Tag: embryo transfer

Bioethics News

CU Study: Insurance for Single Embryo In Vitro Fertilization Preferred

April 14, 2016

(The Denver Post) – Expanding insurance coverage to cover a type of in vitro fertilization known as elective single-embryo transfer could lead to improved health outcomes and lower health care costs, according to a new study that included researchers from the University of Colorado School of Medicine. The study was published in the journal Fertility and Sterility. The senior author of the article was Dr. Alex Polotsky, associate professor of obstetrics and gynecology at the CU medical school.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

IVF twins. Monochorionic twins higher risks

Approximately 7.2% of pregnancies achieved through in-vitro fertilisation (IVF twins) are monochorionic twins pregnancies. Since these type of embryos have a higher risk of preterm birth and low birth weight in particular (Fertility and Sterility 104; 629-632, 2015), there seems little doubt that they should try to reduce their number, perhaps by promoting single embryo transfer in each procedure.

La entrada IVF twins. Monochorionic twins higher risks aparece primero en Observatorio de Bioética, UCV.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Surrogacy Contracts Gain Legal Ground

Surrogacy is legal in many states. Some, like California, directly enforce gestational carrier contracts. Others, like Texas, Illinois, and Virginia, enforce only those contracts that are entered into by a married couple who need a surrogate for medical reasons which a judge approves before embryo transfer occurs.  A Pennsylvania court has now shown why gestational surrogacy contract should be directly enforced in the absence of legislation. Its well-reasoned opinion suggests that more states may be open to this approach to surrogacy.

The Pennsylvania case, In re Baby S., arose out of a gestational surrogacy agreement involving embryos created with donor eggs and the sperm of the husband of the intended parents. The written agreement was indisputably clear that that the intended parents would be the legal rearing parents, their names would appear on the birth certificate, and the carrier would have no rearing rights or duties. Unlike previous cases questioning the validity of a surrogacy contract, the challenge here came not from the carrier who now wished to assert rearing rights (see In re Baby M. and Calvert v. Johnson) but from the wife (the intended rearing mother).  She had praised the carrier’s willingness to help her have a child, which she repeated both at the embryo transfer and at 20 weeks of pregnancy, when both intended parents attended an ultrasound.  A month later she informed the parties that “irreconcilable marital difficulties” would make it difficult for her to co-parent the child with the intended father. She also refused to complete the paperwork for her name to appear on the birth certificate as the mother.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Building families equitably in Ontario

Carolyn McLeod argues that the Ontario government should not contribute to the view that adoption is second best as a way of building families.

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The Ontario government wants to support Ontarians in growing their families. To this end, it has announced it will fund one cycle of in vitro fertilization for up to 400 Ontarians. According to Health Minister Eric Hoskins, this plan promotes “family-building for those who couldn’t otherwise have the opportunity to have children.”

But, of course, procreation is not the only way to have children. Many people – including myself – have children, their own children, but these people have never procreated. Rather, they have adopted children.

Like many people who turn to assisted-reproductive techniques to have children, many of us who choose adoption pay thousands of dollars to build our families. That’s even true of some people who pursue public domestic adoptions, as opposed to private domestic or international adoptions.

Some of these folks pay privately for an adoption home study, for example, along with the parenting training required for an Ontario adoption, because the wait lists in their area for public versions of these services are too long. They are sometimes even encouraged by their local Children’s Aid Society, because of the wait, to pursue a private home study or private parenting classes.

Three Butterfly, by 14 year-old girl (chalk and glue on kraft paper)

In addition, people who choose public adoption often pay for post-adoption support for their families, support that is frequently needed in parenting children who were Crown wards.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Surrogacy as an Iceberg: 90 Percent Below Water

The 2015 US Surrogacy Conference was held in San Francisco on September 26. Attendees were greeted by a series of representatives from surrogacy agencies (based in the US, Mexico, and India) who sought to assure them that although surrogacy can be a trying process “not for the faint of heart,” it is often a tremendously rewarding “journey.” Psychologists, lawyers, and physicians similarly celebrated the quest for children via third-party reproduction.

The audience at various panels ranged from about 15 people (mainly for presentations pertaining to international surrogacy) up to 50 for popular presentations such as The Psychology of Surrogacy and Pre-Genetic Testing & Embryo Transfer Decisions. A substantial portion consisted of male same-sex couples, and they were the target demographic for most presenters. Both at booths describing services and during presentations, images of happy babies, pregnant bellies, and glowing (often same-sex) families were unavoidable. Happy families are, after all, the “happy ending” that surrogacy is designed to attain.

I came to the event not because I was considering hiring a surrogate, but because of a range of questions about commercial surrogacy that I haven’t seen widely considered. Who is served by the “happy ending” that’s so widely advertised, besides parents who want families? The assumption is that babies born from surrogacy arrangements will have loving parents, who expended time, effort, and money on their creation. What about babies who may never know the truth of their origin, or who may experience consequent health risks that are currently unknown and consistently understudied? Surrogates who say they experience great joy after seeing the family they helped to create certainly seem to benefit.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Freezing embryos and FIV: an ethical approach

Added ethical difficulty, the damage inflicted on the embryo, which will be subjected to various freezing/thawing processes, resulting in many of them having to be discarded in the proces….

Introduction

In its July 2014 edition, the journal Fertility and Sterility published three studies that analysed the different circumstances that affect the complicated process of obtaining embryos and their use in in-vitro fertilisation (IVF) cycles.

