Custom Made or Off The Rack?

First off a Happy Thanksgiving to all of you.  It’s been a long fall from my point of view and I’ve been less then satisfied with my ability to get posts up here.  Things might improve a little with the end of the semester but of course, only time will really tell.   In the meantime, I appreciate all of your patience and your participation.

Now, this story from the LA Times caught my eye.   It’s about a new frontier in ART marketing.

Generally if someone is going to do IVF they provide the sperm and eggs which are then combined in a lab to create pre-embryos.   If people are not using their own gametes they generally obtain sperm and/or eggs from banks or clinics.   There’s been lots of discussion here about that process of shopping for gametes and it’s good to keep that in mind.   But the key thing to stress right here is that the individual(s) select the gametes and then they are combined specifically for them.    In effect, the pre-embryos are custom made based on the elections of the customers.

As a part of this process, more embryos are usually created than are needed.  This leads to the extra embryo problem–something else that has been discussed here.   The LA Times article says there are over 500,000 extra embryos in storage in the US.

Dr. Ernest Zeringue offers a different approach.   Here’s how it works:

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.

In other words, he chooses the gametes and creates the pre-embryos and then offers them for sale.   The advantage here is that it works out much cheaper for the people using IVF–cheap enough that he can offer a guarantee.  It seems to me that it is rather like buying off the rack instead of having items custom made. (I think the economy is generated from being able to use all the embryos created in a batch.)    The LA Times article explores the controversy around his practice.

There’s one important concrete thing to note at the outset–all the embryos created from one batch of sperm/eggs are full genetic siblings.   They’ll end up in a dozen different families, though.   Obviously you have to be willing to accept this if you go this route.   And it isn’t clear to me whether there is any thought that eventually these children might meet each other.  (It looks to me like this is not contemplated.   And there are also all the usual questions about anonymous gamete providers.)

So what to think about this?  Most obviously, anyone who objects to the use of third-party gametes will object to this.   That’s pretty straightforward.

But that, it seems to me, is the easy route.   The harder question is could you be okay with the gamete market and not okay with this?  In other words, is there a difference between selling gametes (OK) and selling pre-embryos (not OK).  If you say there is, how do you explain where you are drawing your line?  What is the difference between selling eggs/sperm and selling pre-embryos.

It’s clear that a number of people think there’s an important difference.

“I am horrified by the thought of this,” said Andrew Vorzimer, a Los Angeles fertility lawyer alarmed that a company — not would-be parents — controls embryos. “It is nothing short of the commodification of children.”

(Vorzimer runs the Spin Doctor blog and discusses this at more length there.)    Then there is Dr. Robert Klitzman, a bioethicist at Columbia University, who says

“It gets kind of creepy. There is a yuck factor. We need to proceed very carefully.”

(I’m afraid this doesn’t strike me as very insightful analysis.)

I confess that, for the moment, I am of two minds.  If I can go out and buy sperm, buy eggs and then pay someone to put the two together, how is that so very different from just buying the end product?   Granted I have more control over the makeup of the final product if I buy each component separately, but if I’m willing to give up that control?

It’s already the case that scores of embryos are created that are not needed and end up in freezers.    If anything, the practice here means fewer embryos kept on ice and more transferred to develop into children.   I suppose this is a good thing rather than a bad thing, isn’t it?

I know the concern is commodification–that it brings us ever closer to buying/selling children which I (and virtually everyone else) agrees is off the table.   But the exact argument seems murky to me.   If you can buy all the parts needed and the services to put the parts together, too, is that so very different?

Something to think about while we all digest our lovely meals over the weekend perhaps?

 

 

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77 responses to “Custom Made or Off The Rack?

  1. This issue showed up in an infertility forum I frequent, and so far, everyone is appalled by this practice. For one thing, throw in gestational carriers and you have a situation very similar to the one that sent Theresa Erickson to jail.

    I think the horror and appalled feelings come from the callousness this clinic is showing towards embryo creation. I know that sounds contradictory and maybe it touches on some of the control issues in your previous post, but every couple I know who created embryos from donor eggs and sperm took it very seriously and chose the donors carefully. They intended to create very specific embryos. It’s control plus intent plus the parents’ way of contributing to the creation of their offspring if that makes sense.

    What the clinic in that article is doing is commodity pure and simple. This example is the best I’ve ever seen for a baby factory. I’m trying to imagine what kinds of couples would willingly agree to have embryos with relatively unknown provenance transferred into the woman to become their child. Only the extremely desperate who may have lost touch with reality to some extent would pursue this.

    • I hadn’t thought about the Erickson case (which is discussed here: http://julieshapiro.wordpress.com/2011/08/15/take-three-la-times-weighs-in-on-baby-selling-ring-drawing-lines/) and how it might fit. You are right–what she was doing was exactly this plus the surrogate. So can one distinguish?

      I think I’m inclined to think that once you transfer the embryo you will, assuming all goes well, have a child for sure. I don’t think of the embryo (or pre-embryo) as a child, I guess. So I would draw a line between what Erickson did and what is at issue here. It has the potential to become a child, just as a gamete can be used to create a child.

      I know people think long and hard about selecting gametes and there is something that seems really odd about what’s being offered here. I imagine the only people who would use this would be people for whom the money is otherwise prohibitive. What I mean is that people who have the money probably won’t choose this route. (It really is like ready-to-wear vs. custom made.) Perhaps it is not as much about losing touch as it is about feeling a really acute need and not having the money.

      • See you don’t think of the embryo or pre embryo as a child and neither do I. But as I said below, it’s not like you have not purchased tickets in advance for a plane trip or for a concert before. We do it all the time in every day life – pay in advance for services to be provided later. Whether it’s paying in advance for a series of gymnastics lessons or paying for an all inclusive vacation package, we all know what it is like to pay now in exchange for services to be provided at a later date. These people are paying to raise someone else’s offspring and for parental title and in order for that to happen someone else has to conceive and then either abandon or relinquish their offspring when they are born. This method involves abandonment because they are never named as parents on any record to give them the authority or need to relinquish formally in court. That is part of what is so appalling about gamete donation in general, the abandonment is not treated as a crime for people classified as donors therefore their offspring are not looked at as victims of a crime. Other people that abandon their offspring without ever being named as parents on their birth records are committing a crime but not these guys we call donors. Their offspring lack equal protection against abandonment because their genetic parents are not in the same class as your average every day person – this is why I’m so outraged about gamete donation. It’s a baby human presale and like I said the gamete is their season pass to parenthood.

        • I know it is stating the obvious (and that we both know where we stand) but still, for those who might be reading along/joining us late. You give much greater meaning to the idea of “raising someone else’s offspring” than I do.

          We all know that in lots of ART stuff (but by no means all) you end up raising children not genetically related to you and therefore genetically related to someone else. And I think it’s probably fair to call the child the offspring of the person to whom it is genetically related. (There might be a little slipperiness in the language here because “offspring” is probably freighted with a bit more cultural meaning than is “genetically related child” or something like that.)

          In any event, the key point I’d make is that I don’t think it is such a big deal that a person is raising a child genetically related to other people while you do. And of course, I don’t think it is accurate to suggest that they have paid to aqcuire title to the child from the genetically related people. Neither is anyone abandoning offspring.

