In 1978 Louise Brown became the first “test tube” baby to be born using in vitro fertilization (IVF). Her birth marked the advent of a rapidly advancing reproductive science, and it also became a testament to a changing concept of creation. Her birth was not only a moment of celebration but also one of controversy. For some, IVF opposed traditional or religious beliefs about family and reproduction. Conception took place outside the body and outside the family and was altered through medical intervention. Many of the practices used in IVF and other assisted reproduction technologies (ART) challenged what was commonly thought of as the standard or normal family: one mother, one father, and children. A process such as egg or sperm donation, both of which take a third-party donor to create a fertilized embryo that will then be introduced into the female body using IVF, was therefore seen as counter to traditional family ideology and practice.
The success of IVF, however, opened new possibilities in the treatment of infertility. Proponents continued to see the practice as a means of conceiving a child where it otherwise may not have been possible. Many women who sought the treatment also supported this notion, considering the ability to conceive a child as their right. Today, the predominant public attitude toward assisted reproduction has shifted from wavering opposition to general acceptance. It is widely recognized and practiced as a standard treatment for infertility.
I. Choices and Controversies
II. Risks and Benefits
III. Bioethical Considerations
Choices and Controversies
The phenomenal increase in the number of babies born using alternative methods of fertilization over the past 20 years testifies to the changing outlook on once controversial medical procedures. Furthermore, the demand for reproductive options opens the door to more avenues of scientific exploration to both refine existing reproductive technologies and search for new methods. Accompanying the unprecedented rate of scientific growth, however, is a growing concern over the extent of new plateaus in reproductive technology and their costs. As a result, a new set of controversies and a new set of medical, ethical, and social questions have emerged to shape debate over assisted reproduction.
The new story of reproduction is located at the intersection of shifting social values and a rapidly advancing scientific understanding. New technologies afford women the decision to postpone reproduction. Hypothetically, a woman in her thirties, working toward a successful career or further education, is well aware that with each year the possibility of having a healthy child and an uncomplicated pregnancy diminishes. She is also aware that alternative procedures such as freezing one’s eggs give her the tentative option of conceiving at a chosen future date. The process does not guarantee reproduction, but it does open new considerations in terms of family planning. In a society where fertility and pregnancy are at odds with “career ladders” for women, proponents of new advancements in reproductive technology see it as affording more lifestyle and body choices without sacrificing the desire to also have a family.
Yet skeptics argue that the original design of the fertility treatment was meant to offer infertility options, not lifestyle choices. A controversy over age limits emerges in this conversation because some critics worry how far medical practice will go to allow older women to conceive, even after menopause. Since ART is a relatively unregulated field of practice, no restrictions in age exist thus far. Many of these questions carry both scientific and social implications. On the one hand, reproductive technology has allowed women at many age levels to conceive and start a family. On the other hand, the increasing tendency to treat reproduction and conception as a medical issue has changed the traditional social narrative of the family. As prevalent as many of these controversies may be, their lack of resolution has not slowed the accelerating pace of further research and development.
New advancements and research in assisted reproductive technologies seek to make existing procedures more successful and more available to larger numbers of women. Newer processes mark not only how far we have come but also how far we may yet go. Advancements in reproductive technology create new controversies, many of which remain unaddressed.
Risks and Benefits
One of the predominant issues with infertility treatments is the long-term effect on both the woman and the child. As standard as many of the procedures in ART are, long-term results are relatively unstudied. After all, Louise Brown, who turned 30 in 2008, is still relatively young. New measures are being taken to set up systems of surveillance that track and record the progress, the effects, and the health of the constituents involved. Some critics question how far we should advance medicine without knowing the full set of risks to mother and child. Proponents of the advancement in reproductive technologies see such suspicion of potential risks as a means of limiting female choice, undercutting the availability of IVF.
One of the known complications of ART is the predominance of multiple births. To ensure that pregnancy takes place, multiple embryos can be placed within the woman’s uterus, potentially resulting in multiple births. Newer technologies can help predetermine healthy embryos, thus reducing the possibility of multiple births before implantation takes place. Yet the same technology used to prescreen the embryos can also be applied to screening for a predisposition to genetic diseases and for sex. The prescreening allows the parents to make decisions before fetal pregnancy occurs. The process of prescreening and selection of healthy embryos raises questions about the role of medical selection and the alteration of life outside the body. Some critics fear that the list of prescreening traits may grow longer, resulting in the institution of Brave New World tactics, where “designer babies” and “designer families” are the results of “quality control.”
Interestingly, one of the more pressing quandaries generated by ART is its proximity to cloning. The laboratory techniques generated by ART are the same as those used in cloning. However, in a process such as IVF, the fertilized egg is the result of two biological parents, whereas with cloning, the cloned cell is the exact copy of one parent. Regulations controlling both cloning and stem cell research may also pose restrictions to ART, given that all are seen as working within the embryonic stages of life.
