Friday, February 23, 2018
Futurism (Feb. 2, 2018): Advanced Reproductive Technology is Here. But Who Decides Who Gets Access?, by Claudia Geib:
Reproductive technology has expanded and improved immensely over the years. The accessibility of assisted reproduction, fertility treatments, and even adoption, though, is highly limited, particularly in the United States. All of these processes can be prohibitively expensive, and, often, insurance does not cover them or organizations can arbitrarily choose not to provide them.
As reproductive technology is largely unregulated in the U.S., private organizations that manage processes such as embryo donations have full discretion when choosing who can participate in their programs. The National Embryo Donation Center (NEDC) states in its policies that they will only provide embryos to heterosexual, married couples, for example. The NEDC is founded in the Judeo-Christian worldview, and they explicitly exercise this viewpoint--or their perspective of it, at least--when selecting eligible couples for their services.
Jeffrey Keenan, the NEDC's medical director, says that their policy is to operate based on the "biological reality" of a family and God's intention for conception.
As much as you see gay people having children, you have noticed that none of them do it on their own. It is physically and scientifically impossible for gay people to have a child. So why just because we can have someone act as a surrogate, or because we can donate into a [gay] woman, why does that make it right? It doesn’t, not in and of itself.
Civil rights communities, LGBT groups, and, increasingly, the courts oppose these views. What many consider illegal discrimination, though, endures under the protection of U.S. law since such procedures are not generally considered "medically necessary."
Basic fertility treatments are rarely covered by U.S. insurance policies, and when they are, the insurance company may first require proof and documentation of a medical reason preventing "natural" pregnancy.
This is not the case in many other developed countries, where formal regulations, ethical requirements, and even entire administrative departments preside over reproductive technology. The United Kingdom's Human Fertilisation and Embryology Authority, for example, is solely committed to the regulation of fertility treatments and embryonic research in the U.K.
In the U.S., there is simply "no equality of access" to reproducing, says Antonio Gargiulo, an obstetrician-gynecologist and director of robotic surgery at the Brigham and Women's Hospital in Boston. As it stands, Boston residents do have access to fertility treatments under insurance, though; Massachusetts was the first state to pass laws requiring treatments be covered by insurance back in 1987. Just last year, New York also began requiring insurance companies to provide infertility treatments to those seeking, including homosexual couples and single women.
Many medical professionals, though, are skeptical that the federal government--particularly under the anti-regulation Trump administration--will make any moves toward ensuring fertility treatments and reproductive technology are uniformly covered by insurance and accessible to all Americans.
Sunday, November 19, 2017
New York Times (Nov. 15, 2017): Tech Companies Get High Marks for Covering Infertility Treatments, by Ann Carrns:
With demand for techniques like in vitro fertilization on the rise, information about the insurance coverage available in the workplace becomes more critical. Given that a cycle of in vitro fertilization (IVF) can cost in excess of $20,000 in some instances and that multiple cycles are often required before success is achieved, most companies provide their workers with minimal or no coverage for infertility treatments. A new survey of 250 large employers reveals that companies in the technology, consulting and banking sectors offer generous coverage for costly assisted reproduction procedures. Facebook, for example, covers four cycles of IVF and genetic counseling, a $100,000 value.
The survey, compiled and published by FertilityIQ, ranks employers in areas including the value of the benefits offered and whether preauthorization rules block access to single women or same-sex couples. Microsoft, for example, requires no such preauthorization.
Companies that offer generous benefits for infertility treatment describe themselves as family friendly. The bottom line, however, is a desire to recruit and retain talented employees.
Friday, November 18, 2016
New York Times (Oct. 10, 2016): Some I.V.F. Experts Discourage Multiple Births, by Jane Brody:
In vitro fertilization has many happy stories to recommend it, but it fails more often than it succeeds. Among its other problems is the high incidence of multiple pregnancy, a result of the practice of placing two or more embryos into the uterus in each cycle, in the hopes of achieving success. High-order births are associated with a host of problems, including poor health and development delays, not to mention the threat to the health of a woman who carries a multiple pregnancy to term and is faced with prospect of parenting more than one infant after birth. In the United States, 41.1 percent of all I.V.F. births are multiples.
