6 Ethics for Embryologists 155may be that every embryo shows some sign that is not good – that can be
difficult.It was not only the disappointment of clients in not achieving a preg-
nancy that scientists considered. They were also aware of the cost sig-
nificances of their quality decisions. For example, in the case of poor
quality sperm, while the consultant had the final decision on whether
to go for a simple fertilisation in the wells of a petri dish or via the far
more complex and invasive ICSI procedure, a good deal of this decision
was based on the scientist’s view of motility and morphology through
the microscope. For the client, the decision might mean an investment
of an additional thousand dollars or so for ICSI if the cycle was pri-
vately funded, and in many circumstances, the decision was not clear-
cut. How does one balance the savings made by the initial additional
cost of ICSI, versus the lower likelihood of a pregnancy without it?
While many scientists stepped around the issue by noting that it was
the doctor who made the final call, when pressed further, all acknowl-
edged that that ‘final call’ was based on the information that the scien-
tists relayed to the doctor.
The exercise of judgement was where the element of responsibil-
ity emerged so strongly for the scientists, who uniformly identified
the selection of the ‘best’ embryo from several possibilities as one of
the most stressful and challenging aspects of the job. This was in part
because of the regulatory backdrop to practice, according to which only
one or two embryos would be replaced in any cycle, but it was also an
issue insofar as they understood the humanity of reproductive material
to reside in its ‘potential’. To pick the ‘human’, it turned out, was in
practice to pick the ‘beautiful’, which in embryology meant the most
symmetrical, the embryo with the best developmental rate and even
cleavage (cell division). Metaphors of weeding and culling were often
used to describe this process and many scientists reflected on the simi-
larly ‘wasteful’ quality of ordinary biology in which early eggs were reab-
sorbed before release. Eventual ‘humanness’ was in part an outcome
of quality control, which because of the difficulty of knowing the bio-
chemistry of the egg or embryo relied instead on its manifestation as
outer form.