More research is needed into a controversial fertility treatment, known as three-parent IVF, before it can be considered safe for clinical use, a review has concluded.

Mitochondrial transfer aims to replace a faulty part of a mother's egg with healthy material from a donor.

This means a baby would have a small amount of the donor's genetic material, and therefore three biological parents.

The Human Fertilisation and Embryology Authority (HFEA) carried out the study.

The HFEA is the UK's independent fertility treatment regulator and its conclusions are published in a scientific review of the technique commissioned by the Department for Health.

Inherited disorders

The proposed treatment is designed to help families with rare inherited disorders.

These disorders are due to faulty energy-generating components of cells called mitochondria. Mothers carrying these faulty mitochondria in their eggs are at risk of having children with the inherited disorder.

Under the transfer treatment, the idea is to replace the faulty mitochondria in the eggs or fertilised embryos with those from eggs or early embryos from a healthy, unaffected donor.

The hope is these methods will enable couples to have healthy children and eliminate the disease for subsequent generations, but the technique is controversial because mitochondria carry their own genetic material (DNA).

Labels: abortion, Artificial Reproductive Technology, IVF, more than two parents

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The Michigan Court of Appeals has released for publication its September opinion in Moon v. Michigan Reproductive and IVF Center [pdf]. In that case, Allison Moon sued a fertility clinic because it would not provide services to her as a single woman. Reversing the trial court, the Court of Appeals ruled that the clinic was subject to the state's anti-discrimination law and could not avoid litigation on the basis of a doctor's alleged right to choose his patients. ...

A place of public accommodation includes a "health facility" whose services are "available to the public." Such a facility cannot discriminate on the basis of marital status.

The defendant did not dispute that it was a public accommodation, but it did argue that the law requires a doctor-patient relationship to be consensual and that therefore the doctor could decline to treat anyone. The court ruled that the doctor can decline to treat a patient, but not on one of the grounds identified in the anti-discrimination statute. "A contrary interpretation," the court held, "would allow a doctor to follow his personal prejudices or biases and deny treatment to a patient merely because he is African-American, Jewish, or Italian."

Labels: Artificial Reproductive Technology, discrimination law, IVF, single parenting

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Here’s a telling passage from this Sunday’s Times Magazine story on “selective reduction” — the increasingly commonplace practice whereby twin pregnancies are “reduced” to single babies via abortion:

Dr. Mark Evans, an obstetrician and geneticist, was among the first to reduce a pregnancy. He quickly became one of the procedure’s most visible and busiest practitioners, as well as one of the most prolific authors on the topic. Early on, Evans decided the industry needed guidelines, and in 1988, he and an ethicist with the National Institutes of Health issued them. One of their central tenets was that most reductions below twins violated ethical principles.

Two years later, as demand for twin reductions climbed, Evans published another journal article, arguing that reduction to singletons “crosses the line between doing a procedure for a medical indication versus one for a social indication.” He urged his colleagues to resist becoming “technicians to our patients’ desires.”

But of course, 20 years later …

In 2004, however, Evans publicly reversed his stance, announcing in a major obstetrics journal that he now endorsed twin reductions. For one thing, as more women in their 40s and 50s became pregnant (often thanks to donor eggs), they pushed for two-to-one reductions for social reasons. Evans understood why these women didn’t want to be in their 60s worrying about two tempestuous teenagers or two college-tuition bills. He noted that many of the women were in second marriages, and while they wanted to create a child with their new spouse, they did not want two, especially if they had children from a previous marriage. Others had deferred child rearing for careers or education, or were single women tired of waiting for the right partner. Whatever the particulars, these patients concluded that they lacked the resources to deal with the chaos, stereophonic screaming and exhaustion of raising twins.

...

The liberal camp includes many thinkers I admire, and it has produced some of the more eloquent reflections on biotechnology’s implications for human affairs. But at least in the United States, the liberal effort to (as the Goodman of 1980 put it) “monitor” and “debate” and “control” the development of reproductive technologies has been extraordinarily ineffectual. From embryo experimentation to selective reduction to the eugenic uses of abortion, liberals always promise to draw lines and then never actually manage to draw them. Like Dr. Evans, they find reasons to embrace each new technological leap while promising to resist the next one — and then time passes, science marches on, and they find reasons why the next moral compromise, too, must be accepted for the greater good, or at least tolerated in the name of privacy and choice. You can always count on them to worry, often perceptively, about hypothetical evils, potential slips down the bioethical slope. But they’re either ineffectual or accommodating once an evil actually arrives. Tomorrow, they always say — tomorrow, we’ll draw the line. But tomorrow never comes.

