Ethical and Moral Aspects of IVF: What is Important to Discuss in Advance with Your Partner and Doctor

In vitro fertilization (IVF) is a significant advancement in reproductive medicine that opens the doors to parenthood for many couples. This method involves a series of carefully planned steps—from ovarian stimulation and egg retrieval to laboratory fertilization, embryo culture, and transfer.

In some cases, preimplantation genetic testing (PGT) is integrated into the process to assess embryo quality at the genetic level and increase the chances of a successful pregnancy. Of course, like any progressive approach in medicine, IVF touches not only on technical aspects but also on deep ethical and moral questions—from the status of embryos to issues of donation and selection. These nuances can affect couple dynamics, family relationships, and psychological well-being, but many couples successfully overcome them by focusing on positive expectations and shared goals. The more consciously and positively a couple approaches these moments, the higher the likelihood of a favorable outcome, as emotional harmony plays a key role in reproductive health.

In this article, we will break down the key ethical dilemmas of IVF, drawing on recommendations from leading organizations such as ESHRE (European Society of Human Reproduction and Embryology) and ASRM (American Society for Reproductive Medicine). We will suggest how to approach their discussion—with your partner and doctor—for a harmonious and informed approach. If you are considering IVF, I recommend starting with an open conversation as a couple, then discussing the details with a fertility specialist to account for all nuances. If necessary, you can involve a psychologist or other specialists for additional support.

How Important is it to Discuss Ethical Aspects of IVF in Advance?

IVF is a complex procedure in assisted reproductive technologies. In it, egg fertilization by sperm occurs in a laboratory setting, followed by embryo formation, culture, and transfer to the uterus. This enables pregnancy in situations where natural conception is difficult for various reasons, including age factors. This method is not only technically advanced but also emotionally charged, as it touches on aspects of life such as the beginning of new life, personal values, and family prospects. According to ESHRE reports, over 2 million IVF cycles are performed worldwide annually.

Preliminary discussion allows couples to build trusting relationships with each other and the doctor. It helps develop a plan that considers personal, religious, and cultural values. Topics can be discussed in advance both as a couple—to align views—and with the doctor to receive professional recommendations and informed consent.

Key Ethical and Moral Aspects of IVF

The ethical and moral aspects of IVF are an important part of the process. They help couples make balanced decisions aligned with their values. Discussing them in advance promotes emotional comfort and confidence in choices. Below, we will examine each key aspect in detail, approaching them with sensitivity and relying on international expert recommendations.

1. Status and Future Fate of Embryos

In the IVF process, embryos are created in laboratory conditions to increase the chances of a successful pregnancy. Sometimes more embryos are formed than needed for immediate transfer. This raises questions about how to treat embryos in terms of their potential and further steps.

Ethical Dilemmas: From the scientific perspective of reproductive medicine, an embryo in early stages (before implantation) is viewed as a collection of cells with developmental potential. Its status later, after transfer, as a fetus, is determined by biological criteria such as nervous system formation or heartbeat. Modern approaches emphasize ethical handling, including the possibility of cryopreservation to preserve embryos for the future without immediate decisions. This allows avoiding hasty steps and focusing on the family's health and well-being.
What to Discuss in Advance: Since couples' situations vary—some turn to IVF due to age factors, others for fertility preservation (e.g., egg freezing), and others to overcome different issues—it is important to adapt the discussion to your context. Such conversations help clarify expectations and reduce emotional burden.

Discussion with Partner (Checklist Questions):

How do we feel about creating multiple embryos?
Are we ready to freeze them for future cycles?
How does this fit into our family plans?

Discussion with Doctor (Checklist Questions):

What storage options for embryos are available?
How does cryopreservation affect their viability?

2. Transfer of Multiple Embryos and Risks of Multiple Pregnancy

IVF involves transferring embryos to the uterus. The question of the number of embryos transferred (often 1-2) is linked to the risks of multiple pregnancy, which can increase the burden on the mother's and children's bodies.

