tag:theconversation.com,2011:/ca/topics/fertility-treatment-7496/articlesFertility treatment – The Conversation2024-03-07T13:36:07Ztag:theconversation.com,2011:article/2247212024-03-07T13:36:07Z2024-03-07T13:36:07ZWhat is a frozen embryo worth? Alabama’s IVF case reflects bigger questions over grieving and wrongful death laws<figure><img src="https://images.theconversation.com/files/579978/original/file-20240305-16-b0u7k5.jpg?ixlib=rb-1.1.0&rect=8%2C8%2C2986%2C1985&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An embryologist uses a microscope to view an embryo, visible on a monitor.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/AlabamaFrozenEmbryos/e6f3454e8ba144ccadc7e0a21532fb6c/photo?Query=alabama%20supreme%20court&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=508&currentItemNo=22">AP Photo/Richard Drew, File</a></span></figcaption></figure><p>In the weeks since the Alabama Supreme Court held that <a href="https://thehill.com/homenews/state-watch/4477607-alabama-supreme-court-rules-frozen-embryos-are-children/">embryos are “unborn children</a>” under one state law, most attention has been focused on in vitro fertilization – whether the decision imperils parents’ attempts to create a family. On March 6, 2024, Gov. Kay Ivey signed legislation to <a href="https://apnews.com/article/alabama-ivf-frozen-embryos-ruling-cab8171e80c88a088778dc7a187b7b5a">shield IVF providers from legal liability</a>, though the new law does not address frozen embryos’ legal status.</p>
<p>As <a href="https://health.usf.edu/publichealth/overviewcoph/faculty/katherine-drabiak">a health law professor</a>, I believe it’s also important to understand the laws that shaped the court’s decision: not only Alabama’s laws about “unborn children,” but wrongful death laws. This is a legal claim where family members can bring a civil lawsuit against a person who intentionally or carelessly caused the family member’s death, which is different from any criminal charges.</p>
<p>Over the past 100 years, laws have evolved to reflect a wider sense of what it means to lose a loved one, and how to “compensate” their family. Courts have been asked to interpret how wrongful death laws should apply to situations before a child is born.</p>
<h2>What happened in the clinic?</h2>
<p>The Alabama case, <a href="https://law.justia.com/cases/alabama/supreme-court/2024/sc-2022-0579.html">LePage v. Center for Reproductive Medicine</a>, was brought by three couples who had used IVF at a fertility clinic. They sued the clinic after a patient who wandered into the “cryogenic nursery,” where frozen embryos are stored, picked some up and accidentally dropped them on the floor, destroying them.</p>
<p>In the language of the court, this killed the embryos, since they might have developed into a healthy fetus if implanted in the uterus. </p>
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<a href="https://images.theconversation.com/files/580020/original/file-20240305-18-hv069o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A steel vat, with icy condensation inside, open to reveal white packets inside at the bottom of the container." src="https://images.theconversation.com/files/580020/original/file-20240305-18-hv069o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580020/original/file-20240305-18-hv069o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580020/original/file-20240305-18-hv069o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580020/original/file-20240305-18-hv069o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580020/original/file-20240305-18-hv069o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580020/original/file-20240305-18-hv069o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580020/original/file-20240305-18-hv069o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Containers holding frozen embryos and sperm are stored in liquid nitrogen at a fertility clinic in Fort Myers, Fla., in 2018.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/AlabamaFrozenEmbryos/25b27e79f3e14fb6910ff3de3ebc7dae/photo?Query=alabama%20supreme%20court&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=508&currentItemNo=32">AP Photo/Lynne Sladky, File</a></span>
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<p>The three sets of parents filed a lawsuit based on a claim for <a href="https://www.law.cornell.edu/wex/wrongful_death">wrongful death</a>. Like <a href="https://www.bu.edu/bulawreview/files/2020/03/LENS.pdf">about 40 other states</a>, Alabama allows parents to bring a claim for <a href="https://law.justia.com/codes/alabama/2022/title-6/chapter-5/article-22/section-6-5-391/">wrongful death</a> of an unborn child.</p>
<p>The court said the question in this case centered around whether the term “unborn child” in state laws only refers to an embryo or fetus in utero, or whether there is an “unwritten exception” for embryos that have not yet been transferred to the womb.</p>
<h2>The court’s decision</h2>
<p>Alabama Supreme Court cases in 2011 and 2012 had already held that the state’s wrongful death law <a href="https://casetext.com/case/mack-v-carmack">allows expectant parents to bring a claim</a> following a death at <a href="https://casetext.com/case/hamilton-v-scott-2">any stage of the embryo’s or fetus’s development</a>.</p>
