Promising assisted reproductive technologies come with ethical, legal and social challenges – a developmental biologist and a bioethicist discuss IVF, abortion and the mice with two dads
Promising assisted reproductive technologies come with ethical, legal and social challenges – a developmental biologist and a bioethicist discuss IVF, abortion and the mice with two dads
Assisted reproductive technologies are medical procedures that help people experiencing difficulty having or an inability to have biological children of their own. From in vitro fertilization to genetic screening to creation of viable eggs from the skin cells of two male mice, each new development speaks to the potential of reproductive technologies to expand access to the experience of pregnancy.
Translating advances from the lab to the clinic, however, comes with challenges that go far beyond the purely technical.
Conversations around the ethics and implications of cutting-edge research often happen after the fact, when the science and technology have advanced beyond the point at which open dialogue could best protect affected groups. In the spirit of starting such cross-discipline conversations earlier, we invited developmental biologist Keith Latham of Michigan State University and bioethicist Mary Faith Marshall of the University of Virginia to discuss the ethical and technological potential of in vitro gametogenesis and assisted reproductive technology post-Roe.
How new are the ethical considerations raised by assisted reproductive technologies?
Keith
Every new technology raises many of the same questions, and likely new ones. On the safety and risk-benefit side of the ethical conversation, there’s nothing here that we haven’t dealt with since the 1970s with other reproductive technologies. But it’s important to keep asking questions, because the benefits are hugely dependent on the success rate. There are potential biological costs, but also possible social costs, financial costs, societal costs and many others.
Mary Faith
It’s probably been that way even longer. One of my mentors, Joseph Francis Fletcher, a pioneering bioethicist and Episcopal priest, wrote a book called “Morals and Medicine” in 1954. It was the first non-Roman Catholic treatment of bioethics. And he raised a lot of these issues there, including the technological imperative – the idea that because we can develop the technology to do something, we therefore should develop it.
Fletcher also said that the use of artifice, or human-made creations, is supremely human. That’s what we do: We figure out how things work and we develop new technologies like vaccines and heart-lung machines based on evolving scientific knowledge.
I think that in most cases, scientists should be involved in thinking about the implications of their work. But often, researchers focus more on the direct applications of their work than the potential indirect consequences.
Given the evolution of assisted reproductive technology, and the fact that its evolution is going to continue, I think one of the central questions to consider is, what are the goals of developing it? For assisted reproduction, it’s to help infertile people and people in nontraditional relationships have children.
What are some recent developments in the field of assisted reproductive technology?
Keith
One recent advance in assisted reproductive technology is the expansion of pre-implantation genetic testing methods, particularly DNA sequencing. Many genes come in different variants, or alleles, that can be inherited from each parent. Providers can determine whether an embryo bears a “bad” allele that may increase the risk of certain diseases and select embryos with “healthy” alleles.
Genetic screening raises several ethical concerns. For example, the parents’ genetic profiles could be unwillingly inferred from that of the embryo. This possibility may deter prospective parents from having children, and such knowledge may also have potential effects on any future child. The cost of screening and potential need for additional cycles of IVF may also increase disparities.
There are also considerations about the accuracy of screening predictions without accounting for environmental effects, and what level of genetic risk is “serious” enough for an embryo to be excluded. More extensive screening also raises concerns about possible misuse for purposes other than disease prevention, such as production of “designer babies.”
In vitro gametogenesis involves making egg or sperm cells from other adult cells in the body.
At a genome-editing conference in March 2023, researchers announced that they were able to delete and duplicate whole chromosomes from the skin cells of male mice to make eggs. This method is one potential way to make eggs that do not carry genetic abnormalities.
They were very upfront that this was done at 1% efficiency in mice, which could be lower in humans. That means something bad happened to 99% of the embryos. The biological world is not typically binary, so a portion of that surviving 1% could still be abnormal. Just because the mice survived doesn’t mean they’re OK. I would say at this point, it would be unethical to try this on people.
As with some forms of genetic screening, using this technique to reduce the risk of one disease could inadvertently increase the risk of another. Determining that it is absolutely safe to duplicate a chromosome would require knowing every allele of every gene on that chromosome, and what each allele could do to the health of a person. That’s a pretty tall order, as that could involve identifying hundreds to thousands of genes, and the effects of all their variants may not be known.
Mary Faith
That raises the issue of efficacy and costs to yet another order of magnitude.
