November 17th, 2011

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Why has the health minister, Astrid Krag, chosen to reintroduce in vitro fertilisation (IVF) as a treatment offered by the health service for free to everybody? The number of children conceived with the help of IVF has risen at an alarming rate over the past 15 years. With the proportion of newborns conceived through artificial fertilisation now approaching one out of every ten births – and rising – the time has come to consider the ethical problems this development gives rise to.

LetÂ’s imagine what things might look like 25 years from now if half of all children are artificially conceived, which is highly likely if the present trend continues.

What will happen to our perception of man and woman if children, instead of being conceived during an act of love, become something that is ordered from a lab? And how will it impact on our view of human worth if we are the only species no longer able to reproduce on our own?

And another issue: eggs fertilised outside the uterus are flagrantly accessible for prenatal diagnosis through a process known as pre-implantation genetic diagnosis (PGD). For some young couples, this has even become a reason for choosing artificial conception over the natural way. In their own words, “it feels safer” if a doctor can watch all along. PGD is currently only permitted in connection with the detection of a limited number of disorders, but as the diagnostic techniques improve, will we be able to resist the temptation to screen for many other traits? The path from IVF to eugenics is very short.

Despite these significant concerns, the instances of IVF pregnancies, popularly known as ‘test tube’ babies, had risen dramatically in Denmark until last December. There are several reasons why. One is that an increasing number of young women and couples delay the decision to start a family. Neither their university programmes nor their demanding workplaces are very family-friendly. On top of that, it is very much in the spirit of our age to stay young as long as possible – in the case of women, almost to the point of the menopause.

The only snag with this is that womenÂ’s fertility begins to decrease already at the age of 25, and after their mid-30s it begins to fall precipitously. That being the case, itÂ’s not hard to understand why career-orientated couples have been the largest group taking advantage of the generous IVF programmes.

A second reason for the increasing use of IVF is men’s decreasing sperm quality. In one European study of conscripted soldiers, 40 percent of Danish men were found to have below normal sperm quality. Instead of making an effort to right this terrible situation for the good of society, we offer a procedure called ‘microinsemination’ (ICSI), in which a handicapped sperm cell is injected into an egg. This, though, has the effect of passing on the problem of poor sperm to a new generation. Unfortunately, the number of microinsemination treatments is growing at a more rapid rate than other forms of IVF treatments.

A third reason for the increase is the fertilisation industryÂ’s particularly effective lobbying effort. ItÂ’s apparently difficult for the media to think clearly once groups representing businesses and their patients start to turn up the volume on yet another information campaign. And why shouldnÂ’t they be thankful? Childless couples are the stuff compelling articles are made of.

Given the popularity of artificial insemination, despite the problems associated with it, it came as a surprise last year when the then-health minister Bertel Haarder moved last December to require payment for artificial insemination treatments at the nationÂ’s public hospitals. There are plenty of other healthcare issues that need funding. WhatÂ’s more, the law still made it possible for those with a true financial need to receive treatment for free.

Since then, the fertilisation industry has shamelessly used financial arguments to criticise the decision. Among their claims are that people won’t have children if they have to pay for it, and that IVF for free makes economic sense in a society with a low population growth rate. Their mindset seems to be that citizens are ‘customers’, who are – unfairly – required to fight for their natural right to have children. By this argument, children are a good the state is required to provide.

The understanding of one of the cornerstones of democracy – that we make choices in the name of the common good – seems to be stuck in an age when children were conceived on straw mattresses. With that in mind, it may not be surprising that the new health minister has given in to the fertilisation industry and will repeal the law change passed on December 16 of last year.

Consider this another victory for the career culture of the middle class. If Krag really wants to do something for those at the bottom of society, she should instead make it free to have oneÂ’s teeth checked every six months. But, then again, doing that wouldnÂ’t shut the mouth of the fertilisation industry.

The author is a journalist and author. He was a member of parliamentÂ’s ethics advisory panel on biotechnology and healthcare issues, Det Etiske RÃ¥d, from 2003 to 2011. His particular areas of interest include human optimisation, behaviour medication and the genetic diagnosis of embryos.

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