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.
Friday, February 16, 2018
New York Times (Feb. 13, 2018): American Fertility Is Falling Short of What Women Want, by Lyman Stone:
Fertility rates in the United States have fallen below the replacement rate, and are beginning to diverge substantially from what women state as their reproductive goals. Whereas, women say they want on average 2.7 children, current rates show they will probably have no more than 1.8. That gap is the highest it has been in 40 years.
Explanations for the drop in fertility include postponing marriage, having less sex, and the decline in pregnancy rates among young women. That low rate now affects women throughout their 20s and early 30s. In the background is the fact that contraceptive technology has improved while reproductive technology has not.
Falling fertility rates might portend trouble for Social Security, a graying population in need of care, and stagnant economic growth.
Wednesday, February 7, 2018
Rewire (Jan. 25, 2018): For Nonbinary Parents, Giving Birth Can Be Especially Fraught, by S.E. Smith
Pregnancy and childbirth are vulnerable times in any parent's life. Add to that the highly gendered-status of both pregnancy and birth, and trans and non-binary parents are finding it difficult to locate an inclusive community with educated medical staff as they, too, enter childrearing chapters.
With the trans community, conversations about birth and parenting are few and far between and often fraught with discomfort. Now, though, more parents-to-be identify as trans men or somewhere else on the non-binary spectrum of gender identity. And the medical community has not yet caught up. "And, as in any area of reproductive health-care services, this isn’t simply a matter of gender: Race, class, and geography can play a huge role in whether non-binary people are able to access inclusive, affirming birth care."
Gender-affirming care--including asking for a patient's pronouns with their name, using gender-affirming language, and regularly seeking consent before performing examinations, particularly those that require a medical professional to touch the patient's genitalia--is important. When it is absent, patients report both physical and psychological trauma.
Many in the trans and non-binary communities are increasingly seeking home births with gender-affirming midwives in order to create the most comfortable environments for themselves. Midwifery can be prohibitively expensive though, and insurance rarely covers it. So for others, a hospital may be the safest or the only choice. Advocates say that hospitals and birth collectives would do well to invest in specialized training for medical providers "to ensure that everyone at a facility is trans-competent, or working on getting there."
This issue is likely to amplify in coming years with a more visible nonbinary community, as well as a more active movement to reframe the way we look at pregnancy and birthing. Trans people—binary and otherwise—are some of the biggest stakeholders in the conversation, and they’re contributing with inclusive birthing classes and provider training in addition to working as care providers themselves.
The trans and non-binary communities call on leaders within the medical community to initiate changes from the inside, including re-training initiatives and reframing core educational documents for inclusivity.
Friday, August 18, 2017
The New York Times (Aug. 16, 2017): Sperm Count in Western Men Has Dropped Over 50 Percent Since 1973, Paper Finds, by Maya Salam
The sperm count of men in Western countries has been declining precipitously with no signs of “leveling off,” according to new research, bolstering a school of thought that male health in the modern world is at risk, possibly threatening fertility.
By examining thousands of studies and conducting a meta-analysis of 185 — the most comprehensive effort to date — an international team of researchers ultimately looked at semen samples from 42,935 men from 50 countries from 1973 to 2011.
They found that sperm concentration — the number of sperm per milliliter of semen — had declined each year, amounting to a 52.4 percent total decline, in men from North America, Europe, Australia and New Zealand.
Possible causes that researchers have identified include exposure to cigarette smoke, alcohol, and chemicals--such as phthalates--in utero. Age, obesity, and stress also play a role in lowered sperm count and quality. While long-term consequences have yet to be identified, research shows that fertility rates in Western nations are too low to sustain the current population.
Monday, July 18, 2016
The Atlantic (July 13, 2016): Why the Male Pill Still Doesn't Exist, by Andy Extance
While America was introduced to the female birth control pill, and the first tests in hopes of creating a pill for men were conducted as early as 1957, many lament the fact that a male 'pill' equivalent to that of female hormonal contraception still does not exist. There are a variety of issues that have delayed the development of a male pill - there is a lack of commitment to contraception; pharmaceutical companies are less interested in making a product for men; and dangerous side effects documented from previous drug trials. But studies show that the interest, across gender identities, for a male pill is there. The article highlights the social acceptance of women bearing the responsibility of taking contraception, and researchers' worry that they may not be able to create a product that would be as easy as to administer as the female pill. Over the years, researchers have explored various hormonal and non-hormonal methods. One of the researches believes that the answer is probably out there and the work just needs to be completed:
[Elaine] Lissner is adamant that the ideas that seem to have faltered are not dead, they’re just resting. “We keep collecting new methods and never finish the ones we have,” she fumes. “Pick one and make something! Finish the job!”