<p>In addition, Alabama <a href="https://ballotpedia.org/Alabama_Amendment_2,_State_Abortion_Policy_Amendment_(2018)">amended its state constitution</a> in 2018 to affirm that public policy of the state should protect “the rights of the unborn child.”</p>
<p><a href="https://law.justia.com/cases/alabama/supreme-court/2024/sc-2022-0579.html">Combining the previous cases</a>, the state constitution and even dictionary definitions, the court said nothing in the current wrongful death law would exempt “extrauterine children – that is, unborn children who are located outside of a biological uterus at the time they are killed.”</p>
<p>This ruling does not mean that the parents won a wrongful death lawsuit, but that a court will be able to hear the parents’ claim for wrongful death.</p>
<h2>The legal ‘value’ of an embryo</h2>
<p>This is significant because in <a href="https://doi.org/10.1016/j.xfre.2020.06.007">other cases</a> where embryos were destroyed, the law generally has treated embryos as <a href="https://www.nbcnews.com/health/health-news/university-hospitals-fertility-clinic-faces-new-lawsuits-after-tank-failures-n962341">parents’ property</a>, or allege negligence by the clinic. Only a <a href="https://doi.org/10.1016/j.fertnstert.2022.12.038">handful of other states</a> – including Illinois, Missouri and Georgia – allow wrongful death lawsuits for embryos.</p>
<p>IVF <a href="https://www.nytimes.com/article/ivf-treatment-costs-guide.html">is a significant investment</a> of time and money, and involves a variety of <a href="https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716">medical risks</a>. In a case where fertility treatment goes wrong, couples could try to recoup those costs through civil lawsuits that sometimes treat frozen embryos as property.</p>
<p>However, that does not account for each embryo’s biological and emotional uniqueness. Before the Alabama ruling, other cases had tried to classify embryos as <a href="https://www.courthousenews.com/would-be-parents-want-embryos-deemed-people-after-clinic-meltdown/">living people</a> to signify their <a href="https://abcnews.go.com/US/families-sue-cleveland-clinic-malfunction-possibly-destroyed-embryos/story?id=53683517">irreplaceable value</a>. </p>
<p>Some <a href="https://vanderbiltlawreview.org/lawreview/2022/11/abortion-pregnancy-loss-subjective-fetal-personhood/">legal experts</a> assert that embryos only have “subjective and relational value.” In other words, only parents can decide whether or not they are important and have meaning.</p>
<p>Other <a href="https://contemporarythinkers.org/robert-george/book/embryo-defense-human-life/">experts suggest</a> that embryos have inherent value because they are each genetically distinct, unique human life at the earliest stage. They argue that allowing protection for some stages of human development but not others violates human rights principles.</p>
<h2>How wrongful death laws work</h2>
<p>How the value of an embryo is defined also shapes whether wrongful death laws would apply.</p>
<p>Wrongful death laws were originally designed to compensate family members for the loss of that person’s <a href="https://heinonline.org/HOL/Page?handle=hein.journals/wsulr5&div=17&g_sent=1&casa_token=&collection=journals">services and contributions</a>. Damages from a lawsuit could pay medical bills, funeral expenses and lost earnings from that person’s job, for example.</p>
<p>Each state has its own wrongful death law. <a href="https://www.bu.edu/bulawreview/files/2020/03/LENS.pdf">Since the 1850s</a>, these laws have allowed parents to bring claims to recover damages from a person who causes their child’s death. Initially, these laws were designed as an economic tool because parents expected their children to work.</p>
<p>Now, according to some <a href="https://www.bu.edu/bulawreview/files/2020/03/LENS.pdf">legal scholars</a>, many states recognize that losing a child means much more: a moral injury, pain and <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1286251">the anguish</a> from losing the child’s company and affection. Some states allow the family to <a href="https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2059&ChapterID=57">recover damages for suffering and grief</a> – recognizing a person’s inherent value, not only their economic value.</p>
<p><a href="https://casetext.com/case/stinnett-v-kennedy-1">Awarding damages</a> to a grieving family is meant to deter risky actions that could result in loss of life.</p>
<p>By the mid-1900s, courts began to allow wrongful death claims for children that died before birth as a result of another person’s negligence or carelessness. Some states specify that <a href="https://nebraskalegislature.gov/laws/statutes.php?statute=30-809">this includes at any stage of gestation</a>. </p>
<p>Some laws, including in <a href="https://nebraskalegislature.gov/laws/statutes.php?statute=30-809">Nebraska</a> and <a href="https://statutes.capitol.texas.gov/Docs/CP/htm/CP.71.htm#:%7E:text=71.003.,inside%20or%20outside%20this%20state.">Texas</a>, prevent families from suing the pregnant woman, or from suing her medical provider, if she opts to have a medical procedure that results in unintended fetal loss. Others specify that the law <a href="https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2059&ChapterID=57#:%7E:text=Whenever%20the%20death%20of%20a,then%20and%20in%20every%20such">does not apply</a> in cases of abortion. </p>
