In bioethics, emerging technologies often rekindle prior discourse. For example, gene editing discoveries around 2017 revived worries about enhancing children, such as making them more intelligent, first raised during gene therapy debates in the ’90s.
We see the pattern again with the emergence of stem cells, which can be used to create sperm and eggs. This technology could advance fertility research, and possibly, one day to enable reproduction itself — what STAT Lab Dish columnist Paul Knoepfler cleverly called “stem cell in vitro fertilization.” Stem cell IVF could enable same-sex couples and single parents to have genetically related children, or have children using stems cells from an unrelated stem cell donor. As Knoepfler notes, some will find this unsettling. While discomfort is a starting point, it should not be treated as verdict. Interested individuals and groups — from researchers to policymakers to prospective parents — should discuss and translate the unease around stem cell IVF into clear guardrails prioritizing safety and child welfare.
Technologies like IVF have become widely accepted since the birth of Louise Brown, the first “test tube baby,” nearly 50 years ago. Public acceptance of same-sex marriage has also grown, with about 2 in 3 Americans in favor today. So, if more people are accepting of IVF and same-sex marriage, why does stem cell IVF seem so unsettling?
Strong feelings are often framed as ethical judgements. Humanities scholar Leon Kass famously argued that human reproductive cloning is repugnant — akin to cannibalism or bestiality. According to Kass, this “yuck factor” frames disgust as a moral warning when we cannot yet articulate what is at stake. Although some consider disgust as a fallible moral heuristic, it does not mean it has no relevance. While disgust about stem cell IVF is not an argument, it may signal that societal norms and practices are being challenged. Thus, visceral responses are a cue to identify reasons why stem cell IVF might be unsettling.
One reason is the belief that stem cell IVF upsets the “natural order” by separating the unitive end (spouses giving themselves to each other in a bodily act) and the procreative end (the same act brings a child into being): A marital act viewed as a comprehensive union should not be severed from the coming-to-be child by replacing it with a procedure like stem cell IVF.
A second reason some may find stem cell IVF unsettling centers on possible harms to children. These might be physical harms caused by laboratory techniques or harms stemming from deviations in the traditional family structure.
A third source of unease relates to fears of genetically engineered children, as Knoepfler notes. Although stems cell IVF does not itself require gene editing, the two are often conflated, fueling fears of “designer” children when considering ethics of reproductive technologies.
How, then, do we move forward among those who consider stem cell IVF as abhorrent while others — such as some same-sex couples — are excited about the prospect of having a genetically related child? A durable route forward does not require abandonment of one’s values, but agreement on outcomes — a narrower set of rules that can guide policy even amid moral disagreement. This approach reflects the spirit of pluralistic democracy; it does not delegitimize one’s beliefs but allows for a workable solution.
Agreement on a narrow set of rules begins by ensuring a high bar for safety. As explained 20 years ago, the largest benefit of stem cell-derived gametes is to better understand human reproduction and infertility. IVF practitioners also need opportunities to train prior to performing reproductive procedures; using eggs and sperm derived from stem cells could reduce burdens on donors. Most interest in stem-cell-made sex cells lies in laboratory use; only after safety is well-established should clinical applications proceed. Clinical studies must prioritize child health and include long-term follow-up, with proportionate oversight and safeguards against premature commercialization.
Ensuring the safety of children born from stem cell IVF is most important and necessary to demonstrate before such technology can be used. When stem cell IVF was first imagined two decades ago, some feared that children born through such “artificial” means, or who come to know they lack a genetic tie to a parent, might face psychological or identity harms, or have an altered childhood experience. Similar arguments were raised about IVF nearly 50 years ago.
But decades of evidence show otherwise.
Across dozens of studies, children’s well-being and outcomes track more closely with parenting quality, family stability, and openness about origins than with the number, gender, or genetic relatedness of parents. Research on families formed through IVF, surrogacy, adoption, and raised by single or same-sex parent(s) show that children typically display healthy emotional and behavioral development. Current evidence strongly indicates that children born through stem cell IVF would likewise thrive, though ongoing research will be essential.
Another persistent source of public unrest is the fear of genetic enhancement. As new biotechnologies emerge, concerns about “designer” children remain strong. Many national and international policies already prohibit germline genetic editing and could serve as frameworks to distinguish between acceptable reproductive uses and ethically fraught enhancements. Regulatory focus should fall on downstream consequences, such as attempts to engineer intelligence, rather than the stem cell IVF technique itself.
For instance, if Americans want to prohibit designer children, a policy or law must prohibit any and all technologies that create genetically engineered children, rather than focusing on individual techniques such as CRISPR gene editing, gene transfer, and prime editing.
Many additional ethical issues deserve further discourse, including offsetting high costs of stem cell IVF, consent in the use of donated cells, the recognition of solo and multi-parent families, and legal and privacy concerns. Whatever ethical issues we face, solutions must emerge from inclusive moral deliberation that bring diverse worldviews into the dialogue. The goal of deliberative democracy is not persuasion but reciprocal understanding, valuing different viewpoints even when we disagree. Only through such engagement can we navigate fundamental philosophical differences and reach workable, respectful solutions in contemporary society.
Zubin Master is associate professor in the Department of Social Sciences and Health Policy at Wake Forest University School of Medicine and associate director of Wake Forest University’s Center for Bioethics, Health & Society. Scott D. Rhodes is professor and chair of the Department of Social Sciences and Health Policy at Wake Forest University of School of Medicine. The views expressed here are those of the authors and not their respective academic institutions.