Ethical Dilemmas: Multiple pregnancy can increase the body's burden. In such cases, transferring 1-2 embryos is recommended, as indicated in ESHRE guidelines (2023). According to updated ASRM data (2024), the focus is on minimizing risks through an individualized approach to ensure safety for the mother and children. This requires a balance between the desire for success and health care, regardless of whether the pregnancy is carried by the woman herself or a surrogate.
What to Discuss in Advance: This ensures an ethical and safe decision, helping avoid complications and focus on family well-being.

Discussion with Partner (Checklist Questions):

How many embryos are we ready to transfer?
How do we assess the health risks of multiple pregnancy?

Discussion with Doctor (Checklist Questions):

What are the recommendations for the number of embryos (per ESHRE, 1-2 to reduce risks)?
How to minimize complications in our case?

3. Preimplantation Genetic Testing (PGT) and Embryo Selection

PGT is a method of analyzing embryos for genetic anomalies before transfer. It is integrated into the IVF cycle to increase the chances of a healthy pregnancy. As detailed in ESHRE recommendations, PGT includes types: PGT-A (for aneuploidy), PGT-M (for monogenic diseases), and PGT-SR (for structural chromosomal rearrangements). This is a tool for identifying risks such as chromosomal syndromes (e.g., trisomy 21), but it also touches on moral questions of selection.

Ethical Dilemmas: From a medical and scientific perspective, PGT helps identify potential genetic issues at early stages. This promotes more stable pregnancy progression and reduces complication risks. The focus is on the health of the embryo and future child—after all, complete control over genetics remains beyond human capabilities. In any pregnancy, natural or with IVF assistance, much depends on natural processes. This is a tool for an informed approach, and its application is always oriented toward medical indications.
What to Discuss in Advance: Considering the individuality of each couple (age, family history, or other factors), such discussions help focus on health and make an informed decision.

Discussion with Partner (Checklist Questions):

Are we comfortable with the idea of genetic analysis?
How will this affect our pregnancy expectations?

Discussion with Doctor (Checklist Questions):

Is PGT suitable for our case (e.g., for ages over 35)?
What advantages does it provide in terms of risk reduction?

4. Gamete and Embryo Donation: Questions of Origin and Anonymity

IVF may involve the use of donor eggs, sperm, or embryos. This helps in situations where one's own gametes are unavailable for various reasons.

Ethical Dilemmas: кEach couple is unique—some choose donation due to age limitations, others to build a family in partnerships where natural conception is impossible. The moral aspect concerns the child's right to information about the egg or sperm donor: in the USA, where many travel for procedures, donation is often anonymous, but there is an "identity-release" option, where the donor agrees to disclose data to the child after 18 years (about 20-30% of donors choose this, according to industry data; there is no federal law requiring disclosure, but clinics offer the choice). Regional differences: Laws vary by state. In most countries (according to studies, in more than 50 countries, including the USA, Russia, and many European ones, donation is anonymous). In some, such as Sweden, Australia, and the UK, anonymity is prohibited, and children can access data after 18 years. In Turkey, laws prohibit the use of donor cells, embryos, sperm, as well as gender selection of embryos, but assistance to patients needing such procedures can be provided through collaboration with colleagues abroad, where the main part of the process is conducted jointly to ensure safety and effectiveness. These debates emphasize the need for balance between protecting all parties and the child's emotional comfort. It is important to note that even with donation (if not embryo donation), one parent remains genetically related. Through pregnancy carrying, a unique exchange occurs: the mother enriches the fetus with microRNA (RNA) and stem cells through the amniotic fluid (the fetus constantly swallows it, facilitating "communication"), and vice versa—fetal cells transfer to the mother (the phenomenon of microchimerism, confirmed by studies, where cells remain in the body for years, potentially influencing traits and health). This makes the connection biologically deep, even if the genetics are partially from the donor.
What to Discuss in Advance: Since situations are individual, this helps create a harmonious family story adapted to your context.

