Dr. Ernest Zeringue was looking for a niche in the cutthroat industry of fertility treatments.
He seized on price, a huge obstacle for many patients, and in late
2010 began advertising a deal at his Davis, Calif., clinic unheard of
anywhere else: Pregnancy for $9,800 or your money back.
That's about half the price for in vitro fertilization
at many other clinics, which do not include money-back guarantees.
Typically, insurance coverage is limited and patients pay again and
again until they give birth — or give up.
Zeringue sharply cuts costs by creating a single batch of embryos
from one egg donor and one sperm donor, then divvying it up among
several patients. The clinic, not the customer, controls the embryos,
typically making babies for three or four patients while paying just
once for the donors and the laboratory work.
People buying this option from Zeringue must accept concessions: They
have no genetic connection to their children, and those children will
probably have full biological siblings born to other parents.
Want baby mice? Grab a petri dish. After producing normal mouse pups last year using sperm derived from stem cells,
University team of researchers has now accomplished the same feat
using eggs created the same way. The study may eventually lead to new
ways of helping
infertile couples conceive.
Although the procedures can be expensive, an increasing
number of couples and individuals are undergoing treatment for
fertility assistance. ART includes fertility treatments in which both a
woman’s egg and a man’s sperm are handled. More than 1 percent of all
infants born in the United States each year are conceived using ART,
according to the Centers for Disease Control and Prevention (CDC).
In vitro fertilization (IVF) is a process by which an
egg is fertilized by sperm in a petri dish. Once an embryo has been
created, it is then transferred—inserted inside a woman’s uterus—for
possible implantation. IVF also can be used with an egg donation, where
the woman providing the egg does not gestate the embryo. Sometimes
potential parents, also known as intended parents, use surrogates to
carry the embryos to term.
“The concept of parenthood is changing these days,”
says Naomi Cahn, the John Theodore Fey Research Professor of Law at The
George Washington University (GW) where she specializes in family law
and reproductive technology. “One major problem is the concept of an
embryo comes with political implications.”
Are Indians turning to surrogacy themselves after becoming an international fertility tourist destination? From IBNLive:
New Delhi: Aamir Khan and Kiran Rao are among the first celebrities to talk about it openly, but how many Indians are turning to surrogacy? Or even know about the possibilities of IVF? It's a pressing issue given that 30 million couples in India struggle with infertility.
At this point, India doesn't have a law governing IVF or surrogacy but there is a draft bill in the works that aims to protect the rights of surrogates, and regulate the assisted reproduction industry in India estimated to be worth more than Rs 25,000 crore. That's even as a debate is raging worldwide.
A lack of government regulation overseeing reproductive technology is failing to protect prospective parents and their would-be kids, lawyers and infertility support groups claim — one year after a landmark Federal Court ruling on the private industry.
Uncertainty about rules on matters such as the collection of donor information, the number of embryos that can be implanted, and compensation for donors and surrogates were expected to be settled following the December 2010 Supreme Court of Canada decision.
But little about the fertility laws has been made clear since then, said Diane Allen, who used assisted reproductive technology 27 years ago to conceive her son, Chris.
A story that might be a hoax and is under investigation, from USA Today:
BEIJING – The photo was undeniably cute: a studio portrait of eight babies in identical onesies and perky white cotton hats, sporting an array of expressions from giggly to goofy, baffled to bawling.
Intended as an advertisement for the studio, the photo grabbed a different kind of attention: In a country that limits most couples to one child, many Chinese were amazed to learn that a couple had spent nearly a million yuan ($160,000) and illegally enlisted two surrogate mothers to help have the four boys and four girls.
The incident has highlighted both the use of birth surrogates, a violation of Chinese law, and how wealthy Chinese do as they please, with scant regard for the rules that constrain others. The most common reaction, though, has been simple disbelief.
On the Need for the Regulation of Fertility Market
"Oct. 17 (Bloomberg) -- Naomi Cahn, law professor at George Washington University Law School and author of "Test Tube Families: Why the Fertility Market Needs Legal Regulation," and Bloomberg Law's Jason Brocks talk about federal and state regulation of sperm donations and the welfare of donor-conceived children. They speak with Spencer Mazyck on a Bloomberg Law podcast."
