Assisted reproductive technologies: new opportunities
The article attempts to evaluate the potential of assisted reproductive technologies to influence fertility, based on calculations made using the latest available statistical data from the world, Europe and Russia. It examines assisted reproductive technologies in a historical and ethical context, since both influence the readiness of different populations to use them to overcome involuntary childlessness and problems with reproductive health. The analysis, based on existing statistics (which have important quality limitations varying from one country to another and are probably incomplete), allows us to tentatively presuppose that, on a worldwide scale, many indicators of ART efficiency have reached a kind of “plateau” – that is, have stopped increasing and stabilized. In some countries, indicators of the availability of these technologies to the population have stabilized as well. This has happened in those countries where they are close to the maximum, where the share of ART children in the country’s total annual fertility is over 4%. The “old” reproductive technologies – in-vitro fertilisation, ICSI, surrogacy and gamete donation – have already occupied their “niche” in the area of reproductive options, and their growth potential now seems limited. One reason for this is the practiсe of limiting the number of embryos during one transfer to two in order to decrease the number of fetuses in one pregnancy, which leads, on the one hand, to a somewhat lower ART pregnancy rate, but on the other, to improved health of the resulting children.The demographic potential of ART can be increased if the following occur: they become economically and geographically accessible to larger numbers of people; they are used more often by women of a relatively younger reproductive age (younger than 34 or at least 40 years); the role of superstitions and religious bans of various associated practices is diminished; and new technologies are developed which would allow women of older reproductive ages to have their own genetic children (freezing of eggs and ovarian tissue, cytoplasm donation, etc.).