After the Alabama Supreme Court’s recent ruling that frozen embryos deserve the same protections as children, politicians have been falling over themselves to find ways to defend the US IVF industry. Even Donald Trump, reputedly a pro-life stalwart, declared that: “The Republican Party should always be on the side of the Miracle of Life — and the side of Mothers, Fathers, and their Beautiful Babies. IVF is an important part of that.” 

Not for the first time, Trump doesn’t know what he is talking about. I’d like to convince you that IVF is a morally complex issue, so complex and tangled that it needs to be regulated. This is the case whether or not you believe that frozen embryos are “extrauterine children” living in a “cryogenic nursery”, in the words of the Court.

Of course, the moral stakes rise if they are “extrauterine children”. That notion may not be popular, but it has the advantage of complete consistency. Otherwise, you are forced into the contradiction of arguing that frozen embryos are not children because they are outside the womb and also that foetuses are not children because they are inside the womb.*

But I accept that the argument for banning it is ultimately philosophical and hard for most people to appreciate. The argument for close scrutiny and tight regulation, however, is based squarely on its capacity for harm. IVF is an industry with a dark past, a chaotic present, and an ominous future.

You wouldn’t know from the media or politicians that IVF has been responsible for any harm. Journalists have failed to do their homework. But I have been tracking the industry for 20 years or so and I can assure you that there are dark corners and dusty cupboards everywhere.

That’s also the picture you get from speaking with lawyers. "I've represented thousands of would-be parents whose eggs and embryos were lost, destroyed, or even mixed up by their fertility clinics,” says leading fertility lawyer Adam Wolf, of Peiffer Wolf, a California law firm. He says that “Hopefully, the chaos and confusion for fertility patients in Alabama will help motivate federal lawmakers to finally create a system of regulation for this industry, like they already have in the UK and virtually every other developed country."

Of course, IVF clinics have produced bundles of joy for thousands of people – roughly 100,000 IVF babies are born in the US every year, accounting for 2 percent of all births. Michelle and Barack Obama’s two daughters are IVF children. Robert Edwards, the British physiologist who developed IVF, won the Nobel Prize for Medicine in 2010.

No wonder most Americans, even pro-life Republicans, support IVF. A poll for a consultancy run by Kellyanne Conway, a former senior advisor to President Trump, found that “Even within staunchly conservative circles”, 78 percent of “pro-life advocates” and 83 percent of Evangelicals display “significant and unwavering support” for IVF.

This support is based on ignorance of how the fertility industrial complex works. IVF in the United States is “Wild West” medicine – it’s barely regulated. Authorities probably take more care supervising the cosmetics industry. It is quickly becoming corporatised, commercialised, and industrialised. In fact, the Alabama decision might end up being the best thing that ever happened to it, because state and federal politicians are rushing to protect it.

That would be a mistake. IVF is an acronym which encompasses a whole range of fertility products in addition to in vitro fertilisation. As an example, take Boston IVF, one of the leading IVF centres in the United States. Its treatments include IVF, donor eggs, donor sperm, surrogacy, egg freezing, genetic screening, sex selection, family building for gay men, transgender services, and multi-foetal pregnancy reduction (aborting foetuses which are surplus to requirements). Do Americans really want to protect all of these practices?

So the ruckus about the Alabama Supreme Court’s decision is an opportunity to reassess an industry whose aims, business practices and technology have never been seriously questioned. Here are 13 reasons why voters and politicians should think twice before giving the IVF industry more protection.

Human rights. The fundamental problem with IVF is that it “outsources” sexual intimacy. In a sense, technologists and accountants become as much a part of the process of creating a baby as the parents. But every human being has a right to begin life as an act of love by a mother and a father. 

That's the position of a well-known religious body of which President Biden is a dissenting member. But it's also the opinion of Dolce and Gabbana, the Italian gay fashion icons. In an interview with the Italian magazine Panorama, they set out the case against IVF. “No chemical offspring and rented uterus: life has a natural flow, there are things that should not be changed … You are born to a mother and a father – or at least that’s how it should be. I call them children of chemistry, synthetic children. Rented uterus, semen chosen from a catalog.” 

More and more and more frozen embryos. No one keeps tabs on the total number of human embryos frozen in US fertility clinics. But there may be as many as 1.5 million of them. This number is only going to grow as the IVF industry expands. Why are there so many? Partly because the parents cannot decide what do to with them. Even if they don’t think that they are “children”, they are still precious and hard to discard.