<h2>What the case means moving forward</h2>
<p>Some policymakers have <a href="https://time.com/6835548/lawmakers-ivf-embryos-alabama-legislation/">expressed concern</a> that Alabama’s decision “criminalizes” parents from trying to grow their family, or that they would face <a href="https://www.cnn.com/2024/02/27/us/ivf-ruling-impact-other-states/index.html">prosecution</a>. However, this is not accurate, since this case only relates to civil lawsuits, not criminal law.</p>
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<a href="https://images.theconversation.com/files/580222/original/file-20240306-28-lwkhnd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman in a long white sweater, holding a pink sign that says 'I just want to be a mom,' speaks with another blonde woman in a doctor's coat." src="https://images.theconversation.com/files/580222/original/file-20240306-28-lwkhnd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/580222/original/file-20240306-28-lwkhnd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580222/original/file-20240306-28-lwkhnd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580222/original/file-20240306-28-lwkhnd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580222/original/file-20240306-28-lwkhnd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580222/original/file-20240306-28-lwkhnd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580222/original/file-20240306-28-lwkhnd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Patients and doctors gathered outside the Alabama Statehouse in Montgomery on Feb. 28, 2024, urging lawmakers to protect IVF services in the state.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/AlabamaIVFAffectedGroups/e3ec159eb74c437297b40e73d8835780/photo?Query=ivf&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=110&currentItemNo=4">Kim Chandler/AP</a></span>
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<p>Nor does the decision prohibit using IVF. The Alabama attorney general has stated that he <a href="https://www.cnn.com/2024/02/23/us/alabama-ivf-embryos-supreme-court-ruling-legislation/index.html">does not intend</a> to use this decision to prosecute either parents or IVF providers. However, several fertility clinics announced that they would <a href="https://www.nytimes.com/2024/02/23/us/politics/alabama-ivf-treatment-law.html">pause their IVF services</a> while assessing the law.</p>
<p>Based on the U.S. Constitution, courts can only <a href="https://www.ncsl.org/about-state-legislatures/separation-of-powers-legislative-judicial-relations">interpret what the law is</a>, not decide what they think it should be. </p>
<p>In response, state legislators rapidly proposed <a href="https://www.cnn.com/2024/02/27/us/ivf-ruling-impact-other-states/index.html">a variety of bills</a> aimed at preserving IVF. The bill signed into law on March 6, 2024 <a href="https://www.newsfromthestates.com/article/alabama-legislature-passes-bills-aimed-protecting-vitro-fertilization?emci=9460e6e7-4cd7-ee11-85f9-002248223794&emdi=a8a94336-c3d7-ee11-85f9-002248223794&ceid=519099">gives broad immunity</a> to IVF clinics, shielding providers from prosecution and lawsuits “for the damage to or death of an embryo.” However, it provides more protection than is standard, which may create unintended consequences – for example, potentially making it more difficult to sue for negligence or breach of contract.</p>
<p>As Alabama legislators discuss next steps, they need to incorporate the state constitution while considering how to reflect the will of their voters.</p><img src="https://counter.theconversation.com/content/224721/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine Drabiak does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Alabama’s case began when three couples sued an IVF clinic where their frozen embryos had accidentally been dropped.Katherine Drabiak, Professor of Health Law, Public Health Law and Medical Ethics, University of South FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2082762023-07-13T12:37:38Z2023-07-13T12:37:38ZPromising assisted reproductive technologies come with ethical, legal and social challenges – a developmental biologist and a bioethicist discuss IVF, abortion and the mice with two dads<figure><img src="https://images.theconversation.com/files/534595/original/file-20230628-23-se3fkd.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2000%2C1500&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A few days after successful fertilization, an embryo becomes a rapidly dividing ball of cells called a blastocyst.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/blastocyst-embryo-illustration-royalty-free-illustration/1498384521">Juan Gaertner/Science Photo Library via Getty Images</a></span></figcaption></figure><p><em>Assisted reproductive technologies are medical procedures that help people experiencing difficulty having or an inability to have biological children of their own. From in vitro fertilization to genetic screening to creation of viable eggs from the <a href="https://doi.org/10.1038/s41586-023-05834-x">skin cells of two male mice</a>, each new development speaks to the potential of reproductive technologies to expand access to the experience of pregnancy.</em> </p>
