새로운 임신 기술과 '위험', 그리고 아픈 아이들 : 보조생식술 결과의 국제비교를 중심으로 = New Reproductive Technologies, 'Risks', and Unhealthy Children : International Comparison of ART Results Reports

국문 초록 (Abstract)

이 논문은 새로운 임신 기술이 수반하는 '위험'에 대해, 특히 체외수정(IVF) 기술로 태어난 아이들 건강 조사 연구를 중심으로 살펴본다. 흔히 시험관아기로 불리는 이 기술은 불임부부에게 자신의 아이를 가질 수 있는 희망을 준 기술로 찬사를 받았고 전 세계에 널리 확산 되었다. 그런데 이로부터 태어난 아이들의 건강에 대한 우려가 유럽과 북미를 중심으로 제기 되었다. 이러한 우려는 아이들에 대한 추적조사 자료와 함께 실증적으로 제기되었고, 이에 대한 대책으로 체외수정 시술에서 한 번에 이식하는 배아의 수에 대한 규제가 이루어졌다. 그런데 한국을 비롯하여 아시아 국가에서는 이러한 추적조사가 거의 이루어진 바 없고 한번에 이식하는 배아의 수도 그동안 별 변화가 없었다. 이와 함께 전체 출생 인구에서 다태아가 차지하는 비율은 급격히 증가하고 있다. 또 다른 한편, 전 세계적으로도 아이들에 대한연구는 많이 이루어진 반면 이 기술이 여성에 미치는 영향에 대해서는 소수의 연구가 있을뿐이다. 이러한 점에서 이 기술 '위험'의 인지와 대책 마련에서 지구적 불균등을, '위험' 문제구성에서 성별 정치의 일면을 읽을 수 있다. 또한 무엇이 '위험'으로 간주되고 어떤 대책이 마련되는가를 보면 기술 위험의 사회적 구성 또한 발견할 수 있다.

다국어 초록 (Multilingual Abstract)

This paper intends to study the risks of technology, particularly in terms of the health outcome surveys and follow-up of children born through IVF (in vitro fertilization, also known more colloquially as test-tube babies). From the early stage of IVF's development, the disabilities of children born through IVF was the key target for risk management practices, and the follow-up studies of the children born through IVF have been working through samples or complete enumeration surveys in mostly European countries. The results showed that the overall health outcomes of IVF children were relatively poorer than for other children, and the multiple pregnancies and births from multiple embryo implantations was pointed out as the main cause for this. Such an analysis result was followed by legislative or administrative regulation of the number of embryos allowed to be transferred in actual IVF practice. Risk management status differs from country to country. Since the first 'test tube baby' was born in Korea in 1985, 235,000 cases were accumulated between 1992, when official reporting began, and 2007. However, no follow-up study of the children has been conducted nor has the official regulation of the number of embryos been transferred along with the technology. Even today, the rate of transferring 4 or more embryos in an IVF procedure is more than 50% in Korea, and the ratio of multiple-births to the total number of babies born began rapidly increasing in the 2000's. I suggest that the risk of technology should be considered not just as a side effect of technological development but as an essential part of those processes. Furthermore, the social construction of the risks, which considers risk according to the locality's status of technological development, can also be observed.

목차 (Table of Contents)

• 국문초록
• Ⅰ. 들어가며
• Ⅱ. 기존 연구 및 이론적 배경
• Ⅲ. '위험'에 대한 인지와 조사 보고
• Ⅲ. '위험'에 대한 대처
• Ⅳ. 기술 '위험' 관리의 지구적 불균등
• Ⅴ. 기술 '위험'의 성별 정치
• Ⅵ. 나오며
• 참고문헌
• Abstract

참고문헌 (Reference)

1 하정옥, "한국 생명의료기술의 전환에 관한 연구 : 재생산기술로부터 생명공학기술로" 서울대학교 대학원 2006

2 하정옥, "한국 생명의료기술의 사회적 관리 미비와 재생산의 비가시화: 체외수정기술 자료 구성의 국제 비교를 중심으로" 한국여성연구원 23 (23): 141-188, 2006

