IVF mistakes that would have confounded King Solomon

 IVF helps many people welcome children into their families, but also makes possible mistakes that would have confounded King Solomon.

Haaretz has the story:

Israeli Court Orders Birth Mother to Give Toddler to Biological Parents After IVF Mix-up by Chen Maanit
"A woman in her third trimester of pregnancy discovered that she had been implanted with the wrong embryo two years ago. An Israeli judge has ruled that the toddler, now two years old, be raised by her biological parents."  

 

HT: Itai Ashlagi 

*******

And another, on this side of the ocean, from the NYT:

An I.V.F. Mix-Up, a Shocking Discovery and an Unbearable Choice
Two couples in California discovered they were raising each other’s genetic children. Should they switch their girls?   By Susan Dominus

"Wolf believes that the public becomes aware of only a fraction of the errors that occur in fertility-clinic labs. In Zoë and May’s cases, as in the case of the twins carried by the Korean American woman in New York, the mistake was apparent because the children were a different race from the birth parents. In most instances, parents who accept and bond with their baby may never suspect something is wrong. Even when discovered, such mistakes rarely make the news. “Most of my cases you never hear about, because we settle them before we file lawsuits,” Wolf said. “And the settlement agreements have confidentiality agreements, because the clinics want to ensure that there will be no negative publicity as a result of its error.”

"I.V.F. procedures are underregulated relative to most medical procedures, says Dov Fox, a law professor at the University of San Diego with a focus on bioethics. States do not mandate that fertility clinics report preventable and damaging mistakes when they happen, as is required of hospitals. Some emblematic problems, Fox told me, included clinics or labs relying on pen-and-paper labeling systems and faulty screening measures; Wolf cited a failure of clinic employees to respond to alarms on the freezers that store embryos. “I sometimes think of our lawsuits as the policing of the fertility industry,” Wolf said, “because nobody else is holding them accountable.”

"Now heavily dominated by private equity, the industry is rife with for-profit, high-volume fertility clinics operating in a regulatory dead zone. Oversight of fertility clinics has been limited, Fox said, because of the challenges it poses politically: Although many conservatives would like to impose restrictions, including limiting the number of embryos a lab can create, they have historically not wanted to jeopardize efforts to restrict abortion by also attacking I.V.F., which is broadly popular. Many Democrats, meanwhile, have been reluctant to regulate the industry for fear of opening the door to restrictions that might, for example, limit who is eligible for I.V.F. (as in some countries, where gay couples are excluded). Fox expects that the overturning of Roe v. Wade will lead to new scrutiny of I.V.F., which might ultimately threaten its wide availability."

Abortion on the ballot

 And in other news, we're in new territory for the American experiment.  This will surely have effects on controversial markets (among other things).  An interesting feature of yesterday's vote was that many states preserved or restored abortion rights. 

CNN has the still-unfolding story: 

7 states vote to protect abortion rights, while efforts to expand access in Florida and South Dakota fail by By Amy O’Kruk, Annette Choi, Lauren Mascarenhas, Kaanita Iyer and Piper Hudspeth Blackburn, CNN, Updated 8:22 AM EST, Wed November 6, 2024

"More than two years after the US Supreme Court overturned Roe v. Wade and ended the federal constitutional right to an abortion, voters in 10 states cast ballots on whether to cement reproductive rights in their state constitutions.

"Measures to protect abortion access in Arizona, Colorado, New York, Maryland, Missouri, Montana and Nevada will pass, CNN projects. In New York, Colorado and Maryland, where abortion is legal at least up to the point of viability, the measures will maintain current abortion access. In Missouri, the amendment will remarkably expand access to abortion, which is currently banned with no exceptions for rape or incest. Similarly in Arizona, the amendment is expected to overturn the state’s ban on abortions 15 weeks into pregnancy.

"But a Florida amendment to protect the right to an abortion up to the point of viability will fail, CNN projects, with the amendment falling short of the 60% voter threshold for passage. The state’s six-week ban will remain in place.

"And South Dakota’s ban on abortions with an exception to save the life of the mother will hold as a majority of voters cast a ballot against an initiative to legalize abortion – with regulations – during the first and second trimesters of pregnancy.

"Voters in Nebraska also weighed in on the issue as they faced dueling measures on the ballot: One that would invalidate the state’s 12-week abortion ban, which makes exceptions for sexual assault, incest and medical emergencies, and the other to uphold the restriction."

Uterus transplants--update

Reproductive options continue to grow... Here's an update on transplantation of the uterus.

