Assisted reproductive technologies have given rise to unprecedented ethical and legal dilemmas. Extra embryos often result from the assisted reproductive process, and some couples generously put their surplus embryos up for adoption, to be implanted in another woman. Other women and couples donate the embryos for stem-cell research. One study found that 60% of couples were willing to donate their surplus embryos to research, 22% were willing to donate to another couple, and 24% would discard them (Kliff, 2007). Other situations result in controversy, as when a divorcing couple disagrees about what to do with the embryos they froze before they ended their mar­riage. By 2000, more than 20,000 frozen embryos were the subjects of such disputes (Silvertsen, 2000).

Conceiving Children: process and Choice

Further ethical questions arise regarding selling embryos and paying women for their ova and men for their sperm. Unlike the United States, Canada and China prohibit paying women for ova, resulting in a shortage of eggs and embryos for IVF. Women with sufficient financial resources resort to "international reproductive travel"—going to other countries to purchase ova or embryos for IVF (Heng, 2009).

Pre-implantation genetic diagnosis of embryos is currently available and is used to screen for serious genetic problems. Genetic alteration prior to implantation might be implemented in the near future (Geary & Moon, 2006). Genetic alteration could give parents with a known genetic defect—

0 predisposing them to developing Alzheimer’s, breast cancer, cystic fibrosis, or another illness—the ability to have their eggs and sperm genetically altered to

1 remove the illness-causing genetic material prior to in vitro fertilization and implantation (Begley, 2001). Nine months later the couple’s baby will be born

I without the legacy of family genetic problems. Many bioethicists support this development, which can shield children from disabling and life-threatening genetic problems. Others oppose this technology because it could be used to genetically engineer "designer babies," selecting for characteristics such as hair, eye, and skin color (Moses, 2009).

I Reproductive technology has made it possible for women past the age of < menopause to become pregnant, carry the pregnancy, and deliver their babies. The postmenopausal woman’s own ova are not viable, so ova from a younger woman are fertilized in vitro, usually with the sperm from the older woman’s husband. With hormonal assistance, the woman’s uterus can maintain a preg­nancy. Women as old as 70 have had babies by means of ART (Caplan, 2008). In the future, younger women may have their ova preserved by freezing to offer them some protection against the decline in fertility with aging (Stoop et al., 2011).

Should elderly parents who may die before their children reach adulthood be denied the use of reproductive technology? Some believe that the welfare of current and future children should be taken into account, but others maintain that it is unethical to deny women the opportunity to conceive on the basis of age alone (Murray, 2009). Current guidelines from the American Society for Reproductive Medicine state that fertility programs can withhold services only if they have well-substantiated judgments that the woman or couple cannot provide adequate child rearing (Rubin, 2009).

Fifty years ago assisted reproductive techniques were found in science fiction stories instead of at the numerous assisted reproductive centers in the United States. Assisted reproduction is currently a $3 billion a year industry (Coeytaux et al., 2011). Financial incentive and technological advancements will continue to expand the options for repro­ductive technologies as well as the legal, ethical, and personal quandaries that invariably accompany them. The director of the Project on Biotechnology in the Public Interest at the Center for Genetics and Society summarizes:

Responsible federal oversight of the fertility industry, in ways that protect reproduc­tive rights and actually improve appropriate access to fertility, is not only possible but long overdue. Comprehensive policies have been adopted in Canada, the United Kingdom, and elsewhere. It’s time for the United States to catch up and move beyond its reputation as the "Wild West" of assisted reproduction. (Reynolds, 2009, p. 3)