Tuesday, May 15, 2007

Demand for Egg Donors increases

As Demand for Donor Eggs Soars, High Prices Stir Ethical Concerns

Published: May 15, 2007
Samantha Carolan was 23 and fresh out of graduate school when she decided to donate eggs to an infertile couple. Ms. Carolan concedes that she would never have done it if not for the money, $7,000 that she used to pay off some student loans.
She has since had a second egg extraction, for which she was paid $8,000, and she is planning a third before taking a break.
“The first time, it’s frightening,” said Ms. Carolan, now 24, of Winfield Park, N.J. “It is surgery, and I don’t think I would have done it without compensation. But I had very limited pain, and it was a great experience for me. I would have done it the second time for less money or even no compensation.”
Though many egg donors derive great satisfaction from knowing that they helped someone start a family, the price of eggs has soared in recent years as demand has increased, and the sizable payments raise controversy.
A survey published this month in the journal Fertility and Sterility, “What Is Happening to the Price of Eggs?” found that the national average compensation for donors was $4,217. At least one center told the authors of the paper that it paid $15,000. Many centers did not respond.
Though laws prohibit the sale of transplant organs, sperm donors have always received small payments, and prospective parents in the United States are allowed to compensate women for their far greater expenditure of time and energy. (Many countries, including Canada and Britain, do prohibit payments to egg donors.)
The American Society for Reproductive Medicine considers compensation of $5,000 or more to “require justification” and sums exceeding $10,000 “beyond what is appropriate.”
Meanwhile, advertisements recruiting students from elite universities to donate promise tens of thousands of dollars, and donor agencies have sprung up, appealing to would-be parents with online videos and photo galleries of donors. According to the Centers for Disease Control and Prevention, 5,767 babies were born in 2003 from donor eggs; the number of actual egg donations is probably much higher, however, because the success rate is fairly low.
Ethicists and some women’s health advocates worry that lucrative payments are enticing young women with credit-card debt and steep tuition bills to sell eggs without seriously evaluating the risks.
“The real issue is whether the money can cloud someone’s judgment,” said Josephine Johnston, an associate for law and bioethics at the Hastings Center, a research group in Garrison, N.Y., that specializes in medical ethics. She does not oppose compensation, but she does worry about high prices.
“We hear about egg donors being paid enormous amounts of money, $50,000 or $60,000,” Ms. Johnston said. “How much is that person actually giving informed consent about the medical procedure and really listening and thinking as it’s being described and its risks are explained?”
Adding to the debate was a proposal by lawmakers in Maryland to ban payments for eggs. Proponents of compensation say if payments are lowered or eliminated, the supply of eggs will dwindle or dry up.
“Women aren’t exactly lining up to be donors,” said Dr. Mark Sauer, director of the Center for Women’s Reproductive Care at the Columbia University Medical Center. “There are a lot more recipients than donors.”
Part of the problem is that the risks of donation have not been thoroughly studied. Although the consensus among most reproductive endocrinologists is that extraction is safe, five deaths have been reported in Britain. There are enough unanswered questions that stem cell researchers have promised not to pay for eggs.
“One of the most striking facts about in vitro fertilization is just how little is known with certainty about the long-term health outcomes for the women who undergo the procedure,” a recent report by the Institute of Medicine said.
The 2005 guidelines of the National Academy of Sciences for human embryonic stem cell research discourage paying for eggs for research. The California Institute for Regenerative Medicine reimburses women only for out-of-pocket expenses like lost wages or cab fare.
“As a public agency, we felt we shouldn’t be putting money on the table that might induce someone to take a risk,” said Geoffrey Lomax, senior officer for medical and ethical standards at the institute.
So far, women have not come forward to give away eggs for research. “I just completed an outreach initiative to 21 institutions across the state that we’ve funded,” Dr. Lomax said. “No one has had an egg donated specifically for research.”
The reluctance is understandable. The process of egg extraction is time consuming, and it is not comfortable. For some women, it can be painful. A woman first has to take medications to stop her menstrual cycle and then daily hormone injections for several weeks to stimulate her ovaries to produce a crop of mature eggs at once.
The drugs may cause bloating, weight gain, moodiness and irritability, and there is a risk of a rare condition called ovarian hyperstimulation syndrome that can cause life-threatening complications, blood clots and kidney failure.
The egg extraction itself is a surgical procedure in which a thin needle is inserted through the vagina into the ovary to retrieve the eggs and liquid from the follicles. Risks include adverse responses to anesthesia, infection, bleeding or the inadvertent puncture of an organ.
It is the long-term risks, both physical and psychological, that are harder to assess. Questions have been raised about whether extraction may jeopardize the donor’s fertility, and critics worry about the potential psychological harm to a donor of eggs as a young woman who later finds that she is unable to have children.
And since egg donors go through much the same process as women trying to conceive in vitro, there are concerns that they may be prone to the higher rates of certain cancers that some studies have found among infertility patients. Still, said Dr. James A. Grifo, director of the division of reproductive endocrinology at the New York University School of Medicine, “There is no credible evidence of long-lasting effects or health consequences down the line.”
That does not necessarily mean that the procedures are safe.
“There’s no health-outcome data collected by anybody other than some voluntary reporting, and there’s no postmarket testing on how these drugs are being used,” said Susan Berke Fogel, co-founder of the Pro-Choice Alliance for Responsible Research, a project of the Public Health Institute in Oakland, Calif.
In a recent article in The New England Journal of Medicine, a Harvard Business School professor said the controversy over the price of eggs was obscuring questions of women’s health. The author, Debora L. Spar, an economist who wrote “The Baby Business” last year, calls for more studies of the drugs being used, more long-term follow-up of donors and federal regulations to ensure proper informed consent.
When Ms. Carolan went to donate, the short-term risks were described to her in detail, but she said she did not recall any mention of possible long-term risks. Her family opposed her decision because they worried about her health, she said, and her friends did not understand.
“They all think I’m crazy,” she said. “If the topic comes up, and I tell friends I’ve done it, they’re like: ‘Why? Oh my God, aren’t you afraid you have a baby out there?’ They’re so stunned and shocked.”