3 OECD 대한민국 정책센터 사회정책본부, "한 눈에 보는 OECD 보건지표 2009" 2010

4 대한산부인과학회 인공수태시술의료기관 심사소위원회, "조사보고서 - 한국보조생식술의 현황: 1994년" 41 (41): 236-252, 1998

5 이혜정, "우리나라 모자보건 정책사업 분석 - 미숙아와 저체중출생아를 중심으로 -" 아동간호학회 15 (15): 81-87, 2009

6 하정옥, "생명의료기술의 사회학: 체외수정기술 논의를 중심으로" 서울대학교 여성연구소 2004

7 대한산부인과학회 보조생식술소위원회, "사보고서 - 한국보조생식술의 현황:2007년" 53 (53): 1052-1077, 2010

8 대한산부인과학회 보조생식술소위원회, "사보고서 - 한국보조생식술의 현황:2006년" 52 (52): 1212-1238, 2009

9 대한산부인과학회 보조생식술소위원회, "사보고서 - 한국보조생식술의 현황:2005년" 51 (51): 1421-1447, 2008

10 대한산부인과학회 인공수태시술의료기관 심사소위원회, "사보고서 - 한국보조생식술의 현황:2004년" 50 (50): 1615-1639, 2007

11 대한산부인과학회 인공수태시술의료기관 심사소위원회, "사보고서 - 한국보조생식술의 현황:2003년" 49 (49): 2480-2497, 2006

12 대한산부인과학회 인공수태시술의료기관 심사소위원회, "사보고서 - 한국보조생식술의 현황:2002년" 48 (48): 2777-2796, 2005

13 대한산부인과학회 인공수태시술의료기관 심사소위원회, "사보고서 - 한국보조생식술의 현황:2001년" 47 (47): 2285-2302, 2004

14 대한산부인과학회 인공수태시술의료기관 심사소위원회, "사보고서 - 한국보조생식술의 현황:2000" 46 (46): 1888-1904, 2003

15 대한산부인과학회 인공수태시술의료기관 심사소위원회, "사보고서 - 한국보조생식술의 현황:1999년" 45 (45): 1700-1717, 2002

16 대한산부인과학회 인공수태시술의료기관 심사소위원회, "사보고서 - 한국보조생식술의 현황:1998년" 44 (44): 1883-1899, 2001

17 대한산부인과학회 인공수태시술의료기관 심사소위원회, "사보고서 - 한국보조생식술의 현황:1997년" 42 (42): 2151-2175, 1999

18 대한산부인과학회 인공수태시술의료기관 심사소위원회, "사보고서 - 한국보조생식술의 현황:1996년" 42 (42): 231-253, 1999

19 대한산부인과학회 인공수태시술의료기관 심사소위원회, "사보고서 - 한국보조생식술의 현황:1995년" 42 (42): 681-703, 1999

20 최영민, "불임부부지원사업 보고: 2006년" 대한산부인과학회 2007

21 대한산부인과학회 인공수태시술의료기관 심사소위원회, "대한산부인과학회 보조생식술 윤리지침"

22 Saldeen, P., "Would Legislation Imposing Single ET Be a Feasible Way to Reduce the Rate of Multiple Pregnancies after IVF Treatment?" 20 (20): 4-8, 2005

23 G. D. Adamson, "World Collaborative Report on IVF, 2000" 85 (85): 1586-1622, 2000

24 de Mouzon, J., "World Collaborative Report on IVF Preliminary Data for 1995" 14 (14): 251S-265S, 1997

25 J. de Mouzon, "World Collaborative Report on ART, 2002" 24 (24): 2310-2320, 2002

26 D. Adamson, "World Collaborative Report on ART, 1998" 209-219, 2002

27 Min, J. K., "What Is the Most Relevant Standard of Success in Assisted Reproduction? The Singleton, Term Gestation, Live Birth Rate per Cycle Initiated: The BESST Endpoint for Assisted Reproduction" 19 (19): 3-7, 2004

28 Foresta, C., "Warning Note on Male Infertility Treatment" 347 (347): 618-, 1996

29 Foresta, C., "Use of ICSI in Severe Male Factor Infertility" 348 (348): 59-, 1996

30 Nyboe Andersen, A., "Trends in the Use of Intracytoplasmatic Sperm Injection Marked Variability between Countries" 14 (14): 593-604, 2008

