OPINIONS
In vitro babies – medical and legal aspects: a European and North American perspective

On the basis of observations in Europe and North America, this review will focus on Assisted Reproductive

Technologies (ART) and their impact on pregnancy outcomes; in particular multiple births, prematurity, and their

impact on birth defects. In Europe, since 1985 this experience has been somewhat different from that in North

America due not only to the differing populations, cultures, religious perspectives, but also to the rapid implementation

of medical technologies, relative freedom from governmental regulation, as well as the different forms of

payment for medical care that exist between the two continents. This review will focus on the impact of ART on

the complications of pregnancy, multiple gestations and prematurity, and will evaluate the required process and

content of informed consent surrounding ART from the legal perspective. Issues related to complications resulting

from the use of ART from the perspective of neonatal care providers will be highlighted as well as its impact

on the health care system in both regions. Given the impact of ART on both sides of the Atlantic, we propose that

governments, as well as professional organizations – including reproductive specialists, neonatologists, and health

economists – recommend that a legal limitation on the number of embryo transfers be imposed and that embryo

transfer restrictions be coupled with reimbursement for ART services. We suggest that reproductive rights should

not be infringed but that greater concern for and monitoring of the safety of both mothers and their newborns

be undertaken by various professional organizations and governments in Europe and North America. We also propose

systematic centralized reporting of the effectiveness of each form of ART, along with any associated complications,

and that ART babies be carefully monitored for birth defects and imprinting disorders on both continents.