Uterus Transplant in Women With Absolute Uterine-Factor Infertility, by Giuliano Testa, MD, MBA1; Greg J. McKenna, MD1; Anji Wall, MD, PhD1; et alJohanna Bayer, MD1; Anthony R. Gregg, MD2; Ann Marie Warren, PhD3,4; Seung Hee S. Lee, MD1; Eric Martinez, MD1; Amar Gupta, MD1; Robert Gunby, MD2; Liza Johannesson, MD, PhD1,5, JAMA. Published online August 15, 2024. doi:10.1001/jama.2024.11679

"Assisted reproductive technologies have provided millions of women with fertility options. However, absolute uterine infertility, affecting 1 in 500 women, remains a barrier in reproductive medicine. Absolute uterine infertility can be acquired or congenital and due to either a dysfunctional or an absent uterus. Affected women who want to have children traditionally choose between adoption or surrogacy where legally available. The development of uterus transplant offers an option for women with absolute uterine infertility to experience pregnancy and childbirth. Since the first successful uterus transplant in 2011,1 more than 100 uterus transplant procedures have been performed worldwide, using grafts from living or deceased donors. Although no registry exists that precisely reports the number of live births resulting from these procedures, it is estimated that there are more than 70 live births worldwide.2,3 As of May 1, 2024, there have been 48 uterus transplants and 33 live births in the US."

Surrogacy in Israel

In Israel, where commercial surrogacy is legal, surrogates are more and more coming from educated and religious communities. 

Haaretz has the story:

Married, Educated, Not in It for the Money: The New Profile of Israeli Surrogate Mothers. Who are the Israeli women who wish to be pregnant and give birth for others? The answer to that question has changed dramatically over the past decade  by Ronny Linder

""I'm a little tired of women telling me how disadvantaged all surrogates are, so I thought of starting a thread just for surrogates, with: name + our occupation + town. I'll go first." This is what one moderator of an open Facebook surrogacy group wrote, about a year ago – and the responses came pouring in: a computer programmer from Tekoa, a sociolinguistics Ph.D. from Kfar Sava, a school principal from Jerusalem, a postgraduate student of gender studies from Hatzeva, a lawyer from Gush Etzion, an oncology nurse from Mevasseret Zion and so on and on.

"The post and the responses to it, written in reaction to the prevalent perception that views surrogacy as bearing the potential for exploitation of disadvantaged women who must "hire out" their uteruses for money, largely reflects the great transformation, over a few short years, in the profile of surrogate mothers and of the entire field in Israel. 

...

"Since the surrogacy law was legislated in 1996, almost 1,300 children have been born in Israel through surrogacy procedures. In recent years, the number has averaged around 80 children per year. Data collected by the Health Ministry about surrogate mothers between 2022 and 2023, reveals the changes in the profiles of women who choose to take on the task, as compared with the last study, in 2010. That study, which reviewed surrogate mothers during the years 1996-2010, was conducted by Etti Samama as part of the work for her doctoral thesis in health-system management at Ben-Gurion University. To compile recent data, Adam Ringel and Eti Dekel, for many years the national supervisor of the surrogacy law, collected information from 246 cases – 90 percent of the cases filed with committee in the last couple of years. 

...

"The data indicate a fundamental change in the socio-economic status of women who choose to become surrogates. In terms of education, while in 2010 the majority of surrogate mothers had a high school education (70 percent), nearly one fifth (18 percent) had less than 12 years of schooling, and only 7 percent had academic degrees. Less than a decade and a half later, however, the picture has been transformed: 65 percent of surrogate mothers have an academic degree, and only about one fifth have only a high school education (14 percent) or less than 12 years of schooling (8 percent). The proportion of those with academic degrees among surrogates is significantly higher than that group's share of the population, which is 38 percent.

"A similarly changed picture emerges in terms of employment: In 2023, only 2.5 percent of surrogates were unemployed, compared with 25 percent in 2010. No less interesting is the finding regarding geographical dispersal of surrogates, as compared with the general public: In recent years, almost half (45 percent) of them come from kibbutzim, moshavim and organized communities – compared with just 12 percent in 2010.

...

"An absolute majority of surrogates come from [the world of] religious Zionism, on the one hand, or are secular women from kibbutzim and other organized communities, on the other," Ringel elucidates. "These two groups are seemingly worlds apart, but in the world of surrogacy, you see the resemblance between them. These are independent, strong women, with a fully developed values-based worldview, who are looking to do something big for others, who see surrogacy as a calling, as female empowerment and as the ultimate giving."

"What happened between 2010 and 2024 that led to such dramatic change in the profile of surrogate mothers? Experts in the field ascribe the change mainly to the opening up of the option for married women to become surrogates, beginning in 2010 – a move that significantly increased the pool of potential surrogates and also changed their socio-economic backgrounds.

"This is indeed a transformation: in 2010, all surrogates were unmarried women, 75 percent of them divorced, the rest single (and a few widows). In contrast, in 2022-2023, 80 percent of surrogates were married or in relationships, and only 20 percent were divorced or single.

...

 "There was always an altruistic element with surrogates, but ever since married and more affluent women entered the picture – the economic part became more of a bonus, rather than the main motive," Dekel points out."

IVF for sex selection: legal in the U.S

Slate has the story:

The Parents Who Want Daughters—and Daughters Only. Sex selection with IVF is banned in much of the world. Not in the U.S. by Emi Nietfeld

"Sex selection was once controversial in the U.S. and is banned in almost every other country. Many Americans unaware of the process still assume that it’s that way. In reality, it has now become a standard part of IVF here. For some, the option to sex select is a perk of an otherwise exacting process. For others, it’s the whole point of doing IVF in the first place.

