As technology marches on, what are the medical and ethical ramifications for individuals, for families, and for society?
Future of Reproduction – Priceless, with Questions
On May 1, 2014, a panel of experts meets on stage for Exploring the Future of Reproduction, held at the UCSF Medical Center at Mission Bay, Byers Hall, with moderator Dr. Kiki. Panelists will examine the possibilities and challenges of technology in human reproduction and cover, among other topics, the medical and ethical ramifications for individuals, for families, and for society as prospective parents have ever more options for procreation.
Panelist Nolwenn Bühler is a University of Zurich social anthropologist studying assisted reproductive technologies, especially egg donation and freezing, in Switzerland. She is currently a visiting researcher at UC Berkeley. We asked her to share a taste of what the May 1 discussion might hold.
1) What are some of the issues around new science and technology when applied to reproduction?
How reproduction is controlled and by whom, who is empowered to reproduce and who is not, and what kind of family model is promoted are questions at the core of the politics of reproduction.
Assisted reproductive technologies (ARTs) increase the degree of human intervention in the biological processes of reproduction and they allow us to separate things out – such as sex from reproduction, gametes from human bodies – and also open the possibility of involving more people in the creation of new human beings.
These technologies do have an impact on categories we often take for granted, such as who the mother is. Thus, one of the issues arising from ARTs is related to new ways of making families and to new ways of defining what parents and children are in relation to each other, and what genealogy and origin means.
There are also financial dimensions to consider as well as the labor required to perform treatment. Usually eggs are hidden in the body, but through ARTs they become transferable extra-corporeal entities and their value changes. They can be exchanged, donated, and sold.
On the one side, reproductive treatment with donated eggs promise the priceless – children – but on the other side they have a price, and the procedure required to retrieve them is invasive and demanding.
Furthermore, eggs are not considered as waste or surplus tissue and not considered to be renewable, making them a rare and precious good. Nowadays, the demand for eggs for the needs of reproductive treatment is increasing in many countries, while donors are still hard to find, with the consequence of an insufficient supply of eggs.
This situation raises conflicting questions about the protection and information of egg donors, as well as about what can be sold or not, what should be paid for or should remain out of the financial domain, and what “work” should be financially compensated.
Another issue, at least in Europe, is related to cross-border reproductive care, more commonly called reproductive tourism. In Europe, countries have different regulations on ARTs that can be more or less restrictive or liberal. In Switzerland, egg donation is prohibited, for example.
Patients may decide to travel across borders to circumvent these restrictions and access these procedures. Gametes and donors can also travel from one country to the other. This phenomena raises, among others, questions about equality, choice, information, transparency, security, traceability, and registering.
2) What are the main differences between available reproductive assistance in Switzerland versus the US?
Switzerland is characterized as very restrictive with regard to reproductive regulation, similar to Germany and Austria. In Switzerland, some technologies such as egg donation, preimplantation genetic diagnosis, and surrogacy are legally prohibited. Sperm, however, can be used in reproductive treatment for married couples.
At a more technical level, embryos cannot be frozen, only zygotes can, and the number of zygotes that can be developed out of the body is limited to three, which has an impact among others on the feasibility of preimplantation genetic diagnosis and the rate of twin pregnancies.
Additionally only heterosexual couples in a “stable relationship,” so currently no single women or same-sex couples, can access these options in Switzerland.
What is similar to the US is that there is no public insurance coverage for IVF, thus access remains mainly on the ability to pay. All these elements have an important impact on medical practices, as well as on patients’ choices and trajectories.
3) Now that treatment makes motherhood an option at older and older ages, how does that change the family dynamic, for better and for the worse?
People often place great hopes in the ability of ARTs to help them to conceive at older age, and are disappointed when they realize that it is not so simple. However, reproductive treatment using donated eggs, that is the eggs of another woman, often younger, as well as the possibility of freezing one’s own eggs open up the possibility of extending female fertility and even raises the prospect of decoupling age and fertility altogether.
On the one hand, this possibility can be read as a new freedom and liberation from the famous “biological clock,” as well as an opportunity of increased equality between men and women. On the other hand, it raises fears for some of intergenerational confusion – for example, how will a young adult deal with a mother who needs care, or is this possibility creating premature orphans? Others make moral judgments about older mothers being selfish, irresponsible, and wanting to have it all.
The extraordinary cases of post-menopausal pregnancies especially tend to raise this kind of concern. However, I think that it is becoming increasingly more normal to have kids in a woman’s forties through egg donation. I also think that before changing families and motherhood, these possibilities change the way reproductive aging and age limits are defined at a biological level and at an individual level.
4) How did you become interested in studying these issues?
I was interested in the relationship between science and society, especially in regard to gender issues and I had the great opportunity to work in a project funded by the Swiss National Science Foundation on the specific topic of ARTs, and I quickly became fascinated by the many questions these technologies raise.
5) What questions and discussions do you expect — and hope — to have during the panel discussion at UCSF Mission Bay?
A point that I find interesting is the important contrast between ARTs in Europe and in the US. I look forward to knowing more about the American situation through the discussion. I also look forward to learning more from people working in the field and researching the subject in other disciplines, I am sure that the discussion will be very enriching!