Assisted reproduction and choice in the biotech age: recommendations for a way forward.

Over the past several decades, millions of people have used new reproductive technologies in their quest for biologically related children. Access to these technologies has enabled people who suffer from infertility, same-sex couples and single women to form biological families. At the same time, these tools can be used to select the sex of a future child [1] or to “de-select” based on a growing number of genetic markers for disabilities and other conditions [2]. While assisted reproductive technologies have increased parental options for those who can afford them, they pose numerous ethical challenges that the reproductive rights, health and justice communities are only beginning to address. The assisted reproduction field has so far developed largely outside the realm of public policy and with little public discussion about how new technologies should be used and who should have access to them. Difficult questions have had minimal public airing. Should access to reproductive technologies be limited to those who can pay for them? Should the characteristics of future children be pre-determined? What about efforts to develop extreme technologies such as reproductive cloning or genetic techniques for producing “enhanced” children? How can we safeguard the well-being of everyone involved in assisted reproduction, including children who are produced and third parties who provide gametes or serve as surrogates? Satisfactory answers to these questions will require robust and nuanced consideration by a full range of stakeholders. We believe that both clear guidelines for providers and enforceable public policies will be needed if we are to make assisted reproduction safer for women, protect the health and rights of all involved, and prevent socially unacceptable uses of the technologies.