First Generation of Sperm Donor-Conceived Children
From the Washington Post:
LaBounty is part of the first documented generation of donor-conceived children: those born in the late 1970s to mid-1980s, when sperm banks began to spread in the United States. These children are now adults, and caring for them has prompted a host of unanticipated issues, ranging from a lack of medical histories to the psychological impact of knowing the circumstances of their conception. Many donor-conceived children are finding out, often only by chance, that they are predisposed to certain illnesses. In one recent case in the news, a donor-conceived teen learned that his biological father, who provided sperm for at least 24 children, carried a genetic disorder that causes a potentially fatal heart defect.
In July, a law went into effect in Washington state giving adults the right to medical and identifying information about their sperm donor. Although the law gives donors the option of vetoing disclosure of their identities, it guarantees that offspring will be able to access their medical histories in every case.
“It’s really landmark legislation,” said Naomi Cahn, a family law professor at George Washington University, though there are still questions about how it will be implemented. For example, sperm is often shipped across state lines. “In the absence of federal law,” Cahn notes, “it’s unclear what the rights are of any individual in each state.”
Wendy Kramer and Professor Naomi Cahn recently published an interesting article in BioNews:
The largest study to date of donor-conceived people has just been published in Human Reproduction (1). Its findings show the need to address two different effects of anonymous donating: first, when should children find out that their parents used donor sperm or eggs; and second, should children ever find out the identity of their donors? The researchers, from California State University and the Donor Sibling Registry, provide definitive answers to these questions. The majority of the 751 respondents believed that early disclosure was important. Three quarters recommended that only 'known' or 'willing to be known' donors should be used.
Today, disclosure turns on the type of family. Study participants who grew up in lesbian, gay, bisexual and transgender (LGBT) or single-parent households were more likely to learn of their origins at an earlier age than those of heterosexual couples. They, in turn, had a healthier or more positive view of their means of conception. The study also found that children in LGBT households are more comfortable expressing curiosity about the donor than those of heterosexual parents, and that they are significantly more likely to express this interest at a younger age. For example, twice as many LGBT offspring expressed an interest in their donor by the age of 11.
Interesting New York Times piece about the cohabitation of a mother, her child, the child's sperm donor, and his domestic partner:
The setup is complicated. Griffin’s mother, Carol Einhorn, a fund-raiser for a nonprofit group, is 48 and single. She conceived through in vitro fertilization with sperm from Mr. (George) Russell, 49, a chiropractor and close friend. Monday, Tuesday, Thursday and Sunday nights, Mr. Russell stays in the spare room of Ms. Einhorn’s apartment. The other three days he lives on President Street with his domestic partner, David Nimmons, 54, an administrator at a nonprofit. Most Sundays, they all have dinner together.
“It’s not like Heather has two mommies,” Mr. Russell said. “It’s George has two families.”
Two addresses, three adults, a winsome toddler and a mixed-breed dog officially named Buck the Dog. None of this was the familial configuration any of them had imagined, but it was, for the moment, their family. It was something they had stumbled into, yet had a certain revisionist logic.
Such is the hiccupping fluidity of the family in the modern world. Six years running now, according to census data, more households consist of the unmarried than the married. More people seem to be deciding that the contours of the traditional nuclear family do not work for them, spawning a profusion of cobbled-together networks in need of nomenclature. Unrelated parents living together, sharing chores and child-rearing. Friends who occupy separate homes but rely on each other for holidays, health care proxies, financial support.
“Some of the strictures that were used to organize society don’t fit human change and growth,” said Ann Schranz, chairwoman of the Alternatives to Marriage Project, a 10-year-old organization. “What matters to us is the health of relationships, not the form of relationships.”
And so here on Plaza Street, four people are testing the fuzzy boundaries of an age-old institution, knowing there is no single answer to what defines family or what defines love.
Griffin, now almost 3, calls Mr. Russell “Uncle George” and Mr. Nimmons “Dave.” At some point, Ms. Einhorn intends to tell her son the truth. Mr. Russell worries about that moment. He never wanted to be a parent; he saw the sperm donation as a favor to a friend. He did not attend the birth or Griffin’s first birthday party. His four sisters were trying to figure out whether they were aunts.
