There are a number of religious arguments typically raised against ARTs. Some Christian traditions claim that all ARTs are ethically impermissible because they separate the natural process of procreation from intercourse within marriage, which is seen as unnatural (for discussion, see Cahill and McCormick, 1987; Fisher, 1989). ARTs are also viewed as a threat to the concept of the family and to the dignity of human beings, particularly inasmuch as technology dominates the origin of the human being. Thus many of these critics argue both that reproduction should not be interfered with (e.g., by using contraception) and that technology should not be used to intervene in or to help to achieve reproduction. Other traditions emphasize the unnaturalness of ARTs. Some Confucian commentators claim that any nonconjugal reproduction weakens the blood ties between family members and leads to moral and social instability (Qiu, 2002). Aside from those writing from a particular religious perspective, there are other critics who do not oppose (married heterosexual) couples making autonomous decisions about reproduction such as using contraception, but who do not view ARTs or other unnatural arrangements as morally permissible (e.g., Marquis, 1989). Still others consider ARTs in relation to environmental ethics, arguing that infertile couples should adopt since the world is already overpopulated and that the desire to have a biologically related child is selfish (for a related argument, see McKibben, 1998). According to this reasoning, individual desires to have children should give way to broader concerns about population health and control.
Further ethical issues are raised by the selection criteria that are used to determine who receives ARTs. In many countries and clinics, these technologies are only made available for married heterosexual couples. Access to ARTs by unmarried (or de facto) couples and lesbian or single women is much more restricted, the latter being considered an instance of social rather than medical infertility. There have also been concerns about postmenopausal women using ARTs and donor eggs to conceive, and many clinics have rules limiting the provision of ARTs to women over a particular age (typically early to mid-forties) in part out of concerns for the welfare of the future child and relatively low success rates (Hope et al., 1995). Finally, particularly in public health-care systems where ARTs are freely available, screening criteria such as age are used to choose the best candidates (those with most likelihood of success) due to limited resources, notably donor sperm, or limits are placed on the number of cycles that can be undergone to attempt to achieve a pregnancy.
In some jurisdictions (e.g., most states in the United States), there is no requirement that insurance companies provide coverage for infertility treatments, which means that only the most affluent can afford to use ARTs. Where public funds are directed at research or treatment using ARTs, there are economic concerns about whether it is just to use considerable health resources to help a relatively small number of people conceive in what are typically overstretched public health-care systems. Some argue that resources might be better utilized for research into and prevention of the various causes of infertility and related population-based problems including environmental issues, rather than individualized clinical solutions. Further, there is considerable disquiet about support for ARTs in populations where evidence shows they are unlikely to be successful, for example older women.
Feminist scholars have expressed concerns about ARTs placing additional psychological, economic, and physical pressures on women to produce biologically related children (Sherwin, 1992; Donchin, 1996). They cite the problematic case of using ARTs to treat primary male infertility. This requires women to undergo onerous fertility treatments involving hyperstimulation of the ovaries and a series of surgical procedures despite the women themselves not being infertile. Further, they argue that infertility itself is a socially defined and interpreted category, rather than a natural disease category (Sherwin, 1992) and one that has been reinforced by a largely male-dominated medical profession. Most of these commentators do not deny that many women wish to have biologically related children, but they emphasize that the social and economic pressures associated with ARTs often are ignored. Others argue that ARTs have not been sufficiently well assessed, particularly with regard to their potential long-term negative effects on women’s health, especially due to the side effects of hyperstimulation (de Melo-Martin, 1998).
Artificial Insemination
Some of the simpler advanced reproductive technologies that do not require the involvement of medical professionals were traditionally adapted from animal husbandry for use in human reproduction, notably artificial insemination by donor (AID) or by husband/partner (AIH). The introduction of semen or concentrated specimens of spermatozoa into a woman’s reproductive tract by noncoital means can be successfully performed with instruments as simple as a turkey baster (Wikler and Wikler, 1991). AI is sometimes coupled with use of hormones to stimulate ovulation at the time of insemination to maximize the chances of fertilization occurring, although these drugs are associated with some risks to the women involved.
In recent years, fears about donor health status, risk of infection (HIV and otherwise), and legal issues (such as establishing paternity) have caused most AI to be performed in medical clinics under a physician’s supervision. Hence some critics note that this procedure has become unduly medicalized. In the past, some doctors avoided paternity issues by mixing sperm from several donors including the male partner, but recent advances in genetic technologies allow paternity testing using DNA and have resulted in clarification in many jurisdictions of the legal standing of children born from AI. Legal issues remain in some places, for instance with custody and adoption of AID children born to lesbian couples.
Some religious traditions do not consider AID to be ethically permissible as they hold it to be equivalent to adultery. Historically there has typically been considerable stigma associated with AID, and often information about the biological father (or even the fact that the child was produced using AID) was not revealed to children born using AID. However, in many countries recent changes in the law or court decisions have established that children born of AID have the right to information about their biological fathers once they are 18 years of age. This change is due in part to long-term psychosocial studies that have shown that there are considerable benefits to disclosure, as is the case with adopted children (Blyth, 1998; McWhinnie, 2000; Ethics Committee of the American Society of Reproductive Medicine, 2004). Following these changes, the rate of anonymous donation for AID programs has decreased dramatically in many countries, apparently because anonymity cannot be guaranteed once the child becomes an adult. In contrast, in the United States, some clinics have reported increased donor rates, apparently among those men who would be happy to have contact with their biologically related children in the future.
In Vitro Fertilization And Embryo Transfer
The first successful birth using in vitro fertilization and embryo transfer (IVF-ET) occurred in 1978. The British scientists involved, Patrick Steptoe and Robert Edwards, drew on embryological studies done for over 20 years in mice, rabbits, and other animals. The procedure involved laparoscopic aspiration of an egg during a woman’s natural cycle, followed by IVF using ejaculated sperm and transfer of the dividing embryo in its early stages into the woman’s uterus, hence creating what became known as a test tube baby. More generally in IVF-ET, eggs are harvested and mixed in Petri dishes either with donor sperm or with sperm from the male partner (if primary male infertility is not thought to be at issue), typically using the healthiest sperm to facilitate fertilization. Eggs may be obtained from the female partner being treated or donated by another woman (e.g., in cases of premature ovarian failure, genetic abnormalities, or reduced egg production due to advanced maternal age). Most women undergoing IVF-ET also have controlled ovarian hyper stimulation prior to aspiration of eggs to increase the number of eggs that are viable. Early fears that babies produced through IVF would be abnormal have not been substantiated. However, in many localities there is inadequate tracking of offspring and potential health problems, including their future reproductive health.