Reproductive technology: Exploring ethical questions

We often hear about technology companies moving faster than their counterparts in politics, ethics and public safety. Self-driving vehicles will soon be on public roads despite a history of fatal accidents, and electric scooters have taken over several major cities, complicating city design and resulting in injuries.

Technological advances have similarly led to incredible possibilities within reproductive health. Physicians now have the ability to perform in vitro fertilization, fetal surgery, egg freezing, and even uterine transplantations.

In addition, scientists have successfully created an artificial womb that can support organ development in extremely premature lambs.

While exciting and well-intended, these innovations are developing faster than our ability to adequately address their bioethical implications.

At the recent 2019 American Society for Bioethics and Humanities’ Annual Conference, multidisciplinary research and discourse warned the scientific community about the dangers of reproductive advancement, emphasizing some key ethical questions to consider.

Elective oocyte cryopreservation

Oocyte cryopreservation, or egg freezing, was first reserved for women undergoing reproductive-failing treatment like chemotherapy and radiation. However, oocyte cryopreservation is now offered electively and has given rise to an estimated $4.3 billion industry that doesn’t allow health insurance coverage and is filled with misleading advertisements targeted at women of prime reproductive age.

Capitalistic egg freezing companies have emerged, and companies like Facebook and Microsoft now offer oocyte cryopreservation as an employee health benefit.

Ethical considerations: Are we giving women more reproductive freedom, or are we only further encouraging the delay of motherhood for career advancement? Should we, instead, be supporting earlier motherhood? And what extent of social inequality are we perpetuating with the lack of medical coverage for these costly services? 

Uterine transplantation

Just as oocyte cryopreservation was intended to help patients preserve fertility, uterine transplantation is the only treatment for absolute uterine factor infertility. However, few surgeries have been attempted, as it is a high-risk procedure in the clinical-trial stage with little successful live births after transplant.

Furthermore, in addition to donor organ harvesting and invasive surgery, immunosuppressive therapy is necessary, causing many to wonder if the benefits could ever justify the surgery.

Ethical considerations: Does uterine transplantation and egg freezing perpetuate the idea that biological children are better than non-biological children? Should these surgeries even be offered if they are largely experimental? And are we truly advancing reproductive freedom by offering uterine transplantation?

The artificial womb

The artificial womb aims to facilitate organ development in premature infants who require neonatal intensive care. Scientists have shown significant progress in their work with lambs, and while no research has been done in humans, it is important to consider the effects of artificial wombs on maternal healthcare.

Ethical considerations: What will the successful creation of the artificial womb for humans do to the current understanding of periviability? Will it govern the decisions a woman can make about her fetus? How will this change the laws around abortion and surrogacy? Could it potentially make these practices obsolete?

Just as self-driving cars and e-scooters have altered city landscapes, technology is, in some cases, redefining reproductive healthcare faster than these questions are being answered. The field of reproductive ethics paints a cautionary tale that the best intentions aren’t always enough.

-By Kristi A. Fu, M.D. candidate enrolled in the Medical Ethics Pathway at Baylor College of Medicine and recipient of the Laurence McCullough Travel Award