Saturday, March 27, 2010

Egg Donation in Oklahoma

Egg Donor Option Preserved in Oklahoma!

A bill to make it unlawful to compensate egg donors in Oklahoma has been thwarted after a Senate committee chairman determined his panel will not consider the issue this session. The sponsor of HB 3077 contends the bill would not prohibit egg donation, only the practice of compensating for it, and promises to bring the bill back next year. By an overwhelming margin, the bill passed the state House weeks earlier and sent the medical and patient communities into around the clock action. Actively opposing the bill were ASRM, the Oklahoma State Medical Society and RESOLVE , The National Infertility Association. ASRM member Dr. Eli Reshef and his colleagues were instrumental in coordinating efforts to educate Oklahoma lawmakers about the detrimental effects on family building options for infertile patients, the purpose of compensation to egg donors, the minimal risks associated with the procedure and the informed consent process employed by doctors. ASRM applauds their diligent efforts. The egg donation process has come under increasing scrutiny as evidenced by legislation introduced in other states at the behest of organizations opposed to assisted reproduction. Exorbitant egg donor fees paid by some egg donor agencies have fueled the debate.

Surrogacy Legislation in Washington State

Gestational Surrogacy Legislation Fails in Washington State

Legislation to allow payment to gestational surrogates passed the Washington House of Representatives in February, but failed to pass in the Senate before the legislative session ended. Current state law bans compensation for surrogate mothers. HB 2793 would have allowed women 21 years and older and who had previously given birth to be eligible to enter into paid surrogacy contracts. Additional requirements included obtaining medical coverage for the pregnancy and immediately after birth, passing mental and physical examinations, and signing a written consent form. Prospective parents also would have to meet certain requirements, including a mental health evaluation and an affidavit from a doctor attesting to a medical need for surrogacy. Gay and lesbian couples would have been exempt from the doctor's certification requirement.

High Fees for Egg Donors

Egg donors offered up to $50,000
Fees far exceed ethics guidelines, study finds
By Clara Moskowitz

Fertility companies are paying egg donors high fees that often exceed guidelines, especially for donors from top colleges and with certain appearances and ethnicities, a new study finds.

The upshot: Parents with infertility problems are willing to pay up to $50,000 for a human egg they hope will produce a smart, attractive child.

The first baby conceived through egg donation was born in 1983. Since then, the practice, which involves transferring fertilized eggs from a donor into a woman's body, has grown dramatically. The rise has been seen particularly among women with ovarian failure, women over 40, and gay men who want to have children through surrogate pregnancy.

While there are few government regulations controlling the use of this technology, the American Society for Reproductive Medicine (ASRM), a professional organization, has issued guidelines. The ASRM ethics committee recommends limits on the amount of money egg donors should be paid, saying "sums of $5,000 or more require justification and sums above $10,000 are not appropriate." Yet the recent study found that out of more than 100 egg-donor ads from 300 college newspapers, about half offered fees above $5,000, with a quarter of the ads touting payments exceeding the $10,000 limit.

SAT scores matter
The study also found that the advertised fees correlated with the average SAT score (standardized test used for college admissions) at the college where the ad was placed, which suggests agencies are paying more to donors who appear more intelligent. This too is a violation of the guidelines, which state that compensation should not vary according to donors' "ethnic or other personal characteristics."

The guidelines were set up to avoid ethical dilemmas associated with putting a price on the seeds for human life, according to the ASRM. And scaling that price based on certain human genetic material that is considered superior is especially worrying to some.

"Commodification is a concern when­ever any monetary value is placed on human oocytes [eggs], but particularly when high values are placed on hu­man oocytes from donors with spe­cific characteristics — a practice that also raises eugenic concerns," wrote the researcher, Aaron D. Levine, a professor of public policy at the Georgia Institute of Technology, in a paper in The Hastings Center Report.

Yet most of the ads Levine found in his study contained appearance or eth­nicity requirements for donors.

The problem is that there are few oversights to make sure fertility clinics and egg donation agencies obey the guidelines, and there are few serious consequences for those who flout the rules.

Levine's study, completed in spring 2006, involved tallying the fees being offered and other characteristics of the various ads for recruiting egg donors.