          And a side note (with some trepidation as I have not read through all the comments yet, so maybe there is more below). I meant to premise this discussion on an assumption you do not seem willing to accept (even for discussion for the moment)–and that is that it is okay to buy/sell gametes. The question is IF is okay to do that, what is the difference with the blended product.

      • I understand from your link that Erickson was not convicted of human traffiking but of defrauding the surrogate? So it doesn’t seem to be the same case at all

        • seems as if erickson would have been honest with the surrogate that her legal standing was as a mother until she relinquished the child, than her operation would have been AOK?

          • I’m dashing in late but I think if Erickson had been honest all the way around then the surrogate probably wouldn’t have agreed to become pregnant. After all, she doesn’t want to risk being left with the baby, which is clearly a risk. So to induce her to cooperate, Erickson had to lie. Then to get the court to sign off, Erickson had to lie–because what she set up didn’t qualify as anything legal under CA law so no court would sign off on it.

            Would it be legal for a woman to become pregnant with the idea of giving the child up for adoption all along? I suppose the woman who does this does nothing illegal. Paying for it seems another matter, though. (Top of my head thought, only, though. Interesting question.)

            • I’m reminded of the other case you posted about Breit and Mason (and you thought they weren’t related? ;)
              The virginia court declared that Mason could not invoke the sperm donor law because the purpose of the law was to ensure that every child had a known legal father and mother.
              (that leads to a discussion of legal philosophy, whether laws are be to adjudicated according the the presumed intent or the strict construction. but thats a separate issue).
              In the same way, this appears to me to be the only rationale to differentiate legally between a woman who is commissioned by a company to become pregnant, and a woman who is commissioned by a person or persons intending to assume parenthood- the wants to ensure that SOMEBODY gets named as parent….

              • ethically i do suppose there is a difference between commissioning a child with the intent to care for it, than commissioning it with the intent to make money off it but I see it as a fine line and don’t see how that could be deduced from the law.

                • for example, a company that actively recruits all the above plus intended parents, as long as they match the parents and the surrogate at the right time, is still the commissioner behinds the scenes trying to make a buck, all legally

                • is there actually such a company? that gets everything- the donors, the IPS and the surrogates altogether?

    • keanne
      Your right about this being a control thing because what is more indicative of parenthood than control and if someone else controls the conception then they are not really parents in their own minds. I notice a lot of flip floppieness from IPs in their writing they say reproduction does not matter to who is the parent but at the same time they want to be all up in the middle of it going so far as to claim that they conceived a child together or reproduced together or have children together all because they were like involved in the decision making process or it was their idea or whatever. Never mind that their body did not actually do any reproducing or conceiving with their spouse.

      Your said
      “I think the horror and appalled feelings come from the callousness this clinic is showing towards embryo creation. I know that sounds contradictory and maybe it touches on some of the control issues in your previous post, but every couple I know who created embryos from donor eggs and sperm took it very seriously and chose the donors carefully. They intended to create very specific embryos. It’s control plus intent plus the parents’ way of contributing to the creation of their offspring if that makes sense.”

      But your right it is contradictory.

  2. I don’t believe a frozen embryo is a person, so I myself have zero ethical issues with there being excess frozen embryos out there – I plan to keep any I have frozen until I reach the age where I’d no longer consider having any more children no matter what the circumstance, at which point they will be destroyed or donated to medical research that would not result in a birth (such as stem cell research). So I see no moral reason to treat infertility with methods that result in fewer leftover embryos. Personally, the one thing I find questionable/problematic about this practice as opposed to the usual ways donor eggs and sperm are obtained and used is that it leads to more full siblings out there not knowing each other, even possibly within the same area and living in close proximity if it’s one clinic doing this for a bunch of families, and I think that’s problematic for them as adults who could meet, have a relationship, etc. With the usual methods the kids aren’t full siblings and usually end up born in different areas of the country.

    • yeah these kids are likely even to be classmates at the same school!

      • It actually says they are spread all over the country and there’s surely no reason to imagine they’d need to be the same age. All of this is to say that I hardly think it is likely they’d be classmates. But I don’t say that because I think there is nothing to address here. Only because I think it’s important to keep things reasonable. It’s possible they could be classmates but hardly likely.

        • Yeah, I brought that up because I assumed if one clinic were to do this, and it was being used more often by people with less money (and therefore less means to travel to a further clinic) that there would be a higher chance of the kids ending up living in the same geographic area.

        • In real life it is not unlikely that people would end up school-mates (if not classmates) enrolled in the same extra curricular activities. The resulting offspring are going to be in the same general age group, within 6 years of one another for grade school is fairly realistic for a public school kid and within 8 years of one another is fairly realistic for private school kids which they are more likely to be IMO. If they are of any kind of unique race or religion they are more likely to wind up in the same private school – for instance a batch of Jewish siblings whipped up in San Francisco would almost certainly generate classmates at Brandeis Hillel Day School. Even if spread widely across the U.S., it is not unlikely that the siblings might wind up members of the same scholastic or fraternal organizations or in the same line of work.
          My first experience with a donor and his family were that they were all in the same metro region of the University where he had donated. No the kids found were not classmates but when college age frequented the same local pubs and whatnot which for most is too close for comfort .

    • Rebecca the donors that this batch of embryos comes from would be full siblings and I think that is deep but let’s not forget that there will amost certainly be scores and scores of paternal siblings and very probably 5 or 6 more maternal siblings. From the perspective of the sperm donor’s full sister all of his children are her full nieces and nephews. If he has 100 children then her children have 100 full 1st cousins.

      Abandoning one’s offspring destroys entire families ability to prevent themselves from entering into incestuous relationships.

      • I don’t think you mean that the donors would be full siblings, do you? And there is no saying that the gametes used in this would be those used in any other ART projects–they could be, of cousre, but it’s not hard to imagine that a clinic could take steps to guard against this. (Yes, there are no guarantees.)

        I know the accidental incest thing gets raised over and over–I’d love to see some serious statisical work on this. But ultimately, aren’t these problems that can be dealt with via openess and disclosure? What I mean is, these are not problems inherent in use of third-party gametes but rather in the details of how they are employed.

        • “I don’t think you mean that the donors would be full siblings, do you?”
          Your right. I meant the offspring of two donors create a nuclear family of full siblings.

          “And there is no saying that the gametes used in this would be those used in any other ART projects–they could be, of cousre, but it’s not hard to imagine that a clinic could take steps to guard against this. (Yes, there are no guarantees.)”
          Wrong. It is very hard to imagine where a clinic would take steps to prevent the donors from being unfaithful to their donor partner in this little nuclear family. These two donors have not nearly reached the ASRM recommended offspring per donor limit by creating a single family with 10 or so brothers and sisters. With the chairmen of the AFA telling me that a 10 offspring limit would increase the cost of sperm 10 times it means the sperm banks are currently investing up front money on donors that have to create at least 100 offspring in order for the clinic to make back their initial investment. I’d imagine that the banks have income projections that limit the amount of time each donor is expected to produce 100 offspring in (in order to make their investment back and not take a loss). I don’t see why selling sperm to a doctor would be any different from the banks point of view than selling sperm to any other private citizen. They don’t take requests to cap the number of offspring a donor creates although I suppose the doctor could buy all the sperm from that donor. You see what I mean with the sperm donor. And with the egg donor it would depend upon whether she was going to donate fresh again, unless they used frozen eggs and in that case she’s much more like the sperm donor with a quota to meet.