31 Klein, R. D., "The Ultimate Colonisation: Reproductive and Genetic Engineering" Attic Press 1992

32 Nygren, K., "The Swedish Experience of ARTs Surveillance, In Current Practices and Controversies in Assisted Reproduction (: Report of a Meeting on “Medical, Ethical and Social Aspects of Assisted Reproduction" World Health Organization 351-354, 2002

33 Msall, M. E., "The Spectrum of Behavioral Outcomes after Extreme Prematurity: Regulatory, Attention, Social, and Adaptive Dimensions" 32 (32): 42-50, 2008

34 Voluntary Licensing Authority for Human In Vitro Fertilisation and Embryology (Medical Research Council/Royal College of Obstetricians and Gynaecologists, "The Second Report of the Voluntary Licensing Authority for Human In Vitro Fertilisation and Embryology" VLA 1987

35 Dickey, R. P., "The Relative Contribution of ARTs and Ovulation Induction to Multiple births in the United States 5 Years after the Society for ART/American Society for Reproductive Medicine Recommendation to Limit the NET" 88 (88): 1554-1561, 2007

36 Barker, D. J. P., "The Origins of the Developmental Origins Theory" 261 (261): 412-417, 2007

37 Wang, J. X., "The Obstetric Outcome of Singleton Pregnancies Following IVF/gamete intra-Fallopian transfer" 9 (9): 141-146, 1994

38 Voluntary Licensing Authority for Human In Vitro Fertilisation and Embryology (Medical Research Council/Royal College of Obstetricians and Gynaecologists, "The First Report of the Voluntary Licensing Authority for Human In Vitro Fertilisation and Embryology" VLA 1986

39 Wang, J. X., "The Effect of Various Infertility Treatments on the Risk of Preterm Birth" 17 (17): 945-949, 2002

40 Barlow, D. H., "The Debate on Single ET in IVF. How Will Today’s Arguments Be Viewed from the Perspective of 2020?" 20 (20): 1-3, 2005

41 Human Fertilisation and Embryology Authority, "Tenth Annual Report and Accounts 2001" HFEA 2002

42 Brown, D., "Studies: Test-Tube Babies Face Higher Health Risks"

43 Fishel, S., "Should ICSI Be the Treatment of Choice for All Cases of In-Vitro Conception" 15 (15): 1278-1283, 2000

44 Ramsey, P., "Shall We ‘Reproduce’?: II. Rejoinders and Future Forecast" 220 (220): 1480-1485, 1972

45 Ramsey, P., "Shall We ‘Reproduce’?: I. The Medical Ethics of IVF" 220 (220): 1346-1350, 1972

46 Hervé, C., "Sex Chromosome Abnormalities After ICSI" 346 (346): 1096-1097, 1995

47 Liebaers, I., "Sex Chromosome Abnormalities After ICSI" 346 (346): 1095-, 1995

48 In't Veld, P., "Sex Chromosomal Abnormalities and ICSI" 346 (346): 773-, 1995

49 Barber, B., "Public Awareness and Government Regulation of Research on IVF in Humans, In HEW Support of Research Involving Human IVF and ET, by the Ethics Advisory Board of the Department of Health, Education and Welfare" US Government Printing Office 1979

50 Bonduelle, M., "Prospective Follow-Up Study of 423 Children Born After ICSI" 11 (11): 1558-1564, 1996

51 Bonduelle, M., "Prenatal Testing in ICSI Pregnancies: Incidence of Chromosomal Anomalies in 1586 Karyotypes and Relation to Sperm Parameters" 17 (17): 2600-2614, 2002

52 Palermo, G., "Pregnancies After Intracytoplasmic Injection of Single Spermatozoon into an Oocyte" 340 (340): 17-18, 1992

53 Bae, J., "Plan of Increasing Medical Support for Premature Babies and Unhealthy Infants" Management Center for Health Promotion 2007

54 Olivennes, F., "Perinatal Outcome and Developmental Studies on Children BornAfter IVF" 8 (8): 117-128, 2002

55 Skakkebk, N. E., "Pathogenesis and Management of Male Infertility" 343 (343): 1473-1479, 1994

56 Halliday, J., "Outcomes of IVF Conceptions: Are They Different?" 21 (21): 67-81, 2007

57 Sutcliffe, A. G., "Outcome in the Second Year of Life after IVF by ICSI: A UK Case-Control Study" 357 (357): 2080-2084, 2001

