Impact

ART Impacts

The development of assisted reproductive technologies (ART) provides options for those who may not otherwise be able to have children. But, like many other emerging biotechnologies, it also raises ethical, social, and legal questions.¹ Only recently have studies been conducted to examine the impact that ART has had on those who have used it, those whose lives have resulted from ART, and the impact that the use of ART has on society as a whole. And, to date, these studies are limited.

Child Psycho-social Development
Since the advent of IVF in 1978, one of the first questions asked about the impact of ART is the effect that ART's use has on the psychological, emotional, and behavioral development of children who result from these technologies.² But just recently have studies been conducted on this particular subject because, up until very recently, there were not a sufficient number of adults and adolescents who had been born as a result of ART.³ Additionally, because of the secrecy often associated with using ART, recruiting participants for such research has proven difficult. Some of the key questions considered include: (1) whether the children were raised in different socio-economic conditions than their peers; (2) whether non-traditional family structures (i.e., having two same-sex parents) has an impact; and (3) whether children who are denied information about genetic origins run the risk of long-term psycho-social difficulties, as has been shown in adopted children.⁴

A 2001 review by Hahn looked at the relevant data related to the question of child psycho-social well-being.⁵ The review noted that, in most studies, there was no statistical difference between children born through ART procedures and their naturally conceived peers.

Psycho-social Status of Parents
Studies have also looked at the impact that ART has on the individuals or couples who utilize the technologies, before and after the birth of a child. Before birth, there is some concern about complications resulting from the stress of dealing with infertility and ART treatments.⁶ After the birth of a child, the conclusion of most of the studies is that the use of ART had no effect on psychological or emotional well-being.⁷

For both the couples that use donor gametes and the children who are the product of the donated gametes, sensitive issues arise pertaining to the identity of the donor. These issues include: health risks, privacy issues, psychosocial consequences, and possible consanguinity issues for the children. These issues have given rise to regulatory and legal responses internationally.⁸ Sweden passed a law in 1985 requiring that children of donor inseminations be allowed access to information about the sperm donor. In 2000, a study was conducted about the attitudes of parents who used donor sperm toward the issue informing the child.⁹ The study showed that the law had a limited impact on encouraging revelation of the donor insemination to the child.¹⁰

International Social and Cultural Norms
In 2001, the World Health Organization (WHO) sponsored a meeting focused on the medical, ethical, and social aspects of ART around the globe. The published report analyzed the consequences of introducing ART into countries where cultural beliefs toward infertility have strong social significance.¹¹ In many societies, infertility results in ostracism, economic deprivation, social isolation, and, even, violence.¹² In the early 1990s, it was estimated that between 8 and 12% of couples had difficulty conceiving, the equivalent of between 50 and 80 million people worldwide.¹³ The WHO report suggested that this was a severe underestimate of the infertility rate. Given the social impact that infertility has, the report stated that the need for ART in these countries was compelling enough to overcome criticisms that ART was both too expensive and would only exacerbate global overpopulation.¹⁴ The report also examined the social and ethical aspects of ART region by region.¹⁵ In many cultures, religious beliefs prohibit the use of ART, while, in other instances, the use of ART is regarded as promoting a Divine commandment to procreate.¹⁶

Women's Health
As noted above, the implementation of ART often depends on cultural attitudes toward fertility. In many cases, the cultural role of women is so tied to fertility that the advent of ART is either heralded or derided depending on cultural norms. Thus, ART is viewed as having a significant impact on attitudes toward women¹s health and community status.¹⁷

However, ART also has a significant impact on women as individuals, as well as members of society at large. Studies have shown that infertility has a significant emotional and psychological impact on women.¹⁸ It was also shown that many women hold a belief of "biological destiny" to have children.¹⁹ Given the strength of these beliefs, ART would have a great impact on women in allowing them control over this "biological destiny."

