ART Frontiers and Parenthood

Just as I was taking a step back to think more broadly about some of the issues I discuss here, the New York Times began a series on the promise and perils of modern reproductive technology.  There have been two articles so far, both on the front page, one yesterday and now another today.   They’re gripping and sobering, too.  Definitely worth a read. 

Today’s story opens with a harrowing account of the experiences of Thomas and Amanda Stansel.  They used intrauterine insemination (IUI) as well as drugs to stimulate super-ovulation.  This is less hi-tech, less expensive, and presumably more common that IVF.     I’ll just leave it to you to read the story, which recounts what followed from their choice.  

Assisted reproductive technology (ART) unquestionably offers new opportunities to countless people who are unable to reproduce without some sort of assistance.   At the same time it brings with it countless difficult decisions and wrenching stories, legal challenges and regrettably, some bad outcomes.   (I realize we probably won’t all agree on which outcomes are bad outcomes, but I think we probably all ought to recognize that there must be some.)

Restricting Access to ART: One View on Ethics

There’s been a lot of discussion on my blog about donor insemination, and particularly the use of anonymous donors.   I’m ready to take this is a broader direction.  I’ll start with this short post. 

 This morning I came across this document, which provides ethical guidance to ART (that’s assisted reproductive technology)   professionals.    (DI is is one facet of ART.)   It was developed by the ASRM(American Society for Reproductive Medicine).  While it doesn’t address the issue of anonymous donors, it is focused on the use of ART by people who will frequently be using anonymous donors.    

It’s not particularly new (2006) but it is interesting to me the way the discussion is organized.  As the title makes clear, this paper is addressed to the use of ART by lesbian, gay or unmarried people.   The question posed is whether it is permissible to discriminate in the provision of ART–that is, to provide it to (heterosexual) married couples, but not to unmarried couples or single people.  

Coming Soon?–Three “Genetic Parents” and the Baby You Choose?

The wonders of modern science seem to consistently produce new questions for us to ponder.  I will turn from my current topic to consider this story. 

You can read the story to get a better idea of the science (I am no expert) but the basic idea is this:   Two female monkeys donate eggs.   The mitochondrial DNA (mDNA) from one is combined with the nuclear DNA of the other.  The resulting egg is then fertilized.   The resulting offspring have DNA from three sources–the two female monkeys and the one male monkey. 

The reason for doing this is that it is possible to have mDNA that could cause various serious diseases while you have perfectly fine nuclear DNA.   In such a case, a woman (for the idea would be to use the technique with humans, of course) could provide an egg which could then be combined with health mDNA from a donor and end up with a child that carries her nuclear DNA.  

Regulating Adoption/ART, II: For Example

This really picks right up on yesterday’s post, so you’ll want to read that first I should think.   I want to offer an example on the theory that this will help me (and perhaps readers, too) evaluate the point I’m trying to make. 

Imagine X, a very wealthy and eccentric single man who wants a child.    (Yes, I’ve been thinking about Michael Jackson and his children yet again.  I know it’s all quite sensationalized, but this item  about the third child, Blanket(?), caught my attention.)   It seems to me he might have two options.  

Plan A:  X tries to adopt a child.   As far as I know, no matter what state the person chose, this would involve some sort of home study that included evaluating  X’s fitness as a parent.   If X were sufficiently eccentric, this could be a problem.  

If You Regulate Adoption, Can You Regulate ART?

I’ve been thinking a little more about yesterday’s post and some comments on the blog and on Facebook (though not all on this post).   In particular, I’ve been thinking about a different way to approach questions about regulation of access to ART in particular and parenthood more generally.  

Let me start from a different point.   Generally we seem to be comfortable with the idea of regulating adoption.   I don’t mean to suggest that we all agree on what exact regulations should be in place.  Indeed, the eligibility of single people and unmarried couples (including lesbian and gay couples) to adopt is very much in contention just now.     What I mean is, there seems to be broad agreement that there should be some regulation of who can adopt.   There’s not a large contingent out there arguing that we should do away with all home-studies and let any person who steps forward become an adoptive parent. 