...

"Still, “the very act of sex selection is sexist,” argues Arianne Shahvisi, a professor of philosophy at Brighton and Sussex Medical School in the U.K., where elective sex selection is illegal.

...

"It’s not just the U.K. Virtually all the industrialized world—including Canada, Australia, and every European country besides Cyprus—bans sex selection except in rare medical cases. Most nations prohibit the practice on the grounds that it promotes sexism and that the children born from it may be harmed by gendered expectations. Widespread preference for a certain sex can also skew the population—as in India and China, where abortion and infanticide of girls have resulted in tens of millions more men than women. 

...

"In 1994 the American Society for Reproductive Medicine, the nonprofit that provides the industry’s professional guidelines, condemned sex selection for nonmedical reasons. Yet with no enforcement power, the guidelines remained just that. Unlike in most peer nations, IVF in America is mostly privately paid and weakly regulated. Instead, market forces dominate. By 2018, despite the ASRM’s recommendation that they not offer sex selection, 75 percent of clinics continued to provide the service. Since then, the ASRM’s ethics committee has updated its position to a neutral stance."

Sperm donation from Denmark to the UK and elsewhere

 The Daily Mail has the story:

'They invaded us once by boat and now they're doing it with sperm!' Why hundreds of British women are giving birth to 'Viking babies' conceived with Danish donors

"These are the main Danish export products - beer, Lego and sperm!"'

"So why are so many British women going Danish? According to Dr Alan Pacey, a fertility expert at the University of Sheffield, one of the reasons is a shortage of homegrown sperm.

'We don't have enough donors in the UK to meet the national need,' he explains. 'We don't have the clinic infrastructure sufficient to recruit enough donors - even when men want to donate.

...

"'The NHS is used to treating patients and you get a fee for treating patients. You don't get a fee for screening a donor that you may not ultimately accept.'

"Compounding the problem for British clinics is the 2005 law that forces men to waive their anonymity, meaning sperm donors face the prospect of offspring turning up on their doorstep once they reach the age of 18.

"Nevertheless, although Danish clinics, among them the world's largest sperm bank, Cryos, cannot sell semen from anonymous donors to British women, business is booming thanks to the huge numbers of local men happy to sign up anyway.

...

"Experts such as Laura Witjens, CEO of the National Gamete Donation Trust, say the excellent customer service deployed by Copenhagen's sperm banks has also contributed to the Viking baby boom.

'It's much easier for a British clinic to order sperm from Denmark which is Fed-exed the next day than to try and recruit their own donors and all the hassle that goes with them,' says Witjens.

'The Danish model is customer service driven. It knows how to deal well with customers, it has a good website, and that's what we could do in the UK as well - it's not rocket science.'

HT: Mario Macis

Children in China

 The NYT ran an interactive story on China's change in family policy, from one child (from 1979 to 2015), to two and now to three. At the link you can see old slogans and new ones.  But it was hard to limit family sizes, and it's hard to increase them. (The relaxation of the one-child policy increased demand for surrogacy in China, where it isn't legal. But it isn't clear how much demand there is for three children families.)

OneThree Is Best: How China’s Family Planning Propaganda Has Changed, By Isabelle Qian and Pablo Robles  

"For decades, China harshly restricted the number of children couples could have, arguing that everyone would be better off with fewer mouths to feed. The government’s one-child policy was woven into the fabric of everyday life, through slogans on street banners and in popular culture and public art.

"Now, faced with a shrinking and aging population, China is using many of the same propaganda channels to send the opposite message: Have more babies.

"The government has also been offering financial incentives for couples to have two or three children. But the efforts have not been successful. The birthrate in China has fallen steeply, and last year was the lowest since the founding of the People’s Republic of China in 1949."

"Under the one-child policy, local governments levied steep “social upbringing fees” on those who had more children than allowed. For some families, these penalties brought financial devastation and fractured marriages.

"As recently as early 2021, people were still being fined heavily for having a third child, only to find out a few months later, in June, that the government passed a law allowing all married couples to have three children. It had also not only abolished these fees nationwide but also encouraged localities to provide extra welfare benefits and longer parental leave for families with three children."

#######

Wednesday, March 1, 2017

Surrogacy in China: available but illegal

France amends its constitution to protect access to abortion

 The decision of the U.S. Supreme Court to overturn Roe v.Wade and end a constitutional right to abortion in the U.S. prompted France to amend its constitution to guarantee access to abortion.

Here's the WSJ story:

France becomes first country to explicitly enshrine abortion rights in constitution  By Karla Adam

"With the endorsement of a specially convened session of lawmakers at the Palace of Versailles, France on Monday became the first country in the world to explicitly enshrine abortion rights in its constitution — an effort galvanized by the rollback of protections in the United States.

"The amendment referring to abortion as a “guaranteed freedom” passed by a vote of 780 in favor and 72 against, far above the required threshold of support from three-fifths of lawmakers, or 512 votes.

"French President Emmanuel Macron announced that a “sealing ceremony,” a tradition reserved for the most significant laws, would take place Friday, coinciding with International Women’s Day.

