Assisted Reproductive Technology: Legal and Ethical Issues

Introduction

Assisted reproductive technology (ART) raises significant ethical and legal challenges for individuals, healthcare professionals, and society at large. ART has successfully helped millions of infertile couples worldwide to have children (Londra, Wallach, & Zhao, 2014). Since the birth of the first in vitro fertilization (IVF) baby in 1978, tremendous strides have been made to improve the technology and expand its use across the globe. However, as with all new technology, ethical and legal challenges have followed in ART's wake.

Ethical Challenges Surrounding Embryos

One of the first and most significant ethical challenges concerns embryos. Most couples undergoing treatment will fertilize as many eggs as possible and freeze the remaining embryos for later use. According to Londra et al. (2014), couples eventually find themselves with many unused embryos and are unable to decide what to do with them. Fertility clinics storing these embryos struggle to dispose of them, fearing that couples may sue if disposal occurs without their explicit consent. The result is that clinics hold large numbers of stored embryos that are neither being used nor disposed of. Some couples may wish to donate their embryos for research, but they are confused by the varying laws and restrictions that limit their ability to do so. By law, the couple owns the frozen embryos and should have the right to decide their fate (Londra et al., 2014). However, the lack of proper guidance and clear information leaves many couples uncertain, and they ultimately choose to keep the embryos in storage indefinitely.

Donating embryos to other couples is another option that could reduce the number of frozen embryos in storage. However, the moral and ethical concerns surrounding embryo donation limit most couples' willingness to proceed (Präg & Mills, 2017). The fear of passing genetically related embryos to an unknown recipient deters many couples from donating. They worry that children born through such donations might one day seek them out and demand DNA testing to confirm biological parentage. The law remains unclear on how such cases should be handled, making it difficult for couples to assess whether they are prepared to accept that risk. Ideally, extra embryos would be destroyed or donated for research that would not result in the birth of a child, since having a genetically related child could create legal complications for the donating couple should that child later discover the truth about the embryo's origins (Präg & Mills, 2017).

The Ethics of Implanting Multiple Embryos

The costs associated with ART are high and are rarely covered by insurance, which deters many couples from pursuing treatment. Those who can afford it often prefer to implant multiple embryos at one time, hoping that at least one will be carried to term — a strategy aimed at reducing overall costs (Londra et al., 2014). However, multiple implantations lead to multiple births, which significantly increase the chances of an unsafe pregnancy. The number of embryos implanted in a woman should therefore be limited to give her the best chance of carrying a pregnancy to term.

While a case can be made for multiple implantations, the risks associated with the practice far outweigh its benefits. The woman already faces difficulty conceiving, and implanting multiple embryos simultaneously introduces additional medical risk. Furthermore, given the high cost of treatment, couples should be confident in the quality of the embryo being implanted rather than adopting a scattershot approach. An additional ethical question arises regarding what happens to multiple fetuses if the couple is unprepared to raise multiple children. Careful consideration should be taken, and couples should be thoroughly counseled on the risks and possible outcomes of multiple embryo transfer before proceeding.