<p><em>Translating advances from the lab to the clinic, however, comes with challenges that go far beyond the purely technical.</em></p>
<p><em>Conversations around the ethics and implications of cutting-edge research often happen after the fact, when the science and technology have advanced beyond the point at which open dialogue could best protect affected groups. In the spirit of starting such cross-discipline conversations earlier, we invited developmental biologist <a href="https://scholar.google.com/citations?user=i6SghEMAAAAJ&hl=en">Keith Latham</a> of Michigan State University and bioethicist <a href="https://www.researchgate.net/profile/Mary-Faith-Marshall">Mary Faith Marshall</a> of the University of Virginia to discuss the ethical and technological potential of <a href="https://www.npr.org/sections/health-shots/2023/05/27/1177191913/sperm-or-egg-in-lab-breakthrough-in-reproduction-designer-babies-ivg">in vitro gametogenesis</a> and assisted reproductive technology post-Roe.</em></p>
<h2>How new are the ethical considerations raised by assisted reproductive technologies?</h2>
<p><strong>Keith</strong></p>
<p>Every new technology raises many of the same questions, and likely new ones. On the safety and risk-benefit side of the ethical conversation, there’s nothing here that we haven’t dealt with since the 1970s with other reproductive technologies. But it’s important to keep asking questions, because the benefits are hugely dependent on the success rate. There are potential biological costs, but also possible social costs, financial costs, societal costs and many others.</p>
<p><strong>Mary Faith</strong> </p>
<p>It’s probably been that way even longer. One of my mentors, Joseph Francis Fletcher, a pioneering bioethicist and Episcopal priest, wrote a book called “<a href="https://press.princeton.edu/books/hardcover/9780691635224/morals-and-medicine">Morals and Medicine</a>” in 1954. It was the first non-Roman Catholic treatment of bioethics. And he raised a lot of these issues there, including the <a href="https://theconversation.com/jurassic-world-scientists-still-havent-learned-that-just-because-you-can-doesnt-mean-you-should-real-world-genetic-engineers-can-learn-from-the-cautionary-tale-184369">technological imperative</a> – the idea that because we can develop the technology to do something, we therefore should develop it.</p>
<p>Fletcher also said that the use of artifice, or human-made creations, is supremely human. That’s what we do: We figure out how things work and we develop new technologies like vaccines and heart-lung machines based on evolving scientific knowledge.</p>
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<a href="https://images.theconversation.com/files/534596/original/file-20230628-30-nfjlun.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Microscopy image of mouse ovum being fertilized by mouse sperm" src="https://images.theconversation.com/files/534596/original/file-20230628-30-nfjlun.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534596/original/file-20230628-30-nfjlun.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534596/original/file-20230628-30-nfjlun.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534596/original/file-20230628-30-nfjlun.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534596/original/file-20230628-30-nfjlun.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=487&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534596/original/file-20230628-30-nfjlun.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=487&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534596/original/file-20230628-30-nfjlun.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=487&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Scientists were able to create a mouse egg from the skin cells of male mice.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/fertilization-of-mouse-ovum-royalty-free-image/523741410">Clouds Hill Imaging Ltd./Corbis Documentary via Getty Images</a></span>
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<p>I think that in most cases, scientists should be involved in thinking about the implications of their work. But often, researchers focus more on the direct applications of their work than the potential indirect consequences. </p>
<p>Given the evolution of assisted reproductive technology, and the fact that its evolution is going to continue, I think one of the central questions to consider is, what are the goals of developing it? For assisted reproduction, it’s to help infertile people and people in nontraditional relationships have children.</p>
<h2>What are some recent developments in the field of assisted reproductive technology?</h2>
<p><strong>Keith</strong></p>
<p>One recent advance in assisted reproductive technology is the expansion of <a href="https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/03/preimplantation-genetic-testing">pre-implantation genetic testing</a> methods, particularly DNA sequencing. Many genes come in different variants, or alleles, that can be inherited from each parent. Providers can determine whether an embryo bears a “bad” allele that may increase the risk of certain diseases and select embryos with “healthy” alleles.</p>
