Ethical and Legal Issues around Assisted Reproductive Technology

Assisted reproductive technology (ART) refers to medical procedures such as fertility medication, Vitro fertilization, intra-cytoplasmic sperm injection, and other procedures used to address infertility. The ART is now a standard technology, which has fruitfully treated millions of infertile couples globally (Aznar and Tudela, 3). Infertility is one area in medicine where physicians have had limited scope in helping their patients. This area’s landscape changed significantly in 1978, with Louise Brown’s birth through in vitro fertilization (IVF). The birth of this first test-tube baby was significant to scientists and clinicians, and infertile patients globally. Decades later, IVF’s accessibility has increased and has been used worldwide (Yovich, 114). This essay argues that while ART has given hope to several people who have infertility, the technology has also introduced countless ethical and legal issues that need to be explored and addressed.

The first ethical issue raised by the adoption of ARTs revolves around embryo politics, particularly how to manage the unused embryos. The of extra embryos fertilized during ART procedures has ethical and legal concerns across, academic, political, religious and social divides, some school of thought ruling ART as an unethical practice because of the issue. Study shows that financial disincentives, high cost of ARTs and lack of insurance coverage forces many couples to go for cheaper ART procedures that involve the implanting multiple embryos simultaneously, creating extra embryos (Khoei, Ellieh et al. 2)

The patient cut on cost by fertilizing multiple eggs and implanting many embryos at once, hoping that at least one will be successful. Multiple implantations increase the probability of multiple births. For instance, a study conducted in 2005 indicates that 11.2% of the ART cycles during that year caused multiple-fetus pregnancies (Khoei, Ellieh et al. 3). The IVF procedures raise concerns about the number of embryos to be produced and kept for future use. What happens when couples differ on the disposition of the extra embryos? Is it right to apply the pre-implantation genetic diagnosis (PGD) to select the embryo to implant? (Yovich, 116). These are ethical dilemmas surrounding ARTs, particularly in societies vexed by an embryo’s moral status, which must be addressed.

Another area in ART procedures that raises ethical and legal concerns is the third-party assisted reproduction or the donor gametes. ARTs are mostly sought by people incapable of reproducing using their biological or genetic capabilities. Homosexuals, single men, and women who desire to have biologically associated children seek sperm or egg donation and gestational services at a fee. About 12% of IVF cycles in the US in 2005 applied donor eggs from women in their forties who learned that they could not conceive using their eggs (Cobo, Ana, et al. 762). Even though Intracytoplasmic sperm injection (ICSI) has minimized heterosexual couples going for sperm donation, studies show that lesbian couples still request IVF procedure. People cannot produce even a single sperm, and single women who desire to have children genetically related to one rearing parents. Studies show that about 11.9% of IVF cycles comprise infants born through donor eggs annually (Cobo, Ana, et al. 758).

In recent years, concerns surrounding donor gametes have progressively become noticeable. A woman who donates oocytes must be subjected to IVF. However, IVF has inherent health risks, including surgical risks and ovarian hyper-stimulation syndrome; hence, women donating require oocyte require informed consent and even counseling. Some have expressed ethical concern that the financial compensation to oocyte donors may result in the exploitation of poor and low-income women who may accept oocyte donation procedures against their best interest despite the risk involved. Another legal and ethical concern is preserving the anonymity of the donor (Bracewell-Milnes et al. 456). This is an emotionally charged issue since, universally, humans consider it significant to known one genetic root. 

Some couples also go for surrogacy or contract motherhood as a third-party reproduction method, raising a myriad of legal and ethical issues. Surrogacy is used primarily by heterosexual couples where the woman cannot carry the pregnancy or produce an egg. Some gay partners, single men, and even heterosexual couples achieve parenthood using surrogate women who provide genetic factors and gestation and deliver the newborn after birth (Twine, 25). However, contracting a third-party woman to gestate a child for pay and deliver them to others to raise has elicited intense ethical and legal controversy. Some states allow for surrogacy. Others have banned the practice outright, while some states refuse to enforce the contract in case of a dispute between the parties. There is also a high cost of surrogacy in states that accept the procedure, forcing many couples to seek the services overseas. For instance, surrogacy in use can cost up to $50,000 in the US, while a similar procedure cost about $10,000 in India (Twine, 33).

The major ethical and legal dilemma often concerns how policy and law should recognize and weigh the importance of genetic factors and gestation and post-birth rearing in determining the child’s parental rights. There is also concern that low-income and poor women may be exploited as they are desperate for money. The ethical and moral consequences of transforming the normal biological functions of a women’s body into a commercial transaction is another dilemma in surrogacy procedure (Patel et al. 212). Like donor gametes, surrogates and gestational carriers are also under significant emotional and medical risks; hence, anonymity preservation also features an ethical concern. Hence, despite helping millions of helpless couples to have children, there is a myriad of ethical dilemmas around surrogacy that must be reexamined and addressed.

Lastly, cost implication is another ethical concern surrounding ART, exacerbated primarily by the inequitable access to health care. In most countries, the economic barriers to IVF create preferential access of ARTs to couples with financial power while neglecting the low-income groups who may also need the services. The current average cost of a single IVF cycle in the US $12,000. The figures exclude medication which can run between $1500 and $3000 per cycle (Crawford, Sara, et al. 446). The costs, however, vary per country. Study shows that the “cost per cost per live birth for autologous ART treatment cycles” in the US, the UK, and Canada ranges between $33,000 and $41,000, while in Japan, Scandinavia, and Austrian is between $24,000 and $25,000. The government funding for ARTs also varies across countries. There is no deferral funding for IVF in the US. The UK study shows that only about 25% of all the IVF cycles are funded by the NHS (National Health Service) (Crawford, Sara, et al. 449). The high cost of ARTs coupled with no government funding implies that the services can only be access by couples with financial power, discriminating low-income population.

The ART fruitfully treated millions of infertile couples globally, giving hope to many people who cannot naturally get a child. However, despite its immense success in addressing infertility issues, it argues that ART has also introduced countless ethical and legal issues that need to be explored and addressed. Such include the management of the unused embryos, concerns with the donor gametes and surrogates, and the high cost of ART procedures as discussed in this paper.

References

Aznar, Justo, and Julio Tudela. “Bioethics of assisted reproductive technology.” Innovations in Assisted Reproduction Technology. IntechOpen, 2020.

Bracewell-Milnes, Timothy, et al. “Investigating psychosocial attitudes, motivations and experiences of oocyte donors, recipients and egg sharers: a systematic review.” Human Reproduction Update 22.4 (2016): 450-465.

Cobo, Ana, et al. “Oocyte vitrification as an efficient option for elective fertility preservation.” Fertility and sterility 105.3 (2016): 755-764.

Crawford, Sara, et al. “Costs of achieving live birth from assisted reproductive technology: a comparison of sequential single and double embryo transfer approaches.” Fertility and sterility 105.2 (2016): 444-450.

Khoei, Ellieh, et al. “Infantile Prognosis of Neonates Conceived by Assisted Reproductive Techniques: A prospective Study.” (2020).

Patel, Nayana Hitesh, et al. “Insight into different aspects of surrogacy practices.” Journal of human reproductive sciences 11.3 (2018): 212.

Twine, F. W. (2015). Outsourcing the Womb: Race, class and gestational surrogacy in a global market. Routledge.

Yovich, John Lui. “Founding pioneers of IVF update: Innovative researchers generating livebirths by 1982.” Reproductive Biology 20.1 (2020): 111-113.