Advances in assisted reproduction technology are never without controversy. Questions of ethics and policy plague each innovation, along with concerns about safety and efficacy. But once a technology is available to the public, finding new uses for it is never far behind.
Mitochondrial replacement techniques (MRTs) are the latest example. These involve combining genetic material from the nucleus of one woman鈥檚 egg, DNA from the mitochondria of another woman鈥檚 egg and a sperm. After a long wait, doctors at Newcastle University in the UK have been licensed to use this to produce somewhat misleadingly named 鈥渢hree-parent babies鈥�. At least two such babies are expected to be born this year. In these cases, the technique was chosen because mothers risked passing on serious diseases from the mitochondria in their eggs.
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Now discussion has inevitably turned to other potential applications. Perhaps most prominent is the idea of helping same-sex female couples produce genetically related children.
In the absence of other means to share genes between two eggs, and despite the low level of genetic relatedness between the mitochondrial donor and the child (about 0.2 per cent), MRTs seem an obvious way to fulfil this need. For same-sex female couples, other options have ranged from not having their own children at all, to , such as where one donates the egg and the other carries the fetus.
Powerful desire
Debate on using MRTs for this purpose has been sparked by a by researchers at King鈥檚 College London. They argue 鈥渢hat if MRTs fall within the remit of the reproductive freedom of heterosexual couples where women are at risk of transmitting [mitochondrial] disease, then they also fall within the remit of the reproductive freedom of [same-sex female] couples.鈥�
They say that in places like the UK, where the LGBTQ community mostly enjoys reproductive freedom, that freedom should extend to every kind of assisted reproductive technique (ART) that heterosexual couples are able to access. It would be an important message of equality of access, given that many countries strictly curtail procreative liberties for homosexual couples, where same-sex couples are prevented from adopting or accessing donor sperm or eggs.
To do this with MRTs is, admittedly, a radical idea, but it鈥檚 not a totally new one. In conceptualising ways that same-sex female families might produce genetically related children, MRT didn鈥檛 yet have a name. Despite this, the author concluded that, if found to be safe, the procedure 鈥渟hould be seen as a valid method of family formation鈥�.
The UK鈥檚 Nuffield Council on Bioethics, in its , also anticipated the possibility of same-sex female couples seeking to use the technique.
The overriding point is that the desire for genetically related children is powerful, no matter the gender or sexuality of parents. There are strong social and cultural reasons to believe that this relatedness is important within a family dynamic, and the prevalence of ARTs in our society supports this idea. Same-sex female couples using MRT would in large part be doing so for the same reason many heterosexual couples use IVF: to produce a genetically related child.
A question of rights
Are there any good reasons not to allow this? The bioethicist Francoise Baylis, a long-time critic of MRTs in general, classifies such use by same-sex couples as a 鈥渉arm to society鈥� in.
It鈥檚 unclear to me, along with the King鈥檚 College authors, why this would be the case, other than the argument that says use of this technique for a non-medical reason is unethical on religious grounds, or because many critics believe that by allowing parents to change inheritable mitochondrial DNA, MRT is . However, this is not compelling, as other forms of ART are regularly used for non-medical reasons, for example when a single woman has frozen her eggs and uses IVF to have a child.
There is also a recurring-yet-futile argument against taxpayer funding for assisted reproduction for same-sex couples. The UK has already settled that debate: that same-sex female couples should be offered intrauterine insemination with donor sperm. If this is unsuccessful, IVF should be offered.
And while UK law does not recognise the possibility of two mothers, a second woman can be added to a child鈥檚 birth certificate as a 鈥減arent鈥�, where the child does not have a legal father 鈥� for example in the case of sperm donation via a licensed clinic.
There is no specific, legal, positive right to a biologically related child in the UK. But there is certainly political, social and cultural significance in producing one. Reproductive freedom can absolutely be seen as a human right: every person has the right to have children or not, and use the technology available to do so. MRT should be made available to same-sex couples.
