Ivf

Friday, 25 September 2015

US IVF clinics help Aussie parents select their baby’s gender


About one out of five couples who come to HRC Fertility, a network of fertility clinics in southern California, doesn’t need help getting pregnant. Instead, they come for what is called family balancing, or non-medical sex selection.
According to the network’s medical director, Daniel Potter, these couples usually have one, two or three children and want in-vitro fertilisation to guarantee a child of the other sex.
In Australia, couples under­going IVF treatment do not have the right to choose their unborn child’s sex but in the US they do, and Potter sees 15 to 20 visiting Australian couples every month.
“Typically it’s women wanting to have a daughter, that’s 80 per cent of what we do,” he says.
“Since they were little, the child modelling parenting behaviour has created an entity that for them is usually a daughter. For many women, they have projected the future with that entity: taking her to ballet class, walking down the aisle, that kind of thing. When they have two boys, and they find out they’re pregnant for the third time and (it’s another) boy, (if) they’re crying it’s not because they … resent that son, they’re crying to mourn the loss of that entity they’ve had their whole life.”
Non-medical sex selection is a controversial practice legal in only a few countries, including the US and Mexico. It involves the same technology used to screen for genetic diseases, pre-implantation genetic testing, and even though safety concerns have been addressed, the broader ethical questions remain. In Australia, the National Health and Medical Research Council has floated those ethical questions again as part of a rewrite of guidelines for clinicians and researchers on the use of assisted reproductive technology.
Even in the US, these ethical questions have engendered a mixed response. In June the American Society for Reproductive Medicine issued a position paper saying practitioners are under “no ethical obligation to provide or refuse to provide non-medically indicated methods of sex selection”. But the ethics committee of the American Congress of Obstetricians and Gynecologists reaffirmed last year a committee opinion opposing the practice of sex selection for personal and family reasons.
“We don’t want people to use technology that’s really intended to help couples with medical needs for non-medical reasons,” says Sigal Klipstein, head of the ACOG ethics committee. She says IVF is considered a very safe procedure, but as with any medical procedure there is a low risk of bleeding and infection, as well as overstimulation of the ovaries.
Potter says about half the patients he sees for non-medical sex selection come from abroad. He was recently in Australia for reunions with about 60 families he helped to select their children’s sex, including the Kanavans from Victoria.
Katie Kanavan, 33, travelled from her home in Melbourne to Potter’s clinic twice to undergo IVF/PGD. She already had three boys, all conceived naturally. She and her husband, Stuart, wanted to ensure their next child was a girl and had no such guarantee in Australia. “We wanted to give our boys a sister and we wanted to have a daughter as well,” she says.
The Kanavans spent about $US50,000 on two cycles of IVF/PGD and travel expenses. “It was a pretty big gamble for our family,” Katie Kanavan says. “We saved a lot. We did take money out on our mortgage.” They now have a girl, Ruby-Rose, 2. “We’ve completed our family,” Kanavan says. “I’d do it in a heartbeat again.”
Family balancing should be allowed locally, says David Molloy, chairman of the IVF Directors group in Australia. But it could not be publicly funded, given the range of views on such issues. While well-off parents were paying big money to travel to the US, others were trying unconventional and unproven methods at home, such as “intercourse timing, douching (or) powdered bulls’ testicles”.
“Given there’s a whole heap of unauthorised gender selection happening in bedrooms around Australia, I think it’s reasonable to allow scientific gender selection that actually does work,” Molloy says. He says patients frequently ask about the possibility of choosing their baby’s sex.
Michael Chapman, vice-president of the Fertility Society of Australia, acknowledges that most people may oppose the concept but says about 60 per cent of IVF patients want the option. He considers that reasonable, given how emotionally and financially invested they had to be in IVF.
The NHMRC’s Australian Health Ethics Committee, which produced the draft guidelines, suggests the public debate “would be enhanced through the exploration of some of the complex ethical and social issues raised by non-medical sex selection, through the use of illustrative case studies”.
Those case studies extend beyond family balancing to the replacement of a deceased child and borderline medical reasons, such as where a couple has a boy with autism and believes there would be less chance of their second child having autism if it were a girl.
Arthur Caplan, ethics director at New York University’s medical school, says family balancing can become a smokescreen for families that want boys: “When you are treating the fertile in order to produce something that they prefer as opposed to a disease, I do think you’re really opening the door to a potential slope toward eugenics.”
Potter says although there have been cases of couples wanting a child capable of providing bone marrow to a sick sibling, they were rare.
Sometimes family balancing is sought in second marriages, where a couple wants only one child and there are children from previous relationships, but mothers wanting daughters is the most common cause.
Potter says the Australian women he sees do not have firm views on whether the ethical guidelines should change, instead arriving just “happy and very appreciative that we are there to provide the service to them”.
Like Molloy, he believes that if there is no public funding involved, opposition to sex selection will fade away.
David Kaufman, a program director at the US National Human Genome Research Institute, doesn’t expect a trend to emerge for designer babies. Unlike sex selection, genetic testing of embryos for other traits is much more complicated because most of them are governed by multiple genes. “In most cases we don’t even know all the genes and even if we did you’re pretty unlikely to produce an embryo with the perfect combination of all those genes,” he says.
Potter says every case is different and the couples he helped all had their own, sometimes deeply emotional, reasons for wanting to choose a boy or a girl.
“These are not monsters, these are normal loving families who would like to have a gender represented in their family that currently isn’t,” he says.