Labels: abortion, Artificial Reproductive Technology, bioethics

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The New York Times Magazine explores the "stigma" (undeserved? archaic? regrettable?) surrounding the emerging trend of eliminating one fetus when IVF results in twins. This is a very sad paragraph, among many:

Jenny’s decision to reduce twins to a single fetus was never really in doubt. The idea of managing two infants at this point in her life terrified her. She and her husband already had grade-school-age children, and she took pride in being a good mother. She felt that twins would soak up everything she had to give, leaving nothing for her older children. Even the twins would be robbed, because, at best, she could give each one only half of her attention and, she feared, only half of her love. Jenny desperately wanted another child, but not at the risk of becoming a second-rate parent. “This is bad, but it’s not anywhere as bad as neglecting your child or not giving everything you can to the children you have,” she told me, referring to the reduction.

I don't mean to minimize the hardship that can accompany multiple births, but this excerpt reflects an unfortunate (though increasingly common) view of parental love: a limited commodity that, when extended to one child, necessarily reduces its availability to another child. Not to mention the underlying premise that non-existence is preferable to existence in a household with "too many" kids.

Labels: abortion, Artificial Reproductive Technology, culture, family size, IVF, motherhood, parenting

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...When it is complete you screw on the forest-green lid, write your name and your wife’s name on the label, put it all in a biohazard bag, and ring the buzzer. Along comes a woman, another nurse. She takes the bag and holds it up to the light. If you read the paperwork there is a request that you don’t make any jokes during this moment.

The worst thing that can happen in that room is “failure to produce.” They warn you about it. Men go in and hours later have not come out. They’re sobbing and their arms are sore. Their wives or partners are out in the waiting room, surly from hormone treatments. No one has sympathy for a man who can’t produce. They should have sympathy but they don’t. You do not want to be that guy. And so far I have not failed. Just in case, I have special videos on my phone.

The nurse will take the biohazard bag to a room filled with machines. They will run the sample through a centrifuge. I will join my wife, who is filled with chemicals that encourage ovulation, in a treatment room. A doctor will use a plastic syringe to inject my purified and enhanced semen into my wife. Then we will wait.

Three years of waiting. Everywhere around us there are waves of bouncing sons, bounties of daughters, stroller wheels creaking under the cheerful load. Facebook updates, email messages, and Christmas cards arrive with pictures of tots, their faces smeared with avocado or cake frosting. Babies on rugs, babies in hats. Invitations to baby showers with cursive script and cartoon storks. Over a beer an expectant father—another expectant father—gives me the news, tells me that his wife will soon have her second or third. Am I happy for him? What else can I be? Once again I put out my hand, close my eyes, and wish them joy.

Every day at least once our cat Desdemona, a pretty green-eyed cat, carries a pair of clean socks in her mouth as if the pair of socks was a kitten. Then she drops them to the floor and yowls in anguish, as if she is dying. She looks at me and yowls some more. I go to her and stroke her ears and say, “I know, sweetie.” Sometimes we come home and find three or four pairs, three or four sock babies, scattered around the house.

Labels: Artificial Reproductive Technology, culture, infertility, IVF

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In October 2007 a son was born to Yigal Amir, the assassin of Yitzhak Rabin, and Larisa Trembovler, the divorcée and mother of four whom he had married by proxy while behind bars. The birth followed a series of controversial conjugal visits at the Ayalon Prison, where Amir was then incarcerated. These were in turn preceded by a lengthy court battle involving, at various times, the Israel Prison Service, the internal security service known as Shin Bet, various members of the Knesset, and the Amirs. ...

In the end, the Israeli Supreme Court ruled for Amir, determining that, like all prisoners, he was entitled to certain basic human rights, including the right to bring children into the world and to have a family. ...

In the pre-state period of the Yishuv, or Jewish community in British Mandatory Palestine, a Committee on Birthrate Problems was attached to the National Committee. It called upon David Ben-Gurion, later Israel’s first prime minister, to use both his moral and financial influence to increase the Jewish birthrate. It also asked for the establishment of a “childbirth regime” as “a cornerstone of our Zionist policy and as one of the main functions of our social and local offices; not less important than recruitment to the army, spreading the Hebrew language, purchasing land or maintaining the right for immigration.”