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."
Monday, February 8, 2016
New York Times (Feb. 4, 2016): Pentagon to Offer Plan to Store Eggs and Sperm to Retain Young Troops, by Michael S. Schmidt:
In an effort to retain troops on active duty by making the military more family friendly, the Pentagon wants to reassure those who fear injury to their reproductive organs or who want to pursue a military career before having children. Given the expense (an estimate is that the program will cost the Pentagon $150 million per year), almost no employers offer egg and sperm freezing to their employees. Legal and ethical questions related to this service have yet to be resolved.
The Pentagon has recently improved the lives of service members in various ways related to having children, including longer maternity leaves, improved child care and the creation of lactation rooms at military facilities. The initiatives are meant to address the greater emphasis that millenials place on work-life balance than did previous generations.
Wednesday, March 4, 2015
The Guardian: Britain's House of Lords approves conception of three person babies, by Hannah Devlin:
Britain has become the first country in the world to permit the use of “three-person IVF” to prevent incurable genetic diseases.
The House of Lords voted by 280 votes to 48 on Tuesday evening to approve changes to the law allowing fertility clinics to carry out mitochondrial donation. Babies conceived through this IVF technique would have biological material from three different people – a mother, father and a female donor. . . .
Technically the baby would have three biological parents, with 99.8% of genetic material coming from the mother and father and 0.2% coming from the mitochondrial donor. . . .
PBS: Why the term 'three-person baby' makes doctors wince, by Rebecca Johnson:
MELAS is one of about 200 known mitochondrial diseases, a subject that has featured prominently in the news since the British Parliament’s House of Commons on Feb. 3 approved further testing and research on mitochondrial replacement IVF. The procedure has beencommonly referred to in news stories as “three-person babies” or “three-parent babies.”
But it’s a term that makes doctors wince. . . .
Saturday, November 29, 2014
Newsweek: Twins: The Fetal Paradox, by Amy Klein:
In 2004, Danielle Decrette went in for in vitro fertilization. It wasn’t her first time—she and her husband had a 3-year-old daughter conceived through IVF—and she knew what she was getting into. Just as he had four years before, Decrette’s doctor stimulated her with hormones, extracted her eggs from her ovaries, fertilized them with sperm in the lab and placed the resulting embryo in her uterus. But this time the process failed. So the doctor decided to transfer two embryos in the next round to increase her odds of getting pregnant.
“You know you could have twins,” the doctor warned her before the procedure. . . .
That was 10 years ago. Today, fertility doctors would almost certainly have pushed her away from the idea of a two-embryo implant . . . .
Tuesday, June 17, 2014
CNN: Time-lapse video reveals secret life of an embryo, helps women conceive, by Kieron Monks & Samantha Bresnahan:
It is estimated that around one in four couples around the world have trouble conceiving. For a small proportion of them, In Vitro Fertilisation (IVF) is a technology that can restore the dream of parenthood.
IVF is the fertilization of an egg by sperm outside the body, where it is cultivated in a lab environment, and if an embryo results it is implanted into the mother's womb. Now the chances of IVF treatment being successful are being boosted by a machine called the Embryoscope. . . .
The commonly accepted practice of selecting only certain embryos for implantation in IVF illustrates that most do not believe embryos have the moral status of persons.
Saturday, March 1, 2014
Study Finds that Men's "Biological Clock" Means Higher Risk of Mental Illness in Children Born to Older Fathers
The New York Times: Mental Illness Risk Higher for Children of Older Fathers, Study Finds, by Benedict Carey:
Children born to middle-aged men are more likely than those born to younger fathers to develop any of a range of mental difficulties, including attention deficits, bipolar disorder, autism and schizophrenia, according to the most comprehensive study to date of paternal age and offspring mental health. . . .
. . . Men have a biological clock of sorts because of random mutations in sperm over time, the report suggests, and the risks associated with later fatherhood may be higher than previously thought. The findings were published on Wednesday in the journal JAMA Psychiatry. . . .
