Surrogacy law in Italy (moderated by subsequent court decisions)

The Italian law governing reproductive technology and surrogacy dates from 2004, but (although I don't think the law has been amended), some of the things it forbids have been modified by subsequent court decisions.

"This law prohibits research and reproductive cloning, the manipulation of embryos, the use of donated eggs or sperm for ART, and the cryopreservation of embryos (with the exception of severe injury/illness preventing embryo transfer). A maximum of three eggs can be fertilized and transferred per reproductive cycle. Sex-selection is only permitted through sperm sorting for sex-lined genetic diseases. All forms of surrogacy are prohibited. The use of preimplantation genetic diagnosis for the selection of embryos is generally prohibited, but has been allowed through the courts on a case-by case basis. Genetic testing for non-medical purposes is prohibited. The use of ART is restricted to stable heterosexual couples who live together, are of reproductive age, are over the age of 18, have documented infertility, and have been first provided the opportunity for adoption.”
(From G12 Country Regulations of Assisted Reproductive Technologies)

Surrogacy and citizenship: bringing the babies home isn't always so easy

Even the U.S., which is a center of surrogacy, employs outdated rules to determine which surrogate children born overseas are automatically American citizens.  Here's a story from the NY Times which (among other things) involves reverse fertility tourism. The American male couple had a friend in Britain serve as the surrogate. (Mostly the tourism goes the other way, because British surrogates can't be paid, so they aren't easy to arrange....)

Both Parents Are American. The U.S. Says Their Baby Isn’t. By Sarah Mervosh.

"James Derek Mize is an American citizen, born and raised in the United States. His husband, who was born in Britain to an American mother, is a United States citizen, too.

"But the couple’s infant daughter isn’t, according to the State Department.

"She was born abroad to a surrogate, using a donor egg and sperm from her British-born father. Those distinct circumstances mean that, under a decades-old policy, she did not qualify for citizenship at birth, even though both her parents are American.
...
"The interpretation [of the law] has led the State Department to regard births from assisted reproductive technology as “out of wedlock,” if the source of the sperm and the egg do not match married parents. Such a designation comes with extra requirements for transmitting citizenship, including showing that a biological parent is an American citizen who has spent at least five years in the United States."

California surrogacy

Surrogacy serves all sorts of people, mostly couples who don't have a working womb between them. But, as Jenny Kleeman reports in the Guardian, it also can serve those whose need isn't medical. She interviews the controversial fertility doctor Vicken Sahakian, who is  known among other things for having helped a Spanish woman become the oldest known person to give birth, at 67.  Here's a link with some excerpts from the excellent, long article (read it all for more about the clients and the surrogates).

'Having a child doesn’t fit into these women's schedule': is this the future of surrogacy? 

"His clients are straight, gay, young and old, and they come to him from across the globe, particularly from China, or parts of Europe where surrogacy is either illegal or very tightly regulated. In the UK, surrogacy is legal, but surrogates can claim only expenses for carrying a child for another person. California law allows surrogates to earn a profit, and upholds the rights of intended parents over anyone else who is involved in the creation of their babies. It’s given the state a reputation as the most surrogacy-friendly place in the world.
...
"And as the range of fertility options open to clients has diversified, so have their requests. Now, a growing number of women are coming to Sahakian for “social” surrogacy: they want to have babies that are biologically their own, but don’t want to carry them. There is no medical reason for them to use a surrogate; they just choose not to be pregnant, so they conceive babies through IVF and then hire another woman to gestate and give birth to their baby. It is the ultimate in outsourced labour.
...
"Five years ago, Sahakian says he would preside over a handful of social surrogacy cases a year; now he sees at least 20. “More and more every year. ... It costs $150,000 to have a baby this way. “If social surrogacy was more affordable, more women would be doing it, absolutely. There’s an advantage to being pregnant, the bonding, I understand that, and from experience I can say that most women love to be pregnant. But a lot of women don’t want to be pregnant and lose a year of their careers.”
...
"The typical candidates are models and actors who are doing well but haven’t yet made their name. “They tell me point blank, ‘If I get pregnant, I will lose my part. I work, I don’t have time because of work. I model, I act, I look good like this and I don’t want to disfigure my body.’”
...
"The official guidelines set out by the American Society for Reproductive Medicine (ASRM) say that gestational carriers – surrogates who carry babies conceived through IVF, with eggs from another woman – should be used only when there is a medical need. But Sahakian has no qualms about “defining medical reasons broadly”, as he puts it. “What’s the end result here? Somebody wants to be a parent. I’m facilitating that. I understand that it’s controversial, it’s borderline unethical for some people, but put yourself in the shoes of a 26-year-old model who is making her living by modelling swimsuits. Tell me something – is it that unethical, to say let’s not destroy this woman’s career?”
...
"Sahakian has a reputation for pushing boundaries, and he relishes it: it’s given him a notoriety that drives his business. In 2001, he helped the oldest woman on record in France, Jeanine Salomone, conceive using donor eggs and give birth at 62. A scandal erupted in France – where both surrogacy and artificial insemination of post-menopausal women are illegal – when it emerged that Jeanine’s brother, Robert, was the biological father of the son she gave birth to. ...
The press descended on Sahakian, who said the siblings had presented themselves in his consulting room as a married couple [they had the same last names], and that Jeanine had lied about her age. "