After the establishment of the state in May 1948, in an attempt to encourage an increase in the birth rate, Ben-Gurion introduced a birth prize awarding 100 lira, then the Israeli currency, and a signed letter to every woman on the birth of her 10th child. Though the amount itself was largely symbolic, the program received significant media attention and even became the subject of a popular dictum: “In honor of the motherland/ Ten boys to be born/ With grandeur we receive/ Ben-Gurion’s prize.”

In 1967 the Israeli demographic center was established to act systematically to realize a state policy directed at raising the Jewish birth rate. In 1968 the Fund for Encouraging Fertility was set up to offer subsidized housing loans for families with three or more children and in which one member had served in the Israel Defense Forces. The 1970 Veteran’s Child Allowance Scheme similarly provided child allowances to large families in which at least one member had served in the IDF or another national security service. Given that Jews are required to do military service—and Arabs exempt from it— some have argued these policies had a de facto discriminatory effect, supporting and encouraging an increase in specifically Jewish fertility.

Today, there are more fertility clinics per capita in Israel than in any other country in the world. Every Israeli, regardless of religion or marital status, is entitled to unlimited rounds of in-vitro fertilization treatment free of charge up to the birth of two live children (or even three, under some health insurance policies). In 1996 Israel passed the Embryo Carrying Agreements Law, making Israel the first country in the world to legalize surrogate mother agreements. According to a 2006 paper prepared for the Knesset, 1,800 IVF treatment cycles are performed each year per million people in Israel, compared to 240 in the United States. A 2010 article in Haaretz stated that Israel performs the highest ratio of fertility treatments among developed Western nations.

Labels: abortion, Artificial Reproductive Technology, contraception, demographics, Israel, IVF, natalism

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Roger Abdelmassih is on the run from police after being convicted of sexually assaulting or raping 39 female patients at his clinic.

New evidence gathered by police and public prosecutors suggests that many of the 8,000 babies born after IVF treatment by him and his team may not be the biological children of the couples raising them. There is no suggestion this is the case with Pele.

Labels: Artificial Reproductive Technology, biological parenthood, Brazil, IVF, parenting

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What’s the News: Babies with three parents and fewer genetic diseases might soon be possible: A UK national health panel has found that techniques for swapping chromosomes between eggs so offspring don’t inherit disease-causing mutations from their mother’s mitochondria are not dangerous. The techniques, which have been tested in mice, monkeys, and human cells, still need to be studied more before making the transfer to the clinic, though, and as with all genetic engineering techniques, there’s a complex ethical maze ahead of researchers.

What’s the Context:

In addition to the DNA you inherit from your mother and father’s egg and sperm, you also inherit a small amount of DNA that’s contained in the mitochondria of the egg. Mitochondria are cellular structures that produce energy for the cell, thought to be descended from bacteria that moved into cells millions of years ago, and have their own mini-genome. The mitochondria in sperm are destroyed during reproduction, so the only ones you inherit are your mother’s.

One child in 6,500 develops a disease linked to mutations in mitochondria, including type 2 diabetes, deafness, blindness, and neurological problems; as many as 1 in 250 people carry mutations that might cause disease when passed on.

Transferring chromosomes (genetic structures found in the nucleus) from one cell to another is old hat in biology, so it makes sense that researchers would try the same trick to avoid diseases that come from DNA mutations in mitochondria (which are outside the nucleus). If chromosomes removed from an egg carrying mitochondrial mutations are inserted in a healthy egg whose own chromosomes have been discarded, the mitochondria are left behind, and the offspring don’t have the disease. The offspring instead inherits the mitochondrial DNA of the donor egg—hence the “three parent” idea.

Labels: abortion, Artificial Reproductive Technology, donor conception, more than two parents, reproduction

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ALMOST 500 single women and lesbians have used IVF and other fertility treatments in the past year in Victoria.

Taxpayers are subsidising the women who plan to raise children without biological dads, the Herald Sun reported.

The law was changed in January 2010 to allow Medicare rebates for women who are not infertile to access assisted reproduction.

IVF clinics are reporting a significant number of women accessing their services for the first time in Victoria. ...

