Fertility technology has always been ethically fraught, as the first recorded case of artificial insemination by donor, in 1884, proves.

Philadelphia physician William Pancoast, employed to treat a couple’s fertility, injected sperm from a medical student into his unknowing and unconsenting female patient while she was under anesthesia.

Nine months later, she gave birth to a baby boy. Pancoast admitted his highly unethical treatment to the woman’s husband several years later, but his female patient was kept in the dark.

We’ve come a long way from the turkey baster technique. As technology advances, so do pioneering techniques. To many, these advances are miraculous – allowing us to save lives, rectify deadly and debilitating genetic flaws, proliferate our idea of family by giving same-sex couples the chance to create their own biological children. To others – particularly religious groups – these new technologies are a threat to the established order and traditional gender roles.

In many cases, technology that is in common usage now, and used to alleviate pain, suffering, illness and death, has faced initial resistance when presented to society. Whether these technologies are outlawed or explored, many will agree that the fertility-assisting technology often raises moral, legal, social, and political issues – concerns that bioethicists have much to say on. How might society and everyday life change as our ability to facilitate and assist the creation of human life – in a variety of ways – progresses?

Three-parent babies

In February this year, Britain’s House of Lords approved the controversial mitochondrial transfer technique that facilitates the conception of three-parent babies.

The technique is primarily a medical one, helping to eliminate mitochondrial diseases – genetic faults in the DNA of tiny structures that provide power for the body’s cells – by swapping the affected mother’s DNA with that from an anonymous female donor. Technically speaking, the baby would have three biological parents, although only 2% of the child’s DNA would come from the mitochondrial donor. Those 2% of genetic material are incapable of determining aspects such as looks and personality; 99.8% of genetic material would be coming from the biological mother and father.

The Catholic church opposes this technique on moral religious grounds. But many argue that the technology is morally sound, including the respected Nuffield Council on Bioethics, which published a report making its stance on it official in 2012.

The technique helps to eliminate mitochondrial diseases by swapping the affected mother’s DNA with that from an anonymous female donor

Since mitochondrial DNA is passed down the maternal line, women affected by mitochondrial diseases are guaranteed to pass on the genetic defects to their children, leaving many with a heart-wrenching choice about whether to have their own biological children. Three-parent IVF could solve this, while eliminating the pain of the children born with the defects.

Around 100 children each year suffer from the effects of mitochondrial defects. In around ten cases, these defects cause severe illnesses such as muscle wasting, liver failure, blindness and brain damage.

As Jeremy Farrar, director of the Wellcome Trust, which supports research into mitochondrial donation at Newcastle University, points out: “Families who know what it is like to care for a child with a devastating disease are the people best placed to decide whether mitochondrial donation is the right option for them. Parliament is to be commended for a considered and compassionate decision to give these families that choice, with proper safeguards under the UK’s internationally admired regulatory system.”

Same-sex families

In the UK, fertility treatments under the National Health Service (NHS) have allowed two-mum families – one biological mother, one adoptive – to reach record levels. Several legal breakthroughs for gay couples seeking to conceive have made this possible. In May 2012, new guidelines for fertility treatment made it possible for gay couples and women over 40 to receive IVF on the NHS, and legal changes in 2009 ensured lesbians could no longer be discriminated against for trying to produce children with donated sperm and no father.

While this is the most common option among lesbian parents, pioneering work by Australian-based researcher Dr Orly Lacham-Kaplan showed that the potential for same-sex couples to produce their own, biological baby is entirely possible.

In 2001, Lacham-Kaplan and her group of researchers at Melbourne’s Monash University developed a revolutionary chemical technique that, she explains, “trains” a somatic cell to “become like a sperm when inside an egg.” This training consists of a series of chemical steps that induce one set of the somatic cell’s chromosomes to leave the egg, effectively turning it into a germ cell that then fertilizes that egg.

Speaking to Factor, Lacham-Kapla, explains: “The technique is useful not just for gay couples but for heterosexual couples when the male is infertile. So it will be, if successful, a treatment as any other treatment – to assist couple having their own biological children regardless of their sexual identities.”

