Pathways to Parenthood: Regulating Assisted Reproductive Technologies in the United States

Abstract

According to the Centers for Disease Control, approximately 10.8 percent of women and 7.5 percent of men in the United States have sought infertility treatment. With advances in medical technology, treatment options range from drug therapy, to in vitro fertilization, to surrogate parenthood. These new technologies - often referred to as assisted reproductive technologies (ART) - have provided infertile couples with new options for becoming parents. They have also opened the door for non-traditional families to be formed, allowing single women and same-sex couples the opportunities to enter parenthood. While ART appears to present a solution to the heartache of infertility, it also evokes debates about women's rights, gay parenting, and eugenics. Thus, debate over the use of assisted reproductive technologies places itself at the intersection of our greatest hopes and biggest fears. More than half of the states have some form of regulation of ART, and these policies vary in scope and influence. This dissertation amasses a comprehensive set of data on state regulation of reproductive technologies and addresses three objectives. The first objective is to understand the ways in which states have attempted to regulate the use of ART. These forms of regulation include banning or restricting contracts with surrogate mothers, limiting who can become a surrogate, determining the legal parentage of children conceived using these technologies, regulating the disposition of excess embryos, and preventing single women from using ART. The second objective is to understand why states are passing such legislation and why there is such variation in state regulation. The final objective is to assess the impact of these regulations on access to fertility treatments in a state. The findings in this analysis show that states have approached the regulation of ART in a variety of ways. Some states have created permissive ART environments with their various legislative and judicial outputs, and some have created restrictive environments. The results suggest that most state regulation does not have a significant impact on the availability of ART options within a state. The results do show, however, that states' efforts to increase access through insurance mandates have increased fertility treatment options.