Keith
Genome editing with CRISPR technology in people carries similar concerns. Because of potential limitations in how precise the technology can be, it may be difficult for researchers to say they are absolutely 100% certain there won’t be off-target changes in the genome. Proceeding without that full knowledge could be risky.
But that’s where bioethicists need to come into play. Researchers don’t know what the full risk is, so how do you make that risk-benefit calculation?
Mary Faith
There’s the option of a voluntary global moratorium on using these technologies on human embryos. But somebody somewhere is still going to do it, because the technology is just sitting there, waiting to be moved forward.
How will the legal landscape affect the development and implementation of assisted reproductive technologies?
Mary Faith
Any research that involves human embryos is in some ways politicized. Not only because the government provides funding to the basic science labs that conduct this research, but because of the wide array of beliefs that members of the public at large have about when life begins or what personhood means.
The Dobbs decision, which overturned the constitutional right to an abortion, has implications for assisted reproduction and beyond. Most people who are pregnant don’t even know they’re pregnant at the earliest stages, and somewhere around 60% of those pregnancies end naturally because of genetic aberrations. Between 1973 and 2005, over 400 women were arrested for miscarriage in the U.S., and I think that number is going to grow. The implications for reproductive health care, and for assisted reproduction in the future, are challenging and frightening.
What will abortion restrictions mean for people who have multiple-gestation pregnancies, in which they carry more than one embryo at the same time? In order to have one healthy child born from that process, the other embryos often need to be removed so they don’t all die. In the past 40 years, the number of twin births doubled and triplet and higher-order births quadrupled, primarily because of fertility treatments.
IVF may transfer one, two, or sometimes three embryos at a time. The cost of care for preterm birth, which is one possible outcome of multiple-gestation pregnancies, can be high. That’s in addition to the cost of delivery. IVF clinics are increasingly transferring just one embryo to mitigate such concerns.
The life-at-conception bills that have been put forth in some U.S. state legislatures and Congress may contain language claiming they are not meant to prevent IVF. But the language of the bills could be extended to affect procedures such as IVF with pre-implantation genetic testing to detect chromosomal abnormalities, particularly when single-embryo transfer is the goal. Pre-implantation genetic testing has been increasing, with one study estimating that over 40% of all IVF cycles in the U.S. in 2018 involved genetic screening.
Could life-at-conception bills criminalize clinics that don’t transfer embryos known to be genetically abnormal? Freezing genetically abnormal embryos could avoid destroying them, but that raises questions of, to what end? Who would pay for the storage, and who would be responsible for those embryos?
How can we determine whether the risks outweigh the benefits when so much is unknown?
Keith
Conducting studies in animal models is an important first step. In some cases, it either hasn’t been done or hasn’t been done extensively. Even with animal studies, you have to recognize that mice, rabbits and monkeys are not human. Animal models may reduce some risks before a technology is used in people, but they won’t eliminate all risks, because of biological differences between species.
The death of Jesse Gelsinger, who was a participant in a gene therapy clinical trial in 1999, led to a halt in all gene therapy clinical trials in the U.S. for a time. When the Food and Drug Administration investigated what went wrong, they found huge numbers of adverse events in both humans and animals that should have been reported to the advisory committee but weren’t. Notably, the principal investigator of the trial was also the primary shareholder of the biotech company that made the drug being tested. That raises questions about the reality of oversight.
I think something like that earlier NIH advisory committee but for reproductive technologies would still be advisable. But researchers, policymakers and regulators need to learn from the lessons of the past to try to ensure that – especially in early-phase research – we’re very thoughtful about the potential risks and that research participants really understand what the implications are for participation in research. That would be one model for translating research from the animal into the human.
The FDA approved a gene therapy for a form of congenital vision loss in 2017. The child in this photo, then 8, first received gene therapy at age 4. Bill West/AP Photo
Keith
A process to make sure that the people conducting studies don’t have a conflict of interest, like having the potential to commercially profit from the technology, would be useful.
Caution, consensus and cooperation should not take second place to profit motives. Altering the human genome in a way that allows human-made genetic changes to be propagated throughout the population has a potential to alter the genetics of the human species as a whole.
Mary Faith
That raises the question of how long it will take for long-term effects to show. It’s one thing for an implanted egg not to survive. But how long will it take to know whether there are effects that aren’t obvious at birth?