Pioneering work by Dr Orly Lacham-Kaplan showed that the potential for same-sex couples to produce their own, biological baby is entirely possible

Despite success in mouse models and high praise from many in the scientific community, resistance and objection from bioethicists stymied her research funding, and Lacham-Kaplan eventually abandoned the project entirely.

Has anyone made use of or built on her research since? Her earlier work with intra-cytoplasmatic sperm injection – also objected to by bioethicists when it was first presented to the medical community – yielded a technique that is now employed daily in fertility clinics.

“Sadly enough, no,” she says. “As I’ve stated, I faced much resentment when the technology was published through the press and in scientific journals. I have tried to develop more ‘socially’ accepted techniques, like developing eggs and ovarian structures in culture from ‘male’ and ‘female’ stem cells, but in the end it was all a bit too much and I left this research altogether. I do hope that one day someone will follow that through; it has great potential.”

Artificial sperm

Judging by the almost daily emails Lacham-Kaplan receives from same-sex couples offering to be “guinea pigs”, same-sex couples agree.

UK fertility clinics are currently prohibited from using artificial sperm and eggs, but with a breakthrough in stem cell research emerging last year, the possibilities for couples and individuals seeking new ways to conceive look closer than ever.

In 2014, Cambridge scientists teamed up with Israel’s Weizmann Institute of Science in a project that saw them using skin cells to create primitive forms of artificial sperm and eggs. These early-stage sex cells were created by culturing human embryonic stem cells under carefully controlled conditions over a week-long period.

Skin cells from a woman could only be used to make eggs because they lack the Y chromosome, while skin cells from a male might theoretically be turned into eggs as well as sperm. However, Azim Surani, who led the work at the Gurdon Institute in Cambridge, has said that this remains unlikely at present, adding: “It’s not impossible that we could take these cells on towards making gametes, but whether we could ever use them is another question for another time.”

Designer babies

Sex selection – where parents choose the gender of their baby for social or ‘family balancing’ reasons – was made illegal in the UK in October 2009, after the government amended the Human Fertilisation and Embryology Act 1990. Since then, UK parents have flocked to the US to access gender selection technology, a loop-hole that many campaigners are concerned about.

Campaigners point to countries like China, where boys are more valued than girls, as an example of why sex selection is morally wrong.

The specter of designer babies – fetuses that have been genetically modified for cosmetic and/or medical purposes – is considered by many to be the apex of fertility technology’s unethical possibilities, and looks more possible than ever now.

Dr Tony Perry, a researcher at University of Bath specialising in cloning, recently announced precise DNA editing at the moment of conception in mice. It is the latest development of Crispr technology, which has allowed researchers to finesse the art of DNA editing. As well as cutting DNA to make mutations, as Perry’s Bath team has done, the technology allows researchers to insert new pieces of genetic code at the site of the cut.

While designer babies are still some way off, Dr Perry and others believes the debate around the legalities of this technology should start in earnest.

Artificial wombs

Artificial wombs – also known as ectogenesis – are perhaps the most taboo fertility technology in current debates. Pro-ectogenesis campaigners argue that artificial wombs might free women from the responsibility of childbearing.

Natural childbirth is still potentially perilous for both mothers and babies, and artificial wombs could ensure the safety of both, offering us the chance to monitor a fetus closely, from zygote-stage – every heartbeat taken and nutrient ingested. It’s also an option that may appeal to transgender women who wish to become biological mothers.

But is ectogenesis ever morally acceptable? And if so, under what circumstances? Will ectogenesis enhance or erode women’s reproductive rights?

While Dr Frida Simonstein of Israel’s Ben Gurion University champions ectogenesis as a feminist tool, allowing women to balance their body clocks with their careers, opponents such as Richard Ashcroft of Imperial College London cite serious potential ramifications: drug or alcohol-addicted mothers being pressured into have foetuses surgically removed and incubated in artificial wombs, women “too posh to push” missing out on essential bonding processes with their children.

“Is creating children with artificial wombs having children at all, or is it a kind of manufacturing of children? It is deeply dangerous,” Ashcroft says.

As fertility technology advances, so must the public and political debate over what is and isn’t acceptable.