Top dollar
He found that only about half of the ads offered $5,000 or less — within the guidelines. Advertisements in the Harvard Crimson, the Daily Princetonian, and the Yale Daily News offered $35,000, and an ad in the Brown Daily Herald offered $50,000 to "an extraordinary egg donor." Many of these high-end fees were promised on behalf of particular couples using agencies to recruit a donor.

Other objections to such high fees for egg donors rest on the worry that the money could induce women to overlook the risks or drawbacks of donating, potentially creating a situation in which women are being exploited. Egg donation typically pays much more than sperm donation, but that is thought to be justified because egg donation is a more medically invasive and time-consuming procedure.

Some people argue that the generous fees aren't necessarily unethical.

"It may lead some women to become egg donors who would not otherwise do so, but that does not mean that they have been exploited, much less unfairly induced," wrote law professor John A. Robertson of the University of Texas in a related commentary in The Hastings Center Report. Robinson is a previous chair of the ASRM ethics committee, and was not involved in Levine's study.

He pointed out that banning payments to egg donors would drastically reduce the number of donated eggs available, presumably because the financial compensation is a large part of the motivating factor for egg donors.

"The ASRM never says what is wrong with pay­ing women who are healthier, more fertile, have a particu­lar ethnic background, a high IQ, or some other desirable characteristics," Robinson wrote. "The charge of 'commodification'; is easily hurled but not easily justified. After all, we allow individuals to choose their mates and sperm donors on the basis of such characteristics. Why not choose egg donors similarly?"

The Hastings Center Report is a publication of The Hastings Center, a nonpartisan bioethics research institution in Garrison, N.Y.

Sunday, March 21, 2010

Ethiopian Adoption nightmare for Australians

Australians caught in Ethiopian adoption nightmare
By Cassie White

Updated Tue Mar 16, 2010 9:03am AEDT

Corruption allegations: A young girl in Ethiopia (AFP: Roberto Schmidt, file photo)

The Evidence
First warning: In 2005, a Federal Government report detailed concerns raised about Ethiopian adoptions.
Second warning: In 2008, Against Child Trafficking wrote to the Government highlighting similar concerns.
Supporting Documents
The US State Department's advisory on changes to its adoption program.
A parent of an adopted child implicates Australia's representative in Ethiopia in the child trafficking racket.
Government's Response
Attorney General website: What's New in Intercountry Adoption
Response from the Attorney-General's Department to questions from ABC News Online
Australian families have made serious allegations of corruption within Australia's inter-country adoption program with Ethiopia.

The ABC has spoken to several families who claim they have been lied to in the course of their adoption process.

They have told heartbreaking stories of their time in Ethiopia - from witnessing their new baby choking on vomit, to a young boy being kept in a bucket to stop him from moving about. One family had to pay a bribe and others found their paperwork falsified with their child's age dramatically altered.

The families say the Federal Government has been slow to act and has not fully investigated the allegations.

When Jody was holding her baby son in her arms, she was distraught to witness an Ethiopian mother discover she had lost hers forever.

"When I was walking [out of the women's centre] a lady screamed and yelled and cried and fell to the ground," she said.

"This mother had come back to the women's shelter [where] she'd placed her baby for adoption. She changed her mind and came back to get it within a couple of days - but it was already gone.

"That was just heart-wrenching and I felt sick."

She added that she thought the process was far too quick to have gone through the proper channels.

Last year Foreign Correspondent revealed corruption within US-Ethiopia adoptions, and more families have spoken out as a result.

It seems some Australians are not protected from corruption despite it being an Australian Government-run program.

The person in charge of the program is Ato Lakew Gebeyehu. ABC News Online made a number of attempts to contact Mr Gebeyehu, but was unable to do so.

Mr Gebeyehu is responsible for Koala House, a transition home for children going to be adopted by Australian families. This home, which is part of the Australian government program, is accused of not properly feeding the children and maintaining their health.

The office of Attorney-General Robert McClelland says a recent review found issues of concern within the program and is working to restructure the program.

ABC News Online has been told by a spokesman for Mr McClelland that Australia will sign a new agreement with Ethiopia, however whether Mr Gebeyehu remains in his position is still to be decided.