<p>Genetic screening <a href="https://doi.org/10.1016/j.fertnstert.2022.03.017">raises several ethical concerns</a>. For example, the parents’ genetic profiles could be unwillingly inferred from that of the embryo. This possibility may deter prospective parents from having children, and such knowledge may also have potential effects on any future child. The cost of screening and potential need for additional cycles of IVF may also increase disparities.</p>
<p>There are also considerations about the <a href="https://doi.org/10.1016/j.fertnstert.2022.03.019">accuracy of screening predictions</a> without accounting for environmental effects, and what <a href="https://doi.org/10.1007/s12687-021-00573-w">level of genetic risk</a> is “serious” enough for an embryo to be excluded. More extensive screening also raises concerns about possible misuse for purposes other than disease prevention, such as production of “<a href="https://theconversation.com/an-american-company-will-test-your-embryos-for-genetic-defects-but-designer-babies-arent-here-just-yet-126833">designer babies</a>.”</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/uhb5gd5B-7g?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In vitro gametogenesis involves making egg or sperm cells from other adult cells in the body.</span></figcaption>
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<p>At a <a href="https://www.nationalacademies.org/news/2023/02/agenda-for-third-international-summit-on-human-genome-editing-march-6-8">genome-editing conference</a> in March 2023, researchers announced that they were able to <a href="https://doi.org/10.1038/s41586-023-05834-x">delete and duplicate whole chromosomes</a> from the skin cells of male mice to make eggs. This method is one potential way to make eggs that do not carry genetic abnormalities. </p>
<p>They were very upfront that this was done at 1% efficiency in mice, which could be lower in humans. That means something bad happened to 99% of the embryos. The biological world is not typically binary, so a portion of that surviving 1% could still be abnormal. Just because the mice survived doesn’t mean they’re OK. I would say at this point, it would be unethical to try this on people.</p>
<p>As with some forms of genetic screening, using this technique to reduce the risk of one disease could inadvertently increase the risk of another. Determining that it is absolutely safe to duplicate a chromosome would require knowing every allele of every gene on that chromosome, and what each allele could do to the health of a person. That’s a pretty tall order, as that could involve identifying hundreds to thousands of genes, and the effects of all their variants may not be known. </p>
<p><strong>Mary Faith</strong></p>
<p>That raises the issue of efficacy and costs to yet another order of magnitude.</p>
<p><strong>Keith</strong> </p>
<p>Genome editing with <a href="https://theconversation.com/human-genome-editing-offers-tantalizing-possibilities-but-without-clear-guidelines-many-ethical-questions-still-remain-200983">CRISPR technology</a> in people carries similar concerns. Because of potential limitations in how precise the technology can be, it may be difficult for researchers to say they are absolutely 100% certain there won’t be off-target changes in the genome. Proceeding without that full knowledge could be risky. </p>
<p>But that’s where bioethicists need to come into play. Researchers don’t know what the full risk is, so how do you make that risk-benefit calculation?</p>
<p><strong>Mary Faith</strong></p>
<p>There’s the option of a voluntary global moratorium on using these technologies on human embryos. But somebody somewhere is <a href="https://theconversation.com/did-he-jiankui-make-people-better-documentary-spurs-a-new-look-at-the-case-of-the-first-gene-edited-babies-196714">still going to do it</a>, because the technology is just sitting there, waiting to be moved forward.</p>
<h2>How will the legal landscape affect the development and implementation of assisted reproductive technologies?</h2>
<p><strong>Mary Faith</strong></p>
<p>Any research that involves human embryos is in some ways politicized. Not only because the <a href="https://doi.org/10.1038/d41586-020-00127-z">government provides funding</a> to the basic science labs that conduct this research, but because of the wide array of beliefs that members of the public at large have about <a href="https://theconversation.com/defining-when-human-life-begins-is-not-a-question-science-can-answer-its-a-question-of-politics-and-ethical-values-165514">when life begins</a> or <a href="https://theconversation.com/what-is-personhood-the-ethics-question-that-needs-a-closer-look-in-abortion-debates-182745">what personhood means</a>.</p>