More access to IVF will NOT increase the birth rate. The IVF industry is beginning to push the notion that IVF is a weapon for fighting declining birth rates. And around the world, governments are subsidising IVF to stave off a demographic winter. What evidence is there that such schemes will work? None.

The best counter-example is Japan, which has one of the highest proportion of IVF babies in the world (5 percent) and one of the lowest birthrates (1.37 children per woman). In fact, IVF may even contribute to decreasing the birth-rate. Women who believe that IVF will solve possible infertility may put off having children until their late 30s, when it may be too late.  

Redefining the family. The American IVF industry has been very forthright about its plan to redefine "family". A policy statement issued last year by the American Society for Reproductive Medicine (ASRM), the peak body for the IVF industry, said that “lesbian, gay, bisexual, transgender, queer, and unpartnered individuals” also have a right to have families. Children do not need to be raised in stable, mum-and-dad families. Expanding the idea of family also increases the size of their market.

Eugenics. Professor Robert Edwards, the British medical scientist who won the Nobel Prize for pioneering IVF, was a member of Britain’s Eugenics Society for most of his career. His ideas about IVF were steeped in eugenics. The temptation for his successors to engage in consumer-driven eugenics is almost irresistible. Such services are not available at the moment, although clinics will screen embryos for diseases. The next step will be tinkering with genes to make potential offspring athletic, smart, blue-eyed, healthier or taller.

The secret sauce. Parents scrutinize every food label to see if it has trace elements of nuts or gluten. How about the culture media in which their embryos live for the first few days of their life? Incredibly, their doctors don’t know what is in it. Would it surprise you to learn that CooperSurgical, a major medical supplies company, is currently facing several lawsuits after its proprietary embryo culture solution destroyed embryos?

“How is it possible that physicians treating patients would not know the composition of a particular treatment that is being administered?” asked one doctor in F&S Reports, a publication of the ASRM. “We must insist that continuing the use of culture media whose composition is not known is outside of the standard of care.” How can governments support an industry which creates children, but which is no more transparent than Coca-Cola about its secret sauce?

Greed. The IVF industry is portrayed in the media as a kindly fairy-godmother who grants desperate parents their fondest wish. But IVF is a business and doctors are human beings driven by profit maximization. According to Adam Wolf, “The US IVF industry is an enormous business. While fertility clinics can do great things, make no mistake: this is a huge industry with lots of money. Hedge funds are investing heavily in the space, and some now even own large networks of fertility clinics.”

One of the pioneers of IVF in the UK, Lord Robert Winston, has been a critic of the IVF business. He has said that the private sector is on a “gravy train” and that the combination of "desperation" from couples and "avarice" from private practices as a "dangerous combination". “More and more infertile couples are being exploited by an increasingly grasping industry that frequently ignores ethical standards,” he said.  

Trophy toddlers. The technology of IVF enables people to treat children as emotional supports. There are women having IVF children in their 60s and 70s around the world, even in countries as poor as India or Uganda. Gay couples like Elton John and David Furnish commission children when they are well into middle age. And, believe it or not, there appears to be a steady trickle of virgins who have never had sexual intercourse who ask for IVF treatment. IVF is not necessarily a family-friendly medical treatment.

The grubby side. Why hasn’t the #MeToo movement protested the close connection between the pornography industry and IVF clinics? Most clinics provide pornography so that men can quickly provide a sperm sample. The Daily Mail Australia reported that “A computer will play a range of pornographic videos and what men choose is monitored to keep the list up to date. 'Midget porn is strangely one of the most popular styles, along with secretaries,' [a] staff member said.”

A UK thinktank even produced a report about this which complained: "That no-one allowed the demeaning impact on female staff to override any spurious claim that this material was necessary is an indictment of the managers of those fertility clinics.”

Genghis Khan wannabees. The number of doctors in the United States who have used their own sperm to inseminate infertile patients is appalling. One of them, Donald Cline, featured in a Netflix series, “Our Father”. He sired more than 90 children.

In the 1980s, wherever there was IVF, there may have been fertility fraud. Ellen Trachman, a Denver lawyer specialising in reproductive technology, estimates that more than 80 American doctors have been caught, mostly after their offspring happened to check their parentage with do-it-yourself DNA testing kids. This may still be happening. A doctor in Washington state recently surrendered his licence after it was discovered that he had used his sperm as recently as 2009.

But doctors are not the worst offenders. Sperm banks are poorly regulated. A California woman recently discovered that she was one of possibly 200 half-siblings, the offspring of an anonymous sperm donor. Nearly all of them have serious health problems, probably due to his genetic contribution.