007", Fertility and Sterility, 103(2) (2015)
  43. Paul A. L. Lancaster, "Congenital Malformations after IVF", Lancet, 2(8572) (1987)
  44. Reija Klemetti, "Comparison of Perinatal Health of Children Born from IVF in Finland in the Early and Late 1990s", Human Reproduction, 17(8) (2002)
  45. R. Mansour, "ICMART World Report: ART 2006", Human Reproduction, 29(7) (2014)
  46. S. Friedler, "Births in Israel Resulting from In-Vitro Fertilization", Embryo Transfer, 1982-1989: National Registry of the Israeli Association for Fertility Research, 1992, pp.7(8), ~
  47. Society for ART, "ART in the U.S. and Canada: 1991 Results from the SART Generated from The AFS Registry", Fertility and Sterility, 59(5) (1993)
  48. Society for ART, "ART in the U.S. and Canada: 1992 Results Generated from The AFS", SART Registry, 1994, pp.62(6), ~
  49. Stephen Harbottle, "Elective Single Embryo Transfer: An Update to UK Best Practice Guidelines", Human Fertility, 18(3) (2015)
  50. Tarun Jain, "Insurance Coverage and Outcomes of IVF", New England Journal of Medicine, 347(9) (2002)
  51. Torbjorn Bergh, "Deliveries and Children Born After IVF in Sweden 1982-95: A Retrospective Cohort Study", Lancet, 354(9190) (1999)
  52. Fertility Clinic Success Rate and Certification Act of 1992:Report (to Accompany H.R. 4773), "U.S. Congress-House of Representatives", U.S. Government Printing Office, ~, pp.H. R. Rep. no.102-624 (1992)
  53. Fertility Clinic Success Rate and Certification Act of 1992: Report (to Accompany H.R. 4773), "U.S. Congress-Senate", U.S. Government Printing Office, ~, pp.S. Rep. no.102-452 (1992)
  54. Voluntary Licensing Authority for Human In Vitro Fertilisation and Embryology, "Guidelines for Both Clinical and Research Application of Human In Vitro Fertilisation (VLA)", ~ (1985)
  55. The First Report of the VLA (VLA), "Voluntary Licensing Authority for Human In Vitro Fertilisation and Embryology", Medical Research Council, 1986
  56. Willem Ombelet, "Multiple Gestation and Infertility Treatment:Registration, Reflection and Reaction—the Belgian Project", Human Reproduction Update, 11(1) (2005)
  57. Yoshiharu Morimoto, "Extraordinary Clinical Success of a Single-Embryo Transfer Policy. What Comes Next?", Fertility and Sterility, 105(2) (2016)

이 간행물의 다른 논문 (8건)

가습기 살균제 연구의 배후에 있는 재정적 이해상충에 대한 비판적 검토- 미국대학의 경우와 비교를 통하여 –김옥주, 공혜정, 신연선pp. 1-43인체유래물 거버넌스: 바이오뱅크 제도화 과정에서 나타난 제공자의 권리포기 문제박범순, 신미이pp. 45-78줄기세포기반치료에 대한 미국의 규제 경향 고찰박수헌pp. 79-101동물실험 연구자의 정신적 스트레스에 관한 예비 연구모효정pp. 133-159약제비 억제와 처방의 질 제고의 딜레마: 처방인센티브제도와 내재적 동기이수옥, 강민아, 배그린pp. 161-183
원문 보기