Rationing Health Care/Rationing Parenthood

There’s a discussion current in the UK just now about access to IVF under the UK’s National Health System.  This little commentary is a reflection of that larger discussion, and I’ll use it as my taking-off point. 

The question currently raised in the UK is whether the NHS should cover IVF.   IVF, like a lot of assisted reproductive technology, is fairly expensive.   Health care resources are limited.   Given these circumstances, perhaps it is reasonable to discuss whether IVF should be covered as necessary medical care, or perhaps doled out on some discretionary basis. 

In the view of the commentator, the problem is that some (many?) people need to resort to IVF because they chose to wait to have kids.  In other words, need for IVF is the logical consequence of free choice.   The implication is that a woman who wants to use IVF because she chose to wait is less deserving (and hence, should be further back in the line) than a woman whose need for IVF is unrelated to her choices in life.   

Lesbian and Gay Parents and the Luck of the Draw

Not long ago, I wrote about the ways in which lesbian and gay families live on patchwork quilt when it comes to legal recognition of their families.   If you look over last few posts you can see what I meant:  The legal entitlements of lesbian and gay parents vary enormously depending on the location of the family in question.  

But of course, on several levels, where a lesbian or gay parent lives is the result of chance.    First there is the chance of where you were born or grow up or where your home turns out to be.   You could read the cases about lesbians mothers living in Louisiana and you can wonder what they are doing there–couldn’t they guess Louisiana would be rather inhospitable?  

Lesbians Ideal Egg-Sharers?

I just cannot resist doing a short post on this, seeing as it does tie back to my post from earlier today.  

Here’s the deal.   Some ART clinics offer egg-sharing.  I believe these clinics are all in the UK, but I’m not sure about this. 

The idea is that if I go in for ART (I assume mainly for IVF) and offer to share some of my eggs, then I get a cut-rate on my own treatment.  (As you can see from the linked article, it’s a very substantial savings.)   The clinic then offers those eggs to another client of theirs who needs eggs.   Especially where egg donors are not paid (as in the UK)  this helps ensure a supply of eggs.  (There’s an egg shortage in the UK, just as there is a sperm shortage.) 

Who Ought to Use ART?

I’m going to interrupt my discussion of West Virginia here just for a moment.   I’ll come back to that later today.  

Last month I wrote about a Newsweek essay focusing on a woman who froze some of her eggs so that she could delay pregnancy and still bear a child with whom she would have a genetic connection.   She did so because although she was getting older, she was not in the circumstances in which she wanted to raise a child.     

Here’s another clip about essentially the same practice.   This one is from Australia.   One woman refers to it what she is doing as “lifestyle egg freezing treatment” and that rather captures what’s troubling me.   The treatment is also apparently known, at least in Australia, as “social egg freezing.”  

This caught my eye because of another story I read several days ago.   This one (off a US website) concerns a practice called “social surrogacy.”  

The Business of ART in a Down Market

I’ve been collecting all this little bits and pieces about the impact of the economic downturn on aspects of childbearing generally and ART in particular.  There’s nothing surprising here, really, but still I thought I’d cluster them together.

Let’s start on the supply side.   I noted before that the supply of sperm and eggs is up.   In an essentially unrestrained market like the US, this makes perfect sense.   People need money.  Some people who were not willing to sell sperm or eggs a year ago are now willing to do so.  It’s not that the price they recieve has risen, it’s that they need the money more.  (Indeed, it seems to me that if the supply of donors is increasing, the price paid to donors ought to go down.)

Perhaps it is worth noting that even as the US is experiencing an expanding supply of gametes, the UK is in the midst of a sperm shortage.   (That’s the backdrop for the post a couple of days ago.)