The ethics of fertility, who can use fertility treatments?
Advances in the field of reproductive medicine provide human beings with greater control of their fertility than any time in history. Between in vitro fertilization (IVF), egg donation, gestational surrogacy, preimplantation genetic diagnosis (PGD), egg freezing and many other fertility options, modern individuals and couples can make choices about their fertility that once only existed in science fiction. Along with these choices however, come new questions. For example, what type of limits should we place on whom can access fertility treatment? (age, sexual orientation, criminal history, financial status, psychological health, physical health). Because some of our treatments can expand fertility beyond biological norms, we must consider the ramifications of our treatments to our patients (individuals and couples), future offspring, and society as a whole.
For some of these questions we have solid and easy answers, for others we do not. This blog post will explore some of the interesting treatment questions we have faced and some we anticipate in the future.
The fantastic success of egg donation has truly eliminated the biological age limit for conception. Proof of this come from reports of women in their mid 60’s conceiving and delivering in India. In fact, from a biological point of view, as long as the uterus is present, any age woman couldtheoretically become pregnant. Importantly, just because any age woman could theoretically become pregnant, does not mean that any age women should become pregnant. As age increases, pregnancy risks to mother and baby increase. Older women will have less time remaining of their life potentially creating a baby destined to become orphaned. For these reasons, not all women who request treatment will be able to access treatment. In general, we do not make specific limits on treatment based on age. Rather, we feel that case by case evaluation best serves this complicated option.
Happily this topic is becoming less controversial by the day. Our practice has always felt that sexual orientation should never be a barrier to accessing fertility treatment. We believe that a person’s sexual orientation has no bearing on their right be become a parent. We are proud to treat people who identify themselves as gay, straight, lesbian, bisexual, transgender or without gender.
We believe that psychological health should not be treated any differently than physical health. For example, if a patient presented with poorly controlled diabetes, we would defer fertility treatment until her diabetes was appropriately controlled. Once controlled, the patient must understand the potential increased risk of becoming pregnant with diabetes. Mental health is no different. Patients with depression, anxiety, panic disorder or other can all be acceptable candidates for fertility treatment; but their symptoms must be well controlled, they must be on the correct type of medication and they must have a doctor who will work with us once they are pregnant.
Unfortunately, fertility treatment can be quite expensive. We do not believe that a person should not become a parent because they have limited financial means. To that end, we offer very competitive pricing through a variety of payment options and treatment plans. In addition, we attempt simpler, less expensive treatment options, before moving on to more expensive modalities. Moreover, we participate in several financial assistance programs.
If you have questions about who may access fertility treatment, feel free to contact us, we’d be happy to chat with you.