Thursday, May 10, 2007

more on the new embryo bank...

'Embryo Bank' Stirs Ethics Fears

Firm Lets Clients Pick Among Fertilized Eggs

By Rob SteinWashington Post Staff WriterSaturday, January 6, 2007; Page A01
A Texas company has started producing batches of ready-made embryos that single women and infertile couples can order after reviewing detailed information about the race, education, appearance, personality and other characteristics of the egg and sperm donors.
The Abraham Center of Life LLC of San Antonio, the first commercial dealer making embryos in advance for unspecified recipients, was created to help make it easier and more affordable for clients to have babies that match their preferences, according to its founder.

Jennalee Ryan, who is selling the service, points out that selecting an embryo is more affordable than selecting both an egg donor and a sperm donor. (Courtesy Of Jennalee Ryan)
Researchers and regulators are reshaping the landscape of?science, medicine?and health, engendering hope -- and disquiet -- for the future of humanity.
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"We're just trying to help people have babies," said Jennalee Ryan, who arranged for an egg donor to start medical treatments to produce a second batch of embryos this week. "For me, that's what this is all about: helping make babies."
But the embryo brokerage, which calls itself "the world's first human embryo bank," raises alarm among some fertility experts and bioethicists, who say the service marks another disturbing step toward commercialization of human reproduction and "designer babies."
"We're increasingly treating children like commodities," said Mark A. Rothstein, a bioethicist at the University of Louisville in Kentucky. "It's like you're ordering a computer from Dell: You give them the specs, and they put it in the mail. I don't think we should consider mail-order computers and other products the same way we consider children."
Prospective parents have long been able to select egg or sperm donors based on ethnicity, education and other traits. Couples can also "adopt" embryos left over at fertility clinics, or have embryos created for them if they need both eggs and sperm. But the new service marks the first time anyone has started turning out embryos as off-the-shelf products.
Before contracting for the embryos, clients can evaluate the egg and sperm donors, and can even see pictures of them as babies, children and sometimes adults. A fertility specialist will then transfer the embryos into a client's womb or into a surrogate, which Ryan can also arrange.
"We're unique," Ryan said. "We're the only one in the world doing this right now."
Some fertility doctors and ethicists are undisturbed by the Abraham Center because the service does not differ markedly from what already happens routinely at fertility clinics.
"I know some people say: 'This is shocking. Embryos made to order,' " said John A. Robertson of the University of Texas at Austin, who advises fertility specialists on ethical issues. "But if you step back a little bit, you realize that people are already choosing sperm and egg donors in separate transactions. Combining them doesn't pose any new major ethical problems."
But others condemned the process as the unsettling culmination of recent objectionable developments, including the payment of egg and sperm donors and the growing tendency to try to select traits such as sex, intelligence and appearance.
"People have long warned we were moving toward a 'Brave New World,' " said Robert P. George of Princeton University, who serves on the President's Council on Bioethics. "This is just more evidence that we haven't been able to restrain this move towards treating human life like a commodity. This buying and selling of eggs and sperm and now embryos based on IQ points and PhDs and other traits really moves us in the direction of eugenics."

