Tag Archives: Infertility treatment

Breaking News: Surrogacy not for married couples only – singles and gays will have legal rights to have surrogate babies

Single men, single women, gays and lesbians may soon get the legal sanction to undergo surrogacy in India.

The draft bill legalizing the surrogacy process in India has provided for Single parenthood by allowing “Unmarried Couples” and “Single Persons” from India and abroad to have children in India using ART procedures and surrogate mothers.

By conferring the right to have children on unmarried couples and single persons, the bill attempts to achieve several historic feats – legalizing commercial surrogacy, single parenthood, live-in relationships and entitling gays and lesbians to start families using surrogate mothers – at one go.

The bill proposes to set up a mechanism to regulate and supervise surrogacy in India.

The bill, with potential to rewrite the social landscape, may be tabled in the monsoon session of Parliament if the Union Cabinet clears it.

Read more about this on http://epaper.hindustantimes.com//artMailDisp.aspx?article=21_06_2010_001_020&typ=1&pub=264

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Ethical Issues Related to Birth of IVF Octuplets : Not a Cause for Celebration, Doctors Warn

 

Two newspapers recently published two opinion pieces examining the ethical issues surrounding the recent birth of octuplets to a California woman, Nadya Suleman, who reportedly underwent fertility treatments. Summaries appear below.

 


~ Arthur Caplan, Philadelphia Inquirer: “Something has gone terribly wrong when a 33-year-old single woman — who has no home of her own, no job and a mother who worries her daughter is ‘obsessed’ with having children — winds up with 14 of them,” Caplan, director of the University of Pennsylvania Center for Bioethics, writes in an opinion piece. “Examining what exactly went wrong may shed some light on what ought to be done,” Caplan says, adding, “If doctors cannot prevent such shambles from recurring, then society must.” Caplan reports that Suleman became pregnant with all of her 14 children through in vitro fertilization. He writes that the “most obvious questions raised by this sad saga include: How did Nadya Suleman become a fertility patient? And how did she get eight embryos implanted when she already had six young children to care for in a tiny house, with no partner and no income?” Although “[s]ome fertility doctors would answer that it’s not their job to decide how many children a person can have,” Caplan writes that the “idea that doctors should not set limits on who can use reproductive technology to make babies is ethically bonkers.” He continues, “Society needs to discourage mega-multiple births. And it is clear what needs to be done to accomplish that.” Government “needs to get involved,” Caplan says, concluding, “Other nations, such as Britain, keep a regulatory eye on reproductive technologies and those who wish to use them, knowing their use can put kids at risk in ways that nature never envisioned. We owe the same to children born here” (Caplan, Philadelphia Inquirer, 2/6).



~ Ellen Goodman, Miami Herald:  The medical team that delivered the octuplets “expected kudos and high fives,” but “instead of smiles, they saw jaws drop,” syndicated columnist Goodman writes. She continues, “Attention turned from the doctors to the mom, from her courage to her judgment, from the medical success of this delivery team to the ethical failures of fertility treatment.” Questions about whether anyone has “a right to tell anyone else how many kids to have” and whether only women with husbands or certain income levels should have children are “questions that make us feel queasy when we are talking about old-fashioned families,” Goodman writes. She adds, “But they take on a new flavor in the unregulated wild west of fertility technology.” According to Goodman, the “heart of this case” is that “it turns out there are no laws in this country limiting the number of embryos that can be implanted in one womb.” She adds that it is “against all guidelines to implant more than one or two embryos in a woman under 35. Given our experience with the extraordinary high risk of multiple pregnancies for mothers and babies, those who endanger patients ought to lose their licenses.” Goodman also writes that the infants will need “at least $1 million in neonatal care and more if they have the typical range of disabilities for premature babies.” A “reproductive business that generates so much controversy has produced a remarkable consensus,” she says, concluding, “Infertility treatment for an unemployed, single mother of six? Eight embryos in one womb? There must be a proper word in the medical literature to describe this achievement. I think the word is ‘nuts'” (Goodman, Miami Herald, 2/6).

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Birth of first UK baby screened for genetic breast cancer

The first baby to be screened for alterations in the breast cancer-causing gene, BRCA1, was born last week. The child was at risk from inheriting the gene from her father, who has women in three generations of his family who have been diagnosed with breast caner in their twenties as a result of inheriting the defective gene.

breast_cancer22 Paul Serhal, the fertility expert who treated the couple at the Assisted Conception unit of University College Hospital, London, said: ‘This little girl will not face the spectre of developing this genetic form of breast cancer or ovarian cancer in her adult life. The parents will have been spared the risk of inflicting this disease on their daughter. The lasting legacy is the eradication of the transmission of this form of cancer that has blighted these families for generations.’