They analysed the ovarian stimulation procedures used to obtain oocytes for subsequent fertilisation in the laboratory, and the advantage of transferring the embryos obtained in the same cycle in which they were obtained, or freezing embryos them by different methods and transferring them in subsequent cycles.

In view of the findings of these studies, it seems that the likelihood of success for achieving a pregnancy varies according to whether one or other method is used. The neonate’s health can also be affected by the IVF method selected, all factors that pose not only a clinical, but also an ethical dilemma.

Ovarian stimulation

The first step in the IVF process consists of obtaining oocytes, either from the future mother or from a donor, for subsequent fertilisation in the laboratory.

The need to work with several of these to increase the probability of success in the assisted fertilisation process requires stimulation of multiple ovulation in the woman, by administering drugs such as clomiphene. These treatments not only cause the proliferation of several ovarian follicles, in which many oocytes will mature (the objective pursued), but they will activate a series of changes that will influence the subsequent implantation process, compromising its success.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

IVF Embryos debate of transferring one or several

IVF embryos A frequent debate in assisted procreation is whether it is better to transfer one or several embryos to obtain better results, as regards pregnancy and birth rates, with minimal risk for mothers and children. This issue was debated in Human Reproduction (28; 2599-2607, 2013), referring especially to the higher risks involved in multiple pregnancies, particularly twin pregnancies due to their frequency. It concluded that the risks for mothers, and especially for children, are substantially greater in twin pregnancies compared to singleton pregnancies, so single-embryo transfer is preferred.

La entrada IVF Embryos debate of transferring one or several aparece primero en Observatorio de Bioética, UCV.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Kudos to Quebec IVF Docs for Reducing the # of Multiple Pregnancies

Françoise Baylis reviews some of the proposed changes to public funding of IVF in Quebec and explains why these changes will not increase the multiple pregnancy rate.

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In August 2010, the province of Quebec began public funding of IVF. Insured services included the transfer of one or two embryos in women 36 years of age or under, and the transfer of up to 3 embryos (including no more than two blastocyst stage embryos) in women 37 years of age or over. Predictably, these regulations resulted in a dramatic reduction in the number of multiple pregnancies in the province (from 27.2% in 2009 to 5.2% in 2013).

Four years later, the Quebec government is now looking to radically revamp its IVF program (see here and here). On November 28, 2014, the government tabled Bill 20, An Act to enact the Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation. Bill 20 replaces public funding of IVF under the provincial health insurance plan with a sliding scale of tax credits. At one end of the spectrum, families earning less than $50,000 a year will be eligible for an 80% tax credit. At the other end of the spectrum, families earning more than $120,000 a year will be eligible for a 20% tax credit. Bill 20 also limits the number of embryos that may be transferred into a woman per cycle. Single embryo transfer will be mandated for women under 37, while women between the ages of 37-42 will be eligible for double embryo transfer.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Facebook and Apple – Increasing choice and control or creating biased solutions?

Reproductive technologies were in the headlines when Facebook and Apple announced they would offer female employees a $20,000 benefit to freeze their eggs. According to the report, this enables women to delay child bearing for different reasons and gives women more control. The announcement states that egg freezing is a pricey but increasingly popular option for women: The procedure typically costs up to $10,000, with an additional $500 for storage each year. After freezing eggs, in vitro fertilisation (IVF) can be used afterwards.

I wish to start with a disclaimer: I’m totally for increasing control and flexibility with reproductive technologies, I think the possibility as such is great, I cheer if some women genuinely wish to use this option, and I totally recognize that Facebook and Apple are just giving an option. However, there is room for questions. First, individual-level solutions are suggested where the actual issue is likely to be socially constructed, and secondly, IVF is seen merely as a handy option. These two are discussed in the following.

 

Social issues, individual solutions

What is the phenomenon that we are trying to solve? Apparently: many women struggle with connecting childbearing and careers. Is this a problem in women’s biology or work life and society? What is the reasonable target of intervention? To what should we put major efforts?

First, as asked in Wired, do we really want to support a society that requires us to work so hard that there is no time to raise children for those who wish to do so?

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

EMBRYO REDUCTION

EMBRYO REDUCTION

“We believe that even a single foetal reduction is ethically questionable and that the practice should not be in use at all”.

One of the main consequences of the use of In Vitro Fertilization is the significant increase in multiple pregnancies; however this can also be caused by ovarian stimulation and intrauterine insemination.

It is widely known that multiple pregnancies increase the risk of suffering from other medical problems in both mothers and their foetuses.

That is why the number of implanted embryos is often regulated in order to reduce the number of multiple pregnancies, especially when there is no decrease in the rate of pregnancy and live births with single embryo transfer, when compared to multiple embryo transfer (Fertil Steril 95; 491, 2010), although not all experts are in agreement on this fact.

As a consequence, some countries have passed laws which regulate the number of embryos that can be transferred, limiting them to no more than two or three. Other countries do not have any regulations to this effect.

At any rate, it is clear that multiple pregnancies still occur and the way to “solve” this issue is to try to reduce the number of foetuses in order to increase the survival rate of those which remain after said reduction.

But before we continue, it is important to first understand what we mean when we say foetus reduction as opposed to selective termination (Reproductive BioMedicine Online, 26; 542-554, 2013). The latter term refers to eliminating foetuses which suffer from some medical condition, Down Syndrome in particular while the first term refers to the elimination of healthy foetuses, and its only aim is to “solve” the problem of multiple pregnancies.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.