Keith
We’re still collecting long-term outcome data for people born using different reproductive technologies. So far there have been no obviously horrible consequences. But some abnormalities could take decades to manifest, and there are many variables to contend with.
One can arguably say that there’s substantial good in helping couples have babies. There can be a benefit to their emotional well-being, and reproduction is a natural part of human health and biology. And a lot of really smart, dedicated people are putting a lot of energy into making sure that the risks are minimized. We can also look to some of the practices and approaches to oversight that have been used over the past several decades.
Mary Faith
And thinking about international guidelines, such as from the Council for International Medical Science and other groups, could provide guidance on protecting human research subjects.
Keith
You hate to advocate for a world where the automatic response to anything new is “no, don’t do that.” My response is, “Show me it’s safe before you do it.” I don’t think that’s unreasonable.
Some people have a view that scientists don’t think about the ethics of research and what’s right and wrong, advisable or inadvisable. But we do think about it. I co-direct a research training program that includes teaching scientists how to responsibly and ethically conduct research, including speakers who specifically address the ethics of reproductive technologies. It is valuable to have a dialogue between scientists and ethicists, because ethicists will often think about things from a different perspective.
As people go through their scientific careers and see new technologies unfold over time, these discussions can help them develop a deeper appreciation and understanding of the broader impact of their research. It becomes our job to make sure that each generation of scientists is motivated to think about these things.
Mary Faith
It’s also really important to include stakeholders – people who are nonscientists, people who experience barriers to reproduction and people who are opposed to the idea – so they have a voice at the table as well. That’s how you get good policies, right? You have everyone who should be at the table, at the table.
Measles infections can be extremely serious. So far in 2025, 14% of the people who got measles had to be hospitalized. Last year, that number was 40%. Measles can damage the lungs and immune system, and also inflict permanent brain damage. Three in 1,000 people who get the disease die. But because measles vaccination programs in the U.S. over the past 60 years have been highly successful, few Americans under 50 have experienced measles directly, making it easy to think of the infection as a mere childhood rash with fever.
When the measles virus infects a person, it binds to specific proteins on the surface of cells. It then inserts its genome and replicates, destroying the cells in the process. This first happens in the upper respiratory tract and the lungs, where the virus can damage the person’s ability to breathe well. In both places, the virus also infects immune cells that carry it to the lymph nodes, and from there, throughout the body.
Measles can wipe out immune cells’ ability to recognize pathogens.
What generally lands people with measles in the hospital is the disease’s effects on the lungs. As the virus destroys lung cells, patients can develop viral pneumonia, which is characterized by severe coughing and difficulty breathing. Measles pneumonia afflicts about 1 in 20 children who get measles and is the most common cause of death from measles in young children.
An especially alarming but still poorly understood effect of measles infection is that it can reduce the immune system’s ability to recognize pathogens it has previously encountered. Researchers had long suspected that children who get the measles vaccine also tend to have better immunity to other diseases, but they were not sure why. A study published in 2019 found that having a measles infection destroyed between 11% and 75% of their antibodies, leaving them vulnerable to many of the infections to which they previously had immunity. This effect, called immune amnesia, lasts until people are reinfected or revaccinated against each disease their immune system forgot.
There is still much to learn about the measles virus. For example, researchers are exploring antibody therapies to treat severe measles. However, even if such treatments work, the best way to prevent the serious effects of measles is to avoid infection by getting vaccinated.
Having the freedom to choose your own health care provider is something many Americans take for granted. But the Supreme Court is weighing whether people who rely on Medicaid for their health insurance have that right, and if they do – is it enforceable by law?
“There’s a right, and the right is the right to choose your doctor,” said Justice Elena Kagan on April 2, 2025, during oral arguments on the case. John J. Bursch, the Alliance Defending Freedom lawyer who is representing South Carolina Director of Health and Human Services Eunice Medina, countered that none of the words in the underlying statute had what he called a “rights-creating pedigree.”
The case started with Julie Edwards, who is enrolled in Medicaid and lives in South Carolina. After she struggled to get contraceptive services, she was able to receive care from a Planned Parenthood South Atlantic clinic in Columbia, South Carolina.
Planned Parenthood and Edwards sued South Carolina, claiming that the state was violating the federal Medicare and Medicaid Act, which Congress passed in 1965, by not letting Edwards obtain care from the provider of her choice.
