Tag: assisted reproduction

Blog Posts (15)

November 3, 2016

Why we should recognize social infertility: the exclusion of lesbian and gay couples and single individuals from definitions of infertility

The diagnosis of infertility is an anomaly among medical conditions because it requires two people, whereas almost all other medical conditions require just one person. For instance, if I break my leg, my diagnosis and treatment does not include or depend upon anyone else within my web of relationships. In contrast, when physicians are assessing a patient for infertility, they inquire about the person’s presumed heterosexual partner. This is because the majority of medical definitions of infertility rely upon heterosexual activity as a prerequisite to determine if an individual is infertile. For example, the World Health Organization (WHO) defines infertility as “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” 

One significant problem with this definition is that it cannot account for lesbian and gay couples and single heterosexual individuals. Lesbian and gay cisgender couples are not having sexual intercourse (i.e. vaginal penile sex), so they are automatically excluded from definitions of infertility. Single heterosexual individuals may be having intercourse, but it may not be “regular,” which we can presume to mean on a consistent basis, and they may not be having unprotected intercourse.  

Yet, lesbian and gay couples and single individuals, regardless of their sexual orientation, are all infertile in a sense because they are not able to sexually reproduce via intercourse. Some in the bioethics literature have used the term “social infertility” to refer to individuals who are unable to reproduce due to factors associated with their partner. This can include individuals in same-sex couples who are not able to engage in intercourse and individuals who do not have a partner and thus are not able to engage in intercourse. 

In recognizing social infertility, the WHO recently changed their definition of infertility to include lesbian and gay couples and single individuals. Unfortunately, insurance companies in the United States do not tend to recognize social infertility. For example, a lesbian couple in New Jersey is suing their insurance company because it will not cover infertility treatment for them. Between the two women, they have had six miscarriages, which shows they are not just socially infertile, but there are also physiological components to their infertility. However, their insurance company is stating that they have not demonstrated that they are infertile because they have not been having heterosexual intercourse. 

The idea of requiring lesbian and gay individuals to prove their infertility by engaging in vaginal penile intercourse is ridiculous, especially given that modern medicine has various ways of assessing an individual’s fertility (e.g. hormonal tests, ovarian reserve, sperm motility, etc.). We need a broader definition of infertility that does not depend upon an individual’s relationship, or lack thereof, with others. The new WHO definition is a step in the right direction to recognize social infertility as well as the fact that lesbian and gay couples and single individuals can experience physiological infertility on top of social infertility.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.
September 30, 2016

Ethics & Society Newsfeed: September 30, 2016

Technology and Ethics Tech Giants Team Up To Tackle The Ethics Of Artificial Intelligence The Partnership on Artificial Intelligence to Benefit People and Society, consisting of Amazon, Facebook, Google, Microsoft and IBM (with Apple in talks to join), weighs in on the … Continue reading
May 27, 2016

Support New York State’s Oncofertility Legislation

As I have discussed in previous blogs, fertility preservation for cancer patients is very expensive and it is rarely covered by insurance. Cost is the primary barrier for why cancer patients do not preserve their fertility before undergoing lifesaving, yet potentially sterilizing, treatments. One cycle of IVF is on average $12,400 and estimates for ovarian tissue cryopreservation range from $5,000-$30,000. Furthermore, annual storage fees for frozen gametes and embryos can run up to hundreds of dollars a year. For many, especially while in the midst of a life-threatening health emergency, these costs are prohibitive, and future fertility is left to chance.

Legislation, however, is currently being considered in New York State that could change this situation. SB7219, authored by State Senator Diane Savino, would alter the current infertility mandate in New York to include coverage for standard fertility preservation services needed by those facing possible iatrogenic (medically-induced) infertility due to treatments such as chemotherapy, radiation, and surgery.

If you are a resident of New York and care about this issue, please contact your state representative to let them know how important this is for you! By bringing together voices of patients, professionals, and families we can help make this change.

