Mental illness, infertility, and sterilization are all possible occurrences, however, and require input from a governing body, a government or a health organization, perhaps, to aid reproduction. Is it their right to use reproductive technologies available simply because it is their right to have sex?
Selective Breeding, that is, naturally occurring events within nature affect who gets to reproduce, with how many mates, how many times. Different reproductive strategies are usually grouped into R-selection and K-selection. R-selection is for organisms like fish and mice, who produce many offspring, who develop and mature quickly. Organisms with R-selection have a shorter life-span, and many offspring may not live out their full life due to lack of resources and a large brood (progeny). K-selection is for organisms like humans, elephants, etc. These organisms have few offspring who are slow to mature, but have a better chance of survival because there are more resources available (lesser brood/progeny), and because of the parental investment placed in their survival. Elephants and Humans teach their offspring how to live, and take care of them while they develop, thus, they can support larger brains (intellect) and learn more from their parents, while stuck in a potentially dangerous state o development without the ability to protect themselves. Thus, parental investment is inversely related to the amount of offspring an organism has, and their rate of development.
To relate this to Never Let Me Go, I believe that humans are meant to have a few children, and although I enjoy the urban centers and innovations that have come from a large population, I can very easily imagine a world where there are so many humans that they cease to be regarded as human beings, and more like expendable mice, just like the clones.
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