Tag: reproductive medicine

Bioethics Blogs

Don’t feel comfortable asking others if they are having regularly scheduled unprotected vaginal penile penetrative intercourse? Then don’t ask them if they are “trying”


One of the first questions a newly
married straight couple often gets from well-meaning friends and family is
“when are you going to start trying?” For those of you who are wondering what
this question is getting at, it is asking them if they are going to start to
try to get pregnant. It is interesting to analyze the language used here.
People typically talk about “trying” without ever specifying what they are in
fact trying to do. Part of the reason for this may be because people assume the
meaning is obvious from the context, such as “they’ve been trying for six
months but haven’t gotten pregnant yet.” Another reason probably has to do with
our societal discomfort talking about sex.

We use general and vague terms to
imply that we are talking about sex, but often don’t feel comfortable out right
discussing it. For example, the birth control pill is generally just referred
to as “the pill.” There is still shame and stigma surrounding sex, particularly
for women and sexual minorities, so it may be easier and safer for a woman to
talk about being on “the pill,” even though everyone knows what she is
referring to, than to overtly announce that she is using contraception.

Even though we as a society may not
feel comfortable explicitly discussing sex, we still feel that it is our
business. From a legal perspective, look at how carefully reproductive medicine
is regulated. For instance, certain reproductive procedures (e.g. abortion and
sterilization) can require waiting mandatory periods – something that is not
common in other areas of nonelective medicine.

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

Don’t feel comfortable asking others if they are having regularly scheduled unprotected vaginal penile penetrative intercourse? Then don’t ask them if they are “trying” to conceive

 

One of the first questions a newly married straight couple
often gets from well-meaning friends and family is “when are you going to start
trying?” For those of you who are wondering what this question is getting at,
it is asking them if they are going to start to try to get pregnant. It is
interesting to analyze the language used here. People typically talk about
“trying” without ever specifying what they are in fact trying to do. Part of
the reason for this may be because people assume the meaning is obvious from
the context, such as “they’ve been trying for six months but haven’t gotten
pregnant yet.” Another reason probably has to do with our societal discomfort
talking about sex.


We use general and vague terms to
imply that we are talking about sex, but often don’t feel comfortable out right
discussing it. For example, the birth control pill is generally just referred
to as “the pill.” There is still shame and stigma surrounding sex, particularly
for women and sexual minorities, so it may be easier and safer for a woman to
talk about being on “the pill,” even though everyone knows what she is
referring to, than to overtly announce that she is using contraception.


Even though we as a society may not
feel comfortable explicitly discussing sex, we still feel that it is our
business. From a legal perspective, look at how carefully reproductive medicine
is regulated. For instance, certain reproductive procedures (e.g. abortion and
sterilization) can require waiting mandatory periods – something that is not
common in other areas of nonelective medicine.

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

Politicize my Bioethics: Compensation for egg cells

by Celina Malavé

“This is my first piece in a series I’m thinking about calling “Politicize my bioethics,” a series that works to give us examples upon which it is absolutely crucial to bring in politics (or really just notice because they are already there), particularly when we are thinking critically about a bioethical issue. In a perfect world, we would be able to have every single identity represented at the table when we are thinking critically about the intersection of medicine, technology, and ethics, but since that is not the case, we must then acknowledge and be aware of the identities each of us is bringing to the table as we work to be future leaders in bioethics.” – Celina Malavé

Egg donation is a recent development in the field of reproductive medicine in which healthy women voluntarily provide around 10-20 mature eggs, or oocytes, for research or assisted reproduction, in exchange for compensation. Prior to donating, donors undergo blood tests—which check hormone levels, blood type, and other markers—a pelvic exam, medical exam, and other evaluations to ensure mental preparedness for donation.[i]  Legal consent forms must also be signed and agreed upon by all parties involved.

To begin the donation process, the donor takes birth control to regulate her menstrual cycle. She is then given a series of powerful hormones injections for weeks prior to donation. A first round of hormones halts ovarian function while a second causes the woman to over-ovulate in order to produce multiple eggs. A final round of injections causes her to release the mature eggs before a minor, yet invasive surgery, is performed to collect the oocytes.

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

Just What We Need: Slicker Infertility Marketing

The most unsettling line in the recent Forbes article on the ambitious infertility startup Prelude comes about halfway through. “The IVF industry in the United States,” writes Miguel Helft, “has everything private equity likes—scale (about $2 billion annually) and growth (more than 10% a year), along with being fragmented and having outdated marketing.” 

