In this article, the co-founders of surrogacy agency Los Angeles Surrogacy discuss the ethics issues raised by the recourse to in-vitro fertilization (IVF) by parents who can’t conceive or carry a child.
What is IVF?
In-vitro fertilization is an assisted reproductive technology (ART) procedure that has gained widespread acceptance since its inception in 1978. This technique involves the fertilization of an egg outside the human body, in a laboratory setting, followed by the implantation of the embryo into the uterus.
IVF has helped millions of couples experiencing infertility issues to conceive and build families. However, as the use of IVF has grown, so have ethical concerns surrounding its application.
Among the main ones, we will focus on embryo selection, preimplantation genetic diagnosis, surrogacy, and accessibility.
- Embryo Selection
Embryo selection is the process of choosing the most viable embryos for implantation, thereby increasing the chances of a successful pregnancy. While this procedure has its benefits, it also raises ethical issues.
The primary one is the potential for the creation of “designer babies,” where parents select embryos based on specific traits, such as physical appearance, intelligence, or other characteristics. This may lead to eugenics, as it could encourage the selection of embryos with socially desirable traits, perpetuating social inequality and discrimination.
In the United States, there is little regulation on embryo selection, with the Society for Assisted Reproductive Technology (SART) providing guidelines that are largely voluntary.
In contrast, Europe has more stringent regulations on embryo selection, as regulators consider the issue in the light of historical precedent, namely the eugenics movement of the late 19th century and early 20th century, and the subsequent rise of Nazism as a racial ideology.
The European Society of Human Reproduction and Embryology (ESHRE) has established guidelines that limit the use of IVF for non-medical purposes, such as sex selection or trait enhancement.
- Preimplantation Genetic Diagnosis
Preimplantation genetic diagnosis (PGD) is a procedure used in conjunction with IVF to screen embryos for genetic abnormalities before implantation.
PGD can help identify embryos with chromosomal abnormalities, single-gene disorders, or other genetic conditions, thereby increasing the likelihood of a healthy baby. This technology has raised ethical questions as it is also associated with a potential for discrimination and opens the door to eugenics.
Ethics specialists argue that PGD could be used for non-medical purposes, such as selecting embryos based on intelligence, athleticism, or other traits.
Additionally, there is a societal concern that the widespread use of PGD might contribute to stigmatization and discrimination against people with developmental disabilities, as parents could increasingly opt for “perfect” embryos.
In the United States, PGD is largely unregulated, with professional societies providing guidelines for its use. In Europe, the situation is more complex: different countries have different regulations. German for example prohibits the use of PGD except in cases of severe genetic disorders. UK legislators have allowed it for a broader range of conditions but under the strict regulation of the Human Fertilisation and Embryology Authority (HFEA).
- Surrogacy
Surrogacy, another aspect of IVF, involves a woman carrying and giving birth to a baby for another person or couple who cannot conceive or carry a child. This method raises its own ethics issues, such as the potential for exploitation, the commoditization of women and children, and the implications for the child’s welfare.
In the United States, surrogacy laws vary on a state by state basis, with some states allowing for commercial surrogacy while others only permit altruistic surrogacy or ban the practice altogether. There is no comprehensive federal regulation, which gives rise to concerns about exploitation and unequal treatment across state lines.
Additionally, the commercial aspect of surrogacy in the United States raises the issue of the commoditization of women’s bodies and the potential for coercion in the decision to become a surrogate.
In Europe, surrogacy is more strictly regulated, with several countries imposing bans or restrictions on the method. For example, Germany, France, Italy, and Spain prohibit all forms of surrogacy, while the United Kingdom only allows for altruistic surrogacy, with no financial gain for the surrogate beyond reimbursement for reasonable expenses.
However, this strict regulatory approach has led some couples to seek surrogacy services in countries with a more lenient legal framework, creating other ethics issues proceeding from international surrogacy arrangements, such as the exploitation of children (under the broader header of child trafficking) and children’s welfare.
- Accessibility and Equity
IVF treatments can be costly, with the average price per cycle in the United States ranging between $12,000 and $15,000, excluding medication and additional procedures like PGD.
This high cost creates significant barriers to access for many couples. Hence an ethical issue about equity in the distribution of fertility treatments.
The issue of accessibility is further exacerbated by the fact that insurance coverage for IVF varies widely within the United States, with only a few states mandating coverage.
In Europe, as usual, the situation is more complex. Countries offer varying levels of financial support for IVF treatments. Some, such as Sweden, provide comprehensive coverage under the banner of equitable access to fertility treatments.
Others, like the United Kingdom, offer limited coverage through the National Health Service (NHS), with strict eligibility criteria and long waiting lists. Couples may then seek private treatment at a high cost.
Role of the surrogacy agency
As a nationwide surrogacy agency, Los Angeles Surrogacy has made its mission to help any couple or individual, without regard for their sexual orientation or marital status, to access the joys of parenthood.
Any surrogacy agency with a national footprint has to consider the financial situation of intended parents, the legal framework of the state they live in, the situation of the surrogacy candidates, and the terms of the surrogacy contract defining the arrangement taking place between parties.
The surrogacy agency will also discuss the respective positions of the intended parents (when they are a couple) in regards to ethics, moral, and financial issues raised by the birth of a child, with a specific concern for the welfare of this child.
The role of the surrogacy agency is not just to match intended parents with surrogates, but to make sure all parties are on the same page with regard to their respective and mutual obligations. The surrogacy agency acts as an advisor to the intended parents and the surrogate mothers.
Role of the regulators
The use of in-vitro fertilization has brought hope to millions of couples worldwide, allowing them to conceive and build families. As technology continues to advance an enable more and more people to become parents, some remaining ethical issues will need to be addressed.
This process will require a delicate balance between respecting individual autonomy and the desire to have children, and protecting the broader societal values of justice, equity, and respect for human dignity.
To achieve this balance, policymakers will have to continue developing a comprehensive regulatory framework capable of ensuring that IVF practices keep adhering to generally accepted ethical principles, while still allowing for the continued advancement of reproductive technologies.
Public dialogue and interdisciplinary collaboration between medical professionals, bioethicists, and policymakers are both crucial in navigating the complex ethical landscape of in-vitro fertilization.