Appleton & Pollak: "Exploring the Connections between Adoption and IVF: Twibling Analyses"
Susan Appleton (Wash. Univ. School of Law St. Louis) & Robert Pollak (Wash. Univ. Saint Louis Buss. School) have posted "Exploring the Connections between Adoption and IVF: Twibling Analyses" (95 Minn. L. Rev. Headnotes 60 (2011)) on SSRN. Here is the abstract:
This essay responds to Trading-Off Reproductive Technology and Adoption: Does Subsidizing IVF Decrease Adoption Rates and Should It Matter?, in which I. Glenn Cohen and Daniel L. Chen analyze what they describe as an arm-chair principle called “the substitution theory”–the claim that facilitating treatment for infertility, including subsidizing in vitro fertilization (IVF), decreases adoptions. Cohen and Chen venture well beyond the arm chair, closely interrogating the substitution theory both normatively and empirically and concluding, contrary to the substitution theory, that IVF subsidies do not decrease and might actually increase adoptions.
Returning to the arm chair, this Response offers two different perspectives. First, we use a family law lens to focus on important elements of Cohen and Chen’s analysis, both explicit and implicit, including adoption, IVF, genetic connections, reproductive autonomy, and gender. We show how these elements are shaped by the authors’ assumptions, prevailing legal principles, and our culture more generally. Next, we use an economic lens to reveal how mandated subsidies for IVF produce varied conduct, depending on the preferences and resources of those who would consider adoption and IVF. Approaching Cohen and Chen’s analysis from these two different vantage points demonstrates that arm-chair theorizing, properly done, can illuminate the relationship between IVF and adoption.
In this latest twist on the growing trend of going overseas for cosmetic surgery, dentistry and other medical treatment, the Caribbean island's Barbados Fertility Centre, located in what the tourist board describes as "a plantation-style facility" in Christ Church, offers treatments for $400-$8,500 . IVF -- in which an egg is fertilized outside the body and then placed in a woman's uterus -- starts at about $6,000, not including medications, which can add a couple of thousand dollars. But that's cheaper than the $10,000 and up typical in the USA. Fertility packages, including air, lodging and certain treatments are available.
A measure that would have outlawed surrogacy birth arrangements in South Dakota was defeated Monday by a state House panel. The Judiciary Committee voted 9-3 to reject the measure after even its main sponsor said the issue needs more study before state law is changed.
Hunt said Monday's hearing demonstrated that South Dakota must eventually adopt laws to regulate surrogacy, particularly cases involving commercial arrangements that pay a lot of money to women who carry other people's babies.
"It's coming. This is going to be a big business. We're going to have to deal with the situation where it's for money," Hunt said.
The bill would have made any surrogacy arrangement or contract unenforceable. It would have kept parental rights with the woman who gives birth to a child, even if she was not the genetic mother.
People involved in such surrogacy agreements could have faced civil penalties and criminal charges.
However, Tom Barnett, director of the South Dakota State Bar, said the measure would likely have prevented all surrogacy births. He said the State Bar, doctors and others could work on a model law that would regulate surrogacy arrangements but not prevent them.
"Surrogacy arrangements are a legitimate method for a loving couple to have their own child. What can be wrong with that?" Barnett said.
Harold Cassid,y of Shrewsbury, N.J., a lawyer who has worked on surrogacy disputes, said surrogate mothers often develop deep ties with a fetus. Surrogacy contracts determine child custody without any consideration of a child's best interests, he said.
Brokers are now inducing women to be surrogate mothers in exchange for money, Cassidy said.
"It calls for a breeding class of women who are to be discarded," Cassidy said.
A long-awaited Supreme Court ruling that takes the business of regulating the clinical world of baby-making out of Ottawa’s hands has raised questions about the future of fertility treatments in Canada, and fears that the black market for human eggs and sperm will continue to thrive.
Judges found the power to regulate and license doctors and clinics offering fertility treatments belongs to the provinces, as an area involving the practice of medicine. But the ruling, released Wednesday, upholds other elements of the federal Assisted Human Reproduction Act, including those governing the use of human embryos in stem cell research.
