Test tube babies have long been stigmatized by society as the unnatural results of scientific dabbling. The words `test tube baby' have been used by school children as an insult, and many adults have seen an artificial means of giving birth as something perhaps only necessary for a lesbian woman, or a luxury item only available to the elite few. The reality is that assisted reproductive technologies (ART) have been helping infertile couples have children since 1978.1 The methods of in vitro fertilization, it's variants, and the other ART procedures are ways for persons that would otherwise have no hope of conception to conceive and, in a rapidly growing percentage of cases, give birth to healthy babies. As the technology has developed, the quality and range of assistance has developed as well. At present, the means of assisted reproduction and the capabilities of these procedures has grown at a somewhat dizzying pace. However, thought to the repercussions of the applications of ART are being disregarded to some extent while the public's knowledge and the understanding of embryologists and geneticists surges forward. It is possible given consideration to things such as the morality of these techniques, the unexplored alternative uses of these procedures, and the potential impact they posses that further development is unnecessary and possibly dangerous.

As of 1995, 20,000 babies had been born as a result of ART treatments.2 Since then, many women and couples have sought the services of IVF clinics all over the world with hopes of the miracle of conception. These people are usually ones who suffer from some sort of condition that renders them infertile or sterile. Women are usually afflicted by a reproductive disorder, such as endometriosis, blocked fallopian tubes, amenorrhoea, or ovarian failure, while men suffer from either an abnormality of, deficiency of, or complete absence of sperm.3 For most of these people, the only course of action is an artificial means of conception. Sometimes the problem is just a matter of timing, and all that is required is a timed schedule generated for the couples' attempts, and perhaps a few prescribed drugs. However, often the problem requires much more than those simple procedures.

When a couple is diagnosed with any of the aforementioned illnesses, they are given a number of options. These ART treatments, inclusive of in vitro fertilization (IVF), gamete intrafallopian transfers (GIFT), intracytoplasmic sperm injections (ICSI), cryopreservation (freezing) and donor oocyte (donor egg) programs, can be costly to couples, but well worth it.4 IVF and GIFT consists of basically the same procedure; in an IVF cycle, eggs and sperm are fertilized in a laboratory, and the resulting embryos are transplanted into either uterus or the fallopian tubes if they are healthy. In GIFT, the eggs are unfertilized when introduced with prepared sperm into the fallopian tubes. ICSI is a new treatment, developed and implemented successfully in 1993, which is used for the treatment of male infertility, and as of 1995, even sterility.5 The procedure involves extracting a single functional sperm from a male and, using a special glass needle, injecting it into an egg held by a pipette for fertilization in a petri dish.6 The remaining methods, cryopreservation and oocyte donor programs, entail the donation and storage of eggs or embryos.7

Ever since the birth of Louise Brown, the first IVF baby, ART has been a topic of fascination for scientists and society alike.8 Scientists have continuously made attempts at improving and expanding these technologies with great success, and the public has become more and more informed and hence has taken greater advantage of the procedures when they could afford it. There have been many developments, inclusive of the ability to mix the fields of genetic testing, assisted reproduction, and possibly cloning, and the added technology has helped those countries with a low population due to infertility to maintain and even increase the number of people living there. The relative rate at which the technology has increased is quite high, seeing that since 1978, 8 new techniques have been discovered.9 A few of these methods are quite new, and though successful, have not been tested to a great extent. In fact, when the ICSI method was developed, Dr. Andr. Van Steirteghem told reporters that `he was not sure how it worked,' even though he developed the procedure himself.10 And though he was not sure about the process or what actually happened, he continued to use the technology as a legitimate means of assisted reproduction.

Medically, the impact of IVF and the other ART procedures has only recently begun to surface. There have been numerous studies related to the current health of IVF patients and their offspring. These reports suggest a number of troubling things. Firstly, ovarian and breast cancer have been linked to the use of hormonal stimulation necessary for most ART methods. It is said that the increased level of ovarian hormones contributes to the development of undetected or malignant cancers, thus making it absolutely necessary for any woman undergoing an ART treatment to get a mammogram and pap smear before she begins an IVF cycle.11 Also, since the use of infertility treatments increases the chance of multiple births, there are bound to be complications in many IVF pregnancies, premature birth being one of the most prevalent. According to another study directed by the St. James Hospital in Leeds, England, these IVF multiple births have led to many cases of blindness in the children born. The blindness is caused by a genetic defect, termed `retinopathy of prematurity (ROP),' which is treatable only if found within anywhere from days to 10 months after birth.12

Britain has been the center of controversy for the IVF and ART debate as of late. The biggest story is that of Diane Blood, a widow who has been fighting the British Human Fertilization and Embryology Authority for two years to win the right to have her late husband's child.13 Along with this was a report from a few months earlier regarding the Garbers, a couple in California who were advertising for a surrogate mother for their deceased daughter's embryos. The dilemma in both situations was the fact that neither the daughter nor the husband had given written consent for the use of their respective gametes, though spoken consent was claimed in both cases. In the US, doctors refused to help the Garbers find a surrogate mother, though there is no law to say that they cannot be helped. In Britain, there is a law that states that anyone donating any part of their person must sign a written consent form before any procedure can take place.14 However, because public opinion differs from culture to culture in terms of policy regarding this situation, there is nothing to say that the Garbers cannot have their wish, or that now that Ms. Blood has ownership of the sperm, that there will not be another European country that will grant her request.