But the ABC has obtained documents showing the Howard government knew of serious concerns about the program in 2005 and that the Rudd government was warned again in 2008 by Brussels-based human rights organisation Against Child Trafficking.

Koala House

The families interviewed by the ABC have had their names changed because of fears they may lose their children and concerns that life will be made hard for surviving biological relatives in Ethiopia.

Australian parents pay thousands of dollars in fees, donations and aid for the care of their children in Koala House.

But all three families say their children were handed to them with a range of problems including severe malnutrition and pneumonia.

Sarah, who has adopted three Ethiopian children, believes the money she paid to care for her children never reached them.

"In our first adoption we took over about 80 kilos of aid. The majority of that was formula, and because we had a baby we also paid the formula fee for her," she said.

"We were also asked to replace all of the formula she would have consumed during her time she was at Koala House ... and it turned out she was actually fed cow's milk and was lactose intolerant.

"She was massively malnourished when we got her. She had full-blown pneumonia because she'd been swallowing her own vomit."

Sarah's older daughter later explained that she was hardly fed.

"She'd get given rice and carrot mixed together as a meal of porridge for breakfast. Except for when the Australian families came ... [they] would put on a big party ... and when that happened, there would be so much food. But when those families went, then it'd be carrot and rice," she said.

Jody says it was a similar story when she and her husband were in Ethiopia to collect their son from Koala House.

"Our son has attachment issues, but he was never held or cuddled until we got him. He was just picked up to be changed or had a bottle propped up on a pillow," she said.

"We were told when we picked him up that they used to sit him in a bucket so he couldn't learn to move around much. He'd worn all the hair off the back of his head from it rubbing against the bucket.

"A friend of ours had an older child who says they only get one meal a day, which was concerning because the amount of money that we raised for the centre. I raised thousands and thousands."

Program reinstated

Earlier this month Mr McClelland announced he will lift a temporary suspension of the adoption program, after concerns of possible breaches of the Hague Convention on inter-country adoption.

The convention is in place to ensure the welfare of children is the priority and that international adoptions are used only as a last resort. Australia is a signatory to the convention but Ethiopia is not.

It will resume operating on April 6 with some changes made, but it appears Mr Gebeyehu will stay in charge.

Against Child Trafficking spokeswoman Roelie Post says Mr Gebeyehu was arrested in Ethiopia and held for 12 days on suspicion of trafficking children to Austria in 2008.

Ms Post says her organisation received little response from the Australian Government after alerting it to this and other alleged concerning practices.

"The children are not orphans. The paperwork is often faked. Parents are declared dead who are not dead and children are given the wrong ages," she said.

"Our organisation sent a letter to the Australian Government with 1,600 pages attached to it with evidence of trafficking in adoptions relating to Australia and India.

"Also we alerted the Australian authorities to Ethiopia, especially to the Ethiopian representative whose name was mentioned in a trafficking case in Austria."

Ms Post does not accept the Australian Government's explanation that Mr Gebeyehu's arrest was just a case of mistaken identity. She thinks there are serious issues that need to be investigated and that the case was mishandled.

"The children come from the same pool, therefore the situation [in Australia] is comparable to adoptions in the US or the Netherlands or any other country."

Sarah says she is aware of older adoptive children recognising each other from Ethiopia and while she stops short of calling it child trafficking, she says it is "on the fringes".

"I have heard that has happened in Australia, where children have known each other prior to coming under Lakew's care - that's a very big coincidence," she said.


All families interviewed by the ABC claim they were not supplied with paperwork and vital information about their children and were blocked by officials from finding information on biological families.

When Anne and her husband adopted their daughter, they say almost all the information about their child's origin was falsified.

They were told she was abandoned, but when through their own search they tracked down the biological parents, they discovered this was a lie.

"The [birth parents] were both devastated, particularly the father. They were so sad to think that their child would have grown up thinking she had been abandoned by them.

"They told us that they could never have done such a thing to their child. They agonised over the decision to relinquish their daughter and they did it legitimately.

"What makes us angry is that our daughter was stripped of her history and there seems to be no valid reason for this to have happened.

"Our child was given a new name and a new birth date and was passed off as having been abandoned."