In an era with precious few opportunities for double digit returns, why not turn the reproductive health sector into the next big thing by furthering its consolidation and selling services using lifestyle content?  “Hey,” Prelude’s hipster-chic splash page calls out, “how’s your fertility doing?” 

If that piques your interest, scrolling down takes you on a kind of virtual stroll through the streets of Williamsburg, Wicker Park, or the Mission District, where you encounter edgily coifed, tatted, and bespectacled folk who presumably are spending as much time thinking about their reproductive fitness as they do their next Americano or Kimchi taco.  But you’ll find scant information about financial, psychological, or medical risks of egg retrieval (unless you count the presumed donor pictured alongside the quotation “I was worried about the discomfort, but seriously, it was no worse than a bikini wax—and for a much higher purpose”) or about failure rates after eggs are thawed and implanted.  Everything is upbeat and empowering, geared toward the “millennial mindset of health, wellness, and control.”

Prelude is targeting 20 to 30 year olds and the main product it’s selling them is their own eggs and sperm on ice.  The site proclaims, “If you are in your 20s or early 30s, there is no better time than now to bank your eggs and sperm.

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

Ethics ignored in ‘3-person embryo’ technique

A fertility doctor in Ukraine is using highly controversial mitochondrial manipulation techniques to treat general infertility ahead of peer review and safety checks, according to New Scientist. Two women are 20 weeks pregnant with embryos created using the technique. Dr Valery Zukin, director of the Clinic of Reproductive Medicine in Kiev, says that he secured approval from ethics committees before proceeding. He plans to present preliminary results at the American Reproductive Technology Congress in New York this weekend. 

Dr Zukin’s clinic offers a full range of fertility services, including surrogacy and egg donation. 

Dr Marcy Darnovsky, of the Center for Genetics and Society, in California, points out that is the second time in three weeks that the magazine has broken stories about rogue fertility doctors using the “three-parent embryo” method.

“We appear to be in a race to the bottom, with fertility doctors ignoring evidence that points to long-term safety risks associated with these embryo engineering techniques,” she says. “They are ignoring ongoing policy debates and conducting dangerous and socially fraught experiments on mothers and children. And they appear to be actively seeking a media splash on the way down.”

Although the UK allows these techniques experimentally, it remains controversial both because of inadequate evidence of its safety, and because they produce “germline” or heritable modifications that raise serious social and ethical concerns.

“As many have predicted, allowing ‘3-person IVF’ for mitochondrial disease opens the door to widespread abuse by fertility clinics seeking to sell the latest IVF ‘upgrade’ to the largest possible customer base,” Darnovsky says.

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

CRISPR Embryos at Karolinska: Controversies Demand Oversight

Rumors have been circulating since 2014 about various research teams around the world applying the genetic engineering tool CRISPR-Cas9 in human embryos. Surprisingly, only two experiments have been officially reported in scientific journals—both of them in nonviable embryos incapable of being used for reproduction, and both out of Guangzhou, China.

CRISPR in viable human embryos

On September 22, NPR’s Rob Stein reported an exclusive look inside the Karolinska Institute in Sweden at ongoing but previously undisclosed work using CRISPR in viable human embryos. Stein had traveled to Stockholm to interview researcher Fredrik Lanner and his colleagues about their program of injecting CRISPR into viable human embryos to “knock out” genes potentially linked to early development. NPR quoted CGS executive director Marcy Darnovsky who cautioned:

It’s a step toward attempts to produce genetically modified human beings. This would be reason for grave concern. … If we’re going to be producing genetically modified babies, we are all too likely to find ourselves in a world where those babies are perceived to be biologically superior. And then we’re in a world of genetic haves and have-nots…

The next day, Hank Greely, director of the Center for Law and the Biosciences at Stanford University, told Eric Niiler in Seeker that there is “good valid medical use” for basic scientific research using CRISPR in embryos, but followed that with a warning:

Still, Greely acknowledges that some scientists or the public might say that the Swedish experiment could be an ethical “slippery slope” toward a gene-edited human. “Even if you don’t intend to, it makes it easier for someone else to do it,” Greely said.

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

First Baby Born Via ‘3-Parent IVF’ Raises Ethical Questions

On Tuesday it was reported that the first live birth resulting from mitochondrial donation was born in New York to a Jordanian couple. According to The New York Times, the fertility procedure – also referred to as “3-parent IVF” – was performed at a Mexican clinic and the baby is a healthy boy.