Dr McBain said donors had no obligations, no responsibility and no rights - but once a child turns 18 he or she has access to identifying information about their donor.

Melbourne IVF has just launched a new online campaign to attract more sperm donors.

Labels: Artificial Reproductive Technology, Australia, donor conception, Fathers, gay parenting, IVF, motherhood, single parenting

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Ryleigh Shepherd was conceived in 1998, the same year as her 11-year-old twin sisters, but she wasn't born until 2010.

The three girls from Walsall, in Great Britain, who were born more than a decade apart in two different centuries, are actually fraternal triplets born through in vitro fertilization (IVF).

Ryleigh came from the same batch of embryos that had allowed her parents -- Lisa and Adrian Shepherd -- to give birth to twins Megan and Bethany.

British experts say they know of no other case in their country in which three siblings from the same round of fertility treatment have been born with such an age gap.

The longest interval between freezing and conception was in the case of a woman from New York City whose embryo had been stored for 20 years, according to a report in the journal Fertility and Sterility.

"It seemed strange to think that we were using embryos that we had stored all those years ago, that were conceived at the same time as the girls," Lisa Shepherd, 37, told Britain's Daily Mail newspaper.

"We knew that if we had another baby it would in effect be the girls' triplet as they were all conceived at the same time," she said. The girls look exactly alike, according to their mother. "It was uncanny."

Labels: Artificial Reproductive Technology, IVF, siblings, United Kingdom

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...Rare it isn’t: not when one in five pregnancies ends at the abortion clinic. So it was a victory for realism, at least, when MTV decided to supplement its hit reality shows “16 and Pregnant” and “Teen Mom” with last week’s special, “No Easy Decision,” which followed Markai Durham, a teen mother who got pregnant a second time and chose abortion.

MTV being MTV, the special’s attitude was resolutely pro-choice. But it was a heartbreaking spectacle, whatever your perspective. Durham and her boyfriend are the kind of young people our culture sets adrift — working-class and undereducated, with weak support networks, few authority figures, and no script for sexual maturity beyond the easily neglected admonition to always use a condom. Their televised agony was a case study in how abortion can simultaneously seem like a moral wrong and the only possible solution — because it promised to keep them out of poverty, and to let them give their first daughter opportunities they never had.

The show was particularly wrenching, though, when juxtaposed with two recent dispatches from the world of midlife, upper-middle-class infertility. Last month there was Vanessa Grigoriadis’s provocative New York Magazine story “Waking Up From the Pill,” which suggested that a lifetime on chemical birth control has encouraged women “to forget about the biological realities of being female ... inadvertently, indirectly, infertility has become the Pill’s primary side effect.” Then on Sunday, The Times Magazine provided a more intimate look at the same issue, in which a midlife parent, the journalist Melanie Thernstrom, chronicled what it took to bring her children into the world: six failed in vitro cycles, an egg donor and two surrogate mothers, and an untold fortune in expenses.

In every era, there’s been a tragic contrast between the burden of unwanted pregnancies and the burden of infertility. But this gap used to be bridged by adoption far more frequently than it is today. Prior to 1973, 20 percent of births to white, unmarried women (and 9 percent of unwed births over all) led to an adoption. Today, just 1 percent of babies born to unwed mothers are adopted, and would-be adoptive parents face a waiting list that has lengthened beyond reason. ...

This is the paradox of America’s unborn. No life is so desperately sought after, so hungrily desired, so carefully nurtured. And yet no life is so legally unprotected, and so frequently destroyed.

Labels: abortion, adoption, Artificial Reproductive Technology, class, contraception, culture, donor conception, infertility, out-of-wedlock births, premarital sex, Ross Douthat

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The risk of pregnant women dying after IVF treatment is more than three times higher than women who conceive naturally, according to a recent study conducted in the Netherlands.

The researchers are calling for improvements surrounding IVF in tracking pregnancies and reporting deaths.

Didi Braat, professor of obstetrics at Radboud University in Nijmegen, who led the research said: ‘Women should be counselled and made aware of the risks they are taking and deaths should be properly reported.’

Braat studied deaths between 1984 and 2008 for the research, identifying that 17 women who had died in pregnancy had undergone IVF treatment, forming a death rate of 42.5% for every 100,000 pregnancies, compared with 12.1 in every 100,000 for women who had conceived naturally. ...