Ryleigh Shepherd was conceived in 1998, the same year as her 11-year-old twin sisters, but she wasn't born until 2010.
The three girls from Walsall, in Great Britain, who were born more than a decade apart in two different centuries, are actually fraternal triplets born through in vitro fertilization (IVF).
Ryleigh came from the same batch of embryos that had allowed her parents -- Lisa and Adrian Shepherd -- to give birth to twins Megan and Bethany.
British experts say they know of no other case in their country in which three siblings from the same round of fertility treatment have been born with such an age gap.
The longest interval between freezing and conception was in the case of a woman from New York City whose embryo had been stored for 20 years, according to a report in the journal Fertility and Sterility.
"It seemed strange to think that we were using embryos that we had stored all those years ago, that were conceived at the same time as the girls," Lisa Shepherd, 37, told Britain's Daily Mail newspaper.
"We knew that if we had another baby it would in effect be the girls' triplet as they were all conceived at the same time," she said. The girls look exactly alike, according to their mother. "It was uncanny."
How long embryos can be frozen and still viable is still not known, but American fertility experts say they have great confidence in the success of new reproductive techniques.
"It's incredibly common for people to go back and second and third time," said Barbara Collura, executive director of RESOLVE, the National Infertility Association. "There have been recorded cases of kids born far longer apart. This doesn't tip the scales."
Fertility experts estimate that about 400,000 embryos are currently in frozen storage in the U.S., and a more comprehensive survey will be underway in the spring.
From the Wall Street Journal on international baby creation markets:
In a hospital room on the Greek island of Crete with views of a sapphire sea lapping at ancient fortress walls, a Bulgarian woman plans to deliver a baby whose biological mother is an anonymous European egg donor, whose father is Italian, and whose birth is being orchestrated from Los Angeles.
She won't be keeping the child. The parents-to-be—an infertile Italian woman and her husband (who provided the sperm)—will take custody of the baby this summer, on the day of birth.
The birth mother is Katia Antonova, a surrogate. She emigrated to Greece from Bulgaria and is a waitress with a husband and three children of her own. She will use the money from her surrogacy to send at least one of her own children to university.
The man bringing together this disparate group is Rudy Rupak, chief executive of PlanetHospital.com LLC, a California company that searches the globe to find the components for its business line. The business, in this case, is creating babies.
Mr. Rupak is a pioneer in a controversial field at the crossroads of reproductive technology and international adoption. Prospective parents put off by the rigor of traditional adoptions are bypassing that system by producing babies of their own—often using an egg donor from one country, a sperm donor from another, and a surrogate who will deliver in a third country to make what some industry participants call "a world baby."
They turn to PlanetHospital and a handful of other companies. "We take care of all aspects of the process, like a concierge service," says Mr. Rupak, a 41-year-old Canadian.
For years couples have turned to sperm donors, egg donors or surrogate mothers to help them become parents. Now the process is being taken to a level that is stretching legal and ethical boundaries. WSJ's Linda Blake reports from India.
Clients tend to be people who want children but can't do it themselves: families suffering from infertility; gay male couples. They may also have trouble adopting because of age or other obstacles.
And they're price sensitive. PlanetHospital's services run from $32,000 to around $68,000, versus up to $200,000 for a U.S. surrogate.
Overseas surrogacy has other advantages. Surrogates in some poorer countries have little or no legal right to the baby. In Greece, a surrogate can be prosecuted for trying to keep a child. By contrast, some U.S. surrogates have tried to legally claim the children they've carried.
The process can bring profound dilemmas. In some cases, clinics end up creating more fetuses than a couple needs, forcing a decision over whether to abort one or more pregnancies. Babies carried to term occasionally find themselves temporarily unable to get a passport.
Mr. Rupak is learning to navigate the uncharted nature of his field—the stateless babies, the ethical complexities. His expansion to Greece, a European Union member nation, is specifically intended to lessen the likelihood of the passport problem for European parents-to-be.
Some of his own clients have faced the abortion decision, Mr. Rupak says. "Sometimes they find the money" to pay for more children than they expected, he says. After all, they went to such lengths. And if they decide otherwise, Mr. Rupak says, "We don't judge."
