Procreative Liberty and Harm to Offspring in Assisted Reproduction.

John A. Robertson, Procreative Liberty and Harm to Offspring in Assisted Reproduction, 30 AM. J. L. & MED. 7 (2004).

Assisted reproductive technologies (ARTs) have enabled many infertile couples to have children but have long been controversial. Opposition initially focused on the "unnaturalness" of laboratory conception and the doubts that healthy children would result. Once children were born, ethical debate shifted to the status and ownership of embryos and the novel forms of family that could result.

In vitro fertilization (IVF) has generally been thought to be safe both for women and offspring. While hyperstimulation of the ovaries and egg retrieval are not risk-free, the incidence of ovarian hyperstimulation syndrome and other untoward effects has remained low. Nor did there appear to be a higher incidence of morbidity and mortality among IVF offspring.

Recently, however, studies of children born from IVF or intractoplasmic sperm injection (ICSI) have shown that there may be a higher incidence of certain rare birth defects and lower birth weight among offspring. One study reported that singletons conceived using ARTL were at an increased risk for low birth weight, while another suggested an increased risk of major birth defects. Still another concluded that children conceived through IVF have an increased risk of neurological problems, especially cerebral palsy. ICSI, which now occurs in almost half of U.S. IVF treatments, has been reported to have a higher risk of sex chromosome and imprinting disorders.

If future studies show that IVE ICSI, and ART variations do have a higher risk of harmful outcomes for offspring, important ethical, legal and policy issues will arise: Does an infertile person's interest in having offspring justify the additional risk to resulting children posed by the procedure itself?. What professional or public policy steps should be taken to minimize those risks or to restrict use of the ARTs causing them? Such an inquiry will depend largely on the degree of harm to offspring, its correctability, and the extent to which parental freedom to reproduce includes the right to take such risks in having children.

In all of the situations surveyed, the child appears to be harmed by the very method of conception, gestation, or social setting of birth. If the "prime consideration...