Donating eggs for fertility: an update

Slate brings us up to date:

INSIDE THE QUIETLY LUCRATIVE BUSINESS OF DONATING HUMAN EGGS

"The first US child conceived from a donated egg was born in 1984. Since then, the procedure has grown into a thriving industry. Demand from aspiring parents, along with a dearth of regulations, have spawned matchmaking agencies that offer to help parents find the perfect young woman whose eggs will result in the equally perfect child.

"Donating eggs can be lucrative, with agencies paying as much as $50,000 per cycle in some cases.
...
"Ads or marketing materials targeting potential donors rarely mention the risks or common complaints. Liz Scheier donated eggs three times between 2005 and 2007, and says she was told there were no known risks associated with egg donation. Today, Scheier is a media liaison for We Are Egg Donors, a women’s health organization that works with more than 1,500 donors to promote transparency and advocate for their concerns. She says that donors nowadays hear the same line she did, delivered almost verbatim. But it’s missing one key detail. “There are no known risks because no one has looked,” she adds.
...
"Egg donation has thrived in the US in part because there are few laws regarding the transfer of unfertilized eggs for reproductive purposes, according to industry experts. They say a handful of states have policies that touch on some aspect of egg donation, generally from the perspective of the recipient.

With few regulations, the US has become a magnet for well-off wannabe parents in other countries where egg donation is regulated, or outright illegal. Egg donation is barred in China, Germany, Italy, and Norway; paying women to donate eggs is prohibited in most of Europe, as well as in Canada and other nations.
...
"In 2011, an egg donor sued ASRM [American Society for Reproductive Medicine] over the organization’s compensation guidelines, which the donor claimed were a form of illegal price-fixing; other donors later joined the case. In a 2016 settlement, ASRM agreed to eliminate its payment suggestions, pay $1.5 million in legal fees, and give the plaintiffs $5,000 each. Agencies were freer to offer donors more money.
...
"Since then, donor pay has soared, particularly for attractive, well-educated donors."


HT: Stephanie Lo

A wedding while expecting "twiblings"

The NY Times has a very 21st century wedding announcement, of two husbands who both wanted to be fathers. Read it all here and feel proud to be human:
And You Thought Your Family Was Modern

Here's the surrogacy bit:

"Dr. Luo, 40, known for his meticulous organizational skills, created a database to track the multiple agencies, fertility doctors, legal issues, egg donors and surrogates involved in fulfilling the couple’s dream of having children.

"However comprehensive, Dr. Luo’s document could not calculate the many emotional ups and downs on the San Francisco couple’s journey to parenthood.

"Yet if all goes as planned, come September, after three years, the involvement of three women, and a significant financial investment — about $300,000 — the couple will be changing diapers for two babies. A boy and a girl, conceived with eggs from the same donor, will each be tied biologically to one of the men. In today’s parlance, they’ll be “twiblings.”

“We’re living our version of our parents’ American dreams,” said Dr. Luo..."

An Israeli gay couple recount their American surrogacy experience

Twins, no less, after a journey through U.S. surrogacy by a gay Israeli couple, from Haaretz:

Two for the Price of One: An Israeli Gay Couple's American Journey to Fatherhood By Hilo Glazer

"From the moment surrogacy for Israeli gay men swung away from Asia and landed in the American kingdom of capitalism, having a baby became a complex spreadsheet in which every row carries a price tag.
...
"We continued shopping in the most experienced agency in the gay fathers’ realm in Israel, which was founded by a marketing man. He mentioned two options: an American route and a Canadian route. The Canadian path is at least 100,000 shekels cheaper because there’s no need to pay the surrogate mother. How so? In Canada, surrogacy is, by law, completely altruistic, the marketing man explained, and the women are good Christians who want “to grant people the right to raise a family.” He added, with a thin smile, that these surrogate mothers receive “enlarged reimbursement of expenses,” and hinted that this was a way to get around the Canadian ban on paid surrogacy.
...
"The first step is to find an egg donor. In this field, America really is the land of opportunity – with a price range to match. We paid the low rate ($8,000) because we made do with the database of candidates that’s attached to the clinic and for which there’s “no charge” to access. It’s a pretty limited database, with about 15 candidates at any given moment.

"But hey, this is America, so there’s no upgrade that money can’t buy. An additional payment of $8,500 to $20,000 provides access to premium databases. There’s one consisting of donors who are models (they call it “donors who look like you,” and you can select the desirable physical qualities), while there’s another of donors who are Ivy League graduates. Unfortunately, there’s no overlap between the databases. An egg from a Jewish donor will cost more – around $20,000 (half to the agency, half to the donor). All told, if you go with the select databases, the cost of the egg donation can reach $35,000.
...
"The next stage, then, is to find the surrogate. The clinic put us in touch with five agencies for surrogates, each of which controls a different region of the country.