Saturday, November 2, 2013
Guttmacher Institute: A Year of Magical Thinking Leads to...Unintended Pregnancy, by Rebecca Wind:
In-depth interviews with 49 women obtaining abortions in the United States found that most of the study participants perceived themselves to be at low risk of becoming pregnant at the time that it happened. According to "Perceptions of Susceptibility to Pregnancy Among U.S. Women Obtaining Abortions," by Lori Frohwirth of the Guttmacher Institute et al., the most common reasons women gave for thinking they were at low risk of pregnancy included a perception of invulnerability, a belief that they were infertile, self-described inattention to the possibility of pregnancy and a belief that they were protected by their (often incorrect) use of a contraceptive method. Most participants gave more than one response. . . .
Saturday, October 26, 2013
In recognition of Intersex Awareness Day, I'm pleased to publish this commentary by Courtney Fraser, Fall Intern at Advocates for Informed Choice (’15, University of California, Berkeley School of Law):
There’s no “I” in LGBT: How Reproductive Justice can (and must) end intersex invisibility
“Intersex? What’s that?” – so begins a series of questions I have become quite accustomed to fielding in my Civil Externship seminar. My classmates, some of whom are avid social justice advocates, are all familiar with reproductive rights; many of them even support LGBT causes, but few have ever heard the word “intersex” before. Most people probably haven’t. In honor of International Intersex Awareness Day, October 26, I’d say there’s no time like the present.
“Intersex” describes those who are born with ambiguous genitalia, or bodies that otherwise do not match societal ideas of “typical” male or female configurations. My externship this fall is with Advocates for Informed Choice, an (read: THE) organization working to protect the rights of intersex people. Right now, I have the honor of being involved with AIC’s groundbreaking litigation on behalf of a child (identified as M.C.) who suffered unnecessary genital surgery while he was still a baby. When I am called upon to explain my work to the class, invariably someone is shocked. That happens? All the time. To how many people? As many as 1 percent of live births are intersex, and 0.1 or 0.2 percent become victims of “normalizing” surgical mutilation.
So why aren’t more people outraged? Why do so few people even know about this?
Tuesday, May 14, 2013
The New York Times: Hospital Mergers Reset Abortion-Access Battle, by Kirk Johnson:
Politicians seeking to restrict access to abortion, a marked trend this year from North Dakota to Arkansas, tend not to get much traction in this part of the country.
Washington is heavily Democratic, leaning left especially on social issues. A majority of voters even put into law a statutory right to abortion in 1970 — the only state ever to do that. The governor, Jay Inslee, a Democrat, is pushing the Legislature even now to pass a law at a special session on Monday requiring health insurers to pay for elective abortions, another first for the state if it makes it to Mr. Inslee’s desk.
But now a wave of proposed and completed mergers between secular and Roman Catholic hospitals, which are barred by church doctrine from performing procedures that could harm the unborn, is raising the prospect that unelected health care administrators could go where politicians could not. . . .
H/T: Grayson Barber
In addition to prohibiting abortions and certain kinds of end-of-life care, Catholic hospitals also refuse to provide contraception (often including emergency contraception for rape survivors), sterilizations, and infertility services. For more about the threats posed by these mergers, see the MergerWatch website.
Saturday, February 16, 2013
Maneesha Deckha (University of Victoria – Faculty of Law) has posted Legislating Respect: A Pro-Choice Feminist Analysis of Embryo Research Restrictions in Canada on SSRN. Here is the abstract:
This article investigates the impact of legislating respect and dignity for the embryo in vitro on the legal and cultural status of the embryo in utero. It evaluates the restrictions on embryo re-search in Canada’s Assisted Human Reproduction Act (AHRA) to consider whether they should receive pro-choice feminist support. Specifically, the article explores whether it is possible for feminists to accord respect to the in vitro embryo, as the AHRA attempts to do, without jeopardizing sup-port for abortion. The article canvasses the theoretical possibilities of this position by comparing the compatibility of feminist articulations of a right to abortion (bodily integrity and equality) with feminist arguments against the expansive use of embryos in research (commodification and exploitation). The article argues that it is logically compatible for feminists to promote “respect” and “dignity” for in vitro embryos while maintaining a pro-choice position on abortion. The article nevertheless cautions against feminist support for AHRA as it currently stands given that, on a practical basis, a feminist understanding of the AHRA’s restricted embryo research regime is difficult to achieve in the public sphere. The article explains why the more likely result for the public sphere will be an unqualified discourse of respect and dignity for embryos in general, which could then problematically revive the abortion debate and destabilize the non-personhood status of the in utero embryo. As a remedy, the article provides recommendations for how AHRA should be amended so as to better ensure that legislative restrictions on embryo research signal a legislative intent that respects women’s reproductive autonomy.