“We’re sending a message to all women: Your body belongs to you, and no one can decide for you,” Prime Minister Gabriel Attal told lawmakers assembled in Versailles."*

#########

Le Monde has the story, in an editorial supporting the amendment:

Enshrining abortion access in the French Constitution is a win for feminism and democracy, EDITORIAL, Le Monde, March 4

"The joint session of both houses of Parliament convened in Versailles on Monday, March 4, to enshrine access to abortion in the French Constitution, marks an important moment in the life of the nation. And a proud moment, too. A few days before International Women's Rights Day on March 8, women's freedom to control their own bodies should be anchored in French law. It also comes at a time when abortion, once thought to be a widely accepted procedure, is being undermined in a number of democracies, most notably the United States.

...

"The three-fifths majority required in Parliament means that a consensus has been reached, despite the fact that abortion still disgusts some on the right and far right. It's a sign that democracy works, despite the distress signals it is sending out.

"At every stage of the lengthy procedure initiated in November 2022, the drafting of the Constitutional reform constantly required perseverance and tact. First in the Assemblée Nationale, where, in response to the shockwave caused in June 2022 by the US Supreme Court's decision to revoke the federal right to abortion, the radical-left La France Insoumise party and the center-right presidential majority agreed to work together on a common cause.

"Then the fight continued in the Sénat, where, in loyalty to Simone Veil's 1975 battle to decriminalize abortion, a number of right-wing Les Républicains elected representatives fought hard to ensure that the debate, which they had reframed, could continue against the advice of their group's president, Bruno Retailleau, and Sénat President Gérard Larcher. Finally, in the government, Justice Minister Eric Dupond-Moretti facilitated the drafting and adoption of the final text. The compromise consists of enshrining the notion of "guaranteed freedom" for women to have access to abortion, without introducing an enforceable "right" to abortion as demanded by the left."

#######

*Regarding the Prime Minister's remark to women that "no one can decide for you" I note that surrogacy remains illegal in France.

Friday, October 18, 2019

Will IVF become more widely legal in France?

Education (and age) versus fertility in the U.S. marriage market

 Markets change over time, including the marriage market.  American marriages have become more assortative in recent years, and it appears that, in the 21st Century, women no longer pay a 'marriage penalty' (measured in spousal income) for graduate education.

The Human Capital–Reproductive Capital Trade-Off in Marriage Market Matching, by Corinne Low, Journal of Political Economy Volume 132, Number 2, February 2024

"Abstract: Throughout the twentieth century, the relationship between women’s human capital and men’s income was nonmonotonic: while college-educated women married richer spouses than high school–educated women, graduate-educated women married poorer spouses than college-educated women. This can be rationalized by a bidimensional matching framework where women’s human capital is negatively correlated with another valuable trait: fertility, or reproductive capital. Such a model predicts nonmonotonicity in income matching with a sufficiently high income distribution of men. A simulation of the model using US Census fertility and income data shows that it can also predict the recent transition to more assortative matching as desired family sizes have fallen."

Notable sentence about the ancien regime: "I provide a simple condition such that there always exists a man rich enough that he prefers a higher fertility but poorer woman to a richer and less fertile woman."

*******

And here's an earlier paper on fertility (through IVF) and age of marriage in Israel:

Gershoni, Naomi, and Corinne Low. 2021. "Older Yet Fairer: How Extended Reproductive Time Horizons Reshaped Marriage Patterns in Israel." American Economic Journal: Applied Economics, 13 (1): 198-234.

"Abstract: Israel's 1994 adoption of free in vitro fertilization (IVF) provides a natural experiment for how fertility time horizons impact women's marriage timing and other outcomes. We find a substantial increase in average age at first marriage following the policy change, using both men and Arab-Israeli women as comparison groups. This shift appears to be driven by both increased marriages by older women and younger women delaying marriage. Age at first birth also increased. Placebo and robustness checks help pinpoint IVF as the source of the change. Our findings suggest age-limited fertility materially impacts women's life timing and outcomes relative to men."

Frozen embryos are children: Alabama Supreme Court ruling

 The Washington Post has the story, which emphasizes the implications this ruling could have on in-vitro fertilization (IVF).  That would also impact surrogacy, and possibly deceased donor transplantation (depending on how it impacts the definitions of who is alive and who isn't...) 

Frozen embryos are children, Ala. high court says in unprecedented ruling. By Dan Rosenzweig-Ziff, February 19, 2024 

"The Alabama Supreme Court ruled Friday that frozen embryos are people and someone can be held liable for destroying them, a decision that reproductive rights advocates say could imperil in vitro fertilization (IVF) and affect the hundreds of thousands of patients who depend on treatments like it each year.

"The first-of-its-kind ruling comes as at least 11 states have broadly defined personhood as beginning at fertilization in their state laws, according to reproductive rights group Pregnancy Justice, and states nationwide mull additional abortion and reproductive restrictions, elevating the issue ahead of the 2024 elections. Federally, the U.S. Supreme Court will decide this term whether to limit access to an abortion drug, the first time the high court will rule on the subject since it overturned Roe v. Wade in 2022.