Surrogate parentage, egg, and sperm donation are three aspects of ART that present several moral dilemmas. Most countries do not allow anonymous donation; a written consent form or some type of contract is necessary to be a donor.15 Most countries do not allow much reimbursement for donation either. One of the major problems that arises from this policy is what could be termed `egg trafficking.' Because of the regulations that the British HEFA has established which allows for only £15 in compensation, there is a shortage of stored eggs and about 2,000 women in line to receive eggs. One woman has turned the shortage into a business bypassing the regulations and paying women who become donors for her agency up to £750. In fact, a woman who is a donor for the agency can make £3,000 a year from donation. Even some doctors at legitimate fertility clinics turn their heads at accepting donors who have received compensation, even though acceptance of such donors has been barred. And of those doctors who abide by the rule, most will still provide the donor with the information that they need to become a donor elsewhere. Another downside to the system is that the process and drugs involved can be jeopardous to the health of these young women. The HEFA suspects that `people are donating for financial gain and nothing else,' making the danger that donors put themselves in seem somewhat senseless. Claire Austin, the owner of the illegal donor agency, contends that the women are given compensation because the people paying are `not paying for your eggs, they're paying for your time, trouble, inconvenience and the discomfort of having daily injections and regular scans.' What Austin is doing is by no means illegal in Britain. There are some, such as Harriet Harman, who would like to see that it is. As the Labor Party's health spokesman, she described the view that is shared by many of Britain's political and medical figures, a `public abhorrence at a market in human tissue.'16

The question of whether or not it is right to have the child of a person who has already passed on surfaces again when considering some possible applications of ART. The very essence of the technology is to provide something to someone that Mother Nature, or God, had originally denied them. Because of ART, it is possible to have the child of a person already dead.17 It is also possible to have children after menopause,18 after having an vasectomy or virtually any other sterilization treatment.19 Studies conducted in 1994 by NF Organon, and international embryology and genetic engineering awareness group, showed attitudes pertaining to ART worldwide. For the great majority, ART was available to only the wealthy, and offered to only married couples. In countries that have strong national religious convictions, the moral codes allowed for use of only the most simplistic methods of assisted reproduction, and even then, using ART was a last resort and frowned upon.20 Another study published in 1994 in the journal of Social Science and Medicine compiled the results of several surveys done worldwide, with the concentration being in Japan and New Zealand. This particular study revealed that people in Japan were quite well informed about biotechnology and genetic engineering, and as a result of that knowledge, Japanese were the most concerned about the possible implications of the science. Also exhibited was the fact that the great majority of countries regulated the age at which a woman could receive treatment, and that the greatest objections to the use of ART and genetic engineering were `that [they were] seen as interfering with nature, playing with God or as unethical.' However, there is no true general consensus on the acceptable perimeters of many of the applications of the IVF procedures.21

In those same surveys, the positive side of ART and genetic testing was addressed; there is a great deal that IVF and testing has to offer in the way of benefits for society. In vitro cloning of certain animals and plants leads to the production of treatments for illnesses, and also to an increase in food stock. Genetic testing and certain IVF procedures lend themselves to the diagnosis and treatment of genetic diseases, and corrective proteins from recombinant DNA technology.22 With all these things that offer a definite positive side to the issue, there still exists things such as `computer-assisted sperm selection,' which would allow a woman to pick and choose particular characteristics of a man who's sperm she would want to use,23 thus exercising her own form of selective genetic engineering.

Unlike in England, there tends to be a surplus of donated embryos in the more developed countries. While this surplus certainly shows that ART procedures are supported in most places, it also presents a moral dilemma, that being deciding what is done with the extra embryos. Are they left there to expire after a certain amount of time, thus wasting human tissue, or are they used in other ways? Some scientists have been using extra embryos to do tests on human tissue. However, this particular usage of the surplus is perhaps the most contested happening of all. Society in general is strictly opposed to the use of human tissue for any type of testing, especially of the sort that genetic engineers would be carrying out, again citing tampering with the natural order of things, attempting to play God, and a fear of the unknown as sufficient reason for their concerns.24

Lastly, there are the many questions relating to the new ability to clone a mammal. Ever since the genetic miracle of Dolly was released, people have been asking what the implications might be. According to the London Times, it may someday be possible to clone a human for use in a bone marrow transplant, and on that same thread, clone a brain dead human, so that there would be no `real' societal impact.25 However, if that were possible, what else would be? It is already possible during IVF treatments to correct some genetic abnormalities in the embryo before it is implanted into the mother. Would it then be possible to genetically perfect any embryo? Would it be possible to have a race of entirely perfect people, with no disease, mental or physical? And what of the implications of that? Fewer early deaths, leading to increased population, leading to the need for more food, fuel, and a higher demand on natural resources, and eventually the exhaustion of those resources. But that is only one possible outcome.

Hitler wanted to create the perfect nation: an Aryan nation, physically, mentally, and genetically perfect. In his time, this goal could only be accomplished by looking at the outward traits of certain individuals and pairing the ones that seemed to fit the formatted description. However, had Hitler been able to access some of the technologies available today, his goal would have been easily attainable through the technology that is presently seen as giving hope to millions of couples who seek simply to exercise their right to raise a child. Is the development if such technology ethical? Is the possibility that it could do greater harm than good enough to terminate the development of such technology? These questions are most likely too much to answer, given what is known and understood about genetic engineering, assisted reproduction, and DNA cloning. But perhaps the best answer is to say that before things are taken any further, we stop to look at what we have, attempt to understand and evaluate those things, and determine whether it is truly necessary to make advances in the technology. Perhaps we are at a point where the most important thing is slow down the pace of change before it gets away form us.