New research shows that single-embryo transfer in women younger than 38 "resulted in a marked reduction in multiple birthrates but no decline in live birthrates." With education and an insurance industry more willing to cover the costs of I.V.F., the rate of multiple births could decline. The infertility industry, however, still thirsty for statistics that will attract consumers, continues to shun single-embryo transfer.
Tuesday, August 30, 2016
New York Times (Aug. 30, 2016): Chinese Women Head Overseas to Freeze Their Eggs, by Carolyn Zhang:
A growing number of single Chinese women are traveling abroad to freeze their eggs. They want the option to become mothers even if busy careers and the lack of a stable partner cause them to delay having children. Single women need to travel because China tightly controls access to assisted reproduction. Infertility treatments for unmarried women are completely banned, making travel abroad necessary. Even heterosexual couples must present proof of their marriage, proof of infertility, and a license to give birth. Reproductive rights in this domain are trumped in China by concerns that reproductive technologies will have a negative impact on its population policies and will create a black market for human eggs. It is also against China's moral code for unmarried women to bear children. Nonetheless, the interest among unmarried women is high. Brokerage firms have begun matching them with clinics abroad. Continuing the trend, some American infertility clinics have opened offices in Chinese cities.
Friday, August 26, 2016
International Business News (Aug. 23, 2016): Potent New Fertility Technique Prevents Side-Effects of In-Vitro Fertilisation for Women, by Léa Surugue:
A new method of in-vitro maturation of eggs promises to improve infertility treatment for some couples pursuing in-vitro fertilization. IVM frees women from having to take as many hormonal injections as they prepare their ovulation cycles for the rigors of IVF. Eggs are removed from their ovaries before the eggs are completely mature. They are matured in the laboratory before being fertilized. The new technique treats the harvested eggs with sythetic cumulin, a substance that is produced when women use hormones to boost their egg production as they prepare for IVF. It appears the method could lead to more successful pregnancies than standard IVF. In the meantime, more tests will have to be conducted before the new method can be offered to patients.
Wednesday, August 24, 2016
New York Times (Jul. 25, 2016): One Woman’s Crusade for Her Husband’s Sperm, by Tamar Lewin:
Sarah Robertson, a Californian who lost her husband to a rare disease at the age of twenty-nine, desired to have a child using the sperm he had stored in an infertility clinic. But when she went to retrieve it, she was told it had vanished. Aaron had been a carrier of a Marfan syndrome, and there is a fifty per cent chance that the diseases will be passed along to any children created with his sperm. In vitro fertilization will be required to ensure that any of her embryos chosen for gestation do not carry the genes linked to the disease. Robertson worries that the clinic may have misappropriated vials of her husband’s sperm and sold them to unwitting women and couples. She wants the clinic to warn those who purchased sperm from the clinic and to pay for testing and treatment of any children born. Attempts at mediation and negotiation have led nowhere. Robertson has now filed suit.
Monday, August 22, 2016
New York Times (Aug. 9, 2016): Four Lesbians, Suing, Say New Jersey Rule on Fertility Treatment is Discriminatory, by Megan Jula:
Couples who need infertility treatment to have children often do not have the resources to pay for it. Insurance is an important resource for filling the gap between the cost of treatment and a couple’s finances. Some states have laws that require insurers to provide coverage for some infertility treatment. By and large, though, the mandates cover only those who can demonstrate failure to conceive after two years of unprotected heterosexual intercourse. This leaves gay and lesbian couples without mandated coverage.