"The Alabama case focused on whether a patient who mistakenly dropped and destroyed other couples’ frozen embryos could be held liable in a wrongful-death lawsuit. The court ruled the patient could, writing that it had long held that “unborn children are ‘children’” and that that was also true for frozen embryos, affording the fertilized eggs the same protection as babies under the Wrongful Death of a Minor Act.

...

"The push for defining personhood has even affected tax law: Georgia now recognizes an “unborn child” as a dependent after six weeks of pregnancy.

Abortion bans in some states lead to late stage abortions in others

Obstacles to abortions in some states mean that some people seeking to end a pregnancy will have a late stage abortion where it's legal--i.e. laws intended to ban abortions or to allow only very early abortions may be moving some abortions much later. 

The New Yorker has a photographic essay:

A SAFE HAVEN FOR LATE ABORTIONS. At a clinic in Maryland, desperate patients arrive from all over the country to terminate their pregnancies.  Photographs by Maggie Shannon.  —Margaret Talbot

"For several years, Morgan Nuzzo, a nurse-midwife, and her friend and colleague Diane Horvath, an ob-gyn, talked about opening a clinic that would provide abortions in all trimesters of pregnancy. In May, 2022, the draft opinion of the Supreme Court ruling that overturned Roe v. Wade was leaked, infusing their plan with fresh urgency. The women had launched a GoFundMe campaign earlier that spring, noting that stand-alone clinics made up the majority of providers offering abortion after fifteen weeks, and that many of these had closed in recent years. Within weeks, Nuzzo and Horvath had raised more than a hundred thousand dollars; that summer, they started training employees for the new clinic, Partners in Abortion Care, in College Park, Maryland. They saw their first patient that October, and by the end of 2023 they had treated nearly five hundred. The youngest was eleven years old, the oldest fifty-three.

...

"Abortions in the second or third trimester are rare—the vast majority of abortions in the United States are performed in the first thirteen weeks of pregnancy—and when they occur the circumstances tend to be desperate. Horvath told me, “We know that when people decide they need an abortion they want to have it as soon as possible. Nobody is hanging out until they get to twenty or thirty weeks, saying, ‘Oh, I think maybe I’ll have my abortion now.’ ” A common scenario, she said, went like this: “You’re in, say, Texas—you’re pregnant and you need an abortion. You found out you were pregnant at eight weeks, which is a very usual time to find out. You arrange for child care—sixty per cent of people who have abortions are already parents—you get the money together, you’re going to have to travel out of state. You go to the next state that you can go to, and you find out you’re too far along for them. So now it’s going to be three times as much money. The cost goes up because the complexity of care goes up. If you travel four or five states over, how many days off is that, how many days of child care?”

Pope Francis calls for a ban on surrogacy

 The Catholic Church has long opposed in-vitro fertilization (IVF), one of the technological tools that allows surrogacy, on the grounds that IVF produces more embryos than are brought to term as babies, and so is comparable to abortion.*  But this week, during his annual "state of the world" foreign policy speech, Pope Francis made clear that he thinks surrogacy should additionally be banned because of the presence of "commercial contracts." 

Here's the story from the National Catholic Register:

Pope Francis Calls Surrogacy ‘Deplorable,’ Calls for Global Ban in Speech to Ambassadors

"Pope Francis called surrogacy “deplorable” and called for a global ban on the exploitative practice of “so-called surrogate motherhood” in a speech to all of the world’s ambassadors to the Vatican on Monday.

“The path to peace calls for respect for life, for every human life, starting with the life of the unborn child in the mother’s womb, which cannot be suppressed or turned into an object of trafficking,” Pope Francis said Jan. 8.

“In this regard, I deem deplorable the practice of so-called surrogate motherhood, which represents a grave violation of the dignity of the woman and the child, based on the exploitation of situations of the mother’s material needs. A child is always a gift and never the basis of a commercial contract.”

"The Pope then called on the international community to prohibit the practice of surrogacy universally."

##########

The United States Conference of Catholic Bishops reiterates the main point in this quote from its spokesperson:

Statement of USCCB on Holy Father’s Remarks on Surrogacy, January 8, 2024

“As Pope Francis stated, with surrogacy, an unborn child is turned into ‘an object of trafficking’ because it exploits the birth mother’s material needs and makes the child the product of a commercial contract. This is why the Catholic Church teaches that the practice of surrogacy is not morally permissible. Instead, we should pray for, and work towards, a world that upholds the profound dignity of every person, at every stage and in every circumstance of life.”

##########

And here's the story in the NYT:

Francis Urges Ban on Surrogacy, Calling It ‘Despicable’  The pope said that an unborn child must not be “turned into an object of trafficking,” expanding his condemnation of a practice already illegal in Italy and some other European countries.  By Jason Horowitz

"Pope Francis on Monday called surrogate motherhood a “despicable” practice that should be universally banned for its “commercialization” of pregnancy, including the practice among wars, terrorism and other threats to peace and humanity in an annual speech to ambassadors.

