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The most obvious manifestation is insurance coverage, a kind of two-edged sword for the fertility trade. On the one hand, when insurers cover infertility as a medical illness, they nearly guarantee a greater demand for fertility treatments: people who previously couldn’t afford treatment suddenly enter the market, and people who bought minimal services now buy more. Thus, political demands in this industry can translate easily into expanded commercial demand. On the other hand, though, insurance coverage comes at a cost, forcing providers to charge only what the insurers will pay. Accordingly, insurance—and even the threat of insurance—acts to cap prices in the industry and put an even greater premium on volume. Tiffany’s and Armani, by contrast, have no such worries.

Political pressures also raise the ever-present specter of regulation. Because infertility treatments have a substantial medical component and often involve procedures that incite moral debate, the industry is a natural candidate for government oversight. In most parts of the world, such oversight is already in place. In the United States, by contrast, federal regulation is minimal, confined to a single piece of legislation (the Fertility Clinic Success Rate and Certification Act of 1992) without any means of enforcement. Still, as with insurance, the threat of regulation hangs heavily over the industry, prodding suppliers to conform to a fairly rigorous regime of self-regulation and often to act as if they were anticipating a regulatory response.

At the same time, regulatory differences between the United States and other countries have also created gaps and opportunities in an increasingly global market. Because U.S. brokers can pay unlimited fees for egg donation, the high end of the global egg trade has gravitated rapidly toward the United States. Because Danish sperm is subject to rigorous standards and guaranteed by the government to remain anonymous, a Danish sperm bank has been able to corner much of the global market for exported sperm. In this fashion, players in the fertility trade skate along the edges of government decree, responding to and often profiting from the political variations they face.

This content is authorized for use only in the HarvardX course "Bioethics: The Law, Medicine, and Ethics of Reproductive Technologies and Genetics," September/October 2016. Copyright 2016 by the President and Fellows of Harvard College. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means without the permission of Harvard Business School.