          “I know the accidental incest thing gets raised over and over–I’d love to see some serious statisical work on this. But ultimately, aren’t these problems that can be dealt with via openess and disclosure? What I mean is, these are not problems inherent in use of third-party gametes but rather in the details of how they are employed.”

          No they cannot be dealt with via openness and disclosure. Those don’t work outside of ART either because you’re leaving truth in the hands of people who may or may not wish to disclose it. You’re allowing one member of a group of relatives to keep private, information that is pertinent to the health and welfare of larger group of related individuals. The current method allows certain people to keep private information that not only belongs to them but to others as well. This is the downfall and injustice of the current model. Someone outside the group of relatives is able to withhold information that is critical to an entire family and to society as well. Information collected by the CDC on the parents of an individual is now genetically inaccurate which impacts the nation’s vital statistics which in turn undermines the accuracy of medical research in the field of heritable disease and birth defects.

          Only by recording genetic parents accurately on birth certificates can family members access information about relatives they don’t know and never heard of when communication within the family breaks down. As long as the parent is made to be accountable on the birth record every member of the family can have access to one another’s birth marriage and death records. This is absolutely essential to being able to leverage the rights that come from kinship title.

    • With the usual methods the kids are not full siblings….would you want to screw your paternal brother Rebecca?

    • I can certainly understand seeing the full sibling thing as problematic and for the reasons you say. But this is fixable without abandoning the practice–if you had some sort of mandatory disclosure you could overcome the problem. Now this might make the product less marketable–some people might not want to buy the frozen embryos under these circumstances. But I some people doubtless would. Again, I think this is largely aimed at people who do not have the money to use more conventional ART/IVF techniques.

      • How could we ensure that all the siblings in this batch would have the ability to gain access to one another’s birth, marriage and death records, the way siblings can when their genetic parents are named on their birth records? How can we ensure that all the siblings in this batch would have the ability to gain access to the birth, marriage and death records of the donors themselves as well as the donor’s other children and all the donor’s other immediate relatives? How can we ensure that the donor and all the donor’s relatives would have the ability to gain access to this batch of siblings birth, marriage and death records as well as obtain those records on any other children of the donors?

        I often read people defend gamete donation by saying that nobody has a right to know their parents, siblings or other relatives; they cite examples including adoption, children born of affairs or otherwise separated and say the government can’t force families to communicate the existence of relatives to one another. But people looking for siblings that were adopted out can look for other birth records with their parents names on them and get copies of them (even if they are not the amended version) and then they will have vital information about that person like their birth day etc in order to undertake a more detailed search for the adopted person. Adoption screws up record access as well and needs to be corrected to be fair.

        It seems its pretty crucial that the donor be recorded as the genetic parent of every single one of their offspring on their birth records so that all the members of their genetic family can freely obtain records on one another despite or against the wishes of the social parents.

  3. Julie – this article and the ensuing discussions on it have been really upsetting me this week. I have been trying to write a post on it and failing because to me it is abolutely horrifying. Text in quotes below from http://www.latimes.com/health/la-me-embryo-20121120,0,6383292,full.story

    1. The clinic does not pre-sell all prior to mixing up the batch of potential human beings – because that is what they are. Those not pre-sold BELONG to the clinic because there are no intended parents.

    “Once the clinic gets buy-in from a few patients, it purchases the sperm from a sperm bank, harvests eggs from the egg donor and combines them in the laboratory.

    A single pairing can result in a dozen embryos, and the clinic keeps the extras frozen while it looks for patients who want them.”

    2. Not one of the articles or posts (excluding your post), that I have read even mentions the concern of / or references the anonymous aspect and the potential impact of that. Yet we know from real human beings created by donor conception – that anonymity is hurtful and harmful to them.

    3. The callous way the incest concern is written where the word incest is replaced with mix their genes? Then to add insult to injury the concern is white-washed away by saying the patients are scattered geographically would only be a viable statement back in the 1600′s when travel, relocation, multiple moves did not happen like it does today.

    “As for concerns that biological siblings could unwittingly meet someday and mix their genes, Zeringue said the chances are remote because patients are scattered geographically.”

    4. This also creates grave concern on the lack of family health history for the donor conceived and their children and grandchildren. What conditions are being genetically screened for, how valid is a family health history provided by a young woman or man at the time of donation. What history would they actually know of at that age (pretty sure they aren’t taking the form home to get the older family members input. What genetic diseases that run in their family that have yet to be identified by gene(s) aren’t being tested for at time of donation? What recessive gene(s) that will be identified in the future that the opposite donor may also have. What about the genetic diseases any of their full siblings will be diagnosed with that would benefit the others knowing? With at least the way it works now – there is a window of opportunity to keep records / be able to make contacts. With this process – I see zero – because the OWNER of the embryo’s certainly isn’t going to be cooperative if they face liablity.

    5. The concept at it’s base level is to create a Store of Embryo’s For Sale – pre-manufactured, pre-packaged, and OWNED by the Store OWNER, and the inhumanity of what is being done neatly swept under the rug, because people are desperate to become parents because THEY want to be parents, with zero thought about what the ones created this way will feel or want.

    • I think in the end your fifth point is right–this is an embryo (or preembryo, if this matters) store. In that light, the question I was meaning to raise here was whether this is worse than the store that sells sperm and eggs–the component parts.

      I do not mean to be insenstive to the other points you raise. They are important. I think you are right to question the ease with which they have been dismissed in the article.

      But I wonder if the root problem isn’t really anonymity and secrecy. I can easily imagine it will end up being extremely problematic for people to learn late in life that they came from a purchased embryo (or however you want to say it). In the same way, I think it is problematic when children aren’t told from early on that they come from third-party gametes. In my best world parents tell their children about their origins. And in this regard I wonder how much difference it will make if you are told you come from the purchased gametes or the purchased embryo.

      • “I think it is problematic when children aren’t told from early on that they come from third-party gametes.”

        It is surprising to me that folks raising donor offspring don’t see the big difference between them telling early and often and adoptive parents telling early and often: Adoptive parents have the benefit of the separation not being their fault. The child can be happy with the adoptive parents while being hurt or angry or disappointed with their parents. They can feel supported by their adoptive parents in managing any grief or sadness they may feel about being separated if the adoptive parent not involved with the parent’s choice to abandon or relinquish.

        I never read anything by people raising donor offspring that addresses how the child will feel about them and their roll in having wanted the genetic parent to be absent from the child’s daily life providing financial support and physical care giving. I never read anything by people raising donor offspring that says how they plan to respond to the child asking why they wanted the genetic parent absent and why they wanted the genetic family to not know or care about them. Adoptive parents can generally say with a straight face that they are happy to have the chance to raise the adopted child but would have preferred that the child never have been subjected to the unfortunate circumstances that prevented the child’s parents from being able to take care of them properly.

        • This seems to be growing further from the topic (the ready to wear vs. custom made) but on more comment from me. (Then I’ll let this tangent go.) There’s lots out there about how children conceived with donor sperm think and for many of them it’s a fine picture. Even the quite controversial Family Scholars study shows that and there are many other sources that say the same.