Two lesbian couples in New Jersey have sued the state, “claiming the mandate discriminates against their sexual orientation—essentially forcing infertile lesbian couples to pay for costly procedures to try to become pregnant.” They seek to recover the cost of their treatments, including artificial insemination and in vitro fertilization.
California and Maryland’s mandates have been updated to require fertility coverage without regard to sexual orientation.
Monday, August 1, 2016
New York Times (July 28, 2016): Sperm Banks Accused of Losing Samples and Lying about Donors, by Tamar Lewin:
A spate of lawsuits accuses sperm banks of deceiving and harming their patients. The allegations have arisen in cases alleging that sperm banks have mishandled sperm, even losing it in some cases, and have failed to put protocols in place to proven the transmission of genetic disorders. Other cases allege that sperm banks have sold sperm that was never meant to be donated in the first place and have misled consumers about donors' characteristics.
The law requires very little of sperm banks. The FDA requires only that sperm be tested for infectious diseases. Banks are not required to verify the information provide by donors or to set limits on the number of children a sperm donor may sire. The American Society for Reproductive Medicine's position is that there is no need for more regulation of sperm banks.
The lawsuits are evidence of dissatisfaction with sperm banks' practices, in an era when parents are more willing to be open with their children about their genetic origins. Still, the problem of sperm-donor anonymity persists. A significant number of donor-conceived children have tried in recent years to gain access to information about their biological fathers. The law provides no mandate for such access. Donor-conceived children are left to discover the information on their own, with success often dependent on their tenacity.
Friday, July 1, 2016
New York Times (June 13, 2016): China's Call to Young Men: Your Nation Needs Your Sperm, by Javier C. Hernández:
Styling it as an important contribution to society, the Chinese government is doing all it can to encourage young men to donate sperm. The country faces severe shortages, and about half of the current volunteers are screened out.
The enticements to donate run the gamut, including coveted iPhones and cash along with messages of patriotism and exhortations to help China deal with its aging population. Culturally, though, donating sperm and using donated sperm are hard to sell. Men in China associate semen with vitality and are reluctant to give any away. Couples struggling with fertility are many times uncomfortable using an unrelated man's sperm to conceive.
Thursday, June 30, 2016
CTV News (June 9, 2016): New IVF Method Limits Transfer of Bad DNA to Babies: Study:
Nuclear transfer, a reproductive technique wherein the nucleus of an egg cell replaces the nucleus of an egg cell that has healthier cytoplasm, holds promise for older women whose eggs have undergone changes with age that make them unsuitable for reproduction.
Now United States scientists want to use the technique to avert birth defects that have their genesis in the cytoplasm of the mother's egg, affect the muscles, eye, brain or heart of the child, and have no effective treatment. The idea is that by transferring the nucleus of an egg to an egg with healthy cytoplasm, disease-causing mutations of the mitochondria (the energy centers of the egg cells, will not be passed on to the child. The technique has been legal in Britain since last year.
So far, the study has shown that that "small tweaks to the existing procedure can reduce the risk of mutant mitochondrial DNA transferal." Two examples are performing the procedure on the day of the egg's fertilization and freezing the egg of the patient rather than that of the donor.
The technique does not remove the risk of the child's contracting a disease but does reduce it. Ongoing research will focus on refining the technique.
Tuesday, June 28, 2016
New York Times (June 11, 2016): Navigating Fertility Clinics with a Click, by Glenn Rifkin:
A heterosexual couple in San Francisco who planned to have children soon after their wedding ran into the roadblock of infertility. They became a statistic in a common story, spending tens of thousands of dollars on treatments without results, and wound up emotionally damaged by the experience.
But this couple's story ends differently than most. Concerned about what they felt was a lack of accountability on the clinic level, they left behind high-paying jobs and started Fertility IQ, a website that assesses fertility doctors and clinics. The website gathers and reports information from patients about their experiences so that others are not caught in the often frustrating and disappointing cycle of seeking medical care via word-of-mouth referrals.
