Assisted reproduction : emerging technologies, ethics, regulation and practice

Assisted reproductive technology (ART) generally involves the application of laboratory or clinical technology to gametes (human egg or sperm) and/or embryos for the purposes of reproduction to assist people to have children. ART often includes a woman taking fertility medication to increase the likelihood of falling pregnant and may include techniques such as artificial insemination (AI), in vitro fertilisation (IVF), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), and intra-cytoplasmic sperm injection (ICSI). Donor sperm, eggs or embryos may be used in some circumstances. In addition, ART may in certain circumstances utilise increased understanding of human genetics in the application of pre-implantation genetic diagnosis (PGD) to select particular embryos for implantation. More recently emerging research and technology has led to children being born as a result of ‘three person’ IVF to avoid mitochondrial disease, and discussion that ART may involve a future in which genome editing may be possible. Such technologies, once only imagined, are ever increasing. While providing positive outcomes for some in assisting them to have children, they challenge society and push boundaries in a number of ways. There may be medical risks and implications for people undergoing treatment and for the children born as a result. There are also significant ethical, social and legal issues raised. Questions concerning not only where to draw the line between what should be permitted or prohibited, but also how best to govern the practice are continually raised. This chapter focuses upon a number of such issues, and outlines relevant law, guidelines, and self-regulatory mechanisms that all serve to govern ART in Australia and its respective states and territories. While it is not possible to cover all issues raised within the field of ART, the discussion aims to highlight the complexity of some such issues, and the role of effective governance in enabling ART to proceed while establishing the bounds within which society has said it may. It also highlights the need for flexibility in regulation in order to be able to respond to rapidly changing science that brings great hope while also posing new challenges into the future.