Because demand for surrogate mothers exceeds supply, hooking up with an agency doesn’t ensure an available woman when the contract is signed. The average waiting time is between four months and a year and a half. We were ready to pay in order not to lose momentum, and we went for the fastest option. The supply of surrogates available in Oregon, where the clinic was situated, had run out, so we had to expand into new territory...
...
"After two weeks, we were informed that a suitable candidate had been found...24, married and the mother of an 18-month-old girl, a part-time preschool teacher living in Oklahoma City. (Motherhood is a condition for surrogacy so that there are no known complications preventing the woman from giving birth.) Oklahoma is considered part of the Bible Belt, but Tiffany, for one, wasn’t put off by the fact that we were a gay couple.
...
"Spreading out the surrogate’s salary over nine months is liable to cause a conflict of interest with her. The classic dilemma is whether to have amniocentesis (generally performed at the start of the second trimester). It’s the most reliable indicator of the embryo’s health but also increases the risk of a miscarriage – a scenario we would obviously not want, but one more fraught with problems for the woman. She, after all, would have endured a rigorous selection process, taken medications, undergone invasive medical procedures, and in the case of a miscarriage, would be rewarded for only a few weeks of work.
...
"American agencies now customarily offer clients a “guarantee to baby” option: In return for a fixed price, the clinic undertakes “to provide” a baby, no matter how many attempts this entails. The deal is also valid for unsuccessful embryo transfer and in case of a miscarriage. Guided by fear of failure and of the need to make a double payment, we – and pretty much all the other couples who face a similar dilemma – opted for the “all inclusive” rate.
...
"The bonus of the visit to Portland was a meeting with the egg donor ...
Into the room came a delicate young woman of 21...accompanied by her fiancé ... She’s a nursing student, he’s starting med school, and both aspire to do volunteer work in plague-ridden regions of Africa.
...
[The surrogate] Tiffany’s life story, which we heard about during her hospitalization, raised a host of ethical questions that had been pushed aside once we’d opted for First World surrogacy over one in India.
... Was her economic plight fundamentally different from the distress of an imagined Indian surrogate mother? Wasn’t the medical risk she took the same? Could we be certain that she had volunteered for the process and not been pushed into it by a relative? Wasn’t her basic salary – about $30,000 – too small compared with the payments received by the doctors and the mediators?  "
***********

Here's a subsequent story from Haaretz (not related to the particular couple above):

Jewish Agency offers loans to staff seeking surrogacy abroad
For the first time in history, a state entity is offering its employees support for the extremely expensive procedure, which is denied to gay men in Israel by law

Embryo adoption

The NY Times has the story:

Embryo ‘Adoption’ Is Growing, but It’s Getting Tangled in the Abortion Debate

"As evangelical Christians, Paul and Susan Lim believe that life begins at conception. So when they decided to have a third child, in vitro fertilization was out of the question, since the process often yields extra embryos.

"But “adopting” the frozen embryos of another couple who had gone through I.V.F. was not.

"Dr. Lim called it a “rescue operation.” To him, transferring donated embryos to his wife’s uterus was akin to saving a life. “These children are being abandoned in a frozen state,” he said. “If they don’t get adopted, they’re dead.”

"As I.V.F. becomes more widespread and the number of spare embryos rises, giving birth with donated embryos is becoming more popular, especially among couples who oppose abortion and are struggling with infertility. But many of the agencies that offer donated embryos, including a vast majority of those supported by federal grants, are affiliated with anti-abortion rights or Christian organizations, leading some people to question whether single people, gay couples and others who might be interested could be missing out.
...
"According to the Centers for Disease Control and Prevention, there were more than 260,000 attempts at I.V.F. in 2016, the most recent year for which data is available. Of those attempts, about 150,000 resulted in transfers of embryos. There is no reliable data on the number of frozen embryos in the United States, but experts estimate the total between 600,000 and one million.

Of the two million transfers of embryos to a woman’s uterus recorded by the C.D.C. from 2000 to 2016, only 16,000 were donor embryos. But over that period, the annual number of donor transfers rose sharply — from 334 in 2000 to 1,940 in 2016 — and experts say it is continuing to increase.
...
"National Embryo Donation Center, based in Knoxville, Tenn., is the largest embryo donation clinic in the country. It also requires potential families to be heterosexual couples who have been “married for a minimum of three years.”
**********
Here is the Center for Disease Control (CDC)'s Assisted Reproductive Technology (ART) page, and their
Assisted Reproductive Technology  National Summary Report for 2016

 *Noted earlier: "Of the 263,577 ART cycles performed in 2016, 65,840 cycles (25%) were started with the intent of cryopreserving (freezing) and storing all
resulting eggs or embryos for potential future use. However, because this cycle type (a banking ycle) cannot result in immediate pregnancy, the 65,840 banking cycles started in 2016 are not included in the majority of this national report."

