Varieties of Infertility And Access to ART

Thinking about ART and third-party gametes and all leads me to think about infertility.   It’s actually surprising to me to look back on this blog and realize how infrequent entries on infertility have been.     It’s curious, because generally speaking the people who use ART, including third-party gametes, are facing some sort of fertility issue.   

Of course, “some sort of fertility issue” can cover a lot of ground.   There are heterosexual couples where a specific fertility issue can be identified for one member of the couple.   There are heterosexual couples who have engaged in unprotected intercourse for a specified period of time (a year?) without conceiving even though no specific problem can be identified.  There are heterosexual couples who probably could conceive but whose genetic material is such that there is an unacceptably high risk of some particular genetic defect in any offspring produced with that genetic material.   There are same sex couples who may or may not have individual fertility issues but do not, between the two of them, produce both egg and sperm.   And there are single people who are in a position akin to that of the same sex couple.  

It is possible (though doubtless controversial) to try to arrange these groups into some sort of spectrum from most to least deserving, or perhaps just to divide them into two groups–deserving and undeserving.  (It’s impossible for me to even write those words without harkening up debates about the deserving vs. the undeserving poor.)  While I am inclined to reject that exercise out of hand, I have to say that I suspect there are extreme cases where even I might wish to label undeserving.  

Is it necessary to consider the deservingness of  all the different categories described above?   I suppose it might be.   For one thing, ART is expensive and so the question of insurance arises.   In that context you could consider the issues raised in this recent article from the Washington Post.   If you are going to offer some sort of insurance, who gets it?   Which of the people above and why?    Even if you don’t think in terms of insurance,  some people may find ART to be morally problematic and this could lead to a conclusion that it is warranted in some deserving cases and not in other undeserving ones. 

Do we need to think, too, about the sort of ART that is required?   For instance, a single woman or a lesbian couple needs sperm, while a single man or a gay male couple needs an egg and a surrogate.  Does this mean we should treat them differently?  Certainly it might, as there are people who accept the use of third party gametes, but not the use of surrogates.     

I don’t have any answers here and I don’t even know that I have any particular questions just now.   It just seemed to me that it was time to move the consumers of ART back into the picture.  

I know that some will say that while it might be a pity that some of the above listed couples or individuals cannot have children, it just is that way and we can be sympathetic and supportive but we cannot change the reality.   (I’m thinking here of the folks who insist that the genetic link is the defining characteristic of parenthood.)   Up to a point I’ll agree.   There are underlying genetic facts we cannot change.   But (and here I return to my familiar turf) for me the underlying genetic facts are not the defining feature of parenthood.


One response to “Varieties of Infertility And Access to ART

  1. Well I don’t think its going to be up to each individual fertile person to decide for themselves if an infertile person is worth going out on a limb for…Would a woman be willing to conceive her offspring with a total stranger who will never meet her or their child just to give her husband the opportunity to raise a child within the confines of marriage? He won’t have the opportunity to raise a child unless 1) his wife thinks he’s deserving of this considerable sacrifice to herself and to her child. Would a fertile man decide that he will conceive his offspring with women he does not know and will never meet so that an infertile male can have the experience of raising a child with his wife? Does the infertile guy deserve this opportunity? The only people qualified to make that determination are the people reproducing.

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