A ‘free-choice-of-provider’ requirement
Medicaid operates as a partnership between the federal government and the states. Congress passed the law that led to its creation based on its power under the Constitution’s spending clause, which allows Congress to subject federal funds to certain requirements.
Two years later, due to concerns that states were restricting which providers Medicaid recipients could choose, Congress added a “free-choice-of-provider” requirement to the program. It states that people enrolled in Medicaid “may obtain such assistance from any institution, agency, community pharmacy, or person, qualified to perform the service or services required.”
This provision is at the core of this case. At issue is whether a civil rights statute provides a right for Medicaid beneficiaries to sue a state when their federal rights have been violated. Known as Section 1983, it was enacted in 1871.
Bursch, backed by the Trump administration, argued before the court that the absence of words like “right” in the Medicaid provision that requires states to provide a free choice of provider means that neither Edwards nor Planned Parenthood has the authority to file a lawsuit to enforce this aspect of the Medicaid statute.
Nicole A. Saharsky, Planned Parenthood’s lawyer, argued that the creation of a right shouldn’t depend on “some kind of magic words test.” Instead, she said it was clear that the Medicaid statute created “a right to choose their own doctor” because “it’s mandatory” that the state provide this option to everyone with health insurance through Medicaid.
She also emphasized that Congress wanted to protect “an intensely personal right” to be able “to choose your doctor, the person that you see when you’re at your most vulnerable, facing … some of the most significant … challenges to your life and your health.”
Restricting Medicaid funds
Through a federal law known as the Hyde Amendment, Medicaid cannot reimburse health care providers for the cost of abortions, with a few exceptions: when a patient’s life is at risk or her pregnancy is due to rape or incest. Some states do cover abortion when their laws allow it, without using any federal funds.
McMaster explained that he removed “abortion clinics,” including Planned Parenthood, from the South Carolina Medicaid Program because he didn’t want state funds to indirectly subsidize abortions.
South Carolina “decided that Planned Parenthood was unqualified for many reasons, chiefly because they’re the nation’s largest abortion provider,” Bursch told the Supreme Court.
And the Supreme Court has long recognized that Section 1983 protects an individual’s ability to sue when their rights under a federal statute have been violated.
The court’s decision in the Medina case on whether Medicaid patients can choose their own health care provider could have consequences far beyond South Carolina. Arkansas, Missouri and Texas have already barred Planned Parenthood from getting reimbursed by Medicaid for any kind of health care. More states could follow suit.
In addition, given Planned Parenthood’s role in providing expansive contraceptive care, disqualifying it from Medicaid could harm access to health care and increase the already-high unintended pregnancy rate in America.
The ramifications, likewise, could extend beyond the finances of Planned Parenthood.
If the court rules in South Carolina’s favor, states could also try to exclude providers based on other characteristics, such as whether their employees belong to unions or if they provide their patients with gender-affirming care, further restricting patients’ choices.
Or, as Kagan observed, states could go the opposite direction and exclude providers that don’t provide abortions and so forth. What’s really at stake, she said, is whether a patient is “entitled to see” the provider they choose regardless of what their state happens to “think about contraception or abortion or gender transition treatment.”
If the Supreme Court rules that Edwards does have a right to get health care at a Planned Parenthood clinic, the controversy would not be over. The lower courts would then have to decide whether South Carolina appropriately removed Planned Parenthood from Medicaid as an “unqualified provider.”
And if the Supreme Court rules in favor of South Carolina, then Planned Parenthood could still sue South Carolina over its decision to find them to be unqualified.
Imagine you’ve planned the trip of a lifetime for your animal-loving family: a cruise to Antarctica with the unique opportunity to view penguins, whales and other rare wildlife. Your adventure-loving kids can kayak through fjords, plunge into icy water and camp under the Antarctic sky.
But rather than being ecstatic, as you anticipated, your kids whine about skipping an after-school scout meeting at a neighbor’s house. Missing this ordinary weekly event triggers such intense FOMO – “fear of missing out” – for them that they don’t want to go on your amazing expedition.
If this kind of debacle sounds familiar to you – or at least if you find it perplexing – you’re not alone. The three of us are marketingprofessors andsocial psychologists who focus on how consumers make decisions and how this shapes well-being. We’ve been studying FOMO for over a decade and recently published our work in the Journal of Personality and Social Psychology. Over the years, we’ve learned what really drives intense feelings of FOMO – which explains why a run-of-the-mill meeting might feel more crucial than an over-the-top vacation.
