What Can and What Ought We to Do in Procreative Technology?
Exploring the ethical dilemmas at the intersection of reproductive biotechnology and moral responsibility
Imagine a world where the deepest human longing—to have a child—can be fulfilled through technological means. Since the birth of Louise Brown, the first "test-tube baby" in 1978 8 , this world has become our reality. Assisted reproductive technologies (ART) have unlocked unprecedented possibilities for millions of couples facing infertility, yet they've simultaneously unleashed what one source describes as "Pandora's box of far-reaching ethical consequences" 8 .
This technological revolution forces us to confront perhaps the most profound question at the intersection of biotechnology and ethics: What can we do versus what ought we to do when it comes to procreative technology?
This question represents a modern form of theodicy—a philosophical and theological concept concerned with justifying human actions in the face of moral dilemmas. As philosopher Rolf Ahlers notes in his work "Biotech and Theodicy," our scientific capacities now require us to "play God," demanding precise ethical judgments that navigate between two problematic extremes: the complete rejection of technological intervention and the uncritical embrace of the mantra that "science knows best" 6 .
Since 1978, over 8 million babies have been born worldwide using IVF and other assisted reproductive technologies.
The central dilemma: balancing technological possibilities with moral responsibilities in human reproduction.
Defined by the American Center for Disease Control as "any fertility-related treatments in which eggs or embryos are manipulated" 4 . The most common ART procedure is in vitro fertilization (IVF), which involves collecting oocytes from ovaries, fertilizing them in a laboratory setting, and transferring resulting embryos into a uterus 4 .
An alternative approach that "seeks to restore or support underlying reproductive function and fertility in support of natural conception, without the use of IVF or IUI" 2 . A specific type called Natural Procreative Technology (NaProTechnology) works with a woman's natural cycle.
This remains the central ethical issue, particularly for stem cell research and procedures that involve the creation, manipulation, or destruction of embryos 6 8 .
ART "dissociates the two meanings of the conjugal act—the unitive meaning from the procreative meaning" 8 when conception occurs in a laboratory.
Our scientific capacities require us to make god-like judgments, demanding precise ethical frameworks 6 .
Traditional objections to all technological intervention in reproduction
"Science knows best" approach without ethical constraints
The international Natural Procreative Technology Evaluation and Surveillance of Treatment for Subfertility (iNEST) was designed as a multicenter, prospective cohort study conducted from 2006 to 2016 across 10 clinics in four countries (Canada, Poland, the UK, and the USA) 2 .
The study followed 834 subfertile couples where the woman was age 18 or more, not pregnant, and seeking a live birth. Couples with known absolute infertility (such as bilateral tubal blockage or azoospermia) were excluded.
Unlike conventional ART, the medical and sometimes surgical evaluations and treatments in the iNEST study aimed "to restore and optimize female and male reproductive function, to facilitate in vivo conception" rather than bypassing biological processes through laboratory fertilization 2 .
Duration: 2006-2016
Locations: 10 clinics, 4 countries
Participants: 834 couples
Live Birth Rate: 44%
Couples with at least one pregnancy
Couples with at least one live birth
Female pelvic surgical procedures
| Characteristic | Result |
|---|---|
| Mean age of women | 34.0 years |
| Women with ≥16 years education | 80% |
| Women with prior live birth | 30% |
| Mean diagnoses per couple | 4.7 |
| Diagnosis | Prevalence |
|---|---|
| Ovulation-related disorders | 87% |
| Nutritional disorders | 47% |
| Endometriosis | 31% |
| Abnormal semen analysis | 24% |
The dramatic difference in questionnaire response rates when financial compensation was provided (approximately double compared to uncompensated periods) underscores the importance of adequate research funding for robust data collection in fertility studies 2 .
Function/Application: Standardized protocol for tracking biomarkers
Example Uses: Daily observation and recording of cervical mucus patterns to identify fertile window and assess cycle health 2
Function/Application: Exogenous FSH and LH injections
Example Uses: Controlled ovarian stimulation in IVF to maximize developing follicles 4
Function/Application: Direct injection of sperm into oocyte
Example Uses: Addresses male factor infertility by ensuring fertilization 4
Function/Application: Screening embryos for genetic disorders
Example Uses: Identification of genetic abnormalities before embryo transfer 4
Birth of Louise Brown, the first "test-tube baby" through IVF 8
Introduction of Intracytoplasmic Sperm Injection (ICSI) for male factor infertility
Development of Preimplantation Genetic Diagnosis (PGD) to screen embryos for genetic disorders
Advancements in cryopreservation techniques for eggs and embryos
Growth of restorative reproductive medicine approaches like NaProTechnology 2
Beyond the philosophical questions of theodicy, procreative technology raises pressing social justice concerns that are often overlooked in ethical discussions. The commercialization of reproduction has created what one source describes as "a global market [where] embryos have fallen prey to the laws of economics" 8 .
The intrusion of technology into reproduction also affects couples and parent-child relationships in profound ways.
Bioethicist Paul Lauritzen, drawing on personal experience with infertility treatments, lamented "a loss of intimacy because of the intrusion of technology into the intimate life of the couple" 8 .
Jean Porter suggests that ART-conceived children may relate to their parents differently, since "while their parents were born independently of anyone's wishes, ART-conceived children would be the foreseen product of a technical procedure" 8 .
The journey through the landscape of procreative technology reveals a territory marked by extraordinary scientific achievement and profound ethical complexity. The theodicic challenge—reconciling what we can do with what we ought to do—requires us to navigate between the Scylla of rejecting technological progress altogether and the Charybdis of uncritically embracing every innovation.
The iNEST study demonstrates that alternatives to conventional ART exist, with nearly half of participants achieving live births through approaches aimed at restoring natural reproductive function rather than bypassing it 2 . Yet even these "natural" approaches require careful ethical reflection and raise questions about resource allocation, research priorities, and the very definition of responsible procreation.
As we move forward, the intersection of emerging technologies like CRISPR gene editing, next-generation sequencing, and artificial intelligence in drug discovery with procreative technology will only intensify these ethical challenges 5 . The conversation must expand beyond academic circles and religious institutions to include broader societal perspectives, particularly those of people experiencing infertility and ART-conceived individuals.
Ultimately, the question of biotech and theodicy in procreative technology may be less about finding definitive answers and more about cultivating practical wisdom—the capacity to navigate complex moral landscapes with both intellectual rigor and human compassion.
In a world where our technological capabilities increasingly outpace our ethical frameworks, such wisdom becomes not just an academic exercise but a necessary condition for preserving our humanity in the face of unprecedented power over the very beginnings of human life.
References will be added here manually.