Sarah adopted two sisters in 2002. She and her husband were told the "orphaned" children were four years old and nine months, with no living relatives.

They later found the eldest daughter was not four, but closer to eight. They also discovered the girls had a mother and that the eldest had two brothers whom she was allegedly warned never to mention.

"She told us exactly where they were and we located them two days later and the brothers told us at the time that she was eight years old," she said.

Jody was also told that her son was abandoned and there was no information about his mother. But years later when her family returned to Ethiopia for their second adoption, they discovered this was not the case.

"With a bit of what we call African persuasion, which is $500, we managed to get a photograph, full name and full details of his birth mother," she said.

"The whole place revolves around money under the table."

Sunday, March 7, 2010

Are frozen embryos better then fresh?

In IVF, frozen embryos may fare better than fresh
Lynne Peeples


The Finnish study suggests that women who use frozen embryos are somewhat less likely to give birth prematurely, compared to children conceived from an egg that is removed, fertilized and implanted "fresh" within the same cycle.

The role of frozen embryos has grown over the last few years, especially in Europe where policies now favor implanting only one embryo at a time to prevent dangerous multiple pregnancies, Dr. Sari Pelkonen, of Oulu University Hospital in Finland and lead author of the study, told Reuters Health by email.

This limit leaves extra embryos available for freezing, but few studies have looked carefully at whether frozen embryos are linked to higher rates of premature babies and other complications.

For their study, published in the journal Human Reproduction, Pelkonen and her colleagues studied data from nearly 2,300 children conceived with frozen embryos, more than 4,100 born after fresh embryos were used, and 32,000 pregnancies that did not require IVF or other fertility treatments.

Overall, 258, or about one in 11, of the babies from the fresh embryo transfer group were born prematurely, compared to 120, or about one in 16, in the frozen embryo transfer group.

Frozen embryos were also less likely to be linked to low birth weight and being small for the length of the pregnancy.

Similar differences were seen between the fresh and frozen embryos in regards to low birth weight-180 (6 percent) versus 76 (4.2 percent)-and being small for the length of the pregnancy-91 (3.1 percent) versus 28 (1.5 percent).

Those relationships held after the researchers took various factors such as the mother's age and socioeconomic status into account.

The only potential negative effect of being born from frozen embryos was that on average, the birth weight of children born from frozen embryos was 134 grams (0.3 pounds) greater than a baby born from a fresh embryo. Although that increased weight is unlikely to lead to any complications, having much larger babies can increase the risk of requiring a cesarean section, for example.

When researchers compared frozen embryo outcomes to those from natural conceptions, they found more premature births among the frozen embryos. However, there were no significant differences in fetal or infant mortality among any of the groups.

"There's a sense people have that frozen aren't as good-that freezing and thawing could harm the embryos. This quiets those concerns," Dr. Helen Kim, Director of the In Vitro Fertilization Program at The University of Chicago, told Reuters in a phone interview.

Why frozen embryos result in more favorable outcomes is still unclear. The freezing and thawing process could filter out the "weak" embryos, leaving only the good quality ones, Dr. Gordon Baker, of the University of Melbourne and The Royal Women's Hospital in Australia, told Reuters Health in an email.

Frozen embryo transfer also allows doctors to time a woman's hormone cycles to more closely mimic natural conception, according to Baker. High estrogen levels and lingering stress from the egg collection procedure performed just a few days before IVF could impair implantation, as well as increase the risk of an unhealthy birth.

Considering effectiveness, price and safety, Pelkonen suggested that the best IVF option might be transferring one or two fresh embryos, followed by freezing the rest for future implantation-which could be done years later.

The average cost of a fresh in vitro fertilization cycle in the U.S. is $12,400, although the cost varies significantly among clinics. Freezing embryos for later use is extra. However, these additional services are relatively inexpensive, notes Baker, at less than one third the cost of a fresh cycle.

Kim agreed. "I always recommend that my patients freeze," she said. "It kills me to throw away perfectly good embryos."

However, a recent study of what happened to frozen embryos at one fertility clinic found that many women who successfully have a baby using donated eggs do not try to achieve a second pregnancy with the excess embryos they've chosen to store. (See Reuters Health report, February 12, 2010.)