The website is a work-in-progress that some have compared with Yelp given its subjectivity. But at least one patient found it to be "invaluable and game-changing."
Wednesday, June 8, 2016
The Chronicle (May 30, 2016): Woman Faces Fight to Use Dead Partner's Sperm, by Andrew Backhouse:
A Queensland woman, granted judicial permission to extract sperm from her deceased fiance will likely face a legal challenge to her use of the sperm to have a child with the aid of in vitro fertilization. The partner's family has returned to New Zealand with his body and may well oppose her use of the extracted sperm. The family gave permission for the extraction on an emergency basis because sperm is rendered useless for fertilization within twenty-four hours of a man's death. The couple had been trying to conceive a child before the man's untimely death. Friends of the couple appeared in court to testify about the couple's commitment and desire to have a family. The presiding judged urged "mature reflection . . . whether to proceed with the use of any extracted material."
Monday, June 6, 2016
New York Times (May 30, 2016): Triplet and Higher-Order Births in U.S. Down 41%, by Nicholas Bakalar:
Women 25 and older and in particular women 45 and older are giving birth to fewer higher-order births, 90 percent of which have been triplets in recent years. The sharpest drop occurred among non-Hispanic white women, though the rate in this group is still 57 percent higher than for non-Hispanic black women and twice as high as the rate for Hispanic women. The increase in higher-order births prior to 1998 was attributed to the rising average maternal age. This average has continued to rise; the decline in higher-order births, then, is thought to be the result of the practices of infertility centers, namely, not implanting multiple embryos in women seeking treatment.
Wednesday, June 1, 2016
Human Reproduction (May 21, 2016): Santa Claus in the Fertility Clinic, by Hans Evers:
The editor-in-chief of this premier medical journal criticizes infertility physicians for creating therapeutic illusions with misdiagnoses, useless medications, and unnecessary treatment. Evers is referring specifically to the unnecessary use of intra-cytoplasmic sperm injection (ICSI) in cases where in vitro fertilization (IVF) by itself would be sufficient to create a viable pregnancy. ICSI is indicated in cases of male-factor infertility, but such cases do not comprise the majority of infertility cases. Evers bases his evaluation on data covering 2008 through 2010 and gathered by the International Committee Monitoring Assisted Reproductive Technology (ICMART). The data show that the ICSI-to-IVF ratio varies from 1.4 in Asia to a staggering 60.3 in the Middle East. Studies show that the use of ICSI in non-male-factor infertility cases results in fewer lives births than the use of IVF alone. It does not improve the chances of a successful fertilization in such cases. Evers calls for the end of this costly and ineffective therapeutic illusion.
Tuesday, May 31, 2016
New York Times (May 21, 2016): Is Egg Freezing Only for White Women?, by Reniqua Allen:
When her most recent intimate relationship ended, Reniqua Allen considered freezing her eggs. Though marketed as a technique to help women gain control over their reproductive lives, including having children to raise alone, egg freezing, as Allen discovered, appears to be a procedure that few black women are considering. The reason is in part marketing: infertility care websites and advertisements spill over with images of happy white families. But Allen also wonders whether the negative stereotype of the single black mother in the United States was driving black women away from this form of assisted reproduction.
Poor black women are criticized for having too many babies they “can’t afford” and professional middle-class black women are criticized for being too picky and not finding a man. But when professional white women follow these same patterns, it’s often labeled a trend or brave or empowering.
In her research, Allen discovered that slowly the terms of the conversation around egg freezing are changing, allowing room for black women at the margins. Whether to embrace egg freezing or reject it is not an easy choice. The choice could be driven by what Allen refers to as "respectability politics" or even unresolved issues she has with her father. Her fervent hope is that whatever choice she makes, she can play a part in making "unconventional decisions the norm."
