Global Ethics in IVF: Harmonizing Regulation, Ensuring Access, and Governing Innovation

Background In vitro fertilization (IVF) has facilitated over 10 million births globally, with annual growth rates exceeding 5%. However, this expansion has intensified ethical challenges spanning genetic selection, embryo management, access equity, and emerging biotechnologies. Methods We conducted a comparative ethical analysis of IVF practices across nine countries (United Kingdom, United States, Israel, Ghana, Italy, Japan, China, India, and France) representing diverse economic, cultural, regulatory, and healthcare contexts. Additional analysis incorporated data from the European Atlas of Fertility Treatment Policies (2024), which systematically evaluated 49 European countries and territories on access to equitable, safe, and efficient fertility treatments using standardized criteria. Data sources included peer-reviewed literature (2020–2025), government reports, professional society guidelines, and legal documents. Results Critical disparities were identified in global IVF governance, affecting 2–3 million treatment cycles annually. Key findings include: (1) stark regulatory inconsistencies in preimplantation genetic testing, ranging from strict medical-only applications (UK) to unrestricted consumer choice (parts of the US); (2) dramatic access inequities, with per-capita utilization varying 200-fold between high- and low-resource settings, and even within Europe, where access scores range from 89.5% (Belgium) to 7.8% (Kosovo); (3) inadequate ethical preparation for emerging technologies including in vitro gametogenesis and CRISPR gene editing; and (4) insufficient integration of diverse cultural and religious perspectives in international guidelines. France’s recent policy evolution (2021–2022) demonstrates both the potential for rapid progressive reform and the persistence of social disparities despite universal coverage. Conclusions Current piecemeal approaches to IVF ethics create regulatory arbitrage and perpetuate global health inequities. We propose a WHO-convened global ethics framework to standardize IVF ethical practices by 2027, addressing disparities in access, regulation, and technology governance.