New Company offering embryos for sale

Embryos for sale

A new company in America is offering embryos for sale in a package deal from around £5,000. Our correspondent talks to the Texas woman behind it and reports on the ethical furore
Is selling embryos 'off the shelf' a step too far? Post your comment using the form below-


Carol Midgley
As any devotee of internet shopping knows, there are few things these days that cannot be bought off the shelf. Snap-on teeth, brand-new breasts, even human kidneys can be yours “to go” if you have the cash and the determination to find them.
But until now, embryos were not one of those things. Yes, you could buy yourself an egg and some sperm in separate transactions or find an IVF patient who would donate leftover embryos to you. But buying a ready-made embryo as you might purchase a Marks & Spencer suit — surely that would be taking consumer culture too far?
Apparently not. A company in Texas that calls itself “the world’s first human embryo bank” is offering couples and single women the chance to order from its batches of existing embryos after browsing detailed information sheets about the race, education, personalities, hair and eye colour of the egg and sperm donors.
The Abraham Center of Life is the first commercial enterprise making embryos in advance for unspecified recipients who pay $2,500 (£1,290) for each embryo. The total price tag for each attempt at pregnancy, including the implantation procedure, is estimated at between $8,000 and $10,000. It has provoked a predictable outcry over the creation of “designer babies” and accusations that human reproduction is being turned into a factory production line, treating babies as groceries on offer.
If you are in the business of buying babies though, it certainly seems to be a bargain. Jennalee Ryan, a mother of six, runs the company from her home in San Antonio. She says the total cost of embryo donation without involving a surrogate mother is “approximately half the cost of adoption and much less expensive than the total IVF procedure, with a greater overall success rate”, (she rates IVF at 30 per cent successful, and claims her method is nearer 70 per cent). The cost for IVF in America can range from $12,000 to $20,000. Adoption, depending on the circumstances, can run into tens of thousands of dollars but, thanks to falling birth rates, contraception and availability of abortion, babies are scarce.
Of course Ryan’s service is so far unproven. She says that the first two women to use it are five months pregnant, though we have only her word for that. Having endured a failed IVF attempt herself three years ago and witnessed many surrogate pregnancies go wrong, she claims that she is motivated more by a desire to help others than by money, and insists that those who criticise her do not properly understand what she is doing.
“If you are a pro-life person, you should be happy because I’m creating a life. If you are pro-choice, you should be happy because I’m creating choice,” she says at her home as she is bombarded for requests for interview by media outlets around the world. What about those who are uncomfortable about the notion of being able to buy instant, designer, babies off the shelf? “All babies are designer babies,” says Ryan. “We mate with people we find attractive.”
And why not, actually, you might say. People have been choosing the physical characteristics of donors for years. Arranged marriages go back centuries and constitute a form of gene selection. Is there much difference, ethically, between obtaining the sperm and egg separately and putting them together for your purposes and someone else doing it for you first? Surely it is only a logical next step in accommodating infertile people who long for a baby in the modern world?
Legally, there is nothing to stop an infertile British woman going to America and availing herself of the services of the Abraham Center of Life. If she is implanted with an embryo that she buys in the US and gives birth in Britain, then in the eyes of the law she is that baby’s natural mother (for women who cannot carry a baby, by the way, Ryan can also arrange a surrogate-mother service at extra cost). But the Human Fertilisation and Embryology Authority warns that a British woman seeking such treatment in America would not have the benefits and guarantees afforded by law in the UK because the fertility business is not regulated as strictly. “You must ask yourself, what will the clinic do with your records. Will it be confidential for ever? What if the clinic closes?” says a spokesman. “As the UK is unique in its standards of fertility treatments, we advise that patients who are considering going abroad check the standards and regulation of clinics in that country.”
There is confusion surrounding the service that Ryan offers, and she is eager to clear up misconceptions. The first is that people can submit a checklist of requirements — such as blue eyes, a rosebud mouth, a fondness for classical music — and she will look for matching donors to “create” a baby to suit them in a manner that evokes the word “eugenics”.
