Mix-ups In some cases, laboratory mix-ups (misidentified gametes, transfer of wrong embryos) have occurred, leading to legal action against the IVF provider and complex paternity suits. An example is the case of a woman in California who received the embryo of another couple and was notified of this mistake after the birth of her son. This has led to many authorities and individual clinics implementing procedures to minimise the risk of such mix-ups. To mitigate risks and errors that could impact patients in IVF laboratories, regulatory authorities, along with institutions that assess hazards and ensure the appropriate handling of vulnerable materials such as oocytes and generic materials, were employed in the United Kingdom. This conversation sparked amid governmental concerns regarding the ethical implications of treating infertility in a laboratory setting, where doctors had all of the medical responsibility, along with philosophers such as Mary Warnock voicing their opinions on bridging medicine and politics to optimise safety. In the late 1970s, medical debates challenged the morality of IVF through religious, medical, and scientific claims, which led to the establishment of the Warnock Committee, chaired by Mary Warnock. The committee outsourced ethical decisions to groups outside of doctors, which ultimately led to the issuing of the Warnock Report, which served to regulate IVF and embryo research. In 1990, the UK passed the Human Fertilization and Embryology Act, institutionalising bioethics as a result. Because of these debates, ethics is handled by experts. The
HFEA, for example, requires clinics to use a double witnessing system; the identity of specimens is checked by two people at each point at which specimens are transferred. Alternatively, technological solutions are gaining favour to reduce the manpower cost of manual double witnessing, and to further reduce risks with uniquely numbered
RFID tags, which can be identified by readers connected to a computer. The computer tracks specimens throughout the process and alerts the embryologist if non-matching specimens are identified. Although the use of RFID tracking has expanded in the US, it is still not widely adopted. The
HFEA, for example, requires clinics to use a double witnessing system; the identity of specimens is checked by two people at each point at which specimens are transferred. Alternatively, technological solutions are gaining favour, to reduce the manpower cost of manual double witnessing and to further reduce risks with uniquely numbered
RFID tags which can be identified by readers connected to a computer. The computer tracks specimens throughout the process and alerts the embryologist if non-matching specimens are identified. Although the use of RFID tracking has expanded in the US, it is still not widely adopted.
Preimplantation genetic diagnosis or screening Pre-implantation genetic diagnosis (PGD) is criticised for giving select demographic groups disproportionate access to a means of creating a child possessing characteristics that they consider "ideal". Many fertile couples now demand equal access to embryonic screening so that their child can be just as healthy as one created through IVF. Mass use of PGD, especially as a means of
population control or in the presence of legal measures related to population or demographic control, can lead to intentional or
unintentional demographic effects such as the skewed live-birth sex ratios seen in China following implementation of its
one-child policy. While PGD was originally designed to screen for embryos carrying hereditary genetic diseases, the method has been applied to select features that are unrelated to diseases, thus raising ethical questions. Examples of such cases include the selection of embryos based on
histocompatibility (HLA) for the donation of tissues to a sick family member, the diagnosis of genetic susceptibility to disease, and
sex selection. These examples raise ethical issues because of the morality of
eugenics. It becomes frowned upon because of the advantage of being able to eliminate unwanted traits and select desired traits. By using PGD, individuals can create a human life unethically and rely on science and not on
natural selection. For example, a deaf British couple, Tom and Paula Lichy, have petitioned to create a deaf baby using IVF. Some
medical ethicists have been very critical of this approach.
Jacob M. Appel wrote that "intentionally culling out blind or deaf embryos might prevent considerable future suffering, while a policy that allowed deaf or blind parents to select
for such traits intentionally would be far more troublesome."
Industry corruption Robert Winston, professor of fertility studies at Imperial College London, had called the industry "corrupt" and "greedy" stating that "one of the major problems facing us in healthcare is that IVF has become a massive commercial industry," and that "what has happened, of course, is that money is corrupting this whole technology", and accused authorities of failing to protect couples from exploitation: "The regulatory authority has done a consistently bad job. It's not prevented the exploitation of people, it's not put out very good information to couples, it's not limited the number of unscientific treatments people have access to". The IVF industry has been described as a market-driven construction of health, medicine and the human body. The industry has been accused of making unscientific claims and distorting facts relating to infertility, in particular through widely exaggerated claims about how common infertility is in society, in an attempt to get as many couples as possible and as soon as possible to try treatments (rather than trying to conceive naturally for a longer time). This risks removing infertility from its social context and reducing the experience to a simple biological malfunction, which not only
can be treated through bio-medical procedures, but should be treated by them.
Older patients All pregnancies can be risky, but there is a greater risk for mothers who are older and are over the age of 40. As people get older, they are more likely to develop conditions such as gestational diabetes and pre-eclampsia. If the mother does conceive over the age of 40, their offspring may be of lower birth weight and more likely to require intensive care. Because of this, the increased risk is a sufficient cause for concern. The high incidence of caesarean in older patients is commonly regarded as a risk. Those conceiving at 40 have a greater risk of gestational hypertension and premature birth. The offspring is at risk when being born from older mothers, and the risks associated with being conceived through IVF.