How You Can Get Involved:

If you are a cancer patient, survivor or family member who has been touched by this issue, please submit your email here:

Coalition to Help Families Struggling with Infertility - Link for Individuals

If you are a healthcare provider serving patients in New York who would be positively impacted by this coverage, please submit your email here:

Coalition to Help Families Struggling with Infertility - Link for Family Building Professionals

If your institution or nonprofit organization is interested in joining the Coalition to Help Families Struggling with Infertility, email advocacy@helpfamilieswithinfertility.net.

Time is of the essence! All communications should be submitted by June 2nd if possible; the last day of the NY legislative session is June 16th.

References:

  1. To read the entire Bill: http://legislation.nysenate.gov/pdf/bills/2015/S7219
  2. To learn more about the Bill or the Coalition: Coalition to Help Families Struggling with Infertility Website

 

- See more at: http://www.allianceforfertilitypreservation.org/blog/support-pending-fertility-preservation-legislation-in-new-york#sthash.EjwhZ7wP.dpuf

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

 

May 16, 2016

Taking a ride down the slippery slope

Did you know: we can now make sperm from embryonic stem cells (in mice).  Not only can we create this sperm, but we can use it to successfully fertilize an egg and develop into a fully grown mouse.  And what is the role of bioethics in this scientific discovery, according to the article?  A brief mention of theoretical ethical issues relegated to the end of the news article that no one reads far enough to see, anyway.

 

Scientific advancements in reproduction have occurred at an unbelievable rate.  We not only have the ability to create sperm, but we can also create an embryo using three genetic donors, choose or reject embryos based on their genetic traits, such as sex, and correct genetic defects by essentially cutting and pasting healthy DNA sequences over defective ones.  Conversely, using such technology, we also have the potential to clone human beings, choose or reject embryos based on traits such as hair color or athletic ability, and irreversibly alter a germ cell line, potentially leading to unknown negative effects in later generations.

 

While breakthroughs in reproductive technologies have the potential to address issues as important and varied as male infertility, uterine factor infertility, mitochondrial disease, genetic defects and disease, and even artificial gestation, one wonders whether anyone is stopping to ask: to what end?  How will we use this technology?  What are the short- and long-term effects?  How might this technology be misused?  And, my personal favorite, when will we start to regulate how and when we tinker with biology at a genetic level?

 

Despite the promise of treatment or eradication of genetic diseases using this technology, there is still a persistent and very realistic fear that this technology will be misused.  Even worse, the misuse may become so common as to be considered acceptable, particularly in our profit-driven fertility industry.  Will the desire to prevent Huntington’s disease also lead to the desire to enhance intelligence?  Can we really resist the urge to create so-called designer babies, and should we accept that while some may win the genetic lottery, others will be able to afford to stack the deck?

 

Bioethicists are sometimes viewed as obstructionists on the path of progress, unnecessarily blocking scientists from discovering all that can be accomplished through science and medicine. (For an excellent rebuttal, read here).  But the very purpose of the vast and diverse field of bioethics is to identify and acknowledge the normative implications of scientific advances and engage in a dialogue that directly addresses the “should” in a world of “could.”  Hence, the age-old question that is often asked but rarely answered: just because we can do it, does it mean we should?

 

In the world of reproductive technologies and germline manipulation, perhaps the answer, sometimes, is no.

 

 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

 

January 28, 2016

My Child, Your Womb

Gestational surrogacy contracts have been in the news again recently as a gestational surrogate reports that the intended father, having discovered that she is expecting triplets, is demanding that she undergo selective reduction to abort one of the fetuses.  Situations such as these, while often not reported, are not necessarily uncommon.  In 2013, a gestational carrier was offered $10,000 to abort when a second trimester ultrasound discovered congenital heart and brain abnormalities.  Despite a well-established Constitutional right to privacy that includes a pregnant woman’s right to procure – or refuse – an abortion, surrogacy contracts routinely include provisions that not only prohibit a surrogate from having an abortion unless there is a medical need, but also give the intended parents sole discretion to determine whether the surrogate should abort where there is evidence of a physical abnormality or other issue.  Such provisions have not been tested in court, but would almost certainly be unenforceable based on the surrogate’s Constitutionally-protected right to reproductive autonomy.