But it is not just the mothers that are putting their health at risk. Swedish researchers have revealed an increased risk of cancer in IVF children. The study showed that out of 26,000 children born through IVF, 53 developed cancer in comparison to an estimated 38 cases in a similar group of naturally conceived children.

Finnish studies also suggest babies born through IVF have a raised risk of prematurity and low birth weight.

Labels: Artificial Reproductive Technology

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A woman who sought help from a prominent Connecticut fertility center last year received embryos, but they belonged to another woman with the same last name.

The mistake happened in April 2009 at the Center for Advanced Reproductive Services at the University of Connecticut Health Center, which will pay a $3,000 fine. ...

That patient who received the embryos was informed of the error within an hour and decided to take the “morning after” pill to prevent the pregnancy, according to state records.

Labels: Artificial Reproductive Technology

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Political consensus in Denmark has resulted in an amendment to legislation governing IVF (in vitro fertilisation) funding. According to the European Society of Human Reproduction and Embryology (ESHRE), free public health services will no longer extend towards assisted reproduction treatments (ART).

Currently, 2,558 cycles of IVF treatment per million people per year are performed in Denmark, the highest level of ART in Europe. By 2007, almost five per cent of all children conceived in Denmark were the result of ART. Dr Søren Ziebe, from the University Hospital, Copenhagen, estimated that on average, each school class had two children born as a result of IVF treatment.

Labels: Artificial Reproductive Technology, Denmark

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KEY POINTS

■ Although clinicians are ethically required to treat all patients in need of medical attention, many providers already impose medical restrictions on access to infertility treatments. Some providers feel that their obligation ends at assessing medical fitness. Others, while acknowledging their responsibility to assess parental fitness, feel ill-prepared to do so.


■ Recommendations from the American Society of Reproductive Medicine (ASRM) include withholding services if there is evidence that the patients are unable to provide adequate care of the child. The ASRM further recommends that assessments of the evidence be made jointly by members of the fertility program involved and that the basis for making these determinations be set down in writing.


■ Current recommendations conclude that fertility services should not be denied to unmarried or homosexual persons or to those infected with HIV. Nevertheless, most fertility clinics are private organizations that can restrict access to services based on their own criteria. Approximately 97% of registered fertility clinics do not offer services to HIV-infected patients.


■ Perhaps the best approach is for each provider to decide on a case-by-case basis before offering infertility treatment which patients he or she considers good candidates and which patients should undergo more intensive psychological testing, counseling, or evaluation.


Labels: Artificial Reproductive Technology, culture, fertility treatment, parenting

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Couples will stop having sex to conceive babies within a decade and use IVF instead, scientists said yesterday.

They say 30-somethings will increasingly rely on artificial methods of fertilisation because natural human reproduction is 'fairly inefficient'.

It means that in future, sex will be nothing more than a leisure activity - the latest blow to the Christian idea that the role of sex is to produce children. ...

The startling vision of the future comes from John Yovich, a veterinary doctor from Murdoch University in Perth, Australia.

He believes IVF can ease the pressure on couples who have delayed having children to pursue a career, because going for the test-tube option will be more effective than trying for a baby naturally.

Labels: Artificial Reproductive Technology, culture

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Errors at fertility clinics almost doubled in 12 months, it was reported today. The number of mistakes at IVF centres in England and Wales rose from 182 in 2007/8 to 334 in 2008/9. Blunders included embryos being lost or implanted in the wrong woman, and eggs being fertilised with the wrong man's sperm.

The figures from the Human Fertilisation and Embryology Authority (HFEA), the IVF regulatory body, were obtained by BBC Radio Five Live's Donal MacIntyre show. The HFEA said the errors represented less than 1% of more than 50,000 IVF cycles.

Labels: Artificial Reproductive Technology, donor conception, United Kingdom

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A fertility clinic is raffling a human egg in London to promote its new “baby profiling” service, which circumvents British IVF (in vitro fertilisation) laws.

The winner will be able to pick the egg donor by racial background, upbringing and education. Payment for profit is illegal in Britain, but the £13,000 of free IVF treatment will be provided in America.

The raffle, to be held on Wednesday, is to promote a tie-up between the Bridge Centre, a fertility clinic in London, and the Genetics and IVF Institute (GIVF) in Fairfax, Virginia. ...