It doesn’t work like that, she says. Ryan already has donors in place to create embryos — typically 20 to 30 from a particular cycle — and she will show applicants the backgrounds of those donors so they can decide whether to accept or reject. “I don’t take orders,” she says. “I say, ‘This is what I have’ and send them the background. If they don’t think it’s right for them, they don’t have to take it.” However, she does use only sperm donors in their twenties and thirties who have at least some tertiary education — some may hold a doctorate or law degree. But, as she says: “Most people who donate at sperm banks have to be college-educated, so why doesn’t anyone shout at sperm banks?” Another misconception is that Ryan runs a clinic. What she actually does is broker between donor embryos and recipients. She hires the services of doctors to perform the medical procedures; the embryos are stored at their various clinics and not, she says laughing, in a refrigerator in her kitchen. One doctor in Houston whom she hired to create her second batch of embryos (the service has been running for only a few months) pulled out after learning what she was doing. She is keen to tell me that she does not have “thousands of embryos sitting on ice”.
Because the service is new it is relatively small: “We are still in the embryonic stages, if you don’t mind the pun.” She has a long waiting list of recipients and, in reality, each batch of embryos is “spoken for” immediately. If the service grows bigger, however, this might not be the case and the idea of “shopping” for a baby may become a fair accusation.
Ryan’s own background is complex. She says she has five children who are biologically hers, and which she raised largely as a single parent, and one adopted son. Ryan recently moved to Texas from California, where she ran an adoption business, Abagail’s Silver Spoon Adoptions, which she says is one of the largest in the nation and provides the bulk of her income. But Ryan’s local newspaper reports that two top San Antonio adoption agencies do not know her. “I’ve been around for 30 years doing adoptions and I’ve never heard of her,” Jan Couve, the executive director of Adoption Affiliates, told the San Antonio Express-News.
According to Ryan, her adoption company in California is less an agency and more a service that facilitates adoptions, while the Texas incarnation is only an adoption advertising service. She says California law allows “adoption facilitators”, who introduce pregnant women to adoptive parents for a fee, but Texas does not.
Josephine Quintavalle, of the UK campaign group Comment on Reproductive Ethics (CORE), is horrified by what she describes as a move towards “supermarket babies” and the “absolute commercialisation of human life”.
“There are plenty of ‘ready-made’ babies around the world that one can adopt,” she says. “This is further devaluing human life.” She worries that with a child bought in such a consumerist way there might be more scope for disappointment. “Expectations are so high now — what about if you don’t get what you want?” she says.
Robert George, of Princeton University, who serves on the President’s Council on Bioethics, says: “This is just more evidence that we haven’t been able to restrain this move towards treating human life like a commodity. This buying and selling of eggs and sperm and now embryos based on IQ points and PhDs and other traits really moves us in the direction of eugenics.” Others, however, do not see it as a particularly alarming development.
John Robertson, of the University of Texas at Austin, who advises fertility specialists on ethical issues, says: “If you step back a little bit, you realise that people are already choosing sperm and egg donors in separate transactions. Combining them doesn’t pose any new major ethical problems.”
The Abraham Center’s name is taken from the first family to use surrogacy services. The introduction to the website quotes from the Bible about how Abraham, at his wife Sarah’s urging, had a son by his wife’s slave-girl Hagar because Sarah was too old to conceive. Some of the language on the website is euphemistic; it talks of egg and sperm “donors” when they are clearly “sellers”.
According to the website, “typically a donor fee will range from $3,500 to $15,000 . . . Additional compensation is offered to those donors who have earned a post-graduate degree; have a unique skill, characteristic or trait; or if she has previously cycled with our programme and her couple achieved a pregnancy.” So far, Ryan says she has produced one batch of 22 embryos using an egg donor in her twenties from Arizona and a sperm donor from a sperm bank operated by the Genetics & IVF Institute in Fairfax, Virginia. He is a lawyer, 6ft tall (1.83m) with blond hair and blue eyes; she is a student, with brown hair and hazel eyes. All donors undergo a health screening and even provide photos of themselves as children as a guide to what the baby might look like.