In India, where there is an estimated $400 million surrogate tourism industry, women agree to be surrogates in exchange for $5,000-7,000, which is far more than they could make otherwise.  In many clinics, surrogates live in dormitories for the duration of the pregnancy and their food and medical care is provided by the clinic.  There are also reports that some clinics have policies against pregnancies of 3 or more fetuses – meaning that selective reduction may occur as a matter of course to reduce the number of fetuses to 2 or 1.  If this is in fact happening, are the surrogates (or even the intended parents) aware of what is happening?  Are they given a voice in the medical care and treatments they receive?  Or are the decisions made by the intended parents or the clinic, and simply imposed on the surrogate?


Surrogacy, as with other assisted reproductive techniques, has been promoted in the name of reproductive autonomy – the right and ability to have more options and exert more control over reproduction.  But in cases such as these, where surrogates are pressured legally, financially and socially to have an abortion, whose reproductive autonomy are we honoring?  While it may be the child of the intended parents, it is the uterus of the surrogate.  The intended parents have an interest in the healthy development and birth of their child, which can be affected by congenital abnormalities, surrogate behavior, or the presence of multiples.  The surrogate has an interest in her own bodily integrity, her own health, and the treatments or procedures performed on her, even in connection with the gestation of another’s child.  Where these interests conflict, whose rights are stronger: the intended parents of the child, or the woman carrying it? 


It seems unconscionable that a woman could be forced to undergo an abortion based on enforcement of a contract.  It is equally disturbing to think that an intended parent would be prevented from objecting to an abortion of his or her child because the surrogate was making the decision to abort.  While both of these decisions in the context of a commercial surrogacy arrangement may be considered a breach of contract, and therefore may have monetary damages, what is left in the aftermath?  A parent whose unborn child was aborted without the parent’s permission?  A surrogate who has been abandoned with a newborn she never intended to keep?  These consequences are far weightier than could be compensated for by money.

 

The problem with blending the rights of reproductive autonomy is trying to separate them again when there is a conflict.  A surrogate will always have the right to determine what happens to her body, which includes the right to have or refuse an abortion, even if the child belongs to someone else.  Is it possible, then, to simultaneously protect the reproductive rights of both the surrogate and the intended parents?  Or will there always be an inherent imbalance of reproductive rights and the potential for coercion in the enforcement of commercial surrogacy agreements?


The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

October 1, 2015

Is it Ethical for Parents to Create a Savior Sibling?

<p style="font-size: 11.2px; line-height: 19.04px;">Savior siblings are children who are born to provide HLA compatible body parts, typically umbilical cord blood to be used for bone marrow transplantation, in order to save the life of their older sibling. They are created using IVF so that the embryos can be screened in order to find and implant one that is a match to the existing child. The <a href="https://en.wikipedia.org/wiki/Adam_Nash_(savior_sibling)">first savior sibling</a>, Adam Nash, was born in the US was born in 2000. Lisa and Jack Nash decided to create a savior sibling after their doctor suggested it might be the best option for a cure for their daughter Molly, who was born with a severe type of Fanconi anemia. Immediately after Adam was born, Molly received a bone marrow transplant using the umbilical cord blood from her brother. The notion of savior siblings gained more attention with Jodi Picoult’s book <em><a href="http://www.jodipicoult.com/my-sisters-keeper.html">My Sister’s Keeper</a></em> and the <a href="http://www.imdb.com/title/tt1078588/?ref_=nv_sr_1">movie based on the book</a>. In contrast to Adam Nash, the savior sibling in the book and movie is expected to continue giving bodily to her sister throughout her childhood, including organ transplantation, rather than one time umbilical cord donation.</p> <p style="font-size: 11.2px; line-height: 19.04px;">Is it ethical for parents to create a savior sibling? Some argue that the parents’ intention plays a role in considering whether it is ethical to create a savior sibling. If the parents were not planning on having any more children and they are the having the savior sibling only for the sake of the older child, then there is the concern of using the savior sibling as a means to an end. If the parents were planning on having more children, then some claim that the savior sibling is wanted for her/his own sake and is not being created for just one purpose (i.e. to save the older child).</p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
January 16, 2015

