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Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
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5

Equity, Access, and Cost Considerations Associated with IVG

Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×

This chapter summarizes a panel discussing the equity, access, and cost considerations associated with IVG. The panel was moderated by Ubaka Ogbogu (University of Alberta), who is studying the ethical, legal, and societal implications of novel and emerging biotechnologies and their associated research. The panelists included Lisa Ikemoto of the University of California, Davis School of Law, a legal expert in reproductive and genetic technology markets and reproductive justice; Amrita Pande of the University of Cape Town, South Africa, a sociologist who researchers transnational reproductive care within the context of the Global South; and Lorian Hardcastle of the University of Calgary, Canada, a professor researching health system financing and regulation of governance of the health care system.

Ogbogu tasked the panelists with “examining how access and cost challenges [of IVG] will play out in a global context and, in particular, how it might impact existing equity, access, cost, pricing, and justice challenges associated with establishment of assisted reproduction.” Panelists discussed several considerations related to equitable access and cost of IVG and other reproductive technologies, including the potential impacts of commercialization, regulations, and public funding. They also reflected on equity issues that extended beyond cost, including surrogacy, particularly transnational surrogacy, and embryo selection.

INITIAL CONSIDERATIONS

Defining Equity

By linking equity, access, and cost in its title, the session appeared to define equity in market terms, Ikemoto challenged. She felt that this framing was “self-limiting.” Such a definition implies that “equity can be achieved by making reproductive IVG affordable for more people without

Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
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jeopardizing profitability.” Conversations about equity need to address more than cost and affordability, Ikemoto said, including whether the new technology is even necessary and could possibly be practiced safely with reliable efficacy, distributed responsibly with the intent of reducing disparities, and implemented responsibly.

Should IVG Be Invested In?

Pande urged participants to reconsider the assumption that IVG should be pursued. Investments into new technologies are justified by their potential to increase human well-being, but “does IVG really increase human well-being? Whose well-being does it increase, and at what cost?” she asked.

Investing in these technologies has a sizable opportunity cost compared to addressing other causes of infertility, particularly within the context of the Global South, Pande said. IVG, if ever available clinically, would likely only benefit a small number of very privileged intended parents, she suggested, rather than addressing the needs of less-resourced communities where, for example, infant mortality is higher. In many parts of the Global South, secondary infertility is more prevalent than primary infertility, she continued.1 Secondary infertility can be due to untreated reproductive tract infection, and to a lesser extent, infections from unsafe abortion or obstetric practice. For these women, access to currently available safe and effective reproductive health care would likely be more effective than new technologies, Pande concluded.

THE POTENTIAL DEMAND FOR SURROGACY DRIVEN BY IVG

National and Cross-Border Considerations

Given her work on the exploitive nature of egg provision and its long-term health effects, Pande questioned whether researchers like her would celebrate that IVG could eliminate the need for gamete donation if it were ever available clinically. However, it would not eliminate the need for gestational surrogates, she suggested, and could exacerbate demand. Lessons from cross-border commercial gestational surrogacy in the Global South reveal that this process is even more exploitative for women, especially women of color, than egg provision, she said. Pande reflected on the potential impact of gestating embryos conceived through IVG and IVF:

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1 According to the World Health Organization, “primary infertility” refers to a person who has never been able to conceive or carry a baby to term; “secondary infertility” is defined as the inability to conceive or carry a baby to term after giving birth.

Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×

“Having babies is a risky business—but having babies where there are so many unknowns is a way more risky business, especially for the women gestating and the babies born.”

Ikemoto echoed Pande’s concerns that IVG could increase demand for surrogacy. In her conversations with doctors across the globe, they “define[d] surrogacy as the intended creation of high-risk pregnancy.” Surrogacy in the United States is becoming more dangerous as states pass bans on abortion care, and “introducing reproductive IVG in this setting is going to put more people in danger,” she concluded.

Women’s Equality

Previous panelists suggested that IVG could bring increased equality to women by reducing the need for the burdensome process of ovarian stimulation and egg retrieval and enabling them to choose to have children at more advanced ages, akin to men. Acknowledging these remarks, a virtual participant asked the panelists to “reflect on how this relates to women’s equality when we consider that this use may also necessitate a surrogate who is also a woman.”