FOMO’s real trigger
People use the term FOMO in many different ways. In our research, we focus on a very specific type of FOMO: the kind that occurs when people miss out on events that involve valued social connections.
With this kind of FOMO, we found that the pain of missing out is not related to missing the actual event or opportunity – although that could be there as well. The FOMO we study happens when people miss the chance to bond with friends, co-workers or teammates they care about.
So, the critical part of FOMO is missing out on interactions with people you value. FOMO about a group dinner at a restaurant isn’t really about the food and great lighting. Nor is FOMO about a concert just about the band’s performance. Instead, it’s about the lost opportunity to connect and make memories with people who are important to you.
Why is this upsetting? Imagine the scenario where all your best friends go out to dinner without you. They bond and make lasting memories with each other – and you’re not there for any of it.
If they get closer to each other, where does that leave you? What happens to your social relationships and your sense of belonging? Do you become a less important friend? Less worthy of future invites? Or even kicked out of the group altogether? The anxiety of FOMO can begin to spiral.
People with what psychologists call an anxiousattachment style chronically fear rejection and isolation from others. Because FOMO involves anxiety about future social belonging, it may not come as a surprise that people who are naturally more anxious about their friendships tend to get more intense FOMO. When we asked people in one of our studies to scroll social media until they encountered something social they missed, we found that the more anxiously attached a participant was, the more intense FOMO they experienced.
Getting FOMO for an amazing event you can’t attend makes sense. But if FOMO is less about the event itself and more about the social bonding, what happens when you miss something that’s not really fun at all?
We find that people anticipate FOMO even for unenjoyable missed events. As long as there is some form of missed social bonding, feelings of FOMO emerge. One of our studies found that people anticipated more FOMO from missing an un-fun event that their friends would be at, than a fun event without their friends.
For better or for worse, sad and stressful events can often be emotionally bonding: Going to a funeral to support a friend, cleaning up the mess after a party, or even white-knuckling through a harrowing initiation ceremony can all offer opportunities to forge stronger connections with one another. Stressful contexts like these can be fertile grounds for FOMO.
How to fend off FOMO
Popular discussions about the negative consequences of FOMO tend to focus on the FOMO people feel from compulsively scrolling on social media and seeing what they missed out on. Consequently, much of the suggestedadvice on howto mitigate FOMO centers on turning off phones or taking a vacation from social media.
Those recommendations may be tough for many people to execute. Plus, they address the symptoms of FOMO, not the cause.
Our finding that the core of FOMO is anxiety about missed social relationships yields a simpler strategy to combat it: Reminding yourself of the last time you connected with close friends may provide a sense of security that staves off feelings of FOMO.
In an experiment testing multiple interventions, we asked 788 study participants to look through their social media feeds until they encountered a post of a missed social event. We asked about 200 of these participants to immediately rate how much FOMO they were feeling. They averaged a 3.2 on a 1-to-7 scale.
Another group of about 200 participants also scrolled through their social media feeds until they encountered a post of a missed social event. But before indicating how much FOMO they were feeling, we asked them to think back to a prior experience socializing and bonding with their friends. Encouragingly, this reflection exercise seemed to curtail FOMO. Their average FOMO rating was 2.7 out of 7, a significant drop.
Reminding yourself about other good times with your pals can help keep FOMO at bay. AJ_Watt/E+ via Getty Images
With the remaining participants, we tested other strategies for mitigating FOMO – thinking about the next time they might see their friends or imagining what they’d say to a FOMO-suffering friend – but the simple reflection exercise was by far the most promising.
So, reminding yourself of the meaningful relationships you already have and reaffirming your social belonging in the moment may help combat the rush of anxiety that is characteristic of FOMO.
And missing out on social bonding experiences doesn’t have to be anxiety-provoking. In fact, in our activity-packed, hectic lives, missing some “must-attend” events may be a welcome relief – especially if you remind yourself that your social belonging is not in jeopardy. Cue a recent wave of counter-FOMO programming called JOMO, or “Joy of Missing Out.”
To quote Stuart Smalley, the fictional self-help guru of 1990s “Saturday Night Live,” reminding yourself that “I’m good enough, I’m smart enough, and doggone it, people like me!” might be just the trick to mitigate FOMO.