Tuesday, 22 September 2015

Womb on hire

On August 25, Neoal's Supreme Court (SC) issued an interim order to close down surrogacy services in the country until the government brings in laws to oversee the issue.
The SC decision came after a writ petition was filed at the court demanding that surrogacy be deemed illegal until Nepal formulates laws on it.
In addition, the petition also mentioned that  surrogate mothers are being financially exploited for their services—the clients are charged up to 10 million rupees (US$94,700) for the complete procedure by the agencies that make all the arrangements, out of which 4 million rupees goes to the hospital and the surrogate mother only receives 300,000-400,000 rupees. 
Surrogacy is a procedure through which a woman bears and gives birth to a child for another couple or person.
If the woman is paid for her services, it is called commercial surrogacy.
Even though commercial surrogacy is allowed in a few Western countries such as the US, it is strictly regulated and is very expensive—it could cost up to $150,000. But it is much cheaper in Asia, particularly in Thailand and India.
Therefore, it attracts huge numbers of foreign clients. Yet, surrogacy has its share of problems.
Last year, an Australian couple were accused of leaving a twin boy with his Thai surrogate mother after discovering that he had Down Syndrome.
After much debate on the issue, in February, the Thai parliament introduced a new law banning all foreign and same-sex couples from seeking surrogacy services in the country.
From now on, surrogate mothers must be Thai and above 25 and no fees will be allowed for the service, which is only available to married heterosexuals with at least one Thai partner.
Here, on the contrary, a year ago, the Nepali Cabinet decided to open the doors for foreign couples to seek surrogacy services.
While the recent Supreme Court order bans it, the government definitely needs to do a lot of homework if it wants to permit surrogacy in Nepal.
To that end, it could begin by studying the surrogacy laws in Thailand. It should also study the related law in India where the government is currently seeking to introduce stricter measures through the Assisted Reproductive Technique Bill pending in the Indian parliament.
Until the government comes up with a new law, the Ministry of Health and Population needs to keep a close watch on possible violations of the ban.
As for the impending law, it must be formulated only after holding consultations with women rights activists and health professionals.
The law should be written by keeping the surrogate mother’s best interests at heart as it is she will bear all the risks.

Monday, 14 September 2015

Give Surrogate Moms their Due Respect, Says this Film by Doctors

25-year-old, Sumi, belonging to an underprivileged family, who gives tuitions to eke out a living, wants to raise money for her widowed sister’s six-year-old daughter’s heart surgery. Finding no other way, out of sheer desperation, she responds to an advertisement in a paper where an affluent lawyer is looking for a surrogate mother.
This is the plot of Bhaswati Roy’s film which has turned the spotlight on surrogacy. It was introduced in India about a decade ago. For a decade, 35-year old History professor, Bhaswati Roy had cherished a dream to make a film on a socially relevant issue. She attended a range of workshops on film-making, developed her script, organised funds and finally began shooting a year and a half ago. Her Bengali film, Shunyo Je Kol (The Empty Lap) will be released next month.
A Film on Surrogacy
Not much is still known about surrogacy and neither Sumi nor the lawyer are initially aware that a surrogate mother must be married and have at least one child.
Nevertheless, the protagonist becomes the surrogate mother. She receives Rs 5 lakhs but she pays a heavy price for it. Her boyfriend severs ties, society rejects her and her tuitions are discontinued. Once the baby is born and she has to hand him over to the lawyer and his wife, she feels the heart-wrenching pain of separation.