First, Pande stated that surrogacy will be necessitated if regulations are not placed on the age at which a person can have a baby. In addition to the potentially exploitative nature of surrogacy for women, especially women of color, Pande pointed out that some women are not choosing to have children at advanced ages due to individual desire but rather because of intense family pressure. For example, women over 65 in rural India have used ART and surrogacy to conceive children. The choice to conceive at this age is “connected with the cultural context.” Many of these cases, Pande said, are women from wealthy households who “need a son” and “are pressuriz[ed]” to conceive one. She again urged participants to “nuance this idea that everything is an individual desire” and consider the societal contexts in which reproductive choices are made.

Surrogacy “mov[es] to places where people … experience economic precarity and that makes surrogacy an attractive option,” Ikemoto said. Economic and gender inequality make surrogacy affordable for some. On a global scale, surrogacy markets move as regulations are imposed. Regulations tend to restrict access and increase cost to intended parents. Within the United States, socioeconomic status influences who is targeted by surrogacy agencies; people from Ivy League colleges are approached for gamete provision, not surrogacy, whereas military spouses have previously been the target of surrogacy agencies, she said. Ikemoto concluded that reproductive technologies can “perpetuat[e] and expan[d] … reproductive stratification.”

Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×

Echoing Ikemoto, Pande reflected on how cross-border surrogacy parallels global factories or “sweatshop factories.”2 Multinational companies have moved their factories from country to country as localities impose regulations to prevent exploitative labor. Similarly, she continued, “as different countries in Asia, which were higher up in the chain economically, started banning cross-border surrogacy and said we are not going to let it exploit the bodies of our women—what happened? It just had a domino effect and pushed it out to countries lower down in the chain so Nepal, then Thailand, Cambodia, and now Ghana and Nigeria.” These exploitative practices must be considered when discussing the potential implications of IVG for clinical use, Pande concluded.

EMBRYO CREATION AND SELECTION

The Potential for Eugenic Practices

If ever successfully developed, IVG could lead to producing many more eggs than can currently be obtained by ovarian stimulation and therefore could generate more embryos than previously possible. In her opening remarks, Pande highlighted the connection between the capacity of IVG to result in more embryos and its potential to expand and routinize prenatal selection: “When doctors and intending parents no longer need to worry about egg retrievals, hormones, how to store and preserve the precious few embryos [they] got from precious few eggs, the desire for prenatal selection may become more compelling,” she concluded.

Referencing past eugenic practices worldwide and current practices, such as embryo sex selection or genetic disease screening, Pande said that “the desire to genetically modify the future generation in a hunt for an assumed ‘perfect’ baby, ‘perfect’ future generation is not science fiction.” She questioned the desire to invest in a technology that could contribute to making prenatal selection routine, emphasizing that it could be “acutely dangerous” at this politically divisive moment. In addition, the potential to couple IVG with gene editing tools, such as CRISPR, that could be used to make heritable genetic changes “should make us all worried,” Pande warned.

Ikemoto wondered whether IVG could open the door to “address[ing] disability as a problem in society by eliminating people born with disabilities.” This very notion is “dehumanizing to all of us,” Ikemoto said, and therefore “deserves a much deeper, honest conversation than any workshop agenda allows for.” Many voices, including diverse voices from

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2 Sweatshops are factories or workshops with poor, socially unacceptable, or even illegal conditions where workers are treated very poorly.

Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×

among disability communities, will need to be engaged in these important and ongoing conversations around IVG and other genetic and reproductive technologies, she continued.

Considering the Societal Context for Individual Choices

Pande pushed participants to move away from considering infertility as an individual problem, genetically related babies as an individual desire, and embryo selection as an individual choice. These are not “individual, innocuous choices made by intended parents,” she said, but rather “fundamentally reaffirm existing structures of inequality and legitimize new forms of race and gender-based inequalities.” Echoing Ikemoto, Pande said that use of these technologies assumes that certain traits, often viewed as disabilities, ought to be eliminated even though treatments and accommodations can provide a “quality of life worth living.” These conversations need to be grounded in disability justice, Pande shared, to provide different perspectives on this problem and fresh solutions.