58 Koudstaal, J., "Obstetric Outcome of Twin Pregnancies after In-Vitro Fertilization: A Matched Control Study in Four Dutch University Hospitals" 15 (15): 935-940, 2000

59 Koudstaal, J., "Obstetric Outcome of Singleton Pregnancies after IVF: A Matched Control Study in Four Dutch University Hospitals" 15 (15): 1819-1825, 2000

60 Craft, I., "Multiple Pregnancy and Assisted Reproduction" (8560) : 692-692, 1987

61 Jones, H. W., "Multiple Pregnancies: A Call for Action" 75 (75): 11-13, 2001

62 Ombelet, W., "Multiple Gestation and Infertility Treatment: Registration, Reflection and Reaction ―The Belgian Project" 11 (11): 3-14, 2005

63 Jadva, V., "Mom by Choice, Single by Life's Circumstance ...’ Findings from a Large Scale Survey of the Experiences of Single Mothers by Choice" 12 (12): 175-184, 2009

64 Kremer, J. A. M., "Microdeletions of the Y Chromosome and ICSI: From Gene to Clinic" 12 (12): 687-691, 1997

65 Bowen, J. R., "Medical and Developmental Outcome at 1 Year for Children Conceived by ICSI" 351 (351): 1529-1534, 1998

66 Tallo, C. P., "Maternal and Neonatal Morbidity Associated with IVF" 127 (127): 794-800, 1995

67 Corea, G., "Man-Made Women: How New Reproductive Technologies Affect Women" Hutchinson 1985

68 Spallone, P, "Made to Order: The Myth of Reproductive and Genetic Progress" Pergamon Press 1987

69 Wilson, C. L., "Looking Downstream: a Review of the Literature on Physical andPsychosocial Health Outcomes in Adolescents and Young Adults WhoWere Conceived by ART" 26 (26): 1209-1219, 2011

70 Schieve, L. A., "Live-Birth Rates and Multiple-Birth Risk Using IVF" 282 (282): 1832-1838, 1999

71 Craft, I., "Licensing Work on IVF and Related Procedures" I (I): 1373-, 1987

72 Anderson, D. C., "Licensing Work on IVF and Related Procedures" I (I): 1373-, 1987

73 Richards, M., "Licensing Work on IVF and Related Procedures" I : 1373-1374, 1987

74 van Balen, F., "Interpreting Infertility: A View from the Social Sciences, In Infertility around the Globe: New Thinking on Childlessness, Gender, and Reproductive Technologies" University of California Press 3-32, 2002

75 Nygren, K., "International Registries of ARTs, In Current Practices and Controversies in Assisted Reproduction (: Report of a Meeting on “Medical, Ethical and Social Aspects of Assisted Reproduction" World Health Organization 377-380, 2002

76 Nygren, K. G., "International Committee for Monitoring ART (ICMART) World Report: ART 2003" 95 (95): 2209-2222, 2011

77 Halliday, J., "Increased Risk of Blastogenesis Birth Defects, Arising in the First4 Weeks of Pregnancy, after ARTs" 25 (25): 59-65, 2010

78 Kerin, J. F., "Incidence of Multiple Pregnancy after IVT and ET" II (II): 537-540, 1983

79 Philipp, E. E., "Impact of the Human Fertilisation and Embryology Act (1990) on the Practice of Reproductive Medicine in the United Kingdom" 59 (59): 285-287, 1993

80 Wisborg, K., "IVF and Preterm Delivery, Low Birth Weight, and Admission to the Neonatal Intensive Care Unit: a Prospective Follow-Up Study" 94 (94): 2102-2106, 2010

81 Kalra, S. K.,l, "IVF and Adverse Childhood Outcomes: What We Know, Where We Are Going, and How We Will Get There. A Glimpse into What Lies behind and Beckons ahead" 95 (95): 1887-1889, 2011