Monday, December 17, 2012
The Hill - Healthwatch Blog: Senate vote to cover fertility care for female military servicemembers, by Ramsey Cox:
The Senate passed a bill Thursday to cover military service members’ in vitro fertilization (IVF) services through the veterans healthcare system.
Senate Veterans Affair Committee Chairwoman Patty Murray (D-Wash.) introduced the Women Veterans and Other Health Care Improvement Act of 2012, S. 3313, which would improve VA services for women veterans and veteran spouses and end the ban on (IVF) services at VA to help severely wounded veterans start families. . . .
Wednesday, December 5, 2012
Richard F. Storrow (CUNY School of Law) has posted Judicial Review of Restrictions on Gamete Donation in Europe on SSRN. Here is the abstract:
The decision of S.H. and Others v. Austria vindicates the right of governments to enact restrictions on gamete donation against claims that these restrictions violate the guarantees of the European Convention on Human Rights. Van Hoof and Pennings in this issue predict that legal diversity on the question of gamete donation will persist in the wake of this decision and discuss how the decision itself is insufficiently protective of the private and family interests of individuals who seek reproduction-assisting medical treatment. This commentary discusses the difficult balancing work of the European Court of Human Rights, its questionable expansion of the margin appreciation doctrine in S.H. and Others v. Austria and how the decision might influence national courts in the future.
Wednesday, October 31, 2012
Jim Hawkins (University of Houston Law Center) has posted Selling Art: An Empirical Assessment of Advertising on Fertility Clinics' Websites on SSRN. Here is the abstract:
Scholarship on assisted reproductive technologies (ART) has emphasized the commercial nature of the interaction between fertility patients and their physicians, but little attention has been paid to precisely how clinics persuade patients to choose their clinic over their competitors. This Article offers evidence about how clinics sell ART based on clinics’ advertising on their websites. To assess clinics’ marketing efforts, I coded advertising information on 372 fertility clinics’ websites. The results from the study confirm some suspicions of prior ART scholarship, while contradicting others. For instance, in line with scholars who are concerned that racial minorities face barriers to accessing ART, I found that 97.28% of the websites that contain pictures of babies have pictures of White babies, and 62.93% have pictures of only White babies. Similarly, in agreement with prior work that challenges the effectiveness of self-regulation, I find low levels of compliance with industry-sponsored advertising regulations. Contrary to the assumption held almost universally in the literature on ART, however, I found that clinics do not prioritize advertising their success rates. Clinics’ websites are more likely to emphasize several other attributes of care instead of their success rates. In light of the new data uncovered by the study, I conclude by offering new regulatory directions for policymakers to consider as they try to keep up with changes in the fertility business.
Tuesday, October 23, 2012
The New York Times: Clinic Raffles Could Make You a Winner, and Maybe a Mother, by Douglas Quenqua:
“That’s right, one lucky woman will win the ultimate chance at starting or building her family,” said a contest announcement issued in April by Long Island I.V.F., a clinic in Melville that offers in vitro fertilization to women who are having difficulty conceiving. . . .
Saturday, August 18, 2012
DC Bar: Reproductive Technology and the Law, by Anna Stolley Persky:
Enid Abrahami, a single mother by choice, conceived her first child with her own egg and a stranger’s sperm, thanks to a fertility clinic in New York. Abrahami then gave birth to her son in Israel, where she lives these days. She had no trouble attaining her son’s American citizenship. Abrahami, who has dual Israeli and American citizenship, grew up in both New York City and Tel Aviv.
When she decided to have a second child, Abrahami found that she was having trouble getting pregnant using her own eggs. So this time she used both somebody else’s egg—called a donor egg—and sperm from the same donor used to conceive her son. Again, for her second child, a daughter, the embryo was transferred to her uterus in New York and the baby was born in Israel.
But this time, when Abrahami went to fill out the paperwork for her daughter’s citizenship, a U.S. Embassy official learned that she was a single mom and had used donor sperm. . . . Abrahami was told that she could not transfer her citizenship onto her daughter. She was told that citizenship is transferred only through DNA, and that she needed proof that at least one of the donors was a U.S. citizen. . . .