...

"Surrogacy is already illegal in Italy and compensated surrogacy is also illegal or restricted in much of Europe. The United Kingdom, the Netherlands, Portugal and several other nations allow surrogacy under certain conditions. Paid surrogacy is legal in some European nations, including Ukraine, Russia and Belarus.

"Surrogate mothers in the United States and Canada are often hired by Europeans, including same-sex couples, seeking to have children..."

##########

Earlier:

Wednesday, April 5, 2023  Surrogacy under siege in Italy

*  Monday, October 4, 2010  From repugnant transaction to Nobel Prize in Medicine

#########

Update: here's the Pope's full speech (in English) from the Vatican Press Office:

Audience with the Diplomatic Corps accredited to the Holy See for the exchange of greetings for the New Year, 08.01.2024

Gamete exchange

 Here's a cheerful story of peer to peer assisted reproduction, from the Washington Post:

Two couples couldn’t have babies, so they helped each other  By Kyle Melnick

"Neva and her wife, Kelsey, were considering using a surrogate or an in vitro method to have a child. John and his wife, Amy, couldn’t carry a pregnancy because of a hysterectomy Amy underwent to treat endometriosis.

“Just give us your sperm,” Neva recalled telling John. “We’ll have a baby, and then we’ll just give you an egg. It’s not a big deal.”

...

"In 2020, John donated sperm so that Kelsey could become pregnant through an insemination service. The Bentons’ baby was born the next year in Kansas. Kelsey, now 32, then acted as a surrogate for the Cardenases and birthed the Arizona couple’s child in July.

...

"the couples bought an insemination kit and wrote up a surrogacy contract with an attorney’s assistance. Kelsey tracked her menstrual cycles; John, who’s now 41, took pills and adjusted his diet to produce healthy sperm."

New technologies and new controversies: using CRISPR to edit human genes

 New technologies are often accompanied by new repugnancies, i.e. by controversies about their moral appropriateness. The future of using CRISPR to edit human genes is still before us, and its history (even to date) has yet to be written. But I'm struck by how it both interacts with and recapitulates older controversies and repugnancies, including those involving HIV, and adoption and assisted reproduction.

The New Yorker has the story:

The Transformative, Alarming Power of Gene Editing. A rogue scientist showed that crispr gives humans the ability to transform ourselves. But should we?  By Dana Goodyear  September 2, 2023

"The Chinese researcher He Jiankui was jailed for creating customized babies. Some observers argue that the real problem wasn’t him—it was the lure of the technology.

...

"To start, he would focus on what he believed was an achievable task: eradicating a disease governed by a single gene. He selected aids, an illness regarded in China as both pernicious and shameful but one for which there might be an elegant fix. H.I.V. enters human cells by way of a receptor created by a gene called CCR5. JK planned to use the gene-editing tool crispr to disrupt CCR5 in human embryos, which would, in theory, render the babies impervious to infection.

"The experiment required volunteers, and, through a chat group associated with an H.I.V./aids charity, he began recruiting couples: H.I.V.-positive men married to uninfected women. Chinese law denies in-vitro fertilization and adoption to H.I.V.-positive people, and natural conception carries a risk of transmission. For couples with an infected partner, JK’s program was a chance at parenthood. It promised confidentiality, which was critical for a marginalized community; an H.I.V. diagnosis in China can cost a person his job. The treatments would take place discreetly, at facilities where only key employees were aware of the experiment.

...

"as scientists from around the world prepared for a gene-editing conference in Hong Kong, JK released a series of YouTube videos, announcing the birth of a set of twins, edited as embryos with crispr. A slim, nervous-seeming man in a pale-blue shirt, he looked earnestly into the camera and said, “Two beautiful little Chinese girls named Lulu and Nana came crying into the world, as healthy as any other babies.” He went on to explain how, when each was only a single cell, he had used crispr to delete CCR5. “I understand my work will be controversial,” he said. “But I believe families need this technology, and I’m willing to take the criticism for them.”

"China’s state-run media celebrated the news, but the scientific community reacted with dismay. A group of Chinese researchers condemned the study as madness. David Baltimore, a Nobel Prize-winning biologist who chaired the Hong Kong event, called it “irresponsible,” saying, “I think there has been a failure of self-regulation by the scientific community.

...

"There were three edited babies, he acknowledged: along with Lulu and Nana, another was on the way.

...

"The Chinese government swiftly withdrew its enthusiasm for JK’s research, and, soon after he returned to the mainland, his lab was locked and he was placed under house arrest. In 2019, he was sentenced to three years in prison for “illegal medical practices,” and fined nearly half a million dollars. Two of his collaborators were given lesser sentences and fined. Among scientists, there was a pervasive sense of embarrassment. JK had misused a powerful technology and gambled with the health of children—experimental subjects he himself had created—without, in the scientists’ view, a compelling medical reason to compensate for the risk. Urnov told me, “He has taken a jar of tar, poured it over the field of crispr, and left an indelible stain. We will never wash that stain off. I am prepared to say that he’s not a fellow-scientist. He’s persona non grata.”