Fertility tourism to the U.S.

The Washington Post suggests that the U.S.A. might be a good place to come if your neighbors at home disapprove of what you hope to do...

From sex selection to surrogates, American IVF clinics provide services outlawed elsewhere

"While many countries have moved in recent years to impose boundaries on assisted reproduction, the U.S. fertility industry remains largely unregulated and routinely offers services outlawed elsewhere. As a result, the United States has emerged as a popular destination for IVF patients from around the world seeking controversial services — not just sex selection, but commercial surrogacy, anonymous sperm donation and screening for physical characteristics such as eye color.
...
"Numerous other countries also are tightening their regulation of the fertility industry. Last year, India banned commercial surrogacy. Next year, Ireland is set to join the Netherlands, Norway, Sweden, Switzerland, Finland, New Zealand and others in prohibiting anonymous sperm donation. And a large number of countries — including China, Canada and Australia — ban gender selection except in rare cases of medical need.
...
"A survey published in March in the Journal of Assisted Reproduction and Genetics found that nearly 73 percent of U.S. fertility clinics offer gender selection. Of those, nearly 84 percent offer it to couples who do not have fertility problems but are considering IVF solely to control the pregnancy’s outcome."

Birthright citizenship and birth tourism

Birthright citizenship (i.e. every child born within the country is a citizen) is (perhaps unsurprisingly) a new-world phenomenon: it occurs widely in the Americas, which were populated largely by immigrants.

The map comes from:
Birthright Citizenship in the United States--A Global Comparison

Prosperous countries that give citizenship to everyone born within their borders (regardless of their parents' citizenship) can be attractive places to give birth, particularly if they have good medical care and comfortable surroundings, and particularly for families whose home may be problematic for political or economic reasons.

Birthright citizenship has become a political issue in the U.S. under the Trump administration, as part of a larger repugnance towards immigration.
NY Times: President Wants to Use Executive Order to End Birthright Citizenship
“We’re the only country in the world where a person comes in and has a baby, and the baby is essentially a citizen of the United States for 85 years, with all of those benefits,” Mr. Trump told Axios during an interview that was released in part on Tuesday, making a false claim. “It’s ridiculous. It’s ridiculous. And it has to end.”

While some of that repugnance focuses on countries in Central and South America, there is also an expensive birth tourism market, catering e.g. to families from Russia and China.

Here's a recent story from Bloomberg:
There’s No Stopping the Russian Baby Boom in Miami
But it’s not, the new mothers insist, about the U.S. passport. “Why does Trump think everyone is dying to have one?”

"Being a birth tourist in Sunny Isles Beach isn’t cheap, with agencies charging as much as $50,000 to set up housing, hire interpreters, find doctors and deal with paperwork. Those who can’t afford that level of service buy smaller packages and rent apartments in far-flung suburbs, sometimes teaming up to share lodgings and expenses.
...
"The focus of Trump’s criticism hasn’t been the abuse of the system but the fact that it exists. One of his arguments against birthright citizenship is that when the babies born on U.S. soil become adults, they can petition for their parents to live permanently in the country.

But to many of the Russians in Sunny Isles, at least, this idea sounded unappealing. The biggest deterrent: They’d have to start paying personal income taxes that are more than double what they are in Russia."
********
And a story of a different sort from Newsweek:
FEDS RAID 'MATERNITY HOTELS' WHERE TOURISTS PAID UP TO $80K TO GIVE BIRTH IN U.S.
"Though it’s not illegal to have their babies in the United States, birth tourists usually lie to immigration officials about their reasons for travel, according to an official cited by NBC. The bigger focus, however, are the organizers of websites that targeted women in China and sold the "maternity hotel" stays to them.

"For that reason, authorities did not arrest the women staying in the buildings on Wednesday, but instead will use them as witnesses in an attempt to prosecute the "handlers."
************

And here's a headline that looks like it could come from the U.S., but comes instead from Canada:

Feds studying 'birth tourism' as new data shows higher non-resident birth rates
BY THE CANADIAN PRESS
"OTTAWA — The federal government is studying the issue of “birth tourism” with a view to better understand the scope of this practice within Canada and its impacts.

"This comes as new research published by Policy Options today shows the number of non-Canadian residents giving birth in Canadian hospitals is much higher than in figures reported by Statistics Canada.
...
"Immigration Minister Ahmed Hussen ... says Canada does not collect information on whether a woman is pregnant when entering Canada, nor can a woman be denied entry solely because she is pregnant or might give birth in Canada."