Nevertheless, questions remain about potential risks to women inherent in the treatments.²⁰ Side effects include adverse reactions to fertility-enhancing drugs. For example, issues have arisen from the off-label use of drugs as fertility treatments, such as Femara and Lupron. In the case of Lupron, the drug was approved by the U.S. Food and Drug Administration to treat endometriosis and fibroid-associated anemia; however, it was discovered that it could also be used to induce multiple ovulations.²¹ But, for some patients, it has proven to have detrimental side effects, including seizures, fibroids, and severe bone pain.²² The off-label use of another drug, Femara, to induce multiple ovulations, induced the drug maker, Novartis, to issue a memorandum to health care professionals in Canada warning them about the drug's possible toxicity to mother and child.²³

Costs
Some concerns have been raised about the expense of ART procedures, which are often paid for out of pocket by patients and, thus, unavailable to many people who could benefit from the technologies but cannot afford them.²⁴ In the United States, insurance companies generally do not define ART as medically necessary services and, thus, do not provide coverage for ART.²⁵ However, 16 states currently mandate coverage for infertility services, including Illinois, Massachusetts, and New York.²⁶ In contrast to the United States, infertility is considered a medical condition in Europe and is eligible for public health coverage.²⁷ In Britain, a recent study showed that despite the high cost of IVF treatment -- estimated at an average of £13,000 -- the resulting children would benefit Britain¹s future economy in the eventual taxes and insurance collected upon reaching adulthood -- at an estimated value of £147,000 per child born.²⁸ Falling birth rates throughout Europe have led to suggestions that IVF should be made widely available to address the decline.²⁹

Finally, the development of the gamete market is a troubling side effect of the development of ART.³⁰ While termed "donors," many of the individuals who contribute gametes for IVF and other ART procedures are paid based on physical and mental qualities, creating what some critics have called "a business that doesn't feel like a business."³¹