The purpose of a donor for this couple was to “overcome flaws in a parent’s mitochondria that can cause grave illnesses in babies.” Thus, the DNA from the egg of the healthy mother who has the mutation, is placed in the egg of a healthy donor after her nuclear DNA is removed. It is important to understand that the mitochondria of a cell are completely separate entities from DNA that determines inheritance.

The Jordanian couple took their chances with the procedure as they had lost two other children to the disease, one at age 6 and the other at 8 months. Dr. John Zhang performed the procedure at the New Hope Fertility Center’s clinic in Mexico as it is “effectively banned” in the United States, though it has been legal in the United Kingdom since last year.

The child is now 5 months old and healthy with normal mitochondria, as was first reported by New Scientist magazine.

Even after the procedure and birth, attitudes of mitochondrial transfers remain suspicious and aversive. “While referring to the procedure as “three-parent IVF” makes for compelling copy, in reality, it is not accurate…it’s also not nearly as controversial or ethically problematic as the ‘three-parent’ moniker makes it sound,”  Fordham University’s Center for Ethics Education Dr.

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

Victory: Eggs-for-Research Bill Dies in California Legislature

The Center for Genetics and Society and allies are celebrating the demise of AB 2531, a bill that would have allowed payments to women who provide eggs for research, effectively expanding the commercial market for human eggs from the fertility sector to the research context.

The bill, which was sponsored by the American Society for Reproductive Medicine, died in the State Legislature last week, never making it to the Governor’s desk. Assemblymember Autumn Burke anticipated a veto from Governor Brown and decided not to bring it up for a vote in the Assembly when it was sent back for concurrence, after passing the Senate on August 29 with amendments that seemed to be a tepid response to opponents’ objections.

CGS and allied women’s health, reproductive justice and public interest organizations opposed the bill because of dramatically insufficient information about the health effects of egg provision; the impossibility of true informed consent given the lack of data; the likelihood that low-income women, women of color, and immigrant women would most likely be affected; and the bill’s conflict with national recommendations for federal policy and with state law. For a full explanation of these concerns, see the opposition floor alert and CGS’ letter to the Senate Health Committee.

Organizations opposing AB 2531 included the Alliance for Humane Biotechnology, Black Women for Wellness, Black Women’s Health Imperative, Breast Cancer Action, Center for Genetics and Society, Friends of the Earth, Forward Together, National Women’s Health Network, Our Bodies Ourselves, Pro-Choice Alliance for Responsible Research, and We Are Egg Donors.

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

Egg Freezing: An Illusory Choice

Lucy Morgan critiques the corporate and political framings of egg freezing as a “solution” to delayed motherhood.

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Earlier this year Timeless, a fictional beauty brand, opened a pop-up shop in London, United Kingdom. Timeless aims to raise public awareness about the growing demand for social egg freezing, a technology that was only recently labelled non-experimental by the American Society for Reproductive Medicine. It provides clear information about the ethical, financial, and social implications of this technology, while encouraging public debate.

Theoretically, egg freezing gives women more time to exert agency and control over their fertility. It is presented as a liberating option, allowing women to “have it all,” to take advantage of the new opportunities available to them, and to become psychologically, economically, and relationally secure before having children.  Advocates of the technology argue that it would be wrong to deny women their right to this reproductive solution.

Framing egg freezing as a solution benefits corporations and governments. It is much easier for business people and politicians to encourage women to have children later than it is to enact corporate or structural changes, such as flexible working hours and better parental leave packages. Corporations that promote or fund egg freezing get positive press and public recognition for “improving gender equality.” Yet, typically, they avoid tackling the larger underlying issues that can lead to delayed motherhood.

Having more options does not guarantee reproductive autonomy; choices made within a constrained system are not truly free. Reproductive decisions are made within an environment, where the structurally imposed constraints of working hours, economic hardship, and dating, limit autonomy.

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 Not Linked to Breast Cancer Risk

August 25, 2016

(Medscape) – Women who undergo in vitro fertilization (IVF) are not at increased risk of developing breast cancer, a Dutch study shows. The findings are consistent with those of previous research showing no significant association between assisted reproductive technology and breast cancer, including a recent study reported by Medscape Medical News from the American Society for Reproductive Medicine 2015 Annual Meeting.

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.