Critics say the business is strewn with pitfalls. "The potential for abuse on many levels is big," says Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia, discussing the industry in general terms. "You're straddling all these [international] boundaries to buy the ingredients and the equipment." Mr. Caplan calls it the "wild, wild west of medicine."
Laws are vague and can conflict from country to country. In 2008, baby Manji was born to an Indian surrogate just weeks after the divorce of her Japanese parents-to-be. (The family wasn't a PlanetHospital client.) According to a Duke University case study in legal ethics, it led to a tangle of Indian and Japanese law that first prevented the little girl from being issued a birth certificate, and later made it difficult for her father bring her home to Japan. Months went by. To fix the problem, Japan issued a special humanitarian visa.
"This area of law is very unsettled," says Evgenia Terehova, PlanetHospital's lawyer. "There can be all sorts of unforeseen circumstances."
While age is key in a woman's odds of conceiving, whether naturally or via assisted reproduction, there is no consistent evidence that a man's age affects the chances of success with infertility treatment, a new research review finds.
In an analysis of 10 studies mostly conducted in the past decade, Israeli researchers found that most of the studies showed no clear relationship between men's age and couples' odds of success with in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).
Both IVF and ICSI involve joining a woman's egg and a man's sperm in a lab dish, then—if fertilization is successful— transferring one or more embryos to the woman's uterus. ICSI is typically used for male fertility problems, including a low sperm count or poor sperm quality. It involves isolating a single sperm and injecting it directly into the egg.
It's known that women's fertility declines after age 35, and drops sharply after about age 40. And the odds of having a baby through assisted reproduction show a similar decrease.
Men are capable of fathering a child even into their golden years. However, studies have indicated that they do have a biological clock of sorts. Sperm quality, research suggests, may decline after age 40, and so too may the chances of having a baby; one study, for example, found that when the man was older than 40, a couple's risk of miscarriage was higher compared with couples in which the man was younger.
However, only a handful of studies have looked at the relationship between men's age and fertility-treatment outcomes. For the new review, reported in the journal Fertility and Sterility, Dr. Lena Dain and colleagues at Carmel Medical Center in Haifa, Israel, pulled together 10 international studies that have looked at the question. Each involved anywhere from about 200 to 2,000 couples who underwent fertility treatment.
Overall, the researchers found, most of the studies failed to find an association between men's age and sperm quality, the odds of couples' conceiving or the chances of ultimately having a baby.
Fertility Saving Procedure Performed on Youngest Ever Toddler
The New York Post reports on the youngest child ever to have a fertility saving procedure performed in the wake of a serious illness:
Thanks to a new miracle surgery, the hope that little Violet Lee can one day have children won't be killed by chemotherapy.
The plucky, 2-year-old Brooklyn girl is set to become the youngest person ever to undergo a fertility procedure when a New York doctor removes one of her ovaries Tuesday and freezes it while she undergoes treatment for a serious immune disease.
The tiny organ will be put on ice for 20 years or more, ready for re-implantation if and when a grown-up Violet decides to have kids of her own.
"It was important that I found a way to allow her to have children," her mom, Tikesha Lee, 32, told The Post.
Violet is set to begin chemo Wednesday, to help her with a bone-marrow transplant she must undergo because of her immune-system troubles.
Both chemo and radiation therapies can render patients sterile.
"It was hard enough to find out your baby needs to go through chemotherapy, but to hear your daughter will be sterile after the treatment -- that one thing gets healed, but another destroyed -- I felt someone punched me in the stomach," her mom said.
The day before the chemo, little Violet will head to Westchester to visit Dr. Kutluk Oktay, who will perform the experimental "fertility preservation" procedure.
The doctor has already performed the surgery on some 40 girls under the age of 18. The previous youngest was 3 years old.
Ovary transplants have already worked in adults. Of the few dozen women who have had the procedure, which Oktay pioneered in 1999, about one-third have had children, he said.
But adult patients are only separated from their ovaries for a couple of years -- not decades, like Oktay's kid patients.
"This is experimental -- down the road, they may or may not get any benefit," Oktay said.