Fertility can be a curious business, as things like embryo screening, designer babies, and egg-freezing become more and more popular amid quiet concerns about the commodification of human life. The number of people in Ireland availing of In Vitro Fertilisation (IVF) treatment has rocketed by 50 per cent, spurred on by the roll-out of State-funded fertility treatment in 2023.
The six fertility hubs established by the HSE are receiving up to 550 referrals monthly, RTE reported in February, with around 150 couples availing of State-funded IVF every month. But the door to ethical dilemmas and legal challenges has not only been left ajar; it has been blown wide open. For example, some will make the argument that everything is being done to assist women to reproduce, and men are not treated in the same way. Last month, a Belfast court heard claims that male couples seeking publicly-funded fertility treatment there faced “unjustified barriers” based on their gender and sexual orientation.
If we do accept IVF, we have to grapple with things like surrogacy. We have to ask ourselves if we are in favour of IVF universally, including same sex couples who want to start families. A key question becomes whether we are supportive of situations where, bluntly, a child is denied, by design, a mother or a father, and whether we think that is fair. We ought to be able to discuss whether everyone really has “a right to a child”. Single would-be parents, unable to find the right partner are also fuelling the growth in surrogacy. Is this a good thing? Yes, there are many great single parents, but I’m sure most would admit that they would rather have a partner in the picture.
Those are pertinent questions. As is the question of whether we should treat women, quite literally, as human incubators, who are enlisted to carry a stranger’s child for nine months, enduring all the sufferings that come with pregnancy, and then say goodbye like they did not have that experience. We should contend with what that does to a woman, psychologically and otherwise. Of course, what I am describing is surrogacy – a modern version of the Handmaid’s Tale, if you will, which relies on the practice of IVF.
Another major element of this debate is one which I was glad to see the Irish Independent reporting on a number of days ago – the high numbers of unwanted, frozen embryos created through the process. This is a kind of moral blackhole that is pretty much ignored.
The world of IVF is an ethical jungle, one well captured in the Independent article written by Danielle Barron. The journalist interviews Ciara Cashen, who is pictured with her adorable five-month-old son, Caelen, who was born after the fourth round of IVF. Her story is one of success tainted with a dilemma, as the new mother contemplates what to do with what she says are in effect her baby’s unborn siblings; the 15 embryos she and her husband Frankie have in storage.
Reading the piece, one learns that these frozen embryos are now referred to as “embabies.” Explaining the process, Ms Cashen, from Nenagh in Tipperary, says:
“Overall, we did four IVF rounds. The first two resulted in miscarriages and the third didn’t take, so we did a second egg harvesting so we could genetically test the embryos for any abnormalities that might have been affecting the pregnancies and that’s how I ended up with 15 embryos.”
Which gives the reader an insight into the relatively new world of what have been termed “designer babies” – something that, on an ethical level, opens up its own concerns. A designer baby, a term rooted in science fiction, refers to an embryo whose genetic makeup is intentionally selected or altered, often to dodge genes associated with diseases or to achieve desirable traits.
Would I for example, as a sufferer of eczema when I was younger, as someone who needed glasses, have made the cut? Probably not. In that sense, it is survival of the fittest. There’s a tweet going viral which ignited the whole conversation around designer babies and eugenics this week, telling the story of the creation of Orchid, an app which offers the world’s first whole embryo screen. The New York Times recently ran a piece on what is a common step in the IVF process, posing the question, “Should human life be optimized?”
The founder of Orchid proudly wrote that her baby got to “win the genetic lottery” and that this is now an option open to everyone else so that parents can be sure their child won’t have some kind of genetic disease. But this is uncomfortably close to the real, actual definition of eugenics – “a set of beliefs and practices that aim to improve the genetic quality of a human population.” I mean, it doesn’t just sound like eugenics. It is eugenics.