Limiting the Number of Embryos Created

Given how expensive IVG might be if ever available clinically, a virtual participant asked panelists to discuss whether the market might limit the number of embryos that could reasonably be made per household. Rather than individuals making choices based upon cost,3 Hardcastle responded that such limitations would likely be set by regulatory bodies. For example, some jurisdictions have rules against embryo destruction that might limit the number of embryos people choose to create both currently and theoretically if IVG were ever available clinically. Hardcastle said that regulators in certain localities could influence the number of embryos generated by placing caps, creating bans on embryo disposition, or disallowing embryo donation to research.

ISSUES AT THE INTERSECTION OF EQUITABLE ACCESS AND COST

During her opening remarks, Hardcastle highlighted six issues at the intersection of equitable access and cost.

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3 Hardcastle noted several incentives for individuals to create more embryos if they are willing to bear the costs, including (1) banking embryos for those wishing to have more than one child; (2) performing sex selection in countries where it is legal; and (3) selecting for other traits, especially if polygenic risk screening improves.

Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×
  1. Compared with other ART technologies, which were largely developed without considering the implications of commercialization, IVG has received initial investment and commercial interest, which may affect its ultimate cost.
  2. Costs could also be driven up for patients if IVG were only available in certain places. For example, the cost of prenatal genetic testing is higher in countries where samples must be sent abroad for testing. If IVG were only available in certain localities, medical tourism could arise because either (1) people go wherever the treatment is available, irrespective of cost; or (2) lower-cost IVG is available in some countries but not others, with those jurisdictions attracting people from abroad seeking treatment.
  3. A view exists in some circles that “the most advanced technology regardless of cost is better.” This attitude may be based upon the perception that expensive resources are inherently valuable. Mindsets such as these can influence people’s support for expensive technologies even if they are unlikely to benefit from them.
  4. Supply and demand for IVG would impact its accessibility and cost. For example, if people seek IVG for reasons other than infertility (e.g., for more gametes that can then be used for expanded embryo screening and selection), the demand for fertility services may outstretch the supply and drive up cost. A potential demand by scientists for embryos for research purposes, if legally permitted, could also compete with demands from those pursuing reproduction. Hardcastle noted that many countries, including Canada, already have long waitlists for both publicly and privately funded fertility services.
  5. Hardcastle questioned what sources of funding could be available for IVG and whether it would be covered by insurers from public or private systems. Insurers might have an incentive to fund IVG, given the potential to reduce downstream costs associated with genetic diseases. This funding could have restrictions, such as only for those seeking to avoid expensive health conditions or within certain age limits.
  6. If ever available clinically, IVG could lead to socioeconomic stratification of who has certain health conditions, Hardcastle speculated, wherein individuals with means could afford IVG to avoid genetic disorders in their offspring. “Do you then have particular health conditions that become relegated only to those who cannot afford the technology?” she questioned. As a result, these diseases may attract less attention and resources from both researchers and policy makers.

Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×

POTENTIAL COST OF IVG

In their opening remarks, Ikemoto and Hardcastle both reflected on how private investments and commercial interests could affect IVG cost. Recent trends in venture capital and private equity investment in the fertility industry indicate that IVG, were it ever available clinically, might be unaffordable for most people, Ikemoto said. Private equity investment in fertility clinics contributes significantly to the cost of IVF, she continued. For example, investor-owned clinics more often encourage “add-on” services that drive up cost. She concluded that “CRISPR [for genome editing] and reproductive IVG seem poised to become the biggest add-ons on the horizon.”

Comparing the Potential Cost of IVG to IVF

Krisiloff provided his perspective as an industry representative. He predicted that the cost of IVG could fall after an initial period where it is very expensive. He asked panelists to reflect on “the relative worth” of pursuing IVG if it starts out expensive but could be scaled through advances and automated practices to bring the cost “down to [that of] IVF.”