82 Tournaye, H., "ICSI: A Technique Too Far?" 26 (26): 63-69, 2003

83 Tripp, B. M., "ICSI and Potential Transmission of Genetic Disease" 277 (277): 963-964, 1997

84 Van Steirteghem, A. C., "Higher Success Rate by ICSI than by Subzonal Insemination. Report of a Second Series of 300 Consecutive Treatment Cycles" 1055-1060, 1993

85 Levene, M. I., "Higher Multiple Births and the Modern Management of Infertility in Britain: For the British Association of Perinatal Medicine" 99 (99): 607-613, 1992

86 Australian In Vitro Fertilisation Collaborative Group, "High Incidence of Preterm Births and Early Losses in Pregnancy after IVF" 291 (291): 1160-1163, 1985

87 Van Steirteghem, A. C., "High Fertilization and Implantation Rate After ICSI" 8 (8): 1061-1066, 1993

88 The Practice Committee of the Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine, "Guidelines on the NET" 82 (82): 773-774, 2004

89 The Practice Committee of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology, "Guidelines on NET" 92 (92): 1518-1519, 2009

90 Voluntary Licensing Authority for Human In Vitro Fertilisation and Embryology (Medical Research Council/Royal College of Obstetricians and Gynaecologists), "Guidelines for Both Clinical and Research Application of Human In Vitro Fertilisation" VLA 1985

91 Morris, R. S., "Genetic Abnormalities, Male Infertility, and ICSI" 347 (347): 1277-, 1996

92 Leunens, L., "Follow-Up of Cognitive and Motor Development of 10-Year-Old Singleton Children Born after ICSI Compared with Spontaneously Conceived Children" 23 (23): 105-111, 2008

93 Miles, H. L., "Fetal Origins of Adult Disease: A Paediatric Perspective" 6 (6): 261-268, 2005

94 Evers, J. L. H., "Female Subfertility" 360 (360): 151-159, 2002

95 Goldenberg, R. L, "Epidemiology and Causes of Preterm Birth" 371 (371): 75-84, 2008

96 Jungheim, E. S., "Embryos Transfer Practices in the United States: A Survey of Clinics Registered with the Society for ART" 94 (94): 1432-1436, 2010

97 Tough, S. C., "Effects of IVF on Low Birth Weight, Preterm Delivery, and Multiple Birth" 136 (136): 618-622, 2000

98 Marcus, A. D., "Dose IVF Cause Birth Defects?; New Research Suggests Links Between Fertility Treatments And Some Health Problems"

99 Kapiteijn, K., "Does Subfertility Explain the Risk of Poor Perinatal Outcome after IVF and Ovarian Hyperstimulation?" 21 (21): 3228-3234, 2006

100 Kremer, J. A. M., "Does ICSI Lead to a Rise in the Frequency of Microdeletions of the AZFc Region of the Y chromosome in Futrue Generation?" 13 (13): 2808-2811, 1998

101 IHE (Institute of Health Economics), "Determinants and Prevention of Low Birth Weight: A Synopsis of the Evidence" Alerta 2008

102 Bergh, T., "Deliveries and Children Born After IVF in Sweden 1982-95: ARetrospective Cohort Study" 354 (354): 1579-1585, 1999

103 Tournaye, H., "Declining Clinical Andrology: Fact or Fiction?" 12 (12): 876-879, 1997

104 Bhattacharya, S., "Conventional IVF versus ICSI for the Treatment of Non-Male- Factor Infertility: A Randomised Controlled Trial" 357 (357): 2075-2079, 2001

105 Lancaster, P. A. L., "Congenital Malformations after IVF" II (II): 1392-1393, 1987

106 te Velde, E. R., "Concerns about Assisted Reproduction" 351 (351): 1524-1525, 1998

107 Thorpe, K., "Comparison of Prevalence of Depression in Mothers of Twins and Mothers of Singletons" 302 (302): 875-878, 1991