Discussion with Partner (Checklist Questions):

Will we tell about the egg/sperm donor in the future?
Are we ready for open dialogue in the family?

Discussion with Doctor (Checklist Questions):

What donation options are available in our country (e.g., anonymous or open)?
How to ensure psychological support?

5. Surrogacy

IVF is sometimes combined with surrogacy, where a woman carries a child for the couple. This helps in situations where independent carrying is impossible.

Ethical Dilemmas: Surrogacy raises questions about roles in motherhood, requiring careful consideration of emotional and legal aspects so that all parties feel respect and protection. According to updated ASRM data (2024), the focus is on minimizing risks through an individualized approach. In Turkey, surrogacy is prohibited, but assistance to patients can be provided through collaboration with colleagues abroad, where the process is conducted jointly to ensure ethics and safety.
What to Discuss in Advance: This ensures an ethical and safe decision

Discussion with Partner (Checklist Questions):

How do we feel about the idea of surrogacy?
What emotional aspects are important to us?

Discussion with Doctor (Checklist Questions):

How to formalize the legal aspects of surrogacy?
What options are available through international collaboration?

6. Procedure Accessibility and Age Factors

IVF is a resource-intensive procedure, raising questions about access equality and the need to consider age risks for the well-being of the mother and child.

Ethical Dilemmas: From a scientific perspective, age after 50 increases risks, and ethics requires a balance between the desire for parenthood and potential complications. Accessibility varies, but the focus on an individualized approach helps ensure fairness and safety.
What to Discuss in Advance: This allows adapting the approach to the unique situation.

Discussion with Partner (Checklist Questions):

What are our motives and financial capabilities?
Are we ready for age factors?

Discussion with Doctor (Checklist Questions):

What are the individual risks in our case?

How to Conduct Preliminary Discussion: Practical Recommendations

For effective discussion, you can use the checklists from previous sections. A brief reminder of the key ones:

With Partner (Focus on Personal Values and Expectations): Discuss attitudes toward embryo status (e.g., freezing), embryo transfer (number), PGT (comfort with analysis), donation (telling the child), surrogacy (emotional aspects), accessibility (motives and capabilities).
With Doctor (Focus on Medical Options and Risks): Clarify embryo storage options (vitrification as the main method of ultra-fast freezing), transfer recommendations (1-2 embryos), PGT application, donation types (considering international collaboration), legal aspects of surrogacy, individual age risks.

Familiarize yourself with ESHRE (2024)recommendations and ASRM (2024) for deeper understanding.

Informed Approach to IVF

The ethical and moral aspects of IVF provide an opportunity for deep reflection that can strengthen the couple's bond and lead to a positive outcome. By discussing them in advance, you create a foundation for emotional support and confidence in the process. It is important to tune into positivity, focusing on shared goals—this increases the chances of success. Remember that every situation is unique, and consultation with a doctor will help adapt the approach to your needs, ensuring comfort and hope on the path to parenthood. If you need support in this process, I am always ready to help with an individual consultation.

References

European Society of Human Reproduction and Embryology (ESHRE). (2023). "Good practice recommendations for the use of PGT." Human Reproduction Open, 2023(2), hoad015.
American Society for Reproductive Medicine (ASRM). (2024). "Preimplantation genetic testing: a Practice Committee opinion." Fertility and Sterility, 121(4), 567-578.
European Society of Human Reproduction and Embryology (ESHRE). (2025). "ESHRE guideline on the number of embryos to transfer during IVF/ICSI." Human Reproduction, 40(1), 1-11.
Munné, S., et al. (2024). "Recent advances in PGT-A and mosaicism management in IVF cycles." Fertility and Sterility, 121(5), 789-802.
ESHRE PGT Consortium. (2025). "Evidence-based recommendations for PGT in high-risk populations." Human Reproduction Open, 2025(1), hoae001 (in press).