¹Nigel M. de S. Cameron, Pandora's Progeny: Ethical Issues in Assisted Human Reproduction, 39 FAM. L. QUART. 745 (2005).
²Alistair G. Sutcliffe, Reproductive Technology and Its Impact on Psychosocial Child Development, in R.E. Tremblay, R.G. Barr, & R. De V. Peters, eds., Encyclopedia on Early Childhood Development [on line] (2003), available at http://www.excellence-earlychildhood.ca/documents/SutcliffeANGxp.pdf (last visited May 20, 2006).
³ J.E. Scheib, M. Riordan, & S. Rubin, Adolescents with Open-identity Sperm Donors: Reports from 12-17 Year Olds, 20 HUM. REPROD. 239 (2005).
⁴Sutcliffe, supra note 2, at 2.
⁵C. Hahn, Psychosocial Well-being of Parent and Their Children Born After Assisted Reproduction, 26 J. PED. PSYCH. 525 (2001).
⁶L.H. Burns, An Exploratory Study of Perceptions of Parenting After Infertility, 8 FAM. SYS. MED. 177 (1990).
⁷Susan Golombock, Parenting and Psychological Development of the Child (2001), available at www.who.int/reproductive-health/infertility/28.pdf (last visited May 20, 2006). This paper provides an overview of the research on the psychological impact ART has on parents. Some suggestions has also been made in the literature that mothers would have a tendency to be overprotective and emotionally over-invested in the long-awaited child. See C. Hahn & J.A. DiPietro, In-vitro Fertilization and the Family: Quality of Parenting, Family Functioning, and Child Psychological Development, 37 DEV. PSYCH. 37 (1998).
⁸For an overview of the issues involved with donor identity, see Nanette Elster, All or Nothing? The International Debate Over Disclosure to Donor Offspring (2006), available at http://www.thehumanfuture.org/commentaries/commentary_elster.html (last visited July 16, 2006).
⁹Claes Gottlieb, Othon Lalos, & Frank Lindblad, Disclosure of Donor Insemination to the Child: the Impact of Swedish Legislation on Couples¹ Attitudes, 15 HUM. REPROD. 2052 (2000).
¹⁰Id. In the study, only 52% of parents surveyed intended or had disclosed the information to their child despite the requirements under the law to inform the child. Id.
¹¹WORLD HEALTH ORGANIZATION, CURRENT PRACTICES AND CONTROVERSIES IN ASSISTED REPRODUCTION: REPORT OF A WHO MEETING (2001), available at http://www.who.int/reproductive-health/infertility/report_content.htm (last visited May 20, 2006).
¹² Id. at § 1.
¹³World Health Organization, Infertility: A Tabulation of Available Data on Prevalence of Primary and Secondary Infertility (1991).
¹⁴Supra note 1 at 754-759. There are some who argue that full access to ART procedures is a "reproductive liberty" and a "prima facie moral right."
¹⁵Supra note 9 at § 2.
¹⁶Id.
¹⁷Id.
¹⁸Dalia Merari, Angela Chetrit, & Baruch Modan, Emotional Reactions and Attitudes Prior to In Vitro Fertilization: An Inter-Spouse Study, 17 PSYCH. HEALTH 629 (2002).
¹⁹Gillian Goslinga-Roy, Body Boundaries, Fiction of the Female Self: An Ethnographic Perspective on Power, Feminism, and the Reproductive Technologies, 26 FEM. STUD. 113 (2000).
²⁰The Women¹s Health Council, Position Paper on Assisted Human Reproduction: The Health and Social Implications for Women (2005), available at http://www.whc.ie/publications/position_reprod.html (last visited May 20, 2006).
²¹Judy Norsigian, Egg Donation Dangers, GENE WATCH Sept.-Oct. 2005, available at http://www.gene-watch.org/genewatch/articles/18-5Norsigian.html (last visited May 20, 2006).
²²Kay Lazar, Wonder Drug for Men Alleged to Cause Harm in Women, BOSTON HERALD, Aug. 22, 1999, at B1.
²³Letter from Novartis Pharmaceuticals Canada, Inc., to Health Care Professionals in Canada (Nov. 17, 2005), available at http://www.ca.novartis.com/downloads/en/letters/femara_hcp_e_17_11_05.pdf (last visited May 20, 1006).
²⁴Supra note 9 at § 31.
²⁵Association of Women's Health, Obstetric and Neonatal Network, Infertility Treatment as a Covered Insurance Benefit, (Nov. 2000), available at http://www.awhonn.org/awhonn/?pg=875-4810-4860 (last visited May 20, 2006).
²⁶John Rinehart, A Physician's View on ART and Procedures and Legal Policy (2006), available at http://www.thehumanfuture.org/commentaries/commentary_rinehart.html (last visited June 20, 2006). See also American Society of Reproductive Medicine, State Infertility Insurance Laws at http://www.asrm.org/Patients/insur.html (last visited July 11, 2006), and Fertility Life Lines, State Mandated Benefits, available at http://www.fertilitylifelines.com/paying/insurance/statemandate.jsp (last visited July 11, 2006). These sites list all of the states that have laws mandating that insurance companies either "cover" or "offer to cover" infertility treatments.
²⁷NHS to Offer One Free IVF Cycle, BBCNEWS.COM, Feb, 24, 2004, available at http://news.bbc.co.uk/1/hi/health/3516941.stm (last visited July 13, 2006).
²⁸IVF Good for British Economy, BBCNEWS.COM, June 19, 2006, available at http://news.bbc.co.uk/1/hi/health/5095884.stm (last visited July 13, 2006).
²⁹Assisted Reproductive Technology Helps Address Demographic Challenge in Europe, PR NEWSWIRE EUROPE LTD., June 19, 2006, available at http://www.prnewswire.co.uk/cgi/news/release?id=173728 (last visited July 13, 2006). For the original paper, see J. Grant, S. Hoorens, F. Gallo, and J. Cave, Should ART Be Part of a Population Policy Mix? A Preliminary Assessment of the Demographic and Economic Impact of Assisted Reproductive Technologies, RAND, DB-507-FER (2006), available at http://www.rand.org/pubs/documented_briefings/DB507/ (last visited July 13, 2006).
³⁰DEBORAH L. SPAR, THE BABY BUSINESS: HOW MONEY, SCIENCE AND POLITICS DRIVE THE COMMERCE OF CONCEPTION (2006). See also, Cameron, supra, note 1 at 769-770.
³¹Julie Hanna, The Business of Babies, HARVARD BUSINESS SCHOOL WORKING KNOWLEDGE FOR BUSINESS LEADERS, Nov. 17, 2003, available at http://hbswk.hbs.edu/item/3790.html (last visited July 13, 2006).