          I think the bottom line is that not everyone sees the genetic linkn as such an important thing as you do and for people who do not, there isn’t such a big difference here. A lesbian couple saying to a child “we wanted to raise a child together and our friend John helped us do that” can be fine for the child. They don’t think it’s a big deal that they are not being raised by/financially supported by their genetic parents. At the same time, ome children do feel this is a big deal, or at least feel it is a big deal that they don’t have contact with their genetic parents. (I’m not aware of many people who have known donors who feel that they were cheated because their donor isn’t acting as legal parent.) These things vary just as they do with adoptions. The details around it make a huge difference.

  4. The results are the same; people bough or were gifted parental title and custody of another person’s offspring without going through the process of a court approved adoption. It’s still the same black market adoption with a twist that gamete donation has always been.

    You have never been at all concerned with how a woman comes to be pregnant; In your mind she gives birth she is the mother and that is that. Nothing about this should bother you at all Julie. You don’t think the method of conception should impact who the state recognizes as a child’s parents and neither do I.

    See I don’t thiink that embryos or gametes are babies but I still think this is all baby selling. Why? Why? With all the examples of pre-sale in this world why is it such a hard concept for people to grasp? Have you ever bought tickets to a show next month? Pay now for something given later? Have you ever bought tickets for an airplane trip next week? They pay someone to agree to reproduce and abandon their offspring once their offspring are born and the agreements say pretty much exactly that. The gametes are the method in which the donor makes good on their promise and giving the gametes to whomever whether it be a clinic or a person directly is like sending them the tickets in the mail before the show. Its their pass to parenthood they have control they have the ticket. There would be less control if they had to wait until after the child was born and go through a court approved adoption. What if the donor changed their mind?

    Different twist on the same rape of human dignity and civil liberties.

    • To be clear–is it fair to say you do not see this as meaningfully different from selling sperm/eggs? This is really the question I wanted to raise in there a difference. You’ll notice that there are many people who are ok with sale of sperm/eggs and NOT ok with this. There are people drawing a line here and that’s interesting to me. This is a different discussion from whether the sale of sperm/eggs bad. It seems to me unsurprising that if you think selling eggs/sperm is bad then you will think this is bad, too. Indeed, accepting this and not the sperm/egg market would be quite odd.

      (FWIW, I do buy things in advance–movie tickets for this afternoon are the most recent example. I don’t get the analogy you are offering. But I gather it is about buying sperm and eggs as much as about buying embryos, so it’s relevant to the root disagreement we have rather than this narrower topic.)

      • Then to address the heart of your question I am guessing that people who think egg and sperm selling is fine, while embryo selling is bad are either intended parents or are marketing to intended parents. The desire to have been part of reproductive process in order to feel more like the child’s parent rather than adoptive parent seems evident in the act of selecting donors that are as close as possible to either themselves, their mate, or their ideal mate. The God-like parental symbolism that comes with creating a human being is probably closer when one does the the donor picking and then comes the embryo then in getting the embryo post conception. The embryo post conception is evidence that someone else was managing the creation effort, so it would feel maybe like they are less parent or God like.

        The reality is that it does not matter whose idea it is for two individuals to reproduce and create offspring. It does not matter who helps them to do it, they are the ones who reproduced to create another individual. Those helpers could not have created the same person without them. In the end it won’t matter why two people got together and reproduced, but I’m sure it must not seem that way to people seeking out the experience of creating a person.

        • I don’t know if this is true. I think there are lots of people–like Kisrita, perhaps–who think that an embryo is qualitatively different from gametes. They might draw a line here.

  5. To me, looking over from this side of the pond, it doesn’t look much different from what else is going on in the US. Surely commodification is already happening through the buying and selling of gametes, over and above the cost it takes to collect and store them? The lack of traceability for the donor etc is just the same as is being done at most other US clinics already but one step further down the process of creating a child.

    The practice of being able to choose your donor from a detailed book of profiles doesn’t really exist here either due to laws on disclosure and the donor shortage. If you want that here, you have to go the known donor route. That’s the thing that really makes my jaw drop: choosing from a catalogue like you might choose a pair of shoes. If you look at other businesses that are springing up to address related concerns (I’m thinking of Genepeeks whose approach to donor testing is a form of quality control) it’s all focused on the process rather than the emotional impact.

    • This is sort of my point–if you take a step back from this, why is it any different from what we already do? Not to say that what we already do (commodify sperm/eggs) is good or bad–just to say that this looks awfully similar to me.

      I’m going to have to go look at Genepeeks–I’ve not heard of it/them.

  6. I have the same question as you julie although not as sharply.
    you already know I’m not excited about the gamete market, and I don’t consider an embryo a person, but still commercial embryo selling seems somehow worse and I can’t figure out why.
    when couples donate or sell an unused embryo of their own, especially if it’s people who are known, I’m less bothered but not sure why either.

  7. Julie:

    I have been working with our main regulatory organizations (ASRM & SART) regarding the creation of embryos without a destination. I wrote a blog on the topic at http://bit.ly/XDTJvt. If I had distill my remarks (minus the lengthy discussion that should accompany each statement, as in the blog), they would be as follows:

    * Combining egg donors with sperm donors and creating embryos for transfer is commonly called a donor/donor split cycle but should never be called “donor embryos” from the get go. This demeans the amazing gift that true embryo donors give in donating their embryos to patients in need.

    * Embryos deserve an intermediate level of respect somewhere between simple cells and the ultimate legal and moral respect we give to our patients.

    * Business, corporations or sole practitioners should never own life. They can help to maintain and foster the embryos but should not be responsible for disposition decisions.

    * Even though this process touted by California Conceptions potentially saves some patients money and builds families, the ends do not always justify the means.

    * You can be certain that forces that want to control IVF and/or give personhood to embryos will jump on any situation where a business can own the embryos for even a short period of time. The law of unintended consequences marches forward.

    * Our guiding societies need to take a very careful look at this practice and render a decision that will be fair and best to the greatest number of individuals.

    * While I am a potential competitor to California Conceptions, this issue is far bigger than either of our practices. I did not come to my decision to write the blog, publish the position statement and bring these issues up on EDN lightly. It took me over a year and the L.A. Times article to come to the conclusion that I needed to take a stand.

    We also developed a position statement stressing how a true embryo donation program differs from California Conceptions (http://bit.ly/UfPIJY). This might be worth a review by your readers.

    Thank you for allowing me to chime in on this very important topic.

    Craig R. Sweet, M.D.
    Medical & Practice Director
    Embryo Donation International

    • ‘* Business, corporations or sole practitioners should never own life. ”

      But private citizens should be able to buy and sell human beings, no problem. The things you say doctor are such gems. Why don’t you tell us what you meant to say.

      That scramble thing you did for me is cute. I can still see your blog you just have not said anything interesting there lately..

      • Marilyn–please don’t be snarky to people who join to comment. He added some real substance to the conversation and I know you can disagree more civilly. If we want people with diverse views to talk together a lot of self-restraint is required.

        No one here has advocated buying/selling human beings. That’s just your interpretation of what other people are advocating.

        • “No one here has advocated buying/selling human beings. That’s just your interpretation of what other people are advocating.”

          What did you think of my ticket analogy?

          I know it sounds like all a person is doing is buying tickets when they buy tickets. Surely all they get when they buy tickets are tickets but there is the promise of a show at a latter date. They are not buying the tickets for the ticket’s sake. They would not want the tickets if the ticket did not allow them full access to the show they want to see. So when the show goes on they expect to attend and sit in their assigned seats until the show is over and they don’t want to share those seats with anyone else. They bought more than a ticket they bought the promise of a seat at the show later on.