A single woman in her forties from California and a married woman from Canada in her thirties are said to have each had two of the embryos implanted, and are now five months pregnant. In case they want more children, or should the pregnancies fail, the two clients divided the rest of that batch and had the embryos frozen.
Another young egg donor from Utah (blonde, blue-eyed) who works in the airline industry, is taking hormones to trigger ovulation and create another batch with the same sperm donor. “She is as sweet as can be,” says Ryan. “She is a Mormon, and one of the things that Mormons believe is that we are souls waiting for bodies. So by doing this she is helping to create the vessels for those souls.”
A single woman from California in her forties has signed a contract for two of these embryos, with a 30-day option for more. Any remainders can be shipped frozen to clients on the waiting list.
Ryan argues that her embryos are of good quality because they are from young, fertile donors, and says that there is no emotional attachment on the part of the donors. Joan, 42, from Alabama, is on the waiting list. She and her husband want a sibling for their three-year-old son and contacted Ryan after Joan failed to get pregnant using three egg donors and despaired of the protracted adoption procedure. “You get an idea of what your baby will look like, and it just seems a lot easier and more affordable. I am not going to give up until I have another baby. This seems very attractive,” she says.
Unlike in Britain, American donors can remain anonymous; whether they offer any details about themselves is up to them — and some do. Ryan says she has decided to use only those who would theoretically agree to be traced since she believes it is beneficial to the child to be able to access such details, if desired, at a later date.
Ryan says she would “love” to be able to help women from Britain and elsewhere, and has already had inquiries from Europe. “It was a control thing for me,” she says. “After years of dealing with birth mothers who decided to take [the babies] back . . . watching poor families have to kiss these girls’ butts when they know they are using drugs and alcohol in the pregnancy . . . having to tell a couple who have had their baby at home for two weeks that, actually, they have to give it back . . . If I could have a child for these people, I would do it.
“To me, it’s an answer. If you are desperate for a child, it is an option for you. People can come up with $8,000, but not many can come up with the $30,000 [the potential, accumulated costs of other routes]. I haven’t made money at this; it has cost me money, but I would be happy to break even.”
Despite some of the euphemisms on her website, I remark that she does answer a question with a straight answer. “I don’t apologise,” she says. “I believe in what I do. I am used to having stones thrown at me.”
As her service takes off, that might be just as well.
Legality of creating embryos in advance
No US law prohibits the concept of creating such embryos; in Britain it is illegal to form an “embryo bank”. The Human Fertilisation and Embryology Authority can grant a licence under the Human Fertilisation Act to create embryos only in the course of providing treatment to a person (ie, not in advance). In the US, the embryos created are not used, their future is in the hands of the recipient; here there is a five-year limit on freezing embryos. A British citizen could undergo treatment abroad, then have the baby in Britain entirely legally.
In Britain, a child can contact the egg or sperm donor at the age of 18; the donor cannot trace the child. This would apply had artificial insemination taken place outside Britain. In the US, regulation is on a state-by- state basis, and donors and recipients can waive their right to future contact. Should the child grow up and want to contact his donor parents, the courts are often sympathetic.
Adoption in the US
Britons wishing to adopt internationally must undergo a Home Study assessing their suitability through a registered adoption agency to get approval from the DfES. In the US this can then be taken to adoption agencies for the matching process of finding a child, which varies from state to state. There are varying degrees of difficulty for a potential parent regarding age, marital status (some states preclude unmarried couples), sexual orientation and expense. There may be additional requirements, ie, a psychotherapy report. Many state laws also prefer the foster-care system in the hope of returning children to their natural parents. The adoption is recognised by British law, but the child must obtain entry clearance and Home Office approval to be recognised as a British citizen.

