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

VOTE

It was inevitable that the trainwreck that is "octomom" Nadya Suleman would spur calls to regulate reproductive technology — and offer plenty of chances for politicians to grandstand on a headine-grabbing issue.

Georgia state Sen. Ralph Hudgens (R-Of Course) was one of the first to get in on the action, introducing legislation to create limits on the number of embryos that can be transferred to two for a woman under 40 and three for a woman over 40. The across-the-board cap has been widely criticized by infertility specialists, who argue that decisions on how many embryos to transfer must be made on an invidual basis that considers the quality of the embryos, the mother's health and specific fertility problems, and other issues.

But Hudgens' SB 169, which faced a committee hearing this morning, would go much further than simply attempting to keep possibly unstable, unemployed women with six children from having eight more at the same time while living on the public dole. ...

First, the bill would eliminate all forms of payment for gamete (i.e. egg and sperm) donation. No payment for anonymous egg and sperm donors means drastically fewer anonymous donors. Many lesbians use anonymous sperm donors, and many gay men use anonymous egg donors and a surrogate, not only because they may not have someone in their lives to ask to donate, but also because those donors automatically give up parental rights to any children born as a result of their donation.

Using gametes donated by known donors would mean many lesbian and gay parents would have to then ask a court to sever the donor's parental rights — cumbersome and costly for prospective parents who already have to pay out of pocket for either insemination or in vitro fertilization, since these procedures are not covered by health insurance.

But added costs and more difficulty finding donors may be the least of the concerns of lesbian and gay parents should Hudgens' bill pass. Note this important section: "The creation of an in vitro human embryo shall be solely for the purpose of initiating a human pregnancy by means of transfer to the uterus of a human female for the treatment of human infertility." [emphasis added]

Ostensibly this section would forbid the creation of embryos for cloning or stem cell research. But who gets to decide what constitutes "human infertility"? Is the mere absence of having a partner with whom you want or are able to create an embryo enough?

Labels: donor conception, fertility treatment

" target="display" style="text-decoration:none;color: rgb(204,0,0);">

" target="display" style="text-decoration:none;color: rgb(204,0,0);">

VOTE

...To that mix, here's one that's equally controversial: Is it time for federal and state governments to consider legal rules and boundaries for the fertility industry? A new research-based report by the Evan B. Donaldson Adoption Institute, "Old Lessons for a New World," suggests that the answer may finally be "yes."

The report points out that adoption and assisted reproductive technology have much in common as "nontraditional" means of forming families, and that adoption's far-longer history of research, experience and evidence-informed policies therefore could help to improve practices in the world of assisted reproduction.

The report's recommendations include such applicable adoption issues as the problematic effects of secrecy, the need for a child-centered focus and the impact of market forces. Most pointedly, the Donaldson Institute suggests that the legal and regulatory framework for adoption provides a model that assisted reproductive technology could utilize. Thoughtful guidelines on a broad range of activities in assisted reproductive technology - how many embryos should be implanted, how much egg donors should be paid, etc. - already have been promulgated, and there is every reason to believe most clinics try to adhere to these identified "best practices." ...

The organizations working to promote good practices deserve credit for their efforts and their successes. But their guidelines are not mandatory, and as the evidence before our eyes clearly shows, not everyone in any industry - including adoption - follows voluntary standards.

Labels: adoption, donor conception, fertility treatment

VOTE

Just about the time that eight babies began growing inside a California woman's womb, some nationwide policies about fertility treatment were being codified. In June, the American Society for Reproductive Medicine (ASRM) issued updated "Guidelines on Number of Embryos Transferred." Women under age 35 — the octuplets' mom is reportedly 33 — should attempt to transfer no more than two, and preferably only one, fertilized embryo at a time. Women over age 40 should attempt no more than five. (See pictures of multiple births.)

How the California woman, apparently a single mother who already has six young children, including a set of twins, got pregnant is the subject of rampant speculation. But regardless of whether the octuplets are the result of in vitro fertilization (IVF) or fertility drugs — the latter has historically been available on the cheap in Mexico — there is little doubt that from a medical and ethical perspective, something went very wrong. And fertility specialists now find themselves on the defensive, trying to fend off the perception that theirs is an undisciplined, irresponsible profession. ...

Physicians may advise a patient to transfer only one or two embryos, but the patient may insist on double the number — or more. "Doctors' attorneys are advising them, 'You have to do it,' " says Sean Tipton, spokesman for the ASRM. "The courts have made clear that decisions about what to do with embryos are in the hands of patients, not in the hands of physicians."

A doctor, after all, is not the same as a judge.

If women who already have a bunch of kids were to approach Stillman for help conceiving more, he says he'd be obligated to help. "As a parent of two kids, I may think they're crazy, but I'd tell them what I always tell patients: our goal here is as many children as you want, but preferably one at a time."

Labels: donor conception, fertility treatment, medical ethics

VOTE