Dr Rajesh Das, who is Bhaswati’s husband, and four of his friends, from Calcutta Medical College, who have a passionate interest in theatre, agreed to act in her debut film.
Treatment of female infertility through IUI (intra uterine insemination) and IVF (in-vitro fertilisation) have already proven their effectiveness. But when a woman is infertile due to a congenital or acquired defect or her uterus is unable to carry the baby through the full term, then surrogacy is the only answer to get a genetically linked biological baby by hiring a non-defective uterus, the resting and growing place of the embryo.
— Dr Rajesh Das, Actor and husband of Bhaswati Roy

Source: http://www.thequint.com

Monday, 7 September 2015

Embryo freezing and surrogacy

In-vitro fertilisation (IVF) legislation is being reviewed at inter-ministerial level in the light of EU law and some recent judgments of the European Court of Human Rights. Proposals made include introducing the freezing of embryos and permitting surrogate motherhood, while banning commercial surrogacy.
How does one formulate a clear, rational, principled line of thought on both issues? Perhaps a unifying element is sacredness – the sacredness of human life starting with the moment of conception, and the sacredness of the mother’s womb. By ‘sacred’ we mean either a reality sanctified by its relation to God or something held to be of supreme value and inviolable.
Regarding the sacredness of human life, science has clearly established that human life starts at the moment of conception. Precisely then a new, separate human life begins, as yet fully dependent on the mother, but already with a genetic identity different from that of the mother.
So embryo freezing necessarily involves placing a human being not in its mother’s womb, where it naturally belongs, but in ‘lunar’ conditions, lacking warmth in every sense. By contrast, the freezing of the unfertilised ovum, which Malta’s Embryo Protection Act allows, does not involve a human being.
It is true that when embryos are frozen, the adults involved could retrieve them later without the need to go through the treatment cycle again. But to achieve this, the embryo, a human being, will have been sacrificed, sometimes even for years, waiting to be retrieved.
Although scientists are proud of their success in implanting formerly frozen embryos and bringing them to term, there is still a dearth of available knowledge as to the long-term effects on people born this way. This alone raises ethical questions about the freezing of embryos.
Furthermore, where embryos are frozen, many are never claimed by the couple involved and subse­quently ‘discarded’. In other words, tiny human beings are not accorded the protection their human dignity calls for, and are effectively killed.
In IVF issues, one may ethically not concentrate exclusively on the adults’ interest in obtaining the best success rate, preferring embryo freezing as best medical practice. This places adults’ concerns squarely above those of the tiny human being conceived, totally disregarding the voiceless embryo.
The other element is the sacred­ness of the womb. On the proposal to introduce surrogate motherhood, Archbishop Charles Scicluna tweeted: “We res­pect a woman’s womb as quasi sac­red. Let us not turn it into another commodity, whether for free or for money.”
Surrogacy, like every pregnancy, involves a close bonding between the mother who lends/leases her womb and the child she carries. The surrogate mother’s womb is infinitely more than a transient container or a temporary resting place for the child. Apart from legal complications and ethical consi­derations, there will surely be emotional trauma and psycho­logical suffering for the mother who after delivery has to give up the child with whom she has bonded.
From the child’s viewpoint it is un­clear how surrogacy affects the per­son’s sense of identity. Just as the child’s conception would not have taken place in the parents’ warm em­brace, so the months of gesta­tion would mean bonding with a woman who will not bring him/her up. So surrogacy is harmful to the mother and the child, even given the best medical assistance and even if there were no commercialisation at all – a big ‘if’, as reality has shown.
The sacredness of the womb therefore implies, in practice, that the womb that carries the child should, in the interests of both mother and child, only be that of the mother of the child.