Ikemoto and Pande challenged the notion that IVF is affordable. Ikemoto stated that “making [IVG] as affordable as IVF still places it in the level of luxury goods.” In countries such as the United States, members of the middle class go into debt to access it, she said. Investors in the reproductive sector use “creative” ways to bring in more users without lowering overall cost, including debt financing,4 fertility insurance coverage, and egg sharing. Through such strategies, clinics can shift the burden to their clients. Therefore, decreasing costs of IVG to the level of IVF would still mean that access is limited, she concluded. Pande shared similar observations from her work in cross-border reproductive care, wherein people travel “all across the world in the hope that there is somewhere to find low-cost IVF, but they never really do.” Both Ikemoto and Pande felt that IVG, like IVF, would likely remain expensive. The cost of IVF has not decreased as many predicted because of add-on services, Hardcastle added. If ever available clinically, IVG would likely be used in conjunction with IVF, she continued. This combined approach, including add-on services and innovations options, would likely keep the cost high, said Hardcastle.

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4 Debt financing for IVF is now so common that mainstream banks advertise fertility loans “to finance your hopes and dreams,” Ikemoto said.

Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×

Potential Impact of Regulations on Cost and Access

Ogbogu noted that several speakers had suggested that regulations may be needed to address ethical and legal concerns if IVG were ever brought to the clinic. He asked panelists to discuss the potential impact that regulation could have on cost and access and whether they could identify the kinds of regulations that might be pursued and which policies could exacerbate access, equity, and cost issues.

Although some policies are designed to increase equity, Hardcastle noted, other regulations can increase cost and indirectly restrict access. She pointed to increased regulation in long-term care during the COVID-19 pandemic as a potential driver of the high costs of such care. She continued, “Whenever we are talking about greater regulation, there are potentially costs that come with that.” In addition to the costs of creating new regulations, the cost of compliance for clinics and the cost of regulations that directly impact the consumer need to be considered. Even well-intended regulations could have cost-related implications. However, regulations can also be used to ease cost barriers. For example, Canada offers federal and provincial tax credits to eligible individuals seeking reproductive services. Policies like these are often explicitly designed to reduce cost and increase access, Hardcastle said.

Ikemoto stated that the rollout of any new reproductive technology to the clinic ought to be accompanied by antidiscrimination law to protect access, “regardless of whether or not you think it is the best technology or should be out there in the first place.” Such laws might expand access and increase the number of potential consumers. One might expect expanded access to reduce cost, Ikemoto said, but this has not been the case with other technologies.

Pande said that the impact of regulations extends outside the borders of the country establishing and enforcing them. Regulations will differ by country, especially with a technology this controversial, she continued, and the global impact will need to be considered. Although establishing formal international regulations is likely infeasible, Pande emphasized the importance of international guidelines such as those for transnational adoption. During their creation, guidelines can facilitate open dialogues between countries to address difficult questions and define best practices if applicable. Developing guidelines for responsible uses, limitations, and best practices associated with IVG could also represent an opportunity for the global community to revisit conversations about other reproductive technologies, Pande concluded.

Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×

PUBLIC FUNDING

A participant drew attention to countries with public health care systems that support ART. If IVG were shown to be safe and made available in the clinic, he asked panelists to reflect on whether countries with nationalized health care might ever publicly fund its clinical use.

Hardcastle said that such funding will likely depend on the individual country and its approach to health care and reproductive medicine. In some countries, including Canada, public funding for ART varies in its accessibility across provinces. One province has such a long waitlist for publicly funded IVF that many choose to access a private cycle while they wait. Hardcastle thought that public funding for IVG would likely be limited to specific uses if it were funded at all. Many European countries are more generous with funding for ART and might consider extending that to IVG if it were ever available clinically, she said. Whether governments choose to fund IVG will depend partly on its cost, and funding may be restricted to certain use cases. Hardcastle concluded, “I think that it will not just be a question of will this be funded or won’t it but rather under what circumstances and what criteria would be attached to public funding.”