Adriana Iliescu held the record for a while as the oldest woman to give birth using IVF and a donor egg, when she gave birth in 2004 at the age of 66. In September 2019, a 74-year-old woman became the oldest-ever to give birth after she delivered twins at a hospital in
Guntur,
Andhra Pradesh.
Pregnancy after menopause Although menopause is a natural barrier to further conception, IVF has allowed people to become pregnant in their fifties and sixties. People whose uteruses have been appropriately prepared receive embryos that originated from an egg donor. Therefore, although they do not have a genetic link with the child, they have a physical link through pregnancy and
childbirth. Even after menopause, the uterus is fully capable of carrying out a pregnancy.
Same-sex couples, single and unmarried parents A 2009 statement from the
ASRM found no persuasive evidence that children are harmed or disadvantaged solely by being raised by single parents, unmarried parents, or homosexual parents. It did not support restricting access to assisted reproductive technologies based on a prospective parent's marital status or sexual orientation. A 2018 study found that children's psychological well-being did not differ when raised by either same-sex parents or heterosexual parents, even finding that psychological well-being was better amongst children raised by same-sex parents. Ethical concerns include reproductive rights, the welfare of offspring, nondiscrimination against unmarried individuals, homosexuals, and professional autonomy. The California Medical Association had initially sided with Brody and Fenton, but the case, ''
North Coast Women's Care Medical Group v. Superior Court'', was decided unanimously by the California State Supreme Court in favour of Benitez on 19 August 2008.
Nadya Suleman came to international attention after having twelve embryos implanted, eight of which survived, resulting in eight newborns being added to her existing six-child family. The Medical Board of California sought to have fertility doctor Michael Kamrava, who treated Suleman, stripped of his license. State officials allege that performing Suleman's procedure is evidence of unreasonable judgment, substandard care, and a lack of concern for the eight children she would conceive and the six she was already struggling to raise. On 1 June 2011, the Medical Board issued a ruling that Kamrava's medical licence be revoked effective 1 July 2011.
Transgender parents The research on
transgender reproduction and family planning is limited. A 2020 comparative study of children born to a transgender father and cisgender mother via donor sperm insemination in France showed no significant differences to IVF and naturally conceived children of cisgender parents. Transgender men can experience challenges in pregnancy and birthing from the cis-normative structure within the medical system, The effect of continued testosterone therapy during pregnancy and breastfeeding is undetermined. Ethical concerns include reproductive rights, reproductive justice, physician autonomy, and transphobia within the health care setting. In May 2012, a court ruled that making anonymous sperm and egg donation in British Columbia illegal. In the UK, Sweden, Norway, Germany, Italy, New Zealand, and some Australian states, donors are not paid and cannot be anonymous. In 2000, a website called
Donor Sibling Registry was created to help biological children with a common donor connect with each other.
Leftover embryos or eggs, unwanted embryos There may be leftover embryos or eggs from IVF procedures if the person for whom they were created has successfully carried one or more pregnancies to term, and no longer wishes to use them. With the patient's permission, these may be donated to help others conceive by means of
third-party reproduction. In
embryo donation, these extra embryos are given to others for
transfer, to produce a successful pregnancy. Embryo recipients have genetic issues or poor-quality embryos or eggs of their own. The resulting child is considered the child of whoever birthed them, and not the child of the donor, the same as occurs with
egg donation or
sperm donation. As per the National Infertility Association, typically, genetic parents donate eggs or embryos to a
fertility clinic where they are preserved by
oocyte cryopreservation or
embryo cryopreservation until a carrier is found for them. The agency conducts the matching process and the donation with the prospective parents, at which time the clinic transfers ownership of the embryos to the prospective parent(s). Alternatives to donating unused embryos are destroying them (or having them
transferred at a time when pregnancy is very unlikely), keeping them frozen indefinitely, or donating them for use in research (rendering them non-viable). Individual moral views on disposing of leftover embryos may depend on personal views on the
beginning of human personhood and the definition and/or value of
potential future persons, and on the value that is given to fundamental research questions. Some people believe donation of leftover embryos for research is a good alternative to discarding the embryos when patients receive proper, honest, and clear information about the research project, the procedures, and the scientific values. During the
embryo selection and transfer phases, many embryos may be discarded in favour of others. This selection may be based on criteria such as genetic disorders or sex. One of the earliest cases of special gene selection through IVF was the case of the Collins family in the 1990s, who selected the sex of their child. The ethical issues remain unresolved as no worldwide consensus exists in science, religion, and philosophy on when a human embryo should be recognised as a person. For those who believe that this is at the moment of conception, IVF becomes a moral question when multiple eggs are fertilised, begin development, and only a few are chosen for the uterus transfer. If IVF were to involve the fertilisation of only a single egg, or at least only the number that will be
transferred, then this would not be an issue. However, this could increase costs dramatically as only a few eggs can be attempted at a time. As a result, the couple must decide what to do with these extra embryos. Depending on their view of the embryo's humanity or the chance that the couple will want to try to have another child, the couple has multiple options for dealing with these extra embryos. Couples can choose to keep them frozen, donate them to other infertile couples, thaw them, or donate them to medical research.