<p>The <a href="https://theconversation.com/roe-overturned-what-you-need-to-know-about-the-supreme-court-abortion-decision-184692">Dobbs decision</a>, which overturned the constitutional right to an abortion, has implications for assisted reproduction and beyond. Most people who are pregnant don’t even know they’re pregnant at the earliest stages, and somewhere around <a href="https://theconversation.com/most-human-embryos-naturally-die-after-conception-restrictive-abortion-laws-fail-to-take-this-embryo-loss-into-account-187904">60% of those pregnancies end naturally</a> because of genetic aberrations. Between 1973 and 2005, <a href="https://doi.org/10.1215/03616878-1966324">over 400 women were arrested for miscarriage in the U.S.</a>, and I think that number is going to grow. The implications for reproductive health care, and for assisted reproduction in the future, are challenging and frightening.</p>
<p>What will abortion restrictions mean for people who have <a href="https://www.cdc.gov/art/key-findings/multiple-births.html">multiple-gestation pregnancies</a>, in which they carry more than one embryo at the same time? In order to have one healthy child born from that process, the other embryos often need to be removed so they don’t all die. In the past 40 years, the number of twin births doubled and triplet and higher-order births quadrupled, primarily because of fertility treatments. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/534477/original/file-20230628-27-v0r0uc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Needle touching eggs in petri dish under microscope in IVF" src="https://images.theconversation.com/files/534477/original/file-20230628-27-v0r0uc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534477/original/file-20230628-27-v0r0uc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534477/original/file-20230628-27-v0r0uc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534477/original/file-20230628-27-v0r0uc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534477/original/file-20230628-27-v0r0uc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534477/original/file-20230628-27-v0r0uc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534477/original/file-20230628-27-v0r0uc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">IVF may involve transferring more than one embryo at a time.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/in-vitro-fertilization-royalty-free-image/1272954210">Antonio Marquez lanza/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p><strong>Keith</strong> </p>
<p>IVF may transfer one, two, or sometimes three embryos at a time. The <a href="https://doi.org/10.1016/j.jpeds.2022.11.038">cost of care for preterm birth</a>, which is one possible outcome of multiple-gestation pregnancies, can be high. That’s in addition to the <a href="https://doi.org/10.1016/j.ajog.2013.10.005">cost of delivery</a>. IVF clinics are increasingly transferring just one embryo to mitigate such concerns.</p>
<p>The life-at-conception bills that have been put forth in some U.S. state legislatures and Congress may contain language claiming they are not meant to prevent IVF. But the language of the bills could be extended to affect procedures such as IVF with pre-implantation genetic testing to detect chromosomal abnormalities, particularly when single-embryo transfer is the goal. Pre-implantation genetic testing has been increasing, with one study estimating that <a href="https://doi.org/10.1001/jama.2022.1892">over 40% of all IVF cycles</a> in the U.S. in 2018 involved genetic screening. </p>
<p>Could life-at-conception bills criminalize clinics that don’t transfer embryos known to be genetically abnormal? Freezing genetically abnormal embryos could avoid destroying them, but that raises questions of, to what end? Who would pay for the storage, and who would be responsible for those embryos?</p>
<h2>How can we determine whether the risks outweigh the benefits when so much is unknown?</h2>
<p><strong>Keith</strong></p>
<p>Conducting studies in animal models is an important first step. In some cases, it either hasn’t been done or hasn’t been done extensively. Even with animal studies, you have to recognize that mice, rabbits and monkeys are not human. Animal models may reduce some risks before a technology is used in people, but they won’t eliminate all risks, because of biological differences between species.</p>
<p><strong>Mary Faith</strong> </p>
<p>We could look to the example of <a href="https://www.genome.gov/25520302/online-education-kit-1972-first-recombinant-dna">early recombinant DNA research in the U.S.</a> The federal government created the <a href="https://doi.org/10.1089%2Fhum.2013.2524">Recombinant DNA Advisory Committee at the National Institutes of Health</a> to oversee animal and early-phase human research involving synthetic or hybrid genetic material. </p>
<p>The <a href="https://doi.org/10.1126/science.307.5712.1028b">death of Jesse Gelsinger</a>, who was a participant in a gene therapy clinical trial in 1999, led to a halt in all gene therapy clinical trials in the U.S. for a time. When the Food and Drug Administration investigated what went wrong, they found huge numbers of adverse events in both humans and animals that should have been reported to the advisory committee but weren’t. Notably, the principal investigator of the trial was also the <a href="https://sciencehistory.org/stories/magazine/the-death-of-jesse-gelsinger-20-years-later/">primary shareholder</a> of the biotech company that made the drug being tested. That raises questions about the reality of oversight.</p>