Believers will easily see the religious sacredness of human life and of the fleshly sanctuary in which it is nurtured for the first few months. Others, however, will also appreciate the inviolability of human life, starting at conception, and why a woman’s womb should be treated as sacred.http://www.surrogacyindiadelhi.com/surrogacy-programs-in-india/

Tuesday, 1 September 2015

Embryo freezing and surrogacy

In-vitro fertilisation (IVF) legislation is being reviewed at inter-ministerial level in the light of EU law and some recent judgments of the European Court of Human Rights. Proposals made include introducing the freezing of embryos and permitting surrogate motherhood, while banning commercial surrogacy.
How does one formulate a clear, rational, principled line of thought on both issues? Perhaps a unifying element is sacredness – the sacredness of human life starting with the moment of conception, and the sacredness of the mother’s womb. By ‘sacred’ we mean either a reality sanctified by its relation to God or something held to be of supreme value and inviolable.
Regarding the sacredness of human life, science has clearly established that human life starts at the moment of conception. Precisely then a new, separate human life begins, as yet fully dependent on the mother, but already with a genetic identity different from that of the mother.
So embryo freezing necessarily involves placing a human being not in its mother’s womb, where it naturally belongs, but in ‘lunar’ conditions, lacking warmth in every sense. By contrast, the freezing of the unfertilised ovum, which Malta’s Embryo Protection Act allows, does not involve a human being.
It is true that when embryos are frozen, the adults involved could retrieve them later without the need to go through the treatment cycle again. But to achieve this, the embryo, a human being, will have been sacrificed, sometimes even for years, waiting to be retrieved.
Although scientists are proud of their success in implanting formerly frozen embryos and bringing them to term, there is still a dearth of available knowledge as to the long-term effects on people born this way. This alone raises ethical questions about the freezing of embryos.
Furthermore, where embryos are frozen, many are never claimed by the couple involved and subse­quently ‘discarded’. In other words, tiny human beings are not accorded the protection their human dignity calls for, and are effectively killed.
In IVF issues, one may ethically not concentrate exclusively on the adults’ interest in obtaining the best success rate, preferring embryo freezing as best medical practice. This places adults’ concerns squarely above those of the tiny human being conceived, totally disregarding the voiceless embryo.
The other element is the sacred­ness of the womb. On the proposal to introduce surrogate motherhood, Archbishop Charles Scicluna tweeted: “We res­pect a woman’s womb as quasi sac­red. Let us not turn it into another commodity, whether for free or for money.”
Surrogacy, like every pregnancy, involves a close bonding between the mother who lends/leases her womb and the child she carries. The surrogate mother’s womb is infinitely more than a transient container or a temporary resting place for the child. Apart from legal complications and ethical consi­derations, there will surely be emotional trauma and psycho­logical suffering for the mother who after delivery has to give up the child with whom she has bonded.
From the child’s viewpoint it is un­clear how surrogacy affects the per­son’s sense of identity. Just as the child’s conception would not have taken place in the parents’ warm em­brace, so the months of gesta­tion would mean bonding with a woman who will not bring him/her up. So surrogacy is harmful to the mother and the child, even given the best medical assistance and even if there were no commercialisation at all – a big ‘if’, as reality has shown.
The sacredness of the womb therefore implies, in practice, that the womb that carries the child should, in the interests of both mother and child, only be that of the mother of the child.
Believers will easily see the religious sacredness of human life and of the fleshly sanctuary in which it is nurtured for the first few months. Others, however, will also appreciate the inviolability of human life, starting at conception, and why a woman’s womb should be treated as sacred.

National commission looking at surrogacy and parenthood

A national commission is currently studying whether there should be a law to regulate surrogacy in the Netherlands.

National commission on parenthood
In 2014 the government set up a national commission to review parenthood. It will also investigate whether surrogacy should be regulated by law in the Netherlands. They will look at questions like:

How is surrogacy assessed, especially in relation to the interests of the child?
How is surrogacy regulated in other countries?

The national commission has been asked to present its findings before 1 May 2016.