Gender selection Gender selection, also known as sex selection, in the context of IVF involves the use of preimplantation genetic testing (PGT) to determine the sex of embryos before transfer into the uterus, allowing prospective parents to choose embryos of a preferred sex. This is typically achieved by means of a
biopsy of cells from embryos at the blastocyst stage and analysing them for sex chromosomes (XX for female, XY for male), alongside screening for genetic abnormalities. The primary aim of IVF remains assisting those with fertility issues to achieve pregnancy. Gender selection adds an elective dimension for reasons such as family balancing – where parents with children of one sex seek the opposite – or medical purposes, like avoiding sex-linked disorders such as
haemophilia or
Duchenne muscular dystrophy that predominantly affect males. The process integrates with standard IVF protocols: ovarian stimulation to produce multiple eggs, retrieval, fertilisation in the lab, embryo culture to day five, biopsy for PGT (which identifies gender via chromosomal analysis), and transfer of selected embryos. PGT can also screen for conditions like
Down syndrome,
cystic fibrosis or
Tay–Sachs disease, enhancing the medical utility of the procedure. Success rates for accurate gender determination approach 100%, though overall pregnancy success varies by factors like maternal age, with rates around 40-50% for women under 35. Costs typically add $3,000-$5,000 for PGT to a base IVF cycle of $10,000-$15,000, totalling over $20,000, though variations depend on location and clinic. Non-medical gender selection remains controversial, with ethical concerns including potential reinforcement of gender stereotypes, societal imbalances (as seen in regions preferring sons), and the commodification of children. Legally, it is prohibited for elective reasons in countries like Canada, the UK, Australia, and much of Europe, permitted only for medical indications to prevent genetic diseases. In the United States, it is legal without federal restrictions, though guided by ethical guidelines from bodies like the American Society for Reproductive Medicine, which allows clinics discretion. Destinations like Mexico and Cyprus permit both medical and non-medical selection, attracting fertility tourism. These disparities raise questions about equity, autonomy, and cross-border ethical standards in reproductive medicine.
Religious response Christianity The
Catholic Church opposes all kinds of
assisted reproductive technology and artificial
contraception, because they separate the procreative goal of
marital sex from the goal of uniting married couples. The Catholic Church permits the use of a small number of reproductive technologies and contraceptive methods, such as
natural family planning, which involves charting ovulation times. It allows other forms of reproductive technologies that allow conception to take place from normative sexual intercourse, such as a fertility lubricant. Pope Benedict XVI had publicly re-emphasised the Catholic Church's opposition to in vitro fertilisation, saying that it replaces love between a husband and wife. The Catechism of the Catholic Church, in accordance with the Catholic understanding of
natural law, teaches that reproduction has an "inseparable connection" to the sexual union of married couples. In addition, the church opposes IVF because it might result in the disposal of embryos; in Catholicism, an embryo is viewed as an individual with a
soul that must be treated as a person. The Catholic Church maintains that it is not objectively evil to be infertile, and advocates adoption as an option for such couples who still wish to have children. The
Lutheran Council in the United States of America, organised by the
Lutheran Church–Missouri Synod and parent bodies of the
Evangelical Lutheran Church in America, produced an authoritative document on the issue of in-vitro fertilisation, which "unanimously concluded that IVF does not
in and of itself violate the will of God as reflected in the Bible, when the wife's egg and husband's sperm are used" (LCUSA n.d.:31). The Lutheran Churches approve of artificial insemination by a husband (AIH), though representatives from the
Lutheran Church-Missouri Synod hold that such IVF is only unobjectionable if the sperm and egg come from husband and wife and all of the fertilised eggs are implanted in the womb of the wife. • IVF of an egg from the wife with the sperm of her husband and the transfer of the fertilised egg back to the uterus of the wife is allowed, provided that the procedure is indicated for a medical reason and is carried out by an expert physician. • Since marriage is a contract between the wife and husband during the span of their marriage, no third party should intrude into the marital functions of sex and procreation. This means that a third-party donor is not acceptable, whether he or she is providing sperm, eggs, embryos, or a uterus. The use of a third party is tantamount to
zina, or
adultery.
Judaism Within the
Orthodox Jewish community, the concept is debated as there is little precedent in traditional Jewish legal texts. Regarding
laws of sexuality, religious challenges include
masturbation (which may be regarded as "seed wasting"
Reform Judaism has generally approved IVF. In the US, the
pineapple has emerged as a symbol of IVF users, possibly because some people thought, without scientific evidence, that eating pineapple might slightly increase the success rate for the procedure. == Emotional involvement with children ==