Back to the Independent article, where the couple interviewed said that they haven’t decided when or if they will go through IVF again. However, there is the admission that they “almost feel guilty” knowing that they will never implant all 15 embryos, who are, after all, their biological children at the earliest stage of human development. A stage we were all at, once.
“We have just had the first so we said we would give it a year and see how we feel about another child,” Ms Cashen says. “The worry, initially, is that you won’t get any at all. Now it feels like good insurance to have some in the ‘bank’ but we almost feel guilty knowing there’s no way we can use them all.”
There’s also the issue of the mounting cost on storing the embryos. The alternative is to destroy them, or place them for embryo adoption. This is a confusing pathway; it is not considered a formal adoption, and while legal in Ireland, is not legally recognised as adoption. The gestational mother and partner, if any, are recognised as the legal parents, and not the couples donating embryos.
It is considered a “transfer of property” and not as adoption, which can sound dehumanising. As detailed by the Human Fertilisation and Embryology Authority, embryos are also donated for research done by laboratory staff, and for research around infertility and genetic diseases. There is no legislation around the issue, meaning that the growing number of fertility clinics here have created their own policies around retention and disposal. Other couples have asked for their embryos to be returned to them so that they can bury or cremate them, while some choose to have their embryos thawed and made into jewellery – with the market for such strange DNA keepsakes growing.
If that sounds ethically problematic, it’s because it is. The Government continually talks about the benefits and successes of IVF, but there is zilch recognition of the reality that in practise, it – literally – renders human life disposable.
Big fertility is also, after all, an industry. A booming business worth millions, through which women suffer physical and mental pain for outcomes that are not assured. In Ireland, the average pregnancy rate for fresh embryo transfers sits at 41% for women aged 18-34 (as per a 2021 HFEA report) but this falls to 6% for women aged 43-50. And data from 2016, published by the BBC, puts the pregnancy rate from thawed eggs at a mere 1.8%. It can be a cycle of hope and loss that plays out on a kind of ethical and moral minefield that goes under the radar in a fiercely morally relativistic culture.
“People do become emotionally attached,” Dr John Kennedy, the medical director of Thérapie Fertility, told the Independent, meaning many tend to delay the decision regarding what to do with surplus embryos.
The purpose of an IVF cycle is to create as many health embryos as possible, he says. “Having too many is a good problem to have but it’s still a problem.”
He also agrees that when it comes to disposal, it’s a tough decision.
“These surplus embryos tend to take up space rent-free in your head,” Kennedy says. “You hear people talk about ‘embabies’ or ‘my frosties’. That just goes to show how emotive it is. For us who work in the field, it is just a group of cells with potential,” he tells the newspaper.
There’s savvy business to be found in embryo freezing, with many clinics offering things like monthly subscriptions to keep embryos in liquid nitrogen tanks (cryostorage) at a temperature of –196 degrees. The way in which the fertility doctor talks about the gulf between how staff see things, and how parents do, is to be expected. Big Fertility, whichever way you look at it, profits from the surplus embryos created. But for the parents of those embryos, it’s a different story. There is a downplaying of not just the financial costs involved – but also the major ethical ones that remain with parents when it comes to IVF.
There have also been messy legal battles, including celebrity ones, where women estranged from their partners or husbands want to use the embryos to get pregnant without his knowledge. Or cases where one partner wants to destroy the embryos or donate them and the other objects. And we would be here all day if I were to talk about the growing number of disturbing and bizarre IVF mix-ups, the latest one reported today, where an Australian woman gave birth to another couple’s child. In these cases, the woman is forced to give the child back to the couple to whom it biologically belongs. The mental and emotional agony for those involved can reach untold levels.
The unilateral message, championed by our own Government, seems to be that if you fork out the cash, a happy and healthy baby will be yours, no questions asked. It’s all so straightforward. But there are questions we should be asking. We have been conditioned to believe that we can ask for what we want, when we want it, and we will get it. That’s just not how life works. A child is not an accessory or a nice thing to have. Human life is not a commodity, even if Big Fertility treats it like it is.