          I know it sounds like all a person is doing is buying gametes when they buy gametes. Surely all they get when they buy gametes is gametes but there is the promise of a parental title over someone else’s child born at a later date. They are not buying gametes for gametes sake. They would not want the gametes if the gamete did not allow them full parental title and custody of the child they want to raise. So when the child is born they expect to be listed as parents and want to act as parents until the child is grown and and they don’t want to share that title with anyone else. They bought more than a gamete they bought the promise of a custody and parental title to a child born later on.

          Have you ever bought a ticket because you wanted the ticket?

          • I’m afraid the ticket analogy doesn’t work for me. I see what you say you are buying when you buy a ticket and I agree with the description. I don’t see what this adds to the gamete discussion.

            I see, of course, that I am not buying the gamete simply to own a gamete–I don’t want to put it on my mantle or anything like that. I buy a gamete because I want to create a child and yes, let’s assume I want to be the legal parent of that child. The law tells me what steps I need to take to become a legal parent of a child. In some states I’d need to take the gametes I purchased to a doctor for insemination. In others I wouldn’t. If I do the right things in the right order, I can end up a legal parent (in some states, anyway) and the provider of the gamete won’t be a legal parent. But this doesn’t seem like buying a ticket anymore. I don’t see what the ticket analogy adds.

            • Well a person does not give anything to anyone to become the genetic or legal parent of their own offspring. They are in a position of power there because they are the creator of their own offspring. This is where the desire for control comes in I think when people desire to create an embryo by choosing donors – it’s close but no banana. That position of power however can be abused and they can be paid, bribed or otherwise enticed to create children that they will not raise. They can be paid to make themselves scarce after the birth of their offspring. Those who pay are buying parental title to their offspring. Whether it is legal or not does not change the fact that they got the child from someone else while the genetic parent did not have to.

            • “I don’t see what this adds to the gamete discussion.”

              You keep saying that I’m drifting off topic when I’m responding to things you or other commentors said

              I quoted a statement by the doctor where he said that companies should never own life (he was talking about life like embryos for sure possibly gametes or other living cells).

              I was acerbic for sure when I pointed out that it’s not like he thinks owning life is wrong, he just thinks companies owning life is wrong. He sells life (his term) to private individuals. That is his business model. Granted, I said he advocates the sale and ownership of people. But he is not talking about ownership of the ‘life’ of an animal or a plant or an insect here – it’s pretty clear he only deals exclusively in selling human life. I’m not reaching with that.

              How can you own something’s life without owning it too?

              • I’m not saying you alone are responsible for the drift. It’s a fine conversation. But between all of us, taken together, we have strayed from the original question about distinguishing between selling gametes and selling sperm. For people looking to read about the head topic, this has gone far afield. It belongs in some other discussion where it is more pertinent. I just think it is time to rein things in here to keep it at least a little organized, but I meant no slap at you and your discussion here. It was as much me who took it here–which is part of why I think I get to call a halt.

            • No no the ticket analogy is working. It adds plenty to the discussion esp because you said nobody here is in favor of buying or selling people.

              In response to the ticket analogy you said (and thank you x 10) :

              “I buy a gamete because I want to create a child and yes,…I want to be the legal parent of that child”

              (thank you again for this)

              So you may WANT to create a child but you can’t all by yourself or with a sterile or same sex partner, what you need is for someone to do it FOR YOU. Like hiring someone to build you a house or sew you a dress, you want it to be yours when they are done creating it for you. That is the whole point of the ‘commissioning’ parent terminology. Someone is creating them a child because they were retained to do so.

              Is that not correct? Commissioning is to retain someone to create something for you.

              You would not say you created your house yourself if you hired a contractor to do it, nor would you say you created a dress yourself if you retained a seamstress to do it. You could create the dress with her sewing machine, but YOU and your body would have to actually do the cutting and the fitting and the sewing. The closest YOU can get to creating a dress or a child without sewing or reproducing yourself is to have someone else make one for you to keep. Are you buying the sewing or are you buying the dress? Do you get to keep the dress? Will you own it because you paid someone to sew it? You can say you designed it, chose the color and the fabric. But it is not really like that with people though. Nobody designs them.

              Nobody we know in this life anyway.

              • I still don’t see the ticket analogy–I’m sorry. Yes, I cannot create a child but I cannot do it all by myself. I hire a team of people (medical and legal) and I buy the materials I need. This doesn’t sound like buying a ticket–it’s more like building a house. (I’m not sure where that gets me, but still, it does seem more like that.)

                For whatever it is worth, I have a lovely house on Cape Cod. It was built for me and I was deeply involved in the process of design, etc. When people ask about the house I do sometimes say “I built it….” But of course I didn’t literally build it. I caused it to be built. That is clearly more accurate.

                I’m just not sure why any of this is actually pertinent. I don’t know who I would say “built” a child. Not the egg donor or the sperm donor. Perhaps this works for me because the woman’s body–the one who is pregnant–builds it.

                really–dinner is now beyond overcooked. Must go.

                • there – you said it you caused it to be built. to be built by whom? Who built the house? You did not build the house you paid someone to build it for you.

                  “I’m just not sure why any of this is actually pertinent. I don’t know who I would say “built” a child. Not the egg donor or the sperm donor. Perhaps this works for me because the woman’s body–the one who is pregnant–builds it.”

                  Oh sure but you did not say you buy the egg to build the child Julie you said you bought the egg to create a child. Create was your word not mine. The reason this is pertinent is that you assert that you are not paying someone for their offspring or for parental title and I say you are not buying the gamete for gamete sake – and you agreed. You said you bought the gamete to create a child for you to be the parent of and I agreed. But I said YOU are not the one creating a child with that gamete, YOU are causing them to create one FOR YOU.

                  You just agreed that you had your house in cape cod built for you and that the whole gamete thing was like that. You are now going to quibble over the term ‘built’. That is such sloppy pool Julie. Your not defending your point your dancing around.

                  You bought the gamete not because you want a gamete but because you want to create a child that you can be the legal parent of. But you admit that you are not creating the child yourself with the gamete but rather having one created for you so that you can keep and raise this child as his or her parent. So the person creating the child is not you but rather the the gamete donor and whomever they are reproducing with. If the gamete donor is reproducing with you then you are creating your own child and so is he – your just going to buy his half out in your donor agreement so he is absent from the child’s life.

                  Possessing the gamete or the embryo does not mean that any action by the gamete is in fact your action – the gamete is you admit still the donors gamete as it is part of his body and it is his cells that reproduce not yours so you are not reproducing you are – as you admit causing his cells to reproduce. Like pushing a kid on a swing – you don’t swing you are making them swing. The could sit there like a lump but it would still be them swinging even though you caused them to swing.

                  All of this hair splitting matters Julie because it boils down to the fact that people are creating their own offspring specifically to be raised by others specifically for the purpose of other people taking parental title. Whether or not money is exchanged people are trying to obtain parental title over other people’s offspring without going through the court approved adoption process. Commissioning Parties are paying someone to do something for them and it is not give them a damn gamete or embryo – they want to have the child and parental title that is the point of the exchange and you admited that.

