Tag: gamete donation

Bioethics Blogs

When Women are Surrogate Mothers: Is that work?

Alana Cattapan, Angela Cameron, and Vanessa Gruben warn that speaking about “compensation” is a way of avoiding difficult conversations about payment to surrogates.

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A recent Canadian Medical Association Journal (CMAJ) news article reported that the Canadian Fertility and Andrology Society (CFAS) has called for the federal government to reconsider the ban on payment for surrogacy in Canada. The article suggests that industry professionals and academics alike are coming around on compensation for surrogacy, with support growing all the time.

In Canada, payment for surrogacy, egg donation, and sperm donation is banned under the 2004 Assisted Human Reproduction Act. Under the Act, surrogates (like egg donors and sperm donors) can be reimbursed for receipted expenses. With a note from their doctor, surrogates can also receive some money for lost work-related income during pregnancy.

The Act states that this reimbursement of expenses must follow the relevant regulations. Until now, however, these regulations have never been drafted. After more than a decade, Health Canada is now in the throes of making them. This is occurring as surrogacy in Canada is expanding to accommodate more and more people from countries where surrogacy is more expensive, harder to access or banned completely.

Women Working in a Field by Winslow Homer 1867.

It is in this context that the CFAS (which is a part-medical association, part-industry organization representing the fertility industry and its doctors, lawyers, scientists and ethicists) has called for the government to reconsider the ban on payment.

 It is important to know that the market in surrogacy in Canada is a profitable one.

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

Why Choose Open Embryo Donation?

Angela Krueger explains some of the benefits of choosing open embryo donation as compared with anonymous embryo donation.

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For a variety of reasons some fertility patients are reluctant to destroy embryos that are left over following the completion of fertility treatments. As a result, there are unknown numbers of frozen embryos in fertility clinics across Canada. Instead of destroying surplus embryos or storing them in perpetuity, fertility patients may choose to donate them to other individuals or couples for use in reproduction.

A number of fertility clinics across Canada offer anonymous embryo donation services to their patients. This involves the anonymous matching of donors and recipients, with little identifying information exchanged between the parties. Typically details such as ethnicity, age, physical characteristics, personal profile, education, occupation, and religion of the donor are given to the recipient family. Equivalent details about the recipient family, however, are not usually provided to the donor. Also, in some cases the donor may never even be made aware of the outcome of the donation.

Only a small number of fertility patients choose anonymous embryo donation for managing their surplus embryos. Patients often regard their embryos as ‘potential children’ and have an emotionally-vested interest in what happens to them.

For the past six years, fertility patients in Canada have also had the option of pursuing open embryo donation. The open model of embryo donation allows the donor to select the recipients. As part of the matching process, potential recipients are assessed by a professional, often a social worker or psychologist, to ensure a ‘good fit’ between the donor and the recipient.

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

Questions About Using “Mosaic” Embryos in IVF

Couples undergoing IVF routinely undergo preimplantation genetic screening, or PGS, to make sure that their embryos are viable and free of genetic disease. However, some embryos have both normal and abnormal cells, and at least some of these “mosaic” embryos are capable of developing into healthy children, as described in a New York Times article. This raises a troubling question: should mosaic embryos be used to create a pregnancy? Fertility specialists are divided on the issue.

In part, the disagreement rests on factual questions regarding the reliability of PGS screening. Dr. Norbert Gleicher questions “whether a biopsy that examines five to ten random cells from the outer shell of a 200-cell embryo can reliably represent the inner cell mass, the crucial core from which the fetus develops.” He reports three normal births after the transfer of mosaic embryos. But Dr. Mark Sauer responds that such a small sample of healthy babies does not warrant a change in the standard practice not to implant mosaic embryos, especially since problems may show up later in childhood or adulthood.

If the only risk is that the embryo won’t implant, and the woman will miscarry, it seems reasonable to allow infertility patients to decide whether to take that risk. But what if there is a serious risk that the child will have developmental defects? Is that a risk that prospective parents should be able to take? Should physicians accede to such a request?

The question is complicated by the fact that, quite apart from the factual issues about the reliability of PGS, there’s another deeper, conceptual question: May prospective parents take risks with the health of their future child if there is no other way that the child can be born?