Are uterus transplants repugnant? And to whom? And why? (in the Irish Times)

Here's an article in the Irish Times on uterus transplants , that makes clear the view that the views of those not directly involved should play a large  and perhaps decisive role in public discussions of transactions that some may find repugnant. The author indicates that among his concerns is that the parentage of the baby might be in doubt (i.e. that a child conceived from the eggs and sperm of his genetic parents and carried to birth by his pregnant genetic mother might have to be regarded as the child of the donor of the uterus...). I wonder if even the author thinks this is a serious reason to ban uterus transplants; rather, I get the sense that he is throwing his net widely in the hope that different objections might resonate with different parts of his audience. Maybe his goal is simply to be controversial. [Just to be clear, I am not disagreeing that child welfare is an important concern when evaluating issues related to reproduction and childbirth...but this concern strikes me as particularly far-fetched.]

Are uterus transplants ethically acceptable?
Several infertile women worldwide have given birth with wombs received from either living or dead donors   by George Winter

"In September 2014, the first live birth following UTx was reported from Sweden by Prof Mats Brännström and colleagues. The recipient had Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome – she was born without a viable womb – and the donor was a 61-year-old friend. Since then, there have been at least 12 successful births worldwide following UTx.

"Recently, it was revealed that the first baby had been born following a womb transplant from a deceased donor. Ten previous attempts had been made in different countries to deliver a live baby following a uterus or womb transplant from a deceased donor, but this – performed by surgeons in Brazil – was the first with a successful outcome.

...

"The UTx procedure begins with in-vitro fertilisation, using the recipient’s egg and her partner’s sperm; the subsequent embryo is frozen; a uterus – from a living or dead donor – is transplanted; the embryo is thawed and implanted; and following pregnancy and delivery by Caesarean section, a hysterectomy is performed, obviating the need for lifelong immunosuppressive therapy."

...

"The “Ethical Considerations” section of the Womb Transplant UK website implies that any societal misgivings on the acceptability of UTx will be ignored: “Ultimately, the decision to go forward will depend on the judgment of the researchers, the participating institution, and most importantly, the patient to whom the transplant will be offered.”

"Hardly an unbiased trio.

"What ethical dilemmas might arise?

"If a transplanted uterus were to jeopardise a recipient’s life, it could be removed; but what if it contains a viable foetus? And there is debate over living versus deceased donation, with Spanish and Japanese teams favouring the Swedish “live” model, and French, Belgian and UK researchers preferring deceased donors. Writing in the journal Bioethics, Dr Nicola Williams cites the view of the International Federation of Gynaecology and Obstetrics that “the retrieval of a uterus from a living donor necessitates a relatively major surgery with its own risk of complications [and] constitutes reason enough to deem the procedure ethically inappropriate”.

"Also, how much would a child be entitled to know about the donor from whose uterus he or she issued, and – irrespective of whether the donor had been dead or alive – would the infant be the child of the donor or the recipient?"

***********

George Winter, the author of the piece, apparently writes often on ethical issues in medicine (although the above is the first article I had read by him). See e.g.  his recent related articles on The ethical considerations of face transplants and 
The brave new world of wombless gestation--Artificial womb technology poses many ethical questions – we need to debate them
(that article is about experimental technology about lamb embryos brought to term "in a plastic “biobag” – literally, a womb with a view ..."  I was relieved to note that, in considering the implications for humans, the author didn't raise the question above about the parentage--or in this case perhaps the humanity--of the baby (so maybe he was just kidding.)

**********

And see my related post from yesterday:
Friday, December 14, 2018  Successful birth in Brazil to a woman who received a uterus transplanted from a deceased donor

Successful birth in Brazil to a woman who received a uterus transplanted from a deceased donor

The Lancet reports the first known case of a live birth to a woman born without a uterus who received a transplanted uterus from a deceased donor.

Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility

December 04, 2018 DOI:https://doi.org/10.1016/S0140-6736(18)31766-5

Background

Uterus transplantation from live donors became a reality to treat infertility following a successful Swedish 2014 series, inspiring uterus transplantation centres and programmes worldwide. However, no case of livebirth via deceased donor uterus has, to our knowledge, been successfully achieved, raising doubts about its feasibility and viability, including whether the womb remains viable after prolonged ischaemia.

Methods

In September, 2016, a 32-year-old woman with congenital uterine absence (Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome) underwent uterine transplantation in Hospital das Clínicas, University of São Paulo, Brazil, from a donor who died of subarachnoid haemorrhage. The donor was 45 years old and had three previous vaginal deliveries. The recipient had one in-vitro fertilisation cycle 4 months before transplant, which yielded eight cryopreserved blastocysts.

Findings

The recipient showed satisfactory postoperative recovery and was discharged after 8 days' observation in hospital. 

...

The female baby weighed 2550 g at birth, appropriate for gestational age, with Apgar scores of 9 at 1 min, 10 at 5 min, and 10 at 10 min, and along with the mother remains healthy and developing normally 7 months post partum. The uterus was removed in the same surgical procedure as the livebirth and immunosuppressive therapy was suspended.

*************

In Brazil (where commercial surrogacy is apparently illegal, and legal surrogates must be family members of the intended mother), the urge to have one's own baby is nevertheless strong. 

