There are important gaps in the ethical, legal, and social implications (ELSI) of assisted reproductive technologies (ART) literature, according to an analysis of ART studies.1 “Some important issues are not being explored enough in research studies, especially those related to equitable access to these technologies, and the level of knowledge people have about them,” asserts Vardit Ravitsky, PhD, one of the study authors and president of The Hastings Center.
Ravitsky and colleagues conducted a systematic literature review of 7,714 relevant articles published from 1999 to 2019. During that period, the global research output increased significantly, about 12% annually. Fertility preservation and surrogacy were the most researched topics.
“ELSI researchers invest a lot of time and effort exploring issues that are not prevalent in clinical use, but that raise conceptually intriguing challenges,” says Ido Alon, PhD, lead author of the study and a postdoctoral fellow at the University of Montreal. Other frequent topics included nonmedical sex selection and mitochondrial replacement techniques.
More than 70% of the research in the analysis came from North America and Western Europe. “Researchers from several well-resourced countries are doing most of the research,” Alon notes.
Many regions are contributing less to the literature. “This means that not all cultural perspectives and values are represented in an area that requires a lot of cultural sensitivity,” Ravitsky explains.
Clinicians and ELSI researchers should be collaborating on studies that focus on issues that emerge from real-life cases, according to the authors. This will allow ELSI research to directly affect clinical guidelines and policymaking. “This is especially important for the areas of public/patient education and decisions related to resource allocation and public funding of ART,” Ravitsky says.
Issues of concern include the financial burden that falls on couples when they have to pay for in vitro fertilization out of pocket and lack of knowledge regarding the decline in fertility for both men and women in their 30s and 40s.
In another paper, the authors called on the research community to promote international collaborations for ELSI research on ART in more regions.2 “This would allow the literature to become more diverse and better represent the great variety of cultural, social, and economic contexts in which ART is practiced,” says Ravitsky, who also co-authored this work.
For example, surrogacy carries different meaning in places with great economic disparities where surrogates may be exploited. “Ethicists can play a crucial role in addressing some of these issues by providing guidance and recommendations on ethical considerations for healthcare providers,” Ravitsky suggests.
Overall, the involvement of ethicists in ELSI research and clinical practice can help promote ART in a responsible and ethical manner. This ensures the needs and interests of patients and communities are prioritized.
“Ethicists should also consider the potential for discrimination and inequality in access to ART, and help make these technologies available to all who need them, regardless of their socioeconomic status, race, ethnicity, or other factors,” Ravitsky says.
REFERENCES
1. Alon I, Chebance Z, Massucci FA, et al. Mapping ethical, legal, & social implications (ELSI) of assisted reproductive technologies. J Assist Reprod Genet 2023;40:2045-2062.
2. Alon I, Chebance Z, Massucci FA, et al. Mapping international research output within ethical, legal, and social implications (ELSI) of assisted reproductive technologies. J Assist Reprod Genet 2023;40:2023-2043.
Ethicists should consider the potential for discrimination and inequality in access to assisted reproductive technologies, and help make these solutions available to all who need them, regardless of their socioeconomic status, race, ethnicity, or other factors.
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