                  So how is this not paying someone for a child? If you can become a legal parent by following these steps it does not change the fact that the steps are a process whereby people buy parental rights to other people’s children, it just means that it is currently legal to do it. So fine lets just say that it is currently legal to buy the parental rights to other people’s children instead of saying that its illegal to do that whilst having an entire process set up to do exactly that that is entirely legal.

                  Everyone in favor of the process sounds so incredibly fake and two faced trying to say that they did not buy the child or that they reproduced because it was their gamete. Buy the way your not suppose to be able to own other people’s body parts anyway.

                  • I fear that you will think I am being difficult but I really do not understand your point here.

                    Yes, I paid someone to build the house. I bought the materials. The house is mine. But a child simply isn’t like a house and the law doesn’t treat legal parentage as a form of ownership. This is why I do not see the point you are making

                    I agree that I do not buy a gamete simply to have a gamete. I buy a gamete because the gamete will be used to create a child. I suppose if I am the lab technician as well, I can say I create the child, but I’m not, so I don’t say I create the child, but I do say I cause the child to be created. I wouldn’t say that the person who produced the gamete created the child either–and perhaps this is an important disagreement. His/her gamete was used to create the child but I don’t think that is the same as him/her creating the child.

                    In any event, let’s assume an embryo is created and let’s assume that it is then transferred to my uterus, just so we are only dealing with purchase of the gamete. Eventually a child is born.

                    I have not (in my view) purchased a child here. I have bought necessary parts. I have paid people to do some work. A child has been created. And, depending on where all this occurs, I may be the legal parent of that child. (In some places I won’t be.) The law looks at the underlying facts and determines legal parentage. It simply isn’t like ownership of a house.

                    I think you assume that the gamete provider has some parental right by virtue of having produced the gamete and so when they hand off the gamete they are handing off parental rights. But I don’t think this is an accurate description of how the law operates. Until there is a child there are no parental rights. Once there is a child, parental rights are assigned in accordance with applicable law. Depending on the state and on the circumstances, parental rights may be assigned to the gamete provider or they may not. If the gamete provider has given up the gametes for the purposes of ART, in many state that person is not (and never was) a parent. They didn’t sell or give up a right–they never had it.

                    I have tried to understand the house analogy–I really have. I do not mean to dance around, as you say. I just don’t see it. Sorry.

                  • “Yes, I paid someone to build the house. I bought the materials. The house is mine. But a child simply isn’t like a house and the law doesn’t treat legal parentage as a form of ownership.”

                    On the contrary, I would say that ironically the law is treating legal parentage exactly like the house- if you buy the materials (the sperm or the egg) the kid is yours.

    • “Our guiding societies need to take a very careful look at this practice and render a decision that will be fair and best to the greatest number of individuals.”

      Wow your actions will be fair and best for the greatest number of individuals. Equity and fairness is not something that is determined by mob rules or by majority vote. Everything you write is so telling of your actual motivations.

      Its fair and best for the largest number of individuals to own and control the smaller number of individuals. You don’t want the liability of actually owning anyone yourself you just want to broker them and take your cut – hands off. Surgical precision.

      • Okay, Marilyn, here you make a fair point but in a manner that I think is less than constructive. Why go for the ad hominem attack about motives?

        I think it is fair to wonder whether its enough that a practice is fair and best for the most individuals. Is this really the right measure? Some things are probably wrong even though they are good for the vast majority of us.

        • First of all I’m going to have to look up ad hominem. Wait a second.Now I’m back and nope it is not an ad hominem attack because I am not saying his motives are bad therefore what he is saying is false; I’m just pointing out that he in fact means exactly what he says and that his motives are that he makes lots and lots of money by treating people unfairly. I’ve read the doctor’s blog and he is always saying stuff that is really telling and sometimes in conflict with medical fact as described by professional organizations like the ASRM. He does not like to really answer questions in a specific way. So yes he earns a living helping separate families and is not really able to explain why what he does is not separating families.

          • By ad hominem I mean commenting on the person (including the person’s motives) rather than the ideas expressed. I’m more interested in the discussion of ideas than in the discussion of motives. I could offer a statement purely for the sake of argument or I could offer it because I believe it or for any other reason. I’d like to focus on the statement, though. At least for the people who are actually here in the conversation I think it helps to keep things civil.

        • Thomas Jefferson said
          “All . . . will bear in mind this sacred principle, that though the will of the majority is in all cases to prevail, that will to be rightful must be reasonable; that the minority possess their equal rights, which equal law must protect and to violate would be oppression. ”

          When you or Dr. Sweet talk about doing what’s best for the greatest number of people, or that the losses experienced by donor offspring can be mitigated rather than prevented, it feels as if the America I was taught to believe in is crumbling around me. All men are created equal but we are not all being born free and are not all granted the same rights and liberties. With majority rule comes the responsibility of ensuring minorities rights. Again minorities must be treated fairly, equitably and justly – the majority should not get to vote away the rights of minorities. The majority should not get to vote themselves into a position where someone that is not their offspring would be legally regarded as their child by virtue of a private trade agreement for that is the stuff of human trade.

          I know that I am no lawyer, doctor or scholar but I feel it in my bones that this ground has been covered before and that someone other than me who is smart and well regarded must have talked about majority rule being tempered with minority rights. This cannot be a novel idea for I know that I am not that smart and could not come up with a concept that basic. So I am going to read and look for something somewhere in the law in the constitution some basic principal that talks about how it is possible to have a system where minorities have the same rights as the majority even when the vote goes to the majority.

          I know in my heart that it was wrong to vote on the rights of gays and lesbians to be married to same sex partners. Something is terribly unjust about that having to be voted upon. The law should have been corrected without any vote. Donor offspring are treated unfairly and there ought be no vote to correct it. All adopted people or donor offspring or anyone with an inaccurate birth record should have to do is prove they are not the offspring of those named on the document – and it should have to be corrected. All someone should have to do to be regarded as legal kin is prove they are genetic kin. I’m so sure that its not too much to ask for equal rights. I’m so sure that it is fair and reasonable to expect all to be equally obligated and equally entitled – but its so tempting for people who are treated poorly to take less than they deserve for something anything more than what they have. This is sad to me. I’m sad I did not go to school I could have really been helpful if I had.

    • Thanks for taking the time to write. There’s lots to think about. I’m particularly struck by the ideas 1) that embryos occupy some intermediate level and 2) that there’s a special problem with ownership of the embryos resting with the clinics (or whatever the entities are.)

      In particular, the latter point makes me think of the frozen embryos that are currently stored all over the world. Those are generally owned by individuals and couples though they are stored at clinics, etc. It’s a problem because the individuals/couples aren’t doing anything with them so they are essentially in permanent storage. Some have perhaps even been abandoned.

      I don’t have anywhere to take these thoughts just yet, but it is yet more to think about.

      • Julie what’s happening now with sperm anyway? The clinic selects the men they think most women will want to mate with. They do the searching. They do the screening. They have legal contracts with the men they select. They have budgets and expenditures where they reimburse donors for their time on spec, without any buyers lined up. Where before, a woman would need a donor and the doctor would call for a donor to come in and he would be reimbursed for his time, now they buy massive amounts of sperm from men they believe will be popular. These banks own those men’s bodies their reproductive freedom. They are shopping and buying something they don’t personally need on speculation people will buy. On the same principal of what donors will be popular, they can simply have their most popular donors conceive children with one another for your bargain basement generic race basic mix of white white, or black white or asain white, asian asian, with no concern as to eye or hair color or height and then they’d move up to more specific kinds of mixes like medical tall eurasian. or legal short jewish or tall middle eastern architectural/engineering. Does it really matter what the intentions were of the people who over produced the batch of embryos being donated?