See earlier post:

Wednesday, January 15, 2014

Womb transplants in Sweden (where surrogacy is illegal)

The demand for blue eyed babies (from American sperm donors) in Brazil

The WSJ has the story:
Demand for American Sperm Is Skyrocketing in Brazil
Explosive growth spurred by more wealthy single women and lesbian couples turning to U.S. donors

"Over the past seven years, human semen imports from the U.S. to Brazil have surged as more rich single women and lesbian couples select donors whose online profiles suggest they will yield light-complexioned and preferably blue-eyed children.

"is one of the fastest-growing markets for imported semen in recent years, said Michelle Ottey, laboratory director of Virginia-based Fairfax Cryobank, a large distributor and the biggest exporter to Brazil. More than 500 tubes of foreign semen frozen in liquid nitrogen arrived at Brazilian airports last year, officials and sperm-bank directors said, up from 16 in 2011. Complete data from Anvisa, Brazil’s health-care regulator, isn’t yet available for 2017.
...
"Money is also a factor setting parameters for the DNA import boom. Carefully categorized and genetically vetted sperm from U.S. providers has to be procured from Brazilian fertility clinics at a cost of some $1,500 a vial, often as part of an in vitro fertilization procedure that costs roughly $7,000 an attempt. Whites are more likely able to afford that in a country where about 80% of the richest 1% are white, according to Brazil’s statistics agency.

"Imports are rising in part because many Brazilians simply don’t trust the national product. Unlike in the U.S., it is illegal to pay men to donate their sperm here, so domestic stocks are low and information about Brazilian donors sparse.

“It basically says ‘brown eyes, brown hair, likes hamburgers’ and what their zodiac sign is—that’s it,” said Alessandra Oliva, 31, of the information available on local donors. She has 29 pages of information on the American father of her 14-month-old son, from a photo of him as a child to genetic tests for cystic fibrosis."

Bleeding (and more) for Canada

Peter Jaworski in USA today discusses Canadian repugnance for paying for blood or sperm.

If it weren’t for America's free-market ways, more Canadians would have trouble getting pregnant.

"Canada used to have a sufficient supply of domestic sperm donors. But in 2004, we passed the Assisted Human Reproduction Act, which made it illegal to compensate donors for their sperm. Shortly thereafter, the number of willing donors plummeted, and sperm donor clinics were shuttered. Now, there is basically just one sperm donor clinic in Canada, and 30-70 Canadian men who donate sperm. Since demand far outstrips supply, we turn to you. We import sperm from for-profit companies in the U.S., where compensating sperm donors is both legal and normal.
...
"Canada has never had enough domestic blood plasma for plasma-protein products, such as immune globulin. Our demand for those products, however, is increasing. Last year, we collected only enough blood plasma from unremunerated donors to manufacture 17% of the immune globulin demanded. The rest we imported from you, in exchange for $623 million, or $512 million U.S.

Reliance on your blood plasma looked like it might change a little bit when, in 2012, a company called Canadian Plasma Resources announced plans to open clinics in Ontario dedicated to collecting blood plasma. The trouble is that its business model included compensating donors. Almost immediately, groups such as the Canadian Union of Public Employees and the Canadian Health Coalition began to lobby the Ontario government to pass a law to stop CPR from opening clinics. Ontario obliged in 2014, passing the Safeguarding Health Care Integrity Act, which among other things made compensation illegal.

When CPR shifted attention to Alberta, so did the groups opposing them. Just this year, the Alberta government introduced the Voluntary Blood Donation Act, which would prohibit compensation.

British Columbia’s government is just now looking at options to ban it as well.

What persuaded these governments? The anti-compensation groups argued that blood plasma from compensated donors was less safe, that people should donate blood plasma for free rather than for money, and that there is something wrong with having a for-profit business model in health care.

The latter two concerns are strangely specific. They don’t seem to apply to you Americans. If they did, the groups would have lobbied to make importation of anything other than products made from unremunerated donors also illegal. But they didn’t.

Instead, they object to a Canadian for-profit company compensating Canadian blood plasma donors in Canada, but American for-profit companies compensating American donors in America does not appear to register on their moral radar. Like the importation of sperm from for-profit U.S. companies that compensate donors, it has all the appearance of moral NIMBYism. It’s fine if it happens in your backyard, and we’ll happily buy the products, but we object to it happening in our backyard."

************

And here, in Canada's National Post:

Peter Jaworski: Canada needs blood plasma. We should pay donors to get it

Canada buys the vast majority of its plasma-protein products from American companies that attract plasma donors by paying them. Yet we ban the same practice here

Surrogacy in France (and IVF for unmarried folks)

Surrogacy has long been illegal in France, but the fact that it is legal elsewhere in the world (such as California) has put pressure on French authorities to recognize French parents and children who have come through surrogacy.