In Britain, donors have to agree to be identified and contacted by any resulting offspring when they reach the age of 18.

Payments are restricted to a maximum fee of £250 for expenses, and as a result donors are in extremely short supply.

One of the first Britons to use the US service is Celia, a 38-year-old married businesswoman from the Midlands, who received two donor eggs in America at Christmas. Last week the prospective mother underwent a three-month scan that confirmed the twin pregnancy, which has cost her a total of £13,000, is progressing normally.

Her donor was a 27-year-old, whose eggs have produced four babies and three pregnancies, including Celia’s twins.

“I wanted someone who looked a bit like me as an adult, but the main consideration was the quality of her eggs,” said Celia. “This woman produces 30 at a time, and they were split between me and another woman, otherwise the cost of donation would have been double the £9,000 we actually paid.”

“I don’t want anyone to know these babies are not mine. Not my family or any of my friends. We don’t intend to tell the children, either.”

Labels: Artificial Reproductive Technology, culture, donor conception, United Kingdom, Virginia

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"Be fruitful and multiply," God instructed Adam and Eve, and men and women have heeded those words ever since. But over the years, God's creatures have become sophisticated enough to rewrite the rules of being fruitful, and most of the new rules don't sit well with leaders of the Roman Catholic Church. ...

The bishops are sympathetic. When Rigali was archbishop of St. Louis, he celebrated a Mass for infertile couples, and the current St. Louis archbishop, Robert Carlson, did the same recently. But many Catholic couples suffering through the heartache of infertility think that the church contributes to their pain by erecting roadblocks to medically assisted pregnancy.

At the meeting in Baltimore, the bishops approved a document on reproductive medical advances, "Life-giving Love in an Age of Technology." The document says: "The church has compassion for couples suffering from infertility and wants to be of real help to them. At the same time, some 'reproductive technologies' are not morally legitimate ways to solve those problems."

Church teaching says technology used to facilitate or support marital conjugation and conception is fine, but any other technology is not. Church teaching allows tests and treatment for low sperm count or problems with ovulation. But artificial insemination, even using the husband's sperm, is prohibited.

"Children have a right to be conceived by the act that expresses and embodies their parents' self-giving love," the U.S. bishops say. "Morally responsible medicine can assist this act but should never substitute for it."

According to a 2002 study by the Centers for Disease Control and Prevention, 7.4 percent of married women of childbearing age were infertile. About 1 percent had tried artificial insemination as a means of becoming pregnant; about four times as many had tried ovulation drugs. According to the American Society for Reproductive Medicine, 85 to 90 percent of infertility cases are treated with drug therapy or surgical procedures; less than 3 percent required assisted reproductive technologies.

Labels: Artificial Reproductive Technology, Catholic Church, culture, infertility, religion

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...Researchers at the Oregon National Primate Research Center were looking for ways to eliminate diseases that can be inherited through maternal DNA. They developed, as the magazine Nature reported last summer, a kind of swap in which defective DNA from the egg is removed and replaced with genetic material from another female’s egg. The researchers say the procedure is also likely to work on humans.

The result would be a baby with three biological parents — or “fractional parents,” as Adam Kolber, a professor at the University of San Diego School of Law, calls them.

He mentioned the idea over lunch at The Times, and it provided plenty of grist for debate among law junkies: Could a baby one day have 100 parents? Could anyone who contributes DNA claim visitation rights? How much DNA is enough? Can a child born outside the United States to foreigners who have DNA from an American citizen claim U.S. citizenship? ...

Since the 1960s, there has been a shift toward recognizing people’s intent in creating familial relationships, as reflected in the rise of no-fault divorce, prenuptial agreements and civil unions. But when it comes to deciding parenthood, courts remain deeply influenced by biology, even when it clashes with intent.

This concern is playing out now in A.G.R. v. D.R.H. & S.H., the biggest surrogacy case in New Jersey since Baby M’s. A woman served as a surrogate for her brother and his male spouse, giving birth to twins conceived with the spouse’s sperm and donor eggs. She signed a contract agreeing that her brother would adopt the children, but the trial court, saying it was following the Baby M decision, ruled that the spouse and the surrogate mother are the legal parents. The surrogate’s brother was given no parental rights.

Labels: Artificial Reproductive Technology, parenting, surrogate motherhood

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