The Brave New World of Assisted Reproductive Technology

Infertility is big business, and may be about to get bigger. Experts estimate approximately 60 to 80 million couples worldwide are infertile, and that doesn’t include same sex couples who want to be parents. The cost of IVF today is about $12,500 for each attempt, as well as the cost of drugs to prepare for the process, all of which is not covered by most health care plans.

America is the wild west of Assisted Reproductive Technology. In some countries, like neighboring Canada, sperm and egg donors must be motivated out of altruism because they are not permitted to sell their wares. As you can imagine, this creates quite a shortage of supply. Sperm donors in the U.S., though, can receive about $150 per deposit and egg donors upwards of $10,000 per retrieval. As a result of this bounty of product, the U.S. is a destination for what is called “reproductive tourism,” couples looking for a destination where regulations are few and, for a price, they can achieve what their own country—and nature—had denied them.

America fits the bill because sperm and egg banks, as well as fertility centers, remain largely unregulated. This multi-billion dollar industry has had its share of nightmare scenarios: donors misrepresenting their backgrounds or health history; center managers providing their own product; offspring finding out they have hundreds of siblings; mix-ups in the distribution of embryos.

What is needed are rigorous controls and supervision of the commercialization of medical advances that have changed the way we think of family and life itself. At present, such facilities check only for STDs and other blood or fluid borne illnesses. Full verified health profiles should be required. In addition, there should be regulations governing the amount of offspring any donor’s gametes can produce. These and other regulations have long been necessary as the number of IVF births have increased over the years and evolved from mostly homologous, that is, gametes from husband and wife, to heterologous, involving donated sperm and/or ovum.

New research is about to make the field even more fertile. In a biology shattering experiment, scientists at the University of Bath have demonstrated they can create mouse embryos from cells carrying all their chromosomes, meaning any cell in the human body could be fertilized by sperm cells. Prior to the experiment, biologists—as well as the rest of us—believed only egg cells were capable of reprograming sperm cells to produce embryos.

This would allow a woman whose fertility had been destroyed, say, by chemotherapy, to still have her own biological children with her male partner. But what it also means is that gay men may be able to produce offspring whose DNA was an equal mixture of each partner. In other words: a motherless child, though a woman would still be needed to serve as a surrogate and birth mother.

We are still, of course, some distance away from this possibility. Moreover, the unknown risk to the offspring if there were indeed to be a human experiment of such a technique might make it difficult for any Institutional Review Board to pass on such research. One can also imagine the howls of protest by religious conservatives objecting to the formation of life contrary to the manner in which nature had imagined it.

But those of us who are old enough may recall hearing the same gasps in 1977 when it was announced that Leslie Brown had given birth to her daughter Louise, the first so-called “test tube baby.” Since then, there have been more than three million IVF births, allowing the 12% of humans who are infertile to enjoy the gift of raising children.

At Woodstock, Richie Havens famously sang: “Sometimes I feel like a motherless child.” It turns out, he may have only been off by about 50 years.


Alan C. Milstein (LAW ’83) is a shareholder at Sherman, Silverstein, Kohl, Rose & Podolsky, P.A., in Moorestown, New Jersey, and Chairman of the firm’s litigation department where he specializes in insurance law, products liability, bioethics, and clinical trial litigation. He is also an adjunct professor at Temple Law where he teaches Bioethics every fall semester.