Here's a post from frequent surrogacy-watcher Ellen Trachman at Above the Law on recent progress:
French Gay Dads Win A Surrogacy Victory

"Many European countries have either completely banned surrogacy, or at least severely limited its legality. France is among those European countries that have outlawed surrogacy within its borders. But despite the ban, high demand by French citizens — including gay couples who want a biologically-linked child — has led to many French citizens conceiving children abroad via surrogacy, and in some cases, turning to desperate measures.
...
"Last week, the Court of Cassation — which is apparently what they call France’s highest court of appeals — ruled on a surrogacy dispute. (Here’s the French manuscript for my fluent followers.) In the case, four couples with children born via surrogacy outside of France asked the court to require the government to recognize their (and especially the non-biological parent’s) parental rights to their child.

At Least It’s Not Three Years Ago. Fortunately, the couples at least had one parent with recognized rights to the child. Three years ago, France was refusing to recognize any French parental rights or French citizenship for a child born elsewhere via surrogacy. The European Court of Human Rights chastised the French government, finding that such a stance was a violation of human rights — specifically for the parentless, and possibly country-less, child. That 2014 ECHR ruling allowed a genetically-linked father to a surrogate-born child to be recognized as the legal parent, and the child be given French citizenship.

...

"[Last week]...the court agreed to a middle route, and ruled that the non-bio partner could adopt the surrogate-born child. 

...  [and on to IVF]

"While campaigning, President Emmanuel Macron took the position that single women and same-sex female couples should be eligible to use assisted reproductive technology services to conceive. Currently, the country allows those services to be available only for heterosexual couples. ...

... Macron hedged his position by saying that he would wait for the National Consultative Ethics Committee to issue a recommendation on the matter before acting. ... last week, after considering the issue for over three years, the Committee finally issued its opinion. It concluded that, indeed, singles and same-sex couples should be permitted to use assisted reproductive technology services. "

Who can be parents in Italy? (Adoption by same sex couples...)

In Italy, Confusion and Division Over Same-Sex Parenting
Court ruling highlights conflicting views over the rights of homosexual couples as parents

"An Italian court’s decision to recognize two homosexual men as the fathers of twin children has exposed confusion and a deep divide in the country over parenting rights of same-sex couples.

It was disclosed earlier this week that a court in the northern Italian city of Trento granted the men full rights as parents to their six-year-old twins, who were born in Canada through surrogacy.

The gay community hailed the decision—the first to accord full parental rights to a non-biological father—as historic in a country that last year became one of the last in Europe to approve civil unions for gay couples. But the ruling kicked up controversy right away, with the head of the main group opposing the civil-unions bill saying it marked a “sad day for Italy.”
...
"The 2016 legislation approving civil unions stopped short of addressing broader questions of parental rights and other family law issues for same-sex couples. Political opposition was so fierce that lawmakers scotched any reference to adoption or parental rights to get the bill passed. As a result, Italian law today recognizes only the biological parent, and joint adoption by gay couples isn’t allowed.

Italian courts have been left to fill that gap in a haphazard way, with some judges approving adoption requests by gay partners of a biological parent and others turning them down. The result: up to 1,000 children of gay couples are caught in a legal limbo.
...
"Riccardo and Lorenzo, the Trento couple who released only their first names, sought to break new ground. The pair, an entrepreneur and a civil servant in their 50s who have been together for more than 20 years, were married in Canada. Their twins were born in Canada via surrogacy, a practice that is illegal in Italy. Canadian law allowed both men to be listed as the twins’ fathers on the birth certificate.

Once back in Italy, the couple sought to have the Italian state recognize the Canadian birth certificate, seeking a parental status that affords more rights than adoption in Italy. An adoptive parent’s relatives have no legal relation with the adopted children, who therefore have no legal status when it comes, for instance, to inheritance from grandparents. The court granted the couple’s request, effectively recognizing both men as fathers.

“[We] sought no more than to see our children’s legal family rights protected, just as with other families,” they said in a statement.

Nichi Vendola, a gay Italian politician and leader in the fight for same-sex rights, hailed the decision. “When you raise, care for and love a child, you’re a father, mother, parent,” he said.

In Italy, however, court decisions don’t set legal precedent, so the legislative gap remains for parliament to fill. With Italy headed to elections this year or next, there is little political appetite to take up the bruising battle over parenting rights again."

Donor sibling registry: matching donor-conceived sibs

The Donor sibling registry is a matching service to help identify half siblings of  "donor conceived people," i.e. people who were conceived from donor sperm or eggs, and who may know only an anonymized donor number.  If your numbers match, you might want to arrange a meeting...

IVF: Experience suggests there's room for some regulation

The Guardian has the story: IVF mix-up: wrong sperm may have fertilised eggs of 26 women
Dozens of women may have had eggs fertilised by sperm cells from someone other than the intended father, say Dutch authorities

"A Dutch medical institution has launched an investigation after discovering that up to 26 women’s eggs may have been fertilised by the wrong sperm at its IVF laboratory.