"JK was released from prison in the spring of 2022, and quickly resumed his efforts at gene editing. 

...

"He said that his new lab would be a nonprofit providing affordable gene therapy for rare conditions, and that he would focus first on Duchenne muscular dystrophy, a fatal disease that causes irreversible muscle damage, primarily in boys. This time, his patients would be not embryos but young children desperate for a cure. I asked if it was an attempt to redeem himself in the scientific community. “I don’t know if I’d use the word ‘redeem,’ ” he said. “I want to do it to help people today.”

...

"As for the debacle that his experiment had caused, JK would admit to no greater error than bad timing. “I do acknowledge that I have done it too quickly,” he said. In one of his YouTube videos, he predicted that in twenty or thirty years gene-edited babies will no longer be controversial, or even remarkable. He likened himself to the pioneering founder of the field of I.V.F., Robert Edwards, whose career had followed a heroic arc. In 1978, when the first I.V.F. baby was born, Edwards was a figure of scandal and opprobrium. In 2010, he was awarded the Nobel Prize."

Egg freezing in China and Hong Kong

 The FT has the story:

China’s fertility treatment rules push single women to Hong Kong

Beijing faces calls to ease access to egg freezing and IVF amid demographic crisis

By Eleanor Olcott and Chan Ho-him 

“Beijing has long banned access to egg freezing or IVF for single women. While unmarried men can freeze their sperm, single women such as Sophia, who declined to give her surname, are not allowed to freeze their eggs.

…

“As a result, more and more Chinese women travel abroad for the procedure, with Hong Kong a top destination given its proximity and strong healthcare system.

…

“While it is possible for single or gay women to freeze their eggs in Hong Kong, only married heterosexual couples can access IVF treatment. In practice, that means eggs are stored until women get married and begin the IVF process.”

Are embryos property?

 A Virginia judge has managed to make a repugnant legal argument about a repugnant transaction, since the relevant precedent he identifies has to do with the ownership of slaves.

Virginia judge rules human embryos are ‘chattel’ based on centuries-old slave laws  by Matthew Barakat, Associated Press

"Frozen human embryos can legally be considered property, or “chattel,” a Virginia judge has ruled, basing his decision in part on a 19th century law governing the treatment of slaves.

"The preliminary opinion by Fairfax County Circuit Court Judge Richard Gardiner – delivered in a long-running dispute between a divorced husband and wife – is being criticized by some for wrongly and unnecessarily delving into a time in Virginia history when it was legally permissible to own human beings.

“It’s repulsive and it’s morally repugnant,” said Susan Crockin, a lawyer and scholar at Georgetown University’s Kennedy Institute of Ethics and an expert in reproductive technology law.

...

"In a separate part of his opinion, Gardiner also said he erred when he initially concluded that human embryos cannot be sold.

“As there is no prohibition on the sale of human embryos, they may be valued and sold, and thus may be considered ‘goods or chattels,’” he wrote."

HT: Kim Krawiec

Will Italy criminalize foreign surrogacy?

 It's hard to ban something that people want and need and is legally available in other jurisdictions, but it looks like Italy might try it regarding surrogacy.  Here's a story from Britain's Sunday Times:

Italian families seeking surrogates abroad could face jail or €1 million fines by Tom Kington

"Italians travelling abroad to seek surrogate mothers to start families could face jail time and a million euro fine thanks to a new bill introduced by senators close to Giorgia Meloni, the Italian prime minister.

"The proposed law, which must be approved by the Italian parliament, describes surrogacy as “an execrable example of the commercialisation of the female body and the treatment of babies as merchandise”.

...

"An Italian law passed in 2004 banned surrogate pregnancies in Italy, forcing couples to travel to countries such as the United States and Canada to find surrogate mothers."

Post Roe (post Dobbs) legal efforts to secure rights established in previous Court decisions

 Since the Supreme Court ruling in Dobbs that overturned Roe and said that abortion was subject to regulation by each State, and not an individual right, there have been attempts in Washington to moderate some of its potential effects, particularly in light of Justice Thomas' opinion that the ruling could lead the way to rolling back other rights established by previous court rulings.

There have been some successes and some failures.

Here's a story from the Guardian about some new regulations and interpretations.

The US government just took two big steps on abortion. Will they matter? While the decisions cannot undo abortion bans in the 13 states they exist, it could make a huge difference where the right is protected  by Poppy Noor

"This week, the federal government announced two decisions designed to improve abortion access in the US. The first, a rule change made by the Food and Drug Administration, allows pharmacies to dispense mifepristone, one of the two drugs needed for a medication abortion. The second, an opinion drafted by the justice department, gives the US Postal Service the all clear to continue mailing abortion pills, even to states where abortion is severely restricted.

South Carolina supreme court rules six-week abortion ban unconstitutional

Read more

...

These decisions cannot undo abortion bans in the 13 states where they exist. While major pharmacies such as Walgreens and CVS have announced they will seek certification to dispense mifepristone, a prescription for it still will not be legal in states with a ban. Anyone distributing or taking abortion pills in banned states could still face severe consequences. And the justice department opinion will not protect anyone sending pills to a banned state from being prosecuted in that state, or anyone who takes the pills knowingly to induce an abortion from being investigated.