Thursday, May 5, 2016
New York Times (May 3, 2016): Fewer Surrogacy Options as Nepal Joins a Trend, by Rachel Abrams:
Nepal has banned surrogacy after serving as a robust surrogacy destination for hopeful parents from around the world. Nepal became a popular destination especially for gay couples after India decided to bar gays from have children via surrogacy there. Developing countries like Nepal, India and Thailand have one by one restricted or prohibited surrogacy to respond to concerns that surrogacy is akin to human trafficking and that surrogates in those countries are exploited by couples who cannot afford surrogacy in the United States. They may also be exploited by agencies and few protections if an agency refuses to pay or the surrogate becomes ill or is injured. Complicating the debate is the fact that surrogates in these countries can earn much, much more than other employment options afford them.
Sunday, March 13, 2016
New York Times (Mar. 10, 2016): First Uterus Transplant in United States Fails, by Denise Grady:
Performed by physicians at the Cleveland Clinic, the first uterus transplant in the United States has failed. The nature of the complications with the transplant have not been revealed, but pathologists are analyzing the uterus in the hopes of determining what went wrong.
The Clinic's uterine transplant program is an effort to enable women without a uterus to become pregnant and give birth.
Tuesday, March 8, 2016
New York Times (Feb. 25, 2016): First Uterus Transplant in U.S. Bolsters Pregnancy Hopes of Many, by Denise Grady:
Doctors at the Cleveland Clinic have performed the first uterus transplant in the United States. The recipient is already a mother, having adopted three boys.
The surgery is complex and multi-phased. The recipient first undergoes egg extraction. The eggs are then fertilized with the sperm of her partner, and the resulting embryos are frozen. The recipient then begins a regime of immunosuppressants, in preparation for the transplant. She will be monitored for a year to determine whether the transplant was successful. Only then will embryos be introduced into the uterus. After one or two successful pregnancies, the uterus will be removed.
The Cleveland Clinic will attempt ten uterine transplants as part of a clinical trial to determine whether it will offer uterine transplant as a standard procedure.
Monday, March 7, 2016
New York Times (Feb. 29, 2016): Veterans Seek Help for Infertility Inflicted by Wounds of War, by Denise Grady:
Despite a new policy giving troops the opportunity to freeze their eggs or sperm before deployment, the military offers veterans no coverage for in vitro fertilization (IVF), leading to questions about how best to support soldiers who sustain injury to their reproductive systems in combat and are medically retired or discharged from the military. Adding insult to injury is the fact that the military does cover IVF for active-duty service members. A bill to rectify this inequity was headed toward a vote last summer, but its sponsor withdrew it when Republicans threatened to riddle it with exceptions that would prohibit the Veterans Administration from having anything to do with Planned Parenthood.
Sunday, February 28, 2016
CNN (Feb. 26, 2016) Should parents be allowed to choose the sex of their baby?, by Carina Storrs:
Prospective parents may have preferences on whether they have a boy or girl. In vitro fertilization (IVF) opens up new possibilities for parents to choose the sex of their baby as well as controversies about whether sex selection is appropriate. The American Society for Reproductive Medicine initially took the position that use of IVF for sex selection should "not be encouraged" but recently eased its stance.
Determination of the sex of an embryo prior to implantation requires genetic screening, which provides prospective parents with genetic information about the embryo, including its sex. Some clinicians argue that manipulating the embryo to conduct the screening creates an unnecessary risk , but there is no current evidence that it is unsafe. There is also concern that the use of IVF for sex selection could divert resources away from medically necessary IVF.
Perhaps the greatest concern about sex selection is that it could cause or reinforce gender bias. In the United States, there is no evidence that parental choice would lead to a gender imbalance, and it appears more likely that sex selection is used as a form of "family balancing." For instance where parents of boys may decide they would like their next child to be a girl. However, even this "gender neutral" form of sex selection may reinforce bias and attitudes about the link between gender differences and biological sex. Canada and the United Kingdom have banned the use of IVF for sex selection except if it is used to avoid the risk of sex-linked genetic diseases.