New advancements in reproductive technology carry risks along with the benefits. Although the technology is often heralded as necessary progress, critics point out that progress must be accompanied by bioethical responsibility. In other words, scientific research and its applications must be carefully understood and monitored for its ethical and moral implications.
Much of the current controversy in ART involves larger institutional practices rather than simply the medical procedures themselves. One such concern is the disposal of unused embryos. Here, the controversy intersects with the dialogue concerning postcoital contraceptive practices (such as the morning-after pill) and research practices in stem cell research—where does life begin? Proponents see the unused embryos, especially in stem cell research, as an opportunity for developing new treatments against disease. Opponents of using or destroying embryos, however, express concern over the increased power for science to manipulate fundamental definitions of life. Some critics even fear that the line between ethical and unethical practice gets ever more slippery as the limitations of embryonic research are further extended. Thus, ART again comes under scrutiny, requiring that more attention be given to regulations and limitations.
In order to address bioethical responsibility in assisted reproductive technology, some critics call for new measures in regulation. Those who call for regulation wish to monitor research practices more closely, including experimenting with new forms and methods of ART and medical practices actively applying existing methods of ART. Some women fear that “regulation” will equate to “restriction” of bodily rights, however, and certainly, determining bodily rights versus moral concerns is a difficult process.
An issue that may be overlooked is the potential of politicizing infertility as discussions of reproduction take place within scientific and political discourse. Reproductive technology, at one point, opened up a new agenda for women wanting both family and career. It was seen as a progressive move in the women’s rights struggle. And yet, the politicization of the practice and the resultant discourse on “property rights” in terms of the female body, and the objectifying of women’s bodies as a scientific or political event, may also be seen as regressive. It may be seen as counterproductive, as a woman’s body becomes a space of experimentation—a scientific workplace.
Another pressing issue as ART moves into the arena of private industry is the blurring of the distinction between consumer and patient. Certainly, the capitalization of the reproductive technology market raises some concerns. ART is a $3-billiona- year industry at the intersection of medical practice and private business.
Profit incentives facilitate the process of freezing, storing, and thawing eggs. That eggs have become a commodity is evidenced by the advertisements that blanket college newspapers offering to pay women for egg donations. For consumers, the concern or emphasis of the practice is on product. For patients, there is not only the health and practice concern but also an emotional concern. Skeptics say that a business is not equipped to handle a woman who, despite ART, cannot conceive a child. They question whether a business attitude toward reproduction can answer and identify her needs. Supporters of ART maintain that the right technology, even if driven by economics, offers the best possible means of addressing infertility. On either side of the issue, the word embryo, not just as a scientific term but as a business one as well, takes on new connotations.
Many social implications result from considering fertility as a commercial business; one of these is that fertility becomes a question of affordability. Access to treatment becomes a question of who can pay and who cannot. ART procedures are extremely costly. The fee for freezing eggs can be almost $10,000. The cost of hormone treatments to stimulate egg production can be another $4,000. The future in vitro fertilization of the eggs will cost around $15,000 to $20,000. Critics of the view that technology brings choice point out that financial cost can actually eliminate choice.
For example, infertility rates are much greater outside the United States; yet, because of the high cost, fewer people have access to the technology or treatment. In many countries, infertility comes at the cost of social exclusion, raising questions, again, about the intention of ART to provide an answer to a social need. Even inside the United States, many insurance policies do not provide for ART, excluding families who cannot afford the thousands of dollars the treatments often incur.
In addition, high costs do not necessarily equate to success. The process of assisted reproduction can offer only a possibility of a healthy pregnancy, not a guaranteed assurance of conceiving a child and bringing it to term. Less than half of the procedures performed result in infants carried to term. Critics point out that there is no reimbursement financially or emotionally for undergoing a process that fails in the end. At the same time, proponents maintain that ART practices offer the best possible solution to infertility.
Public dialogue on reproductive technologies is both steeped in controversy and pressingly necessary as our understanding and advancement of the science continues to move forward, creating many medical, ethical, and social questions along the way. Do these technologies oppose traditional family structures? Do lifestyle choices come at the cost of natural, biological practice? What should be the limits of ART as the biological and ethical implications become better understood? Whether for skeptics or for proponents, the advancement of reproductive technology will certainly challenge the intersection of science and society as social and ethical institutions come face to face with medical and scientific exploration.
- De Jonge, Christopher, and Christopher L. R. Barratt, eds., Assisted Reproduction Technology: Accomplishments and New Horizons. Cambridge, UK: Cambridge University Press, 2002.
- Merrick, Janna C., Reproductive Issues in America: A Reference Handbook. Santa Barbara, CA: ABC-CLIO, 2003.
- Mundy, Liza, Everything Conceivable: How Assisted Reproduction Is Changing Men, Women, and the World. New York: Knopf, 2007.
- Naam, Ramez, More Than Human: Embracing the Promise of Biological Enhancement. New York: Broadway Books, 2005.
- Winkler, Kathleen, High Tech Babies: The Debate over Assisted Reproductive Technology. Berkeley Heights, NJ: Enslow, 2006.