But in states where abortion is protected, both moves could make a big difference, advocates say.

Take California as an example, which recently expanded access for abortion care in its state constitution. Until now, abortion pills had to be dispensed by a doctor, an abortion clinic, or a mail order pharmacy. But even in California, many people live hundreds of miles away from an abortion clinic.

...

"It is unclear whether the FDA ruling will see pharmacies dispensing mifepristone in states with limits on abortion that fall short of total bans."

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

One of the concerns is that some states may declare fetuses to be persons, in a way that would extend their abortion bans to also include forms of assisted reproductive technology such as IVF, which create embryos to allow infertile couples start families.  An effort to protect IVF was introduced just before the close of the previous Congress, but it wasn't made into law, and the new Congress is likely to be less sympathetic.

Right to Build Families Act of 2022 (proposed by Senator Tammy Duckworth, but not enacted)

"A BILL To prohibit the limitation of access to assisted reproductive technology, and all medically necessary care surrounding such technology."

*********

Earlier:

Wednesday, December 14, 2022

Biden Signs Bill to Protect Same-Sex Marriage Rights

Abortion protections and restrictions in the midterm elections

 Here's a post-election report from the NYT on how abortion protections and restrictions fared in the midterm elections. (It tries to reflect not only specific referenda and constitutional amendments, but also the platforms of elected candidates...)

Where the Midterms Mattered Most for Abortion Access  By Allison McCann, Amy Schoenfeld Walker, John-Michael Murphy and Sarah Cahalan

"The first election to put abortion rights to the test after the Supreme Court overturned Roe v. Wade appears unlikely to reshape the map of abortion access — at least not overnight. Voters in much of the country reinforced the status quo, choosing candidates who are likely to either maintain existing protections or restrictions in their states, or deepen them."

*******

Here's MSNBC's roundup, in an opinion piece that looks more at specific laws on the ballot:

The 2022 midterms abortion results should surprise literally no one. When voters get a say in their own individual reproductive rights, most want to keep them. By Emma Gray,

"On Thursday, Montana’s “Born Alive” legislative referendum officially failed.

...

"This meant that Montana’s voters joined Vermonters, Michiganders, Californians and even voters in deep-red Kentucky in protecting abortion rights. Vermont, Michigan and California enshrined reproductive freedom in their state Constitutions, and in Kentucky, voters struck down a proposed constitutional amendment that would have explicitly stated that there is no right to abortion in the state."

The end of anonymous sperm donation...

 In  Colorado, a new law ending anonymous sperm donation seeks to catch up with the technological developments involving genetic sequencing that have already made anonymity of sperm or egg donors fairly fragile. Here's an account in JAMA:

The End of Anonymous Sperm Donation in Colorado--A Step Forward to a New Fertility Future in the US?  by I. Glenn Cohen, JD1; Eli Y. Adashi, MD, MS2; Seema Mohapatra, JD, MPH3   JAMA. Published online October 24, 2022. doi:10.1001/jama.2022.19471

"On May 31, 2022, Colorado became the first state to effectively ban anonymous gamete donation.1 Starting in 2025, fertility clinics in Colorado must collect identity and medical information from sperm and egg donors and may not match donors that do not agree to such disclosure (the statute uses the word “donor” though in many instances compensation is provided). The new law also requires that the clinics make a request that donors update their contact information and medical history at least once every 3 years. The law provides that a donor-conceived person aged 18 years or older shall be provided donor information upon request. The statute purports to also prohibit fertility clinics outside Colorado from providing gametes to Colorado residents (or individuals located in Colorado) if they do not abide by these rules. The statute also instructs clinics not to match a donor once it is known or reasonably should be known that “25 families have been established using a single donor in or outside of Colorado.”1

...

"Two states, Utah and Washington, have enacted statutes requiring the collecting and sharing of identifying information about a donor with donor-conceived children who request it after reaching the age of 18 years.3 However, both states also permit a donor to opt out, thereby limiting the utility of the laws. By contrast, the UK, Germany, Sweden, France, and many other countries have created mandatory registries that donor-conceived individuals can access when they turn 18 years of age, having an effect similar to the new Colorado law.3,4

"The new Colorado law highlights the gap between the law and reality of gamete donor anonymity in the US outside Colorado. Banks have promised donors anonymity in other US states and prior leaks of donor information from banks’ files have been exceedingly rare, if they ever happened at all; the banks have litigated to protect the identifying information provided by the donor.3 But in a practical sense, the promise of anonymity is now much less thoroughgoing.4 Direct-to-consumer genetic testing has become very common, and it has been estimated that 100 million people worldwide have taken a direct-to-consumer genetic test by 2021.4 Studies estimate that a genetic database covering only 2% of the population could match nearly anyone in that population.4 The combination of direct-to-consumer genetic testing, publicly available information, and social media suggest that many donor-conceived individuals will in fact be able to reidentify their gamete donor."