Technological intervention in human reproduction has long been the focus of critical attention and debate. Controversial issues include access to fertility treatment, financial costs, informed consent, professional responsibility and accountability, societal welfare, and patients' welfare, including health risks. Scholars have offered various approaches in response, while governments and nongovernmental organizations, at both the national and international levels, have recommended voluntary guidelines or advocated legislation. However, to date, little attempt has been made to empirically test the validity of these concerns, particularly in the context of the clinical setting.
This dissertation critically examines assisted reproductive technologies in the context of the scholarly literature, the work of government and nongovernmental actors, and clinical practice. Much of this work focuses on assessing claims made about these technologies by examining the views of the parties directly involved with, and affected by, their clinical practice. A study conducted of Chicago-area fertility patients and healthcare providers facilitates this. Normative implications derived from this study are explored and include assessment of the issues examined, the initial research questions posed, directions for further empirical study, and principles to guide the continued use and future development of these technologies.
The study findings indicate that critics accurately identified the key stakeholders involved with, and affected by, assisted reproduction. There is also a close approximation between the claims made by critics and clinical practice for most of the issues examined. Unexpectedly, the cost of treatment, specifically, an insurance plan mandating treatment coverage, was found to be problematic in that an exception adversely effected several fertility patients.
The study findings raise questions about variations found in patient's experiences and the influence of culture—e.g., race, socioeconomic status, sexual orientation—with respect to both the incidence of infertility and access to fertility treatment. Guiding principles are offered, which protect patients and promote their health and well being as well as advocate, safe, effective, ethical, and quality fertility care. These principles also address a research agenda that encourages scientific developments and advances in the diagnosis and treatment of male factor and unexplained infertility, as well as minimizes women's involvement in fertility treatment.