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

British man has fathered 800 children

Another chapter in the Wild West of reproductive technology: the British man who has fathered 800 children and hopes to reach 1000. Simon Watson, 41, has been helping desperate women for 16 years. Married twice, with three children of his own, he advertises his services on Facebook.

Bertold Wiesner,  an obstetrician in London in the 1940s, was the father of about 600 children at his own fertility clinic, but it now appears that Mr Watson has beaten him.

“Usually one [baby] a week pops out. I reckon I’ve got about 800 so far, so within four years I’d like to crack 1,000,” he told the BBC. “I’ve got kids all the way from Spain to Taiwan, so many countries. I’d like to get the world record ever, make sure no-one’s going to break it, get as many as possible.” Sperm donors at a conventional IVF clinic are limited to 10 children.

Typically Mr Watson meets his clients at a petrol station and hands over his donation. He charges 50 Pounds. “If you go to a fertility clinic people have to go through lots of hurdles – counselling sessions, huge amounts of tests and then charge absolute fortunes for the service – but realistically if you’ve got a private donor you can just go and see them, meet them somewhere, get what you want and just go,” he explained.

Mr Watson’s business is not illegal in the UK, but his clients risk sexually transmitted diseases and birth defects – apart from the fact that their child will not have a father.

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

New Frontier in Transplantation

“Of all the ways to be wounded,” regrets Jake from Ernest
Hemingway’s novel The Sun Also Rises,
setting the stage for a narrative which implies the male character’s war injury
to his genitals rendering him irreversibly and torturously impotent. Recently,
the NY Times reported that research on penis transplants would offer a possible
treatment option for men who have suffered injury to the groin in war or other
trauma (www.nytimes.com-heal-troops).  To attempt to restore function and
procreative ability cadaveric penis transplants will be undertaken as an
experimental procedure. As noted in the article cited above, consent from
donor’s family would be secured as with any organ donation. While some may find
such surgical interventions to be less compelling than other transplants which
provide life- saving organs (heart, lung, kidney, liver, pancreas)
transplanting reproductive organs offers important benefits to patients.   

Uterine transplants have been discussed in the media
recently, and seem to hold promise as these transplants have been done successfully
in Sweden(www.nytimes.com-uterus-transplants
). Women born without a uterus may soon be able to receive a cadaveric uterus
in the US. Unlike penis transplants which rely on exclusively cadaveric
donation, live donation has been performed for uterine transplants in Sweden,
and in time may also be available for women in the US.

As progress for both penis and uterus transplantations moves
forward, it will be interesting to see if the dialogue about these two
reproductive systems will differ. At this stage, both procedures are considered
experimental and have yet to be performed in the US, though teams are
reportedly close to beginning the trials.

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

Doin’ what comes natur’lly

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A new medical technology encounters the most resistance when Joe Bloggs thinks it is “unnatural”. If you nailed a placard to a door with the words “plague within”, politicians could not run away fast enough. So the approval of challenging new technologies often depends on reframing the debate either to make them appear natural or to whisk the word away.

After decades of experience with debates about the “naturalness” of IVF, mitochondrial donation, homosexuality, hybrid embryos, GM foods, animal experimentation, cloning, surrogacy, gamete donation and so on, the UK’s Nuffield Council on Bioethics has taken the bull by the horns and written a position paper on “naturalness”. (Summary here. Full report here.)

Since the philosophical debate over naturalness is at least 2,400 years old, a committee of British panjandrums is unlikely to come up with new ideas, but it could give the government an arsenal of arguments to justify controversial policies.

The idea of naturalness is never far from the centre of bioethical discourse. “How dare you refer to my beautiful children as ‘synthetic’?” tweeted Elton John in March 2015 in an argument with Dolce and Gabbana. Bishop Keenan of Paisley argued that a technique to prevent mitochondrial DNA disorders “distorts the natural process of fertility” when it was being debated in Parliament in February.

As the Council’s report points out, the word is susceptible to many interpretations and often people talk at cross purposes.

The report sets out five understandings of naturalness that show the different ways in which the terms “natural” and “unnatural” are used:

Neutral: a neutral/sceptical view that does not equate naturalness with goodness.