"A “procedural error” between mid-April 2015 and mid-November 2016 during the in-vitro fertilisation was to blame, the University Medical Centre in Utrecht said.

"“During fertilisation, sperm cells from one treatment couple may have ended up with the egg cells of 26 other couples,” said a statement.

“Therefore there’s a chance that the egg cells have been fertilised by sperm other than that of the intended father.”

Although the chance of that happening was small the possibility “could not be excluded”, said the centre.

Half the women who underwent fertility treatment had become pregnant or given birth.

“For some of the 26 couples frozen embryos are still available but the chance remains that they [too] have been fertilised by the sperm from a man other than the intended father,” the UMC said.

"The couples had been informed, the centre said.

“The UMC’s board regrets that the couples involved had to receive this news and will do everything within its powers to give clarity on the issue as soon as possible.”

...

"Mix-ups do occur, including one in 2012 when a Singapore mother sued a clinic for alleged negligence after it mixed up her husband’s sperm with that of a stranger.

"The ethnic Chinese woman first suspected that something was amiss when her baby, who was born in 2010, had markedly different skin tone and hair colour from her Caucasian husband, news reports at the time said."
***********

Here's are two recent updates on the Singapore story (and subsequent legal proceedings) from the Straits Times: the first has some details of how the error happened, the second speaks about the legal issues associated with possible damages that might be assessed, and if so for what...
IVF mix-up at Thomson Medical: A look back at the case of 'Baby P'

IVF mix-up at Thomson Medical: Court continues to hear appeal of woman who conceived baby with stranger's sperm

2016 Baby Markets 10th Anniversary International Congress in April

Here's the call for papers:

2016 Baby Markets 10th Anniversary International Congress

April 1-3, 2016 • University of California, Irvine School of Law

The Baby Markets International Congress celebrates the 10th Anniversary of the Baby Markets Roundtable series founded by the Center for Biotechnology and Global Health Policy's Director, Chancellor’s Professor Michele Goodwin.

The Center welcomes abstracts engaging adoption, assisted reproduction, surrogacy trafficking, custodial parenting, care-giving, foster care, legal implications, and more through historical and contemporary lenses. View the full list of Congress themes »

Congress attendees will have the opportunity to submit papers to the Organizing Committee for publication in UC Irvine Law Review. The Organizing Committee will choose a select number of proceedings from the Congress for publication. Papers may also be accepted for the Second Edition of Professor Michele Goodwin’s Baby Markets volume.

All abstracts must be submitted by January 31, 2016. Abstracts should not exceed 250 words.

Ontario's new surrogacy law (and other laws regarding who is the parent of a child)

In Canada, Ontario has just (last month) amended some of its laws regarding the definitions of who are the parents of a child, with implications for surrogacy, among other things.
Bill 28 Projet de loi 28
An Act to amend the
Children’s Law Reform Act,
the Vital Statistics Act
and various other Acts
respecting parentage and
related registrations

Here's the part on surrogacy, which seems to imply that surrogacy in Canada will be subject to legal risk about who the parents are until the child is seven days old.

"7. Where a surrogate and one or more intended parents of
a child to be carried by the surrogate enter into a surrogacy
agreement and a child contemplated by the
agreement is born, the intended parents become the
parents of the child and the surrogate ceases to be a
parent of the child if specified conditions are met.
These conditions include that there are no more than
four intended parents under the agreement, that each of
the parties to the agreement received independent legal
advice before signing, and that the child is conceived
through assisted reproduction. The change in parentage
is also contingent on the surrogate giving written consent
relinquishing the surrogate’s entitlement to parentage
of the child, but the consent may not be given
before the child is seven days old. Until that time, after
the child is born the surrogate and the intended parents
share parental rights and responsibilities respecting the
child, unless the surrogacy agreement provides otherwise.
If the surrogate does not or cannot give consent,
an application may be made to the court for a declaration
of parentage respecting the child. Although a surrogacy
agreement may be used as evidence of parental
intent, it is unenforceable in law. (Section 10)"
**********

Here is some commentary on that and other parts of the law, from the blog Above the Law:
Ontario’s New Surrogacy And Sperm Donation Law Is Both Awesome And Terrible

Crowdfunding For IVF

NPR has a story which involves a combination of very modern transactions:
Please, Baby, Please: Some Couples Turn To Crowdfunding For IVF

"They began with a less costly and less invasive option: IUI or intrauterine insemination. That's where sperm is inserted with a catheter directly into the woman's uterus at the time of ovulation. The procedure costs, on average, just under $1,000 a try.
...

"The next step they took was to try in vitro fertilization, or IVF. This involves fertilizing eggs with sperm in a laboratory dish, then transferring the embryo into the woman's uterus. It can cost $15,000 to $20,000 each try.

"At first, Greg says, they thought about traveling overseas for more affordable treatments, but travel costs would have gobbled up any savings. So, they went online instead, to the crowdfunding site GiveForward. "