The BRCA1 gene, when properly functioning, can help prevent breast cancer, but abnormal variations can significantly increase the risk of developing breast cancer. Females born with the affected gene face a 50-80 per cent risk of contacting breast cancer and a 40-60 per cent chance of developing ovarian cancer.

In 2006 the UK’s Human Fertilisation and Embryology Authority (HFEA) permitted fertility clinics to perform pre-implantation genetic diagnosis (PGD) – a procedure whereby embryos are tested for various conditions, the healthy ones are re-implanted and those that are affected are discarded – to test for this type of gene that makes carriers susceptible to a disease but that does not necessarily lead to disease in all cases. BRCA1 and BRCA2 account for around five per cent of breast cancers and it is thought that roughly 37,000 women in the UK carry BRCA1.

pgd1The couple concerned, who wish to remain anonymous, underwent IVF despite being fertile. A single cell was removed from the 11 embryos created when they were at the eight-cell stage and tested for the defective BRCA1 gene, revealing that only five of the embryos were free from the gene. Two of these were implanted into the mother’s womb, of which one, a girl, pgd21 successfully implanted to develop until birth.  The remaining three healthy embryos were frozen in case the parents want more children in the future. The six embryos carrying the defective BRCA1 gene were discarded.

Given that the breast cancer is increasingly curable and that carriers of the gene do not necessarily develop the disease (and vice versa), questions have been raised over the ethics of the procedure. Josephine Quintavalle, of the campaign group Comment on Reproductive Ethics (Core), told the BBC that she believes the procedure is a step too far, as it gives the message that ‘you are better off dead, than being born with this gene’. She added: ‘I hope 20 years down the line we will have eradicated breast cancer – not eradicated the carriers’.

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Fate of surplus frozen embryos : a difficult decision

Many infertility patients with unused frozen embryos are dissatisfied with the common options offered to them, such as donating to another couple or discarding the embryos, according to a study to be published Thursday in Fertility and Sterility, the New York Times reports. It is estimated that more than 400,000 embryos are frozen at clinics across the U.S., and many infertility patients grapple with the decision of what to do with embryos after they no longer want additional children, the Times reports.

 picture-25The study, which was conducted by researchers at Duke University Medical Center, involved a survey of more than 1,000 infertility patients at nine clinics (Grady, New York Times, 12/4). The survey found that donating embryos for research was the most popular option (Rubin, USA Today, 12/4). Among study participants who said they did not want any more children, 66% said they would be likely to donate their embryos for research, but only four of the nine clinics in the survey offered the option. Fifty-three percent of participants who wanted no additional children said they did not want to donate their unused embryos to other couples, mainly because they did not want their biological offspring to be raised by other people or have to address the possibility that their own children could encounter an unknown sibling in the future. In addition, 43% did not want their embryos discarded, and 20% said that their embryos likely would remain frozen indefinitely. Embryos can remain viable for 10 years or more if properly stored, although not all of them survive after thawing, the Times reports. According to the Times, a small number of study participants “wished for solutions that typically are not offered,” such as holding a ceremony during the thawing and disposal of the embryos or placing the embryos in the woman’s body at a time during her cycle when she was unlikely to become pregnant, so that they would “die naturally” (New York Times, 12/4).

 Lead author Anne Drapkin Lyerly — a bioethicist and associate professor of obstetrics and gynecology at Duke University — said a significant factor impeding embryo donation for research is the Bush administration’s 2001 restrictions on federal funding for research on new embryonic stem cell lines (USA Today, 12/4). Brigid Hogan, chair of the department of cell biology at Duke, said there is insufficient funding to fully research existing embryonic stem cell lines, leaving minimal use for the hundreds of thousands of embryos available. Hogan said, “Even if somebody said, ‘I’ve got 100 embryos I’m donating tomorrow,’ I think there are many places that would just say, ‘We don’t have the funding'” (Collins, Raleigh News and Observer, 12/4). Sean Tipton — a spokesperson for the American Society of Reproductive Medicine, which publishes Fertility and Sterility — said researchers are reluctant to accept embryos donated from other medical centers because of concerns about violating informed consent procedures. Lyerly added that the process of shipping frozen embryos also presents a challenge (USA Today, 12/4).