Societal Context

Pande reflected on the changing sociocultural and political tides that could influence governments to publicly fund fertility treatments. At present, there is no incentive to publicly fund fertility treatments in the Global South, she said, where the governments of many countries are encouraging women and families not to have babies as part of their national population control efforts. Meanwhile, she continued, other countries are experiencing low birth rates and have serious concerns about the impact of their declining populations. For example, China encouraged small families through its One-Child Policy, but “now, it is desperate for women to have babies.”

Cost Negotiations

Ikemoto noted that the U.S. Congress is reluctant to allow the government to negotiate prices, including drug prices. She asked her fellow panelists to discuss whether and how countries that publicly fund reproductive services negotiate cost. Hardcastle noted that costs of ART can be forced down due to government regulations. Governments may opt to cost share for a given service at a certain price point—the government rate. In turn, fertility clinics decide whether they will provide services at

Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×

that rate or see patients with private coverage and charge the market rate. Clinics may choose to accept the lower government rate to avoid dealing with the increased administrative burden (e.g., bill collection) associated with individual payors.

CONCERNS BY USE CASE

Glenn Cohen asked panelists to reflect on issues raised by potential use cases for IVG if it were available clinically, which could include older women, queer couples, and people with conditions causing nontreatable infertility.

Ikemoto did not distinguish between the potential IVG use cases, instead suggesting that the social and ethical implications are not isolated from those of the “rapidly increasing array of reproductive and genetic technologies.” Although IVG stirs hope among some for its potential to offer more choice, Ikemoto said that many have concerns that it will “intensify and amply the scope of the ethical and social implications” for decisions about different use cases.

Echoing Suter’s concerns about how desires are shaped,5 Pande discussed the potential for demand outside of a traditional “supply meets demand” context. For example, she referenced a fertility clinic in Ghana that began offering the opportunity for African couples to use eggs donated from White women. She said, “The Ghanian couples had no idea that was even an option—but then—it was being offered to them.” Clinics across the world are offering “preference packages,” and by offering such packages, “you start creating demand way before the demand even exists,” she concluded.

REPRODUCTIVE STRATIFICATION

Ikemoto noted that reproductive IVG can be rationalized, in part, based on its potential to help “achieve equality for LGBTQ couples” by enabling them to have children who are genetically related to both parents. However, the potential users identified by private equity and other technology investors are likely to be stratified by income, at least for initial use cases, she continued, with affluent gay couples a main target. The average household income for two men, particularly two White men, is higher than that for any other combination of intended parents. This raises further questions about how IVG might or might not help achieve equality and family building within the broader LGBTQ community.

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5 See Chapter 4.

Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×

DISTINGUISHING BETWEEN COST AND PRICE

Greely noted that cost and price mean slightly different things and that conversations about developing IVG ought to distinguish between them. Cost is the expense incurred for making the product or service, he said, whereas price is the amount a customer is willing to pay. The U.S. health sector often has large disparities between cost and price, Greely said. He asked panelists to reflect on discrepancies between cost and price in countries with and without publicly funded access to ART. Hardcastle responded that the price the government is willing to pay for a given ART in jurisdictions in which most of the treatments are covered by public funding or national health insurance can become the de facto price also charged to individuals or private insurance providers. On the other hand, free market jurisdictions with only limited public coverage for an ART will likely experience differences in prices. She added that determining cost and price for a technology are “different processes with different incentives at play” and partly depend on the relationship between a country’s private and public reimbursement system.

Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×
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Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×
Page 68
Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×
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Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×
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Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×
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Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×
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Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×
Page 73
Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×
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Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×
Page 75
Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×
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Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×
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Suggested Citation:"5 Equity, Access, and Cost Considerations Associated with IVG." National Academies of Sciences, Engineering, and Medicine. 2023. In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27259.
×
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Current assisted reproductive technologies such as in vitro fertilization (IVF) do not enable all prospective parents to have genetically related children. The National Academies Board on Health Sciences Policy hosted a workshop in April 2023 to explore the development of in vitro-derived human eggs and sperm from pluripotent stem cells through a process known as in vitro gametogenesis (IVG). Speakers emphasized the impacts of the potential biotechnology on research and reproductive medicine should clinical IVG ever be approved, along with the many social, ethical, legal, and technical considerations its development raises. This proceedings document summarizes workshop discussions.

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