Fertility Medicine as Big Business

One of my repeated rants about news coverage of fertility medicine is that it tends to be overly focused on anecdote and emotion. Tabloid-worthy stories—such as the Nadya Suleman "Octomom" story or the occasional "Win a Baby" promotion whereby a clinic (or recently, a radio station) holds a sweepstakes with IVF treatment as the grand prize—attract interest and some outrage, and then get upstaged by the next dramatic news story. In much news coverage of fertility medicine, happy endings (overjoyed parents with healthy babies) overshadow ongoing ethical concerns.

But I wonder if the news media may finally be waking up to some of the larger, increasingly complex ethical concerns raised by reproductive technology. Just this week, I've read several articles focused on the corporate, profit-driven nature of reproductive medicine, and arguing that the economic realities of fertility medicine deserve more attention.

Several articles responding to a Style Network show about "super-spawners" (sperm donors who contribute their genetic material to dozens or hundreds of children) argue that the corporate nature of gamete donation deserves more scrutiny. At Biopolitical Times, for example, Emily Beitiks notes that the issues raised by such sperm donors go far beyond the logistical problems that many people focus on, such as the chance that half-siblings will unwittingly become involved in incestuous relationships. Beitiks argues:

there are certain things that the numbers alone do not capture. Donor children have raised many concerns around the right to knowledge of one’s genetic heritage that are relevant regardless of how many half-siblings one has. In addition, the economic forces behind the large number of offspring from a single sperm donor are worth considering. Neither Style Exposed nor most of the media coverage has tapped into these deeper questions.  We need to move past the dizzying numbers of offspring and half-siblings, and consider why this is happening. While fertility clinics and sperm banks make families possible for people who otherwise could not have them, their practices are for better or worse motivated at least in part by profits as baby-making has become a multi-million dollar business. It makes economic sense to use the same sperm donor repeatedly, especially if his traits are appealing and marketable. 

In other words, gamete donation and fertility medicine operate under the same sort of efficiency measures that govern other corporate concerns. If a sperm donor is "proven"—if he possesses traits that appeal to prospective parents, if his sperm have been used in a number of successful conceptions—then using his sperm again and again makes economic sense for the clinic, the clients, and the donor. But at what cost? In the Style Network show, one super-donor's fiancée was obviously troubled by the knowledge that her husband-to-be already has several dozen biological children in the world. And adult children conceived via gamete donation are increasingly speaking up about their need to know more about their biological and genetic heritage.

Another expanding corner of the fertility industry—Indian surrogacy—has likewise responded to market pressures, growing far faster than clinics, governments, patients, and others can consider the moral questions it raises. Because hiring an Indian surrogate via an Indian fertility clinic is far less expensive than accessing the same services through a U.S. clinic, surrogacy is becoming accessible even to people without a lot of wealth, thus increasing the number of potential clients. As demand for surrogates grows, so do concerns about how Indian surrogates are recruited, treated, and compensated. As American journalist Scott Carney notes:

Before India, only the American upper classes could afford a surrogate. Now it’s almost within reach of the middle class. While surrogacy has always raised ethical questions, the increasing scale of the industry makes the issue far more urgent. With hundreds of new clinics poised to open, the economics of surrogate pregnancy are moving faster than our understanding of its implications.

I was tempted to title this post It's the Money, Stupid. I didn't, but it seems that perhaps the news media and others are finally recognizing that ethical concerns with fertility medicine go far beyond anecdotes about people who make extreme choices, or nuts-and-bolts health concerns, such as whether IVF-conceived babies are healthy (a question that is still open; see this article about a potential link between IVF and rare genetic disorders) or whether half-siblings will unknowingly get romantically involved. These are important questions. But in our market- and consumer-oriented society, big business tends to act first, adopting practices that improve efficiency and profit, and altering practices for ethical reasons only when the media and public become sufficiently aware of all the ways in which profit motives can undermine human welfare. When it comes to fertility medicine, the welfare of many, many people is involved—prospective parents, much-wanted babies, gamete donors, surrogates, and the families of donors and surrogates. An important step in protecting the welfare of all involved is recognizing that, no matter how altruistic clinicians' motives may be, no matter how much pain infertility causes and how effectively reproductive medicine can help ease that pain, no matter how beautiful and beloved IVF-conceived and surrogate-born babies are, fertility medicine is clearly big business with a significant profit motive.