Woman left infertile after donating eggs

I donated eggs to friends... now I've been left infertileby CHRIS BROOKE - http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=453507&in_page_id=1770

A woman who gave her eggs to help two childless friends fears she has been left infertile by her act of kindness.
Donna Stickels, 26, revealed her personal ordeal to warn other women about the potential dangers of egg donation.
Her story began seven years ago when she offered to help a married friend who was desperate to start a family after years of failed fertility treatment.
Donna's generosity resulted in the delighted woman giving birth to twin boys and she later became their godmother.
A second donation of eggs to another friend failed to result in a pregnancy, but the woman later conceived naturally.
Although both childless women realised their dream of becoming mothers, the fertility treatment appears to have had tragic implications for Donna.
The single mother of a young boy, Donna began trying for a baby with her new partner and discovered gynaecological problems which were stopping her from conceiving this time.
She underwent two operations on an ovary and her Fallopian tubes, but was told in February the surgery had failed and she would never be able to conceive naturally.
Although the doctors would not make a definitive link with the treatment she had in donating eggs, one gynaecologist admitted: 'It could be scar tissue from the procedures.'
Donna, a nanny, said: 'When I read recently how long waiting lists are forcing infertile women to turn to friends and family for donor eggs, alarm bells started ringing in my head. Giving another couple the chance to have a baby is a fantastic feeling, but I'd urge any woman to read my story before making such a huge decision.'
Donna was aged 18 and the working mother of one-year-old Maxwell when she struck of a friendship with Victoria, a married woman in her 30s, through a charity they had volunteered to work for.
She recalled: 'One day, she was sitting on a step outside work, looking sad. We started chatting and she began to pour her heart out about her childlessness. Victoria's last remaining chance of getting pregnant was through donor eggs - though her sister had offered, she had pulled out at the last minute. I was moved by her story, so I didn't think twice and said "I'll do it for you."
'Victoria spent the next few weeks asking whether I was sure: I was. I understood the implications of a woman giving birth to a child who was genetically half mine, but it didn’t bother me - I'd been brought up by my stepfather, and, to me, nurture not nature is what makes a family.'
The clinic tried to dissuade her from going ahead because the women knew each other, but Donna insisted. After blood tests, scans and internal examinations, Donna was given fertility-boosting hormone injections to stimulate the ovaries to produce multiple eggs.
Eight eggs were late removed in hospital and Victoria - not her real name - had three embryos implanted.
'Ten nerve-racking days later, she phoned me and I just managed to make out through the delighted screams that the procedure had worked. She was pregnant, with twins.'
The boys were born in October 2001. 'I was full of pride that I’d helped two little lives into the world,' she said.
Several months later another friend Gina, who knew about Donna's egg donation, revealed she had been trying for a baby for six months and had been diagnosed with premature menopause.
She asked Donna if she would donate eggs and she agreed. 'I just didn't have it in me to say no. I didn’t want to be the person responsible for her being childless.'
In order for Gina to jump the waiting list she had to give eggs to an anonymous recipient as well. It meant a higher dose of hormones and 20 eggs were retrieved.
Gina did not get pregnant from the donation, but got pregnant the following month naturally, said Donna.
Then in 2005 Donna was referred to a gynaecologist after suffering intense pain while trying for a baby with new partner Dan.
'The doctor told me that I had burst cysts on my ovary and adhesions on my Fallopian tubes which were stopping me conceiving,' she said. Surgeons removed her right ovary and tried to clear her Fallopian tubes. The day after her second operation Donna was told she could never have more children.
'I burst into tears,' 'It was as if a door had been shut in my face.' Donna said she had split from Dan under the stress of her infertility. Adding:'When I see Victoria and her boys playing in the park, my heart bursts with happiness at what I was able to do for her. But I do wish I’d been more aware of what risks were involved.'