        • The points you make about how sperm is handled now is part of what makes me wonder about whether we ought to treat premade embryos differently from sperm. It seems to me that many of the same issues arise in both settings which suggests that one ought to support or oppose both. I think you are quite consistent in opposing both. It’s the people who support one and not the other that have more to explain.

      • I guess I wonder why it’s a problem that there are extra embryos, if they aren’t people? Mine (if I have any extra) may end up being stored 10-12 years, because if I had the financial means I’d likely consider having additional children up until 40-42 or so – so it seems like it would be so wasteful to destroy embryos made when I was so young and that would be much more likely to produce a pregnancy.

        • I also have no ethical problem with destryoing embryos but it could be financially and practically onerous to store embryos for years for no purpose.

          • added to, like many medical practices, patients sometimes simply disappear and can not be contacted for a while… leaving the embryos with the clinic who doesn’t want them and isn’t making money but can’t very well discard someone’s property particularly something so irreplaceable.

        • Fair question. I can only offer guesses.

          I suppose there are some logistical issues–clinics have thousands of them stored away and they take up lots of room? Perhaps, too, it turns out that for some people (many people?) it’s hard to figure out what to do with them. They don’t want to destroy them, they don’t want to give them away (the full-sibling thing), and so they just sit. And I can imagine that some think it problematic that more and more keep getting created when there are so many perfectly good ones that aren’t in use. Wouldn’t it be better to just use the existing supply?

        • Rebecca if they harvest your eggs you have no idea how many they really take, they can take more than they tell you and can have them fertilized with the sperm of donors or patients to create embryos for freezing and sale. Or they can tell you that they created fewer embryos (from you and your chosen donor) than they really did, keeping the extra embryos for sale as if they had been donated. Or they could be honest about the number of embryos created and stored but over time they can be implanted into other women for delivery either on purpose or by accident and they would inform you that several of your embryos have not survived the process or were somehow damaged – they could tell you that when they take them or not. They could also simply pretend to thaw and implant one of your embryos in you when you request it and then chalk it up to the pregnancy not taking/failing. There is no way for you to know for sure that your embryos are the ones being implanted into you either. There are several current stories about women who suspected the child they are raising is not theirs and DNA tests proved that to be true. They have no idea whose child they have or who has theirs.

          The extra embryo issue creates an environment where people who should have nothing to do with you suddenly have the ability to force you to reproduce without your knowledge or consent in order for other people to take and raise your offspring. If your white I’m sure one of your embryos would fetch about 10K in fees. Think of how tempting that is for doctors – you’d never know, so in theory it would not cause you any harm. The person who wants to raise someone else’s offspring would never know because the process is suppose to be anonymous and they don’t want to know. The doctor can attribute your gametes or your embryo to some truly existent willing to be known donor with a number – it would likely be 18 years before anyone could discover that the child was not the offspring of that donor. Even if discovered sooner like in the cases I referred to, the doctor does not have to have all his former patients submit to DNA testing just because one child born did not match genetically to a Donor. It’s the perfect crime all profit and no investment. In fact people pay you to give you the gametes and embryos your going to sell at 100% profit and they pay you to store them for you as well. Extra embryos are a huge problem because its way too easy and tempting to misappropriate your body and your offspring.

          It’s all real and it is not uncommon. Look it up.

          • I simply do not think this happens any more often than newborns are getting switched at the hospital. Yes, once in a while a horrible mistake happens or there is an unethical doctor but I do not believe the risk is great enough to base any decisions I make off of it, anymore than I would have a home birth or no kids at all to avoid a switched at the hospital baby.

            • Thought I replied to this already but looks like not. Anyway it happens way more than switched at birth cases because there are security measures in hospitals to prevent that from happening, babies have wrists and birth marks and often are visibly different races and genders and frequently have distinguishing features such as weight and length being not the same as other babies. Sperm egg and embryos are impossible to tell whose is whose and there is a much hotter market for them than for babies because then they can pretend to have made them themselves.

              happens all the time girl its an unending source of profit

              • Embryos have detailed labeling too. Sure, someone could remove the label, but they could also remove the ID tag on a newborn or snatch a kid off the street. Fertility clinics have security measures too, you know. Just because you don’t like ART doesn’t mean that all or most ART doctors are out to trick their patients in every way possible.

                • Rebecca your going to be a great mother. I’m sure that you will be very attentive to your child’s whereabouts and these days they don’t take your baby and put it in a row of incubators lined up like cord wood with a bunch of smoking father’s looking through the glass. These days your whole family is in the labor and delivery room and they hand your baby right to you and your baby sleeps in your room with you – in bed with you if you want. They don’t take your baby anywhere unless your child is sick and then they know which one is the sick one that they are working on. Security measures are extreme in Labor and delivery suites now ask Ki. I have been a construction field rep for healthcare for 20 years and have worked on lots of LDRs it would be near impossible to walk out with the wrong kid in a modern hospital setting.

                  Now you won’t be paying as close attention to your eggs and embryos as you do your baby right? If your baby stayed at the hospital you’d at least visit once and a while. If your walking down the street with your kid you’d be holding their hand. So sure your kid is more likely to get snatched too if you were paying as little attention to him as your going to be paying to your eggs and your embryos.

    • “Combining egg donors with sperm donors and creating embryos for transfer is commonly called a donor/donor split cycle but should never be called “donor embryos” from the get go. This demeans the amazing gift that true embryo donors give in donating their embryos to patients in need.”

      So whose embryos do donors donate if not their own? You are saying that the donors donate their embryos. I would agree. A woman gestating a donated embryo is not gestating a donor embryo? You can’t say she’s gestating her own embryo – that would be false.

  8. Dr. Sweet,

    You stated: “I have been working with our main regulatory organizations (ASRM & SART) regarding the creation of embryos without a destination.”

    What good does working with ASRM & SART do if they have no enforcement ? I believe you said they never would due to liablity issues. If a regulatory org has no ability to do any more than suggest regulations, or best practices, then it is trying in vain to get a for-profit business to not look to the profit margin / growth sector. The regulatory orgs become by default only a seal of approval org. Yet the public assumes they actually regulate and that in itself is where the harm factor comes in. Just like in the adoption community – if an agency is a member of the NCFA or their International counterpoint the public assumes the agency is regulated.

    Off Topic: When will the industry start looking at the concerns the donor conceived individuals who have been speaking out about for the last 10+ years? When will they push to end anonymous “donation” and lobby for it to become laws in each state?

  9. Tao:

    I needed to start somewhere, so I started with ASRM. They investigated my concerns and elevated the issue to SART. SART did a full investigation and agreed with my concerns. California Conceptions (CC) wasn’t a member of SART, so they had limited interactions. I was told I wasn’t the only one to contact them but I was seemingly the first.

    I do believe that position statements help and that ASRM and SART will eventually have to come out with one. In the August draft update of the Ethic’s Committee’s embryo donation summary, there was no mention of the current dilemma. I have been told that the ASRM Ethics Committee will be meeting in January and will probably have to wrestle with this issue then. I would expect some print materials to come out a few months later. What they will decided is uncertain.