 Lyerly said, “The national debate presumes that if you care about and respect a human embryo, you would want that embryo to have a chance at life.” She added, “What we found was that people cared very much about what happened to their embryos, but one of their significant concerns was that their embryos not become children in families other than their own” (Collins, Denver Post, 12/3). Mark Sauer, director of the Center for Women’s Reproductive Care at Columbia University Medical Center, said choosing what to do with the leftover embryos is a “huge issue” for couples, adding that some patients ask to be given their leftover embryos, while others pay storage fees for years and years. The Times reports that some patients stop paying for storage and “disappear, leaving the clinic to decide whether to maintain the embryos for free or to get rid of them.” Sauer said patients who do that “would rather have you pull the trigger on the embryos. It’s like, ‘I don’t want another baby, but I don’t have it in me; I have too much guilt to tell you what to do, to have them discarded.'”

 According to Lyerly, many patients create as many embryos as possible to increase their chances of having a child. She added that more information needs to be given to patients early in the in vitro fertilization process to inform them of their options for unused embryos and letting them know that deciding what to do “may be difficult in ways you don’t anticipate.” She said that discussion about the embryos should be “revisited and not happen just at the time of embryo freezing, because people’s goals and their way of thinking about embryos change as time passes and they go through infertility treatment” (New York Times, 12/4).

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America’s Funniest Surrogate Stories Contest Winner

The following was selected as the Winning Entries in America’s Funniest Surrogate Stories Contest: Grand Prize Winner:

“I’ll never forget our meeting in Virginia… My IM picked me up from the airport to take me for my sonogram and, after that, out to lunch at the local shopping mall. As we pulled into the parking lot, my IM realized that it was time for her Fertinex injection and being that I was an RN, I was elected to give her the shot. She also elected to do it right there in the parking lot!!! O.K… I’ll go along with this… I was nervously laughing about things… It was only the second time I had seen this girl face to face !! And here I was about to give her a shot in the thigh !!!!!

She was so organized, pulling out her ice water bag filled with injections and vials!!! We looked like a bunch of drug dealers in the parking lot dealing our stuff!!! Funny thing was that several mall employees were taking their smoke breaks while we had the car door open drawing up the meds. I was so nervous I couldn’t stop laughing. I was so worried that someone would think the worst!!!”

“Come on Deb, hurry it up !!!” I said. “Now slow down,” she said, “I have to draw up four vials’ worth and it takes time!!!! “Just stick your leg out and let’s get this over with, Deb !!!” She wanted everything to be perfect!!! I just knew we looked suspicious!!! I just knew the longer she took, the more trouble was headed our way !!!!!

She FINALLY let me give her the shot!!!!! Deb was such a PERFECTIONIST!!! I was the nurse and she was making me crazy!!!!!! Well, we were cleaning up our little mess in the car and getting ready to go into the mall for lunch and wouldn’t you know it!!! Mall security drives around the corner with flashing lights!!!! They were driving ever so slowly scouting out the parking lot!!!! I knew it … I just knew it !!!! All I could picture was trying to explain to the FAIRFAX POLICE that these were ONLY infertility drugs!!!!!! All I could think of was missing our transfer because we were locked up in jail for questioning!!! Was Deb worrried ??? OH NO !!!!

That’s Deb, cool as a cucumber, being dragged across the parking lot by her surrogate…. And all she could think about was the drop of Fertinex that leaked out of her injection site!!!!! We slipped away from mall security by the skin of our teeth that day… the closest thing I’ve ever been to being arrested in this lifetime…. and Deb ???? She still complains of MY injection techniques to this day !!!! I sure do love that girl !!!! God couldn’t have paired two funnier people together !!!!!

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Multiple joys: Three gynecologists — and moms — are personal experts on twins and triplets

Talk about multitasking. Of the eight female obstetrician-gynecologists who deliver babies at Sutter Roseville Medical Center in Roseville, California, three are the mothers of multiples.

 

Dr. Amy Riley’s triplets, Julia, Vivian and Alec are now four years old. Dr. Anna Almonte’s twin daughters, Katherine and Elizabeth, are 6. And Dr. Jackie Ho gave birth to the babies of the group – twins Marissa and Ellie Ow – on May 16.

Even more impressive, all three doctors have older children as well. Clearly, they’re well versed in the art of juggling the demands of home and family and a busy career.

 

“People will say, ‘I can’t imagine,’ ” Riley says. “But I can’t imagine anything else.”

For their patients, they set an encouraging example. Riley, Almonte and Ho understand the reassurance implicit in their care of nervous expectant mothers overwhelmed with the idea of carrying, delivering and raising multiples.

