Infertility affects more than 186 million couples worldwide, including 1 in 6 American couples. Worldwide, assisted reproductive technologies (ART) have enabled the birth of over one million babies. Annually, in the United States alone there are over 100,000 fertility procedures performed, at a cost of $4 billion, and 60,000 births result from donor insemination; at least 1,000 from surrogacy arrangements; and more than 40,000 from other ART technologies, such as in vitro fertilization.

However, the ethical, social and political controversies surrounding ART have evolved as quickly as the technologies themselves. For example, in their quest to help infertile couples, fertility specialists have often failed to consider the consequences of their actions on the couples undergoing the procedures and the children born with the aid of the new technologies. Experimental techniques are rapidly introduced in ART clinics, but often with limited prior animal experimentation, randomized clinical trials, or the kind of rigorous data collection that occurs in other types of medical experimentation. Individuals using ART are sometimes inadequately informed about the risks associated with fertility drugs and multiple births, for example.

ART is expensive. In many countries, including the United States, ART is rarely covered by health insurance so not everyone who needs medical assistance to have children benefits from ART. Some ART consumers report that they were not adequately informed in advance about the cost of ART therapies, including the number of therapies that they would have to undergo to achieve a successful birth as well as the costs associated with a high-risk pregnancy, such as that which results from a multiple birth.

Recent studies across the globe show that ART increases the risk that the resulting children will have genetic birth defects and other illnesses. Some countries, such as Belgium, Australia, and the U.K., keep track of how many children conceived through reproductive techniques have genetic abnormalities. Other countries, including the United States, have no institutionalized system. In fact, only the U.K., Canada, Australia and Germany have adopted comprehensive regulatory schemes to address ART procedures and clinics. The full magnitude of the possible physical and psychological risks to ART children is therefore unknown.

The ethical and policy challenges of ART are daunting. For example, ART clinics can examine embryos to allow individuals to decide whether to implant embryos of a certain sex or genetic makeup. But should they? We are the generation that will decide whether to embrace or reject technologies that could profoundly change the human species. It is imperative that society assess the technologies that are already in use, examine the risks ART presents to women and children, and assess emerging technologies to ensure that ART enhances, and does not diminish, the human future.