Final Report (all chapters)

United States. According to a 2002 CDC survey of ART success rates, IVF accounts for more
than 90 percent of all performed cycles involving fresh non-donor eggs.) 8
IVF safety has received considerable attention in the clinical literature, though mostly
abroad. Among the risks associated with IVF mentioned in the literature are birth defects, low
birth weight, neurological disorders, ectopic pregnancies, craniosynostosis, Beckwith-
Wiedemann syndrome, Angelman syndrome, and the cloacal-bladder exstrophy-epispadias
complex. Some of these risks are minute, while others are quite large. In most cases, however, it
should be remembered that these risks reflect statistical associations and not causal relationships.
Before turning our attention to innovative reproductive treatments, a few words about what
has become known as collaborative reproduction are in order. 9 Collaborative reproduction ranges
from fairly prosaic procedures, such as sperm donation, to medical interventions, such as oocyte
and embryo donation. In the United States, sperm donation is a well-established practice,
facilitated by numerous sperm banks. (Interestingly, no one seems to know just how many, even
though the FDA now requires sperm banks to be registered.) 10 From a public health perspective,
this practice is by no means unproblematic. In the late 1990s, the need to prevent the spread of
infectious diseases prompted the FDA to regulate the trade of human tissues, including sperm,
oocyte, and embryo donation. 11
Sperm donation does raise some important ethical questions that go beyond considerations
of safety and efficacy. There remains considerable skepticism about the wisdom of tolerating a
free market for sperm. Much more controversial and problematic from an ethical standpoint are
oocyte and embryo donation. Collaborative reproduction involving oocytes is far less common
than anonymous sperm donation, partly because retrieving oocytes is a costly and painful
medical procedure, but also because oocytes are far more difficult to preserve, though as we
show below, cryopreservation technologies are making progress. The use of third-party embryos
remains very uncommon, in large measure because a full-fledged market for embryos seems to
many to be a very problematic proposition. Not coincidentally, only approximately two percent
of cryopreserved embryos have been put up for adoption – less than number of embryos donated
for research. 12
In some extreme cases, four individuals may be involved in the reproductive process: the
prospective legal parents and the oocyte and the sperm donor. A surrogate mother may also
8
9
10
11
12
Centers for Disease Control and Prevention, "2002 Assisted Reproductive Technology Success Rates: National
Summary and Fertility Clinic Reports," (Atlanta, GA: National Center for Chronic Disease Prevention and
Health Promotion, Division of Reproductive Health, 2004).
Helen M. Alvare, "The Case for Regulating Collaborative Reproduction: A Children's Rights Perspective,"
Harvard Journal on Legislation 40 (2003); Kenneth Baum, "Golden Eggs: Towards the Rational Regulation of
Oocyte Donation," Brigham Young University Law Review (2001).
Note that “donation” in this context should not be interpreted literally. Sperm donation in the United States is a
lucrative business and an industry, complete with its own trade association.
The FDA has promulgated three main new rules: the “establishment registration and listing” rule, the “donor
eligibility” rule, and the “good tissue practice” rule. See chapter 5.1.2 for details.
William Saletan, Leave No Embryo Behind (June 3, 2005 [cited March 14, 2006]).
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