ART: new roles and new problems

Nina Rusanova, Russian Academy of Science

The development of in vitro fertilization (IVF) and its subsequent variations and extensions, all now included under the umbrella of ART (assisted reproductive technologies) changes the role of this medical procedure. ART now is not only method for infertility treatment but real factor of economic and demographic development. ART is competitive product in the internal and external market of medical services which has influence on such processes as migration (“reproductive tourism”), female employment (surrogacy), nuptiality and can change life plans due to cryopreservation of eggs, sperm and embryos. New roles generate new economical, bioethical, juridical problems. ART overcome the barrier of natural selection and make for spread of some heritable diseases; separation of “biological” and “juridical” parenthood creates new types of family relations with their specific rights and duties; the state can use ART as a tool of fertility control, smoothing down or embarrassing availability for some groups. Russia: one of the most liberal reproductive legislation (2003), but neither public nor private insurance coverage. 2007: 51 licensing reproductive center; allowed ART-programs: IVF, artificial insemination, induction of superovulation, IVF surrogacy, gamete/zygote/embryo intrafallopian transfer, multifetal pregnancy reduction, preimplantation genetic diagnosis, donation (including ovarian and testicular tissue donation), micromanipulation (intracytoplasmic sperm injection, assisted hatching etc), cryopreservation, therapeutic cloning; ART-programs with ambiguous status: posthumous insemination, oocyte maturation, experimentation on the preembryo, status of the conceptus. ART treatment ratio very low [2003 – 10555 cycles, 2935 pregnancies, 1830 newborns (0,12% of total live birth)]. Resolve of main problems deal with national demography project (2007) that provides partial support for ART (budget quotas for some cycles of ART for women younger 38-40 years of age, coverage of medicine expenses, quotas division between clinics etc).