PA court ruling involing lesbian couple and sperm donor

Carpenter and Kurtz on Pennsylvania Court Ruling


Dale Carpenter describes a recent court ruling involving a lesbian couple and a sperm donor:
The case involves a lesbian couple who enlisted a male friend to act as a sperm donor, resulting in the births of two children to one of the women. Although the children were raised by the two women, the biological father visited and helped support them financially.
When the lesbian couple split, each woman sought primary custody of the children. The trial court found that both were good parents, but that the best interests of the children would be served by living primarily with the biological mother. The other woman was given partial custody and was ordered to pay child support. The biological father was allowed to have his two biological children one weekend per month but was not ordered to pay child support.
The appellate court upheld the decision to award primary custody to the biological mother. It also accepted the argument that the sperm donor should help with child support. It did so on the basis of court-created "equitable estoppel" principles since the state legislature has done nothing by statute to deal with these issues.
Unsurprisingly, this decision has the religious right hyperventilating. The already hysterical Stanley Kurtz declares that this ruling and others like it will "dissolve the family" and destroy marriage as we know it. That's quite silly and Carpenter points out the many reasons why. First of all, the ruling really has nothing to do the mothers being lesbian; had they been a straight couple using a sperm donor, the issues would have been exactly the same:
Obviously, the thorny issues of assisted reproduction are not unique to gay couples. The court cited as precedent a case in which a biological mother sought and obtained child support from a biological father, who impregnated her while she was still married to her husband. (pp. 14-15) Yet Kurtz says this decision is "a dramatic illustration of the potential for same-sex marriage and Vermont-style civil unions to deconstruct the family."
Gay and straight couples were using assisted reproduction long before gay marriage became a national issue. They will continue to do so regardless of what we decide about it. Kurtz fails to understand that neither "gay marriage" nor the "mere cultural and conceptual momentum of the gay marriage movement" is producing these arrangements. Instead, the opposite is true. The idea of gay marriage has arisen largely as an answer to the problems gay families face in this country (gay couples without children, gay couples with children by prior marriage, gay couples with children by assisted reproduction). These families exist whether Kurtz likes it or not and whether we recognize gay marriage or not. The question is whether we will simply their lives and consolidate their legal obligations and rights by letting them marry.
Carpenter also points out that, in fact, this case and similar cases illustrate the need to have clearly established legal rights and responsibilities for gay couples:
The lesbian couple raising these children obviously could not marry in Pennsylvania. Marriage exists in part to help clarify legal lines of responsibility for children, to give everyone some assurance about who is responsible for them. If gay couples could marry, as straight couples under the same circumstances could, sperm donors and surrogate mothers would be more likely to surrender their parental rights to the couple since they would be reassured that the child would live in a family fully protected in the law. That is, gay marriage might have helped avoid this legalized "triple-parenting" arrangement altogether. While gay marriage won't eliminate these scenarios, just as it hasn't for straight couples, it might make them less likely. The absence of gay marriage is opening the door wider to the very arrangements Kurtz decries.
Indeed so. Most importantly, as Carpenter notes, this case had nothing to do with the couple in question being lesbian:
Nor did the women's civil union have anything to do with the decision, despite what Kurtz claims. The court mentioned it exactly once in its description of the factual background (p. 2). Their civil union was irrelevant to the equitable reasons why the biological father should pay child support (e.g., he had already voluntarily paid support, had given them clothing and toys, etc., pp. 13-14). And the non-custodial woman was a de facto parent with her own obligations to the children under state law regardless of their civil union (which Pennsylvania doesn't recognize) by virtue of her important role in raising and supporting them from birth. Nobody even disputed this.
Nor did either of the women seek to "marry" the sperm donor, much less to form a multiple-partner union with him. It's true that couples who involve a third person in their quest to have a child may want to involve that person in the child's life, but that too is not unique to gay couples. Despite decades of this practice, there's no serious movement for polygamy in this country.
All of this is just intended to fire up the base - "oh my god, that doesn't look just like my family; make it stop!"

Thursday, May 3, 2007

IUIs at Home!

Study Says Do It At Home!

There are few aspects of fertility diagnosis and treatment that strike more panic into the hearts of even the manliest men than the semen analysis or providing a sample for intrauterine insemination (IUI). Let's be frank -- specifically, guys get the willies about the collection of the semen to be analyzed.
Nothing like a closet-sized bathroom and a bunch of printed pornography in a public place to get your engines revved...
So, many people opt to "collect" the sample at home. But because of worries about the quality of the resulting sample -- think driving through morning rush hour traffic with a specially provided container tucked into your shirt for continuing warmth -- home collection isn't always allowed for patients who live too far from the lab.
Enter the thoughtful researchers from University of Rochester Medical Center in New York. They wanted to know just how much difference, if any, it makes to the final outcome of fertility treatment whether or not the guy, ahem, obtains his sample in the privacy of his own home or down the hall from the appropriately disinterested lab personnel. They thought there would be a difference in favor of clinic collection.
Lucky for lots of guys out there (and the women who often have to talk them into this task), they were wrong.
Following strict World Health Organization (WHO) guidelines, they allowed patients to bring a sample from home if they expected their travel time to be less than 45 minutes. Controlling for variables like cause of infertility and treatment drugs used, the study compares pregnancy rates between home-collectors and lab-collectors. No significant difference was found.
Next time you and yours are asked to provide a semen sample, here's a link to the study that you want to print out and present to the fertility treatment team... Location of semen collection and time interval from collection to use for intrauterine insemination, published online in Fertility & Sterility, Gyun Jee Song, Ph.D., Rita Herko, B.S., Vivian Lewis, M.D