108 Human Fertilisation and Embryology Authority, "Code of Practice (Sixth edition)" HFEA 2003

109 Human Fertilisation and Embryology Authority, "Code of Practice (First Edition)" HFEA 1991

110 Spallone, P, "Beyond Conception: The New Politics of Reproduction" Macmillan Education Ltd 1989

111 Kass, L. R., "Babies by Means of IVF: Unethical Experiments on the Unborn?" 285 (285): 1174-1179, 1971

112 Jequier, A. M., "Attitude to Clinical Andrology: A Time for Change" 12 (12): 875-876, 1997

113 Department of Reproductive Health and Research, World Health Organization, "Assisted Reproduction in Developing Countries ― Facing Up to the Issues" 63 : 1-8, 2003

114 Tsirgotis, M., "Assisted Fertilization with ICSI" 62 (62): 781-785, 1994

115 Saigal, S., "An Overview of Mortality and Sequelae of Preterm Birth from Infancy to Adulthood" 371 (371): 75-84, 2008

116 Vayena, E., "ARTs in Developing Countries: Are We Caring Yet?" 92 (92): 413-416, 2009

117 Hansen, M., "ARTs and the Risk of Birth Defects―A Systemic Review" 20 (20): 328-338, 2005

118 Cook, J. L., "ART-Related Multiple Births: Canada in an International Context" 33 (33): 159-167, 2011

119 Nyboe Andersen, A., "ART in Europe, 2003" 22 (22): 1513-1525, 2003

120 The European IVF-Monitoring Programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE)., "ART in Europe, 2002" 21 (21): 1680-1697, 2006

121 The European IVF-Monitoring Programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE)., "ART in Europe, 2001" 20 (20): 1158-1176, 2001

122 The European IVF-Monitoring Programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE)., "ART in Europe, 2000" 19 (19): 490-503, 2004

123 The European IVF-Monitoring Programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE), "ART in Europe, 1999" 17 (17): 3260-3274, 2002

124 The European IVF-Monitoring Programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE), "ART in Europe, 1998" 16 (16): 2459-2471, 2001

125 The European IVF-Monitoring Programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE)., "ART in Europe, 1997. Results Generated from European Registers by ESHRE" 16 (16): 384-391, 2001

126 de Mouzon, J., "ART and IUI in Europe, 2006" 25 (25): 1851-1862, 2006

127 Nyboe Andersen, A., "ART and IUI in Europe, 2005" 24 (24): 1267-1287, 2005

128 Nyboe Andersen, A., "ART and IUI in Europe, 2004" 23 (23): 756-771, 2004

129 Amor, D. J., "A Review of Known Imprinting Syndromes and Their Association with ARTs" 23 (23): 2826-2834, 2008

130 Schoolcraft, W. B., "A Model for Incorporation of ICSI into a Private Practice IVF Program" 65 (65): 258-261, 1996

131 보건복지가족부, "2010년 가족건강사업안내"

132 보건복지가족부, "2009년 모자보건사업안내"

133 Centers for Disease Control and Prevention, "2009 ART Reports" U.S. Department of Health and Human Services 2011

134 Centers for Disease Control and Prevention, "2008 ART Reports" U.S. Department of Health and Human Services 2010

135 Centers for Disease Control and Prevention, "2007 ART Reports" U.S. Department of Health and Human Services 2009

136 보건복지부, "2006년도 모자보건사업안내"

137 Centers for Disease Control and Prevention, "2006 ART Reports" U.S. Department of Health and Human Services 2008

138 Centers for Disease Control and Prevention, "2005 ART Reports" U.S. Department of Health and Human Services 2007

139 Centers for Disease Control and Prevention, "2003 ART Reports" U.S. Department of Health and Human Services 2005

140 Centers for Disease Control and Prevention, "2002 ART Reports" U.S. Department of Health and Human Services 2004

141 Centers for Disease Control and Prevention, "2001 ART Reports" U.S. Department of Health and Human Services 2003

142 Centers for Disease Control and Prevention, "2000 ART Reports" U.S. Department of Health and Human Services 2002

143 Centers for Disease Control and Prevention, "1999 ART Reports" U.S. Department of Health and Human Services 2001

144 Centers for Disease Control and Prevention, "1998 ART Reports" U.S. Department of Health and Human Services 2000

145 Centers for Disease Control and Prevention, "1997 ART Reports" U.S. Department of Health and Human Services 1999

146 Centers for Disease Control and Prevention, "1996 ART Success Rates: National Summary and Fertility Clinic Reports" U.S. Department of Health and Human Services 1998