“I’m very encouraging about twins,” says Almonte, 37, who immigrated from Ukraine a dozen years ago. “I always say, ‘It’s double trouble, but it’s a double joy.’ “

 

According to Centers for Disease Control and Prevention statistics, the twin birth rate – more than 32 per 1,000 births – has increased 42 percent since 1990 and 70 percent since 1980, in large part the result of delayed childbearing. Beginning in their 30s, women are more likely to conceive twins naturally – and even more so when fertility treatments are involved.

 

In contrast, the birth rate for triplets and other multiples has declined slightly in recent years, the CDC says, following American Society of Reproductive Medicine recommendations limiting the number of embryos transferred during fertility procedures.

 

“When I was pregnant with my twins, I had four other couples at the same time in my practice carrying twins,” says Ho, 39, herself a twin. See? Twins, once a relative rarity, seem like they’re everywhere these days. Scratch the surface of most elementary schools and you’ll find a few sets of multiples.

 

And as Cindy Camarena, president of a California Moms of Multiples club, likes to say, when people see twins, they smile. Something about doubled- and even tripled-up siblings, whether identical or fraternal, still delights us.

 

For the record, Ho and Almonte both conceived their twin daughters the old-fashioned way, without the assistance of reproductive technology. “It was nothing but nature,” says Almonte.

 

On the other hand, when Riley and her husband, Damon, decided it was time to expand their family beyond their first daughter, Brenna, now 10, they struggled for several years. “Then one cycle with in-vitro fertilization, and there were three more kids,” says Amy Riley, who lives in Roseville. “It was like winning the lottery after four years of infertility.”

 

Carrying multiple babies comes with multiple risks, including preterm labor and toxemia. As expectant ob-gyns, the doctors knew more about those risks than most pregnant women.

 

“I think knowledge is always good,” says Ho, whose oldest daughter, Caroline, is 8. “When I found out I was having twins, I was very happy but at the same time worried about potential complications. “I was as excited as I could be, but I thought, ‘Am I going to end up having a C-section? Am I going to be able to take them home with me from the hospital, or will I have to leave them in the (neonatal intensive care unit)?’ “The extra knowledge caused extra concerns. But I also knew what to watch out for.”

 

And what do the twins and triplets watch out for? Often as not, each other.

“When there are three,” says Riley, “they learn to be more patient than other kids are. They all yell, ‘Mom,’ at the same time, but there’s only one mom. So they help each other out. And they’re very good at sharing.” “You teach your kids to be independent,” Almonte says. “They entertain each other.” Riley nods. “We had to constantly entertain our older daughter,” she says. “But these guys entertain each other.”

 

Meanwhile, Ho and her husband, Dr. Randy Ow, an ear, nose and throat specialist, make a point of devoting one night each week to their oldest daughter so she won’t feel overlooked in their newly twin-centered Roseville, Calif., household. “Life is good,” Ho says. “I have a very understanding husband. I’m still trying to be there as much as I can for my patients. When I leave work, I’m 100 percent with my kids. They keep us very busy, nonstop.

“We’re so happy with them.”

 

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Couple Celebrate Their Miracle Baby

A mother has become the first in Britain to have a successful pregnancy after receiving a double organ transplant.

Emma Smith, 37, from Little Wymondley gave birth to healthy 6lb baby Oliver at the end of last month despite having a donor pancreas and kidney. 

It is extremely rare because anti-rejection drugs, which must be taken for life, can cause infertility or complications during pregnancy. 

Ms Smith, who lives with her boyfriend Steve, said: “After my transplants I did wonder if I would ever be able to have kids. When I found out it was a complete surprise. The suppressants lower fertility and it is very rare to get pregnant and to go on to have a birth without complications. 

“They didn’t have any data about being pregnant on the drugs I was on, but they didn’t want to take the risk of changing them and damaging my organs so they kept me on the same drugs and monitored me very carefully. 

“I’m thinking of having another baby now. This one has gone so well, I’m quite reassured about it. 

“I hope it shows other people who have had a transplant that they can have children – if it gives them hope then that’s great.” 

Emma was diagnosed with type 1 diabetes when she was 11 and had to have daily injections of insulin. Because of the disease her organs deteriorated until it was necessary to have the transplants five years ago. 

She gave birth at St Mary’s Hospital, London, under the care of leading surgeon Professor Nadey Hakim. 

Prof Hakim said: “It’s special because the fact of having had a transplant you need to be on anti-rejection therapy. Any medication could be detrimental to the foetus and these are very potent drugs. 

“With this little small baby we had to be very careful to have just enough medication on board so the baby doesn’t get damaged. 

“It should encourage patients who’ve had transplants to have a normal life – people will not say ‘I’ve had a transplant I can’t get pregnant’.

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