In for Life: Procreative Liberty for Incarcerated Persons Serving Prison Sentences

<p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">The release of Cuban spy Gerardo Hernandez as part of a prisoner swap made headlines last month not only for the diplomatic implications for Cuba-US relations, but also for the questions surrounding assisted reproductive services for incarcerated persons. According to a brief report from </span><a style="line-height: 19.0400009155273px;" href="http://www.npr.org/blogs/thetwo-way/2014/12/22/372525940/cuban-american-not-so-immaculate-conception">NPR</a><span style="line-height: 19.0400009155273px;">, Hernandez’s spouse wanted to have a child with her incarcerated husband and sought support from a sympathetic US senator to facilitate this expression of reproductive liberty. While this case includes an added layer of intrigue because of the impressive barriers that were overcome to secure the means and support for artificial insemination, the question of how we ought to consider the use of assisted reproductive technology for couples who wish to bear children despite one parent serving a life sentence.</span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">While some children may be conceived where prisoners are permitted conjugal visits, Mr. Hernandez was in a federal prison where it is reported that such visits are not allowed. The only means for reproduction would be via assisted technology such as artificial insemination, a now basic intervention. What about other families who wish to raise children but without the connections or possibility for release? Is it ethical to support such endeavors when one parent will be able to contribute gametes and an occasional visit in a prison setting without freedom to participate in rearing the child? This is not such an easily answered question.</span></p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;"> </span></p>
October 22, 2014

The Ethics of Sperm Freezing for Teenage Boys

<p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">A few weeks ago, I attended the </span><a style="line-height: 19.0400009155273px;" href="http://oncofertility.northwestern.edu/2014-Conference">annual Oncofertility Consortium conference</a><span style="line-height: 19.0400009155273px;"> where Dr. Angel Petropanagos and I presented our poster “Teen Boys and Fertility Preservation: An Ethical Analysis.”</span><span style="line-height: 19.0400009155273px;">  </span><span style="line-height: 19.0400009155273px;">The vast majority of discussions about fertility preservation (FP), particularly FP for “social” (aka nonmedical) reasons, are focused on women in part because FP for women raises more ethical issues.</span><span style="line-height: 19.0400009155273px;">  </span><span style="line-height: 19.0400009155273px;">For instance, egg freezing carries more health risks and is generally less effective than sperm freezing. Furthermore, whereas sperm freezing has been an established method of FP for decades, it was only two years ago that the American Society for Reproductive Medicine lifted the experimental label from egg freezing.</span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">Yet, even established technologies can raise ethical concerns when used in vulnerable groups, such as children. Our research project examines the ethical issues FP raises when used by teenage boys.</span><span style="line-height: 19.0400009155273px;">  </span><span style="line-height: 19.0400009155273px;">In order to undergo sperm freezing, males must produce a sperm sample and this is usually done through masturbation. However, discussions about masturbation can be embarrassing and difficult for adolescent males (as well as for healthcare providers), particularly if they have never masturbated or never masturbated and achieved an ejaculation. Some parents and healthcare providers place a high value on preserving patients’ future option of genetic reproduction, but FP discussions with teen males can be especially challenging due to the sensitive and private nature of sexuality and reproduction. </span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
April 21, 2014

Easter, Fertility, Surrogacy

Most of us who celebrated Easter yesterday likely took part in the tradition of the Easter egg hunt. The egg, an obvious symbol of fertility, is an essential part of our spring celebration. Interestingly, the subject of fertility and “social surrogacy” was the focus of an article in Elle magazine last week. The piece told the story of an aging professional who felt she needed... // Read More »
February 1, 2012

Gingrich on IVF: Bad for Families, Bad for Bioethics

Scientists, reproductive specialists and andrologists had better prepare. If Newt Gingrich has his way (and wins the Presidency), he will have a whole new world in store for science and medicine.…

View More Blog Entries