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

Laboratory Mix-ups

Stine Willum Adrian calls for better ways of dealing with mistakes made by fertility clinic laboratories.

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What does one do when eggs, sperm, or embryos are mixed up in a fertility clinic lab? This is a difficult question, since mix-ups in the laboratory are not supposed to happen. Unfortunately, they sometimes do.

Marcus, a 19 year-old born and raised in Denmark, is the result of such an incident. In July he went public with his story in the Norwegian media in the hope of finding his genetic mother, a woman living in Iran.

Marcus’ parents had gone through fertility treatments at a private Danish clinic. As Marcus grew up, his parents suspected that a mix-up in the laboratory had taken place. With his dark complexion, brown eyes, and dark hair, Marcus looked different from his Scandinavian-looking, blonde-haired, blue-eyed family.

As it turned out, a cryopreserved embryo from an Iranian woman and a sperm donor had been mistakenly implanted into Marcus’ Danish mother. Marcus found out from the clinic that his genetic mother had a sister that lived or had lived in Norway. He hoped to find her and to get in touch with his other genetic relatives, and went to the Norwegian media for assistance.

Copenhagen, Denmark

Marcus’ story is unique in many ways. Since Marcus and his family have made a legal settlement with the clinic, they are restricted with regard to what they may say in public. Therefore, his story has been told in bits and pieces in the media.

From what has been reported, it seems that this mistake was poorly handled by the clinic responsible for it.

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

Critical Medical Humanities – A special feature of Medical Humanities by Elizabeth Lewis

The June issue of Medical Humanities includes a special feature section entitled “Critical Medical Humanities.” This collection opens with a piece by William Viney, Felicity Callard, and Angela Woods, “Critical Medical Humanities: Embracing Entanglement, Taking Risks.” As described in their abstract:

What can the medical humanities achieve? This paper does not seek to define what is meant by the medical humanities, nor to adjudicate the exact disciplinary or interdisciplinary knowledges it should offer, but rather to consider what it might be capable of doing. Exploring the many valences of the word ‘critical’, we argue here for a critical medical humanities characterised by: (i) a widening of the sites and scales of ‘the medical’ beyond the primal scene of the clinical encounter; (ii) greater attention not simply to the context and experience of health and illness, but to their constitution at multiple levels; (iii) closer engagement with critical theory, queer and disability studies, activist politics and other allied fields; (iv) recognition that the arts, humanities and social sciences are best viewed not as in service or in opposition to the clinical and life sciences, but as productively entangled with a ‘biomedical culture’; and, following on from this, (v) robust commitment to new forms of interdisciplinary and cross-sector collaboration. We go on to introduce the five other articles published in this special issue of the journal, reflecting on the ways in which collaboration and critique are articulated in their analyses of immunology, critical neuroscience, toxicity, global clinical labour, and psychological coercion and workfare. As these articles demonstrate, embracing the complex role of critical collaborator—one based on notions of entanglement, rather than servility or antagonism—will, we suggest, develop the imaginative and creative heterodox qualities and practices which have long been recognised as core strengths of the medical humanities.

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

Sperm and egg donation anonymity does not appear to be justified

Sperm and egg donation anonymity  increasingly claims:
children conceived  wish to meet their  parents, and the donors wish to know their childrens

Sperm and egg donation – the donors and their children  will require re-evaluation of eachother relationships throughout the lifetime of the parties involved

Anonymity in reproductive issues is being left behind. Thus, in their updated guidelines for gamete donation in assisted reproduction, the American Society for Reproductive Medicine (ASRM) has stated that those conceived using these methods have a right to know who their genetic parents are. Up to now, almost all gamete donations were anonymous. However, cases in which children conceived using this procedure wish to meet their biological parents, and in which the donors wish to be involved in the life of their children, are becoming increasingly common.

“Donors and programs”, states the Association ASRM,must recognize that they have a unique and ongoing moral relationship with each other, as well as with the recipients and their children, and this obligation does not end with the procurement of gametes. Evolving medical technology, laws, and social standards will require re-evaluation of these relationships throughout the lifetime of the parties involved”.

La entrada Sperm and egg donation anonymity does not appear to be justified 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.