Tuesday, May 1, 2007

Late Motherhood

Fertility & IVF Experts: Don't Bet All On Late MotherhoodMain Category:
In the wake of yet another new record for becoming the world's oldest mother, fertility experts are encouraged by recent research showing that older moms are as capable of good parenting as younger women -- but are increasingly concerned about women naively postponing pregnancy till later in life."Thanks to technology and today's 40- and 50-year-olds often being healthier than in the past, it is more possible than ever to facilitate their desires for pregnancy," said Dr. Nancy Teaff of Reproductive Endocrinology Associates of Charlotte, a specialist in in-vitro fertilization (IVF). "But no one should take that as reason enough to put off giving birth past the normal reproductive years."Women's focus on career development -- combined with rapid advances in fertility medicine -- has produced higher-than-ever increases in the birth rates for older mothers. The birth rate for American women aged 40-44 years has more than doubled in the last 25 years, according to the Centers for Disease Control, a greater increase than in any other age group.But there is a down side, Teaff said: "The media spotlight on women giving birth in their 50s and 60s, especially among celebrities, can be grossly misleading. It can create the fallacy that there is no ticking clock and ultimately create heartache for women who wait too long to try to conceive."In December, a 67-year-old woman from Barcelona, Spain became the world's oldest mother, after having undergone IVF in the United States. Meanwhile, results of a study announced in October by University of Southern California researchers showed that women in their 50s and 60s are just as capable of being good parents as women in their 30s and 40s.The research was based on the mental and physical health of 150 women, a third of whom had become parents in their 50's after receiving in-vitro fertilization (IVF) with donor eggs. "Virtually all of the women 42 and older who we treat with IVF use donor eggs," Teaff noted.In accordance with current guidelines established by the American Society for Reproductive Medicine, the age limit for women who seek fertility treatment at REACH is currently 51. From a purely medical perspective, the ideal time to have a baby is between the ages of 21 and 25.The study also reinforces the use of assisted reproductive technology such as egg freezing for those who wish to begin parenting later in life. Cryopreservation allows women in their 20's and 30's to preserve their fertility by freezing their eggs, which can be implanted in later years with successful pregnancy rates. In just the last few months, scientists at REACH have begun exploring such "egg banking" on a limited basis.About Reproductive Endocrinology Associates of Charlotte (REACH)REACH is led by a nationally recognized team of five physicians who offer comprehensive, state-of-the-art assistance for infertile couples and women with reproductive endocrine problems. REACH physicians, all long-time practitioners in Charlotte, are widely respected for their superior pregnancy success rates -- one of the highest in the region -- and for the finest patient care. REACH is a member of IntegraMed, an exclusive network of fertility practices nationwide.

Embryo Implantation Study

Researcher Calls for End to Common Empirical Treatment-
From a meta-analysis of 13 studies, researchers are concluding that a commonly prescribed therapy should not continue to be used in the current manner. The treatment, prescribing glucocorticoids such as prednisone in hopes of assuring embryo implantation, is empirical as opposed to evidence-based.
Therein lies both the reason and the quandary.
After reviewing all of the studies, which involved a total of 1,759 couples in randomized controlled trials that compared success rates of IVF and IVF with ICSI, the review authors concluded that there simply is not enough evidence of benefit to using prednisone. Plus, there are possible ill effects for developing embryos that could be unwittingly exposed to the steroid hormones.
However, much of fertility treatment has evolved from the empirical use of different therapies. There's nearly always a cost-benefit ratio analysis involved.
"Empirical treatment" refers to therapies that are attempted before a diagnosis is confirmed. Doctors are often in a position to prescribe empirically when there are acceptable reasons -- such as the ethics-based inability to experiment on a population, like embryos, or in cases where the patient will be harmed strictly because of any delay in administering treatment.
On the other hand, evidence-based medicine uses a scientifically-proven framework within which to determine appropriate treatment. The reviewers of the glucocorticoid studies are simply saying that the common prescribing of this class of steroid hormones, like prednisone, has not been well-proven to be beneficial enough, even though the potential adverse effects also have not been well documented.
Patients and their doctors are still in charge of their treatment plan of choice. For many women who either miscarry frequently in the first trimester or who have unexplained failed IVF cycles, the use of prednisone will likely continue until more solid evidence of contraindication is made available.

One Gestational Surrogate's personal story...

Informative website of one surrogate's personal surrogacy journey.