    There have been other instances when practices began to create embryo banks and these were shut down, probably from pressure from ASRM and others.

    I am not aware of any developed nation that would allow for any type of embryo bank to form. I believe the Urkrane is the only location that is performing a similar process but there certainly could be more locations. If would be interested if readers of this blog or my blog (www.EmbryoDonationBlog.com) could give me additional examples.

    I understand that California Conceptions is trying to minimize its embryo bank size. They claim to have only 10 sets of “donated embryos” at any given moment. Ten sets could equal 20 embryos or it could equal 100 embryos. No matter. Any type of embryo bank is a concern, large or small. And let us not forget who is donating these embryos – CC, a business and not a patient.

    Responding you comments regarding attention to the donor-conceived offspring, I think it is absolutely important to discuss these concerns. The fact that full genetic sibling will be scattered to numerous families is a potential problem and I doubt there is any type of an open “embryo donation” policy at CC. Legislative action, if done poorly, could do far more harm than good. I do feel that the reproductive world has been listening better to the donor-conceived offspring and that changes are being made on many levels.

    We will first have to see what the ASRM Ethics Committee comes up with and perhaps the American Bar Association may also chime in on the topic. Beyond that, I’m not sure how much attention this issue will get in other avenues. We will have to be a bit patient.

    • I think there is real value in beginning discussions like this wherever you can. The US generally doesn’t rush towards regulation and most states don’t either–particularly not when regulation is expensive. But professional organizations can help develop standards and best practices and (in general) threats of private liability based on deviations from standard practices can sometimes change behavior. It’s all a part of a process. And I think it is far better to open the discussion in many fora.

      Of course it is true that the ASRM is hardly disinterested and it ought not to be the only forum where discussion occurs. But not everyone in the ASRM is narrowly motivated by a need for ever-rising profits. There are thoughtful, ethical and knowledgeable people there who are in an excellent position to ask important questions and raise the topics.

  10. Julie said: “And in this regard I wonder how much difference it will make if you are told you come from the purchased gametes or the purchased embryo.”

    It may not make a lot of difference to a child or young adult but I would suggest it would make a huge difference – if the individual goes further and either wishes to find their “donors” or learns about the industry. I say this because most adoptees I know had little to no concern regarding our mothers being coerced, or forced, until we delved into the actual practices. We lived in what is commonly called adoption fog – but once that is wiped away and you find out what actually happened to so many mothers the true horror of what was done is very hard to deal with and then there are the Black Market adoptions that are even worse. Getting to my point of comparison with the Store bought embryo’s vs what is the current practice – I would liken the feelings of being “bought off the shelf” so to speak – with the feelings when you find out you were a “Black Market adoption” – the rammifications extend to how you view your parents, their moral compass and your life in general. It would be much worse to find out they went shopping and picked you out ready to go…

    • good point TAO. an embryo while not a full fledged human being is a human being in the making, with a full set of DNA.
      while gametes are only a half a set of DNA, they don’t obtain an identity until they are joined with the other half.
      So an embryo is a full potential human being while gametes is only half, without a true identity.
      Perhaps that is why even those of us who do not view embryos as people still feel that embryo selling is still somehow a significant step beyond gamete sellling.

    • I think I see what you are saying here–and I can certainly see the point you make about adoption. To take an extreme case, discovering you are one of the stolen children from Argentina would be quite different from discovering that you were a part of some legitimate and above-board adoption. (I’m not sure I’m framing this right and I hope you will not take the comment ill if I’ve put it wrong.)

      I’m not sure about the parallel to the premade embryo practice, though. A man might go an provide sperm to a sperm bank. Whatever issues there are with his voluntary decision to do this, are they different depending on who the bank sells the sperm to? I mean, if they are used to custom make embryos or to make off the rack ones does that matter to him? If it does, could we cure the problem by telling men specifically what the sperm would be used for (this is for off-the-rack) and getting permission for that specially? It doesn’t seem to me that this is like the black market adoption.

      I know that’s only half the problem you’ve pointed to and the other piece is harder, I think. Would it change how you viewed your parents–that they didn’t pick the parts individually? I can see that it might, but I need to think about how it might. (And of course, I don’t really know but can only guess at it.)

  11. Dr. Sweet – thank you for responding.

    Will the position papers be made public? This whole Store concept bothers me, regardless if it is called a bank, it is a store and the product is owned by the store. Will the papers have best practice guidelines that the public can access easily, or will it be behind a pay-wall?

    As to the legislation – my preference would be federal – a set of minimum standards each state must meet. I know that would be hard to get put in place but learn from the mess called adoption laws. PUSH for good legislation,or you will have bad actors – who will forever push the limits – and no laws to reign them in. It really is something that deserves that level of attention.

    As to the anonymous issue – step up to the plate and push. Again, don’t let this industry becomes a mirror of adoption, and have donor concieved individuals having to fight every single state legislature to get the laws changed – in adoption the fight has been going on for over three decades. Stop the problem from happening from 2012 on – look to the laws in other countries that have already been there / done that so you don’t have to recreate the wheel – just tweak it.

    What is the industry doing for family health history – that needs to be in a position paper as well – what type of education the donors get on the need to update – the intended parents on the need to update change of address and update as well. The potential for harm not just for the donor conceived but their children, and grandchildren as well. A pet peeve of mine as I was harmed by lack of family health history, and it hasn’t been fun at all retiring in my prime – all from lack of FFH. No one should be subjected to that today – when we all know better now – and the history that would have made a difference to me – happened after my surrender – the same type of history will evolve after donation – to those healthy young donors too.

    • Excellent questions. I really find thinking about the owndership of the embryos fascinating. I haven’t worked out what I want to say yet, but it seems important to try to figure it out.

      The anonymity point stands on its own, of course. Whether store-bought or custom made, there are issues around anonymity and all the related concerns–inadvertant incest, number of siblings, medical history. I think those ought to be addressed (and I will resume the discussion shortly) apart from the custom made/store bought discussion as they are of much broader importance.

  12. Julie,

    Your statement “(I’m not sure I’m framing this right and I hope you will not take the comment ill if I’ve put it wrong.) ”

    Yes that was my point – finding out your adoption was illegal or forced would be terrible thing to have to accept.

    Your statement “I’m not sure about the parallel to the premade embryo practice, though.”

    I’m not talking about the donor’s aspect at all. Current practice as I understand it is that the intended parents pick the gamete providers from profiles – and it is done through an agency / doctor – and they then have embryo’s created (probably not using correct terms) but it is the intended parents driving the boat so to speak – and retaining control of their potential child’s full siblings embryo’s – almost the reverse of how the adoption process works – a case by case basis. That to me makes it a completely different process than some business creating a batch of embryo’s to sell off the shelf. The latter speaks to the we forced or stole these babies and now are willing to sell them to the highest bidder which is what Black Market or the stolen children from Argentina would be.

    That does lead to the final “how would it change your view of your parents”. Straight up clean adoption vs Black Market adoption only in the IVF terms because as it stands right now – embryo banks are the Black Market Adoption comparison. The icky feeling / disgusted feeling of having embryo’s FOR SALE on the shelf makes it a valid comparison – those donor conceived will – if they ever delve into the processes and ethics – also have to question the ethics and moral compass of their parents.

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