<p>I think something like that earlier NIH advisory committee but for reproductive technologies would still be advisable. But researchers, policymakers and regulators need to learn from the lessons of the past to try to ensure that – especially in early-phase research – we’re very thoughtful about the potential risks and that research participants really understand what the implications are for participation in research. That would be one model for translating research from the animal into the human.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/534481/original/file-20230628-30590-2nwhy8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Child looking into a slip lamp microscope for an eye exam with a doctor" src="https://images.theconversation.com/files/534481/original/file-20230628-30590-2nwhy8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534481/original/file-20230628-30590-2nwhy8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534481/original/file-20230628-30590-2nwhy8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534481/original/file-20230628-30590-2nwhy8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534481/original/file-20230628-30590-2nwhy8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534481/original/file-20230628-30590-2nwhy8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534481/original/file-20230628-30590-2nwhy8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The FDA approved a gene therapy for a form of congenital vision loss in 2017. The child in this photo, then 8, first received gene therapy at age 4.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/BlindnessTreatmentPrice/c567cc3a2b244cac8afc2b5ae2c62ca3">Bill West/AP Photo</a></span>
</figcaption>
</figure>
<p><strong>Keith</strong></p>
<p>A process to make sure that the people conducting studies don’t have a conflict of interest, like having the potential to commercially profit from the technology, would be useful. </p>
<p>Caution, consensus and cooperation should not take second place to profit motives. Altering the human genome in a way that allows human-made genetic changes to be <a href="https://doi.org/10.1089/crispr.2020.0096">propagated throughout the population</a> has a potential to alter the genetics of the human species as a whole. </p>
<p><strong>Mary Faith</strong></p>
<p>That raises the question of how long it will take for long-term effects to show. It’s one thing for an implanted egg not to survive. But how long will it take to know whether there are effects that aren’t obvious at birth?</p>
<p><strong>Keith</strong> </p>
<p>We’re still collecting long-term outcome data for people born using different reproductive technologies. So far there have been no obviously horrible consequences. But some abnormalities could take decades to manifest, and there are many variables to contend with. </p>
<p>One can arguably say that there’s substantial good in helping couples have babies. There can be a benefit to their emotional well-being, and reproduction is a natural part of human health and biology. And a lot of really smart, dedicated people are putting a lot of energy into making sure that the risks are minimized. We can also look to some of the practices and approaches to oversight that have been used over the past several decades.</p>
<p><strong>Mary Faith</strong></p>
<p>And thinking about international guidelines, such as from the <a href="https://cioms.ch">Council for International Medical Science</a> and other groups, could provide guidance on protecting human research subjects.</p>
<p><strong>Keith</strong></p>
<p>You hate to advocate for a world where the automatic response to anything new is “no, don’t do that.” My response is, “Show me it’s safe before you do it.” I don’t think that’s unreasonable.</p>
<p>Some people have a view that scientists don’t think about the ethics of research and what’s right and wrong, advisable or inadvisable. But we do think about it. I co-direct a research training program that includes teaching scientists how to responsibly and ethically conduct research, including speakers who specifically address the ethics of reproductive technologies. It is valuable to have a dialogue between scientists and ethicists, because ethicists will often think about things from a different perspective. </p>
<p>As people go through their scientific careers and see new technologies unfold over time, these discussions can help them develop a deeper appreciation and understanding of the broader impact of their research. It becomes our job to make sure that each generation of scientists is motivated to think about these things. </p>
<p><strong>Mary Faith</strong></p>
<p>It’s also really important to include stakeholders – people who are nonscientists, people who experience barriers to reproduction and people who are opposed to the idea – so they have a voice at the table as well. That’s how you get good policies, right? You have everyone who should be at the table, at the table.</p><img src="https://counter.theconversation.com/content/208276/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Scientists can create viable eggs from two male mice. In the wake of CRISPR controversies and restrictive abortion laws, two experts start a dialogue on ethical research in reproductive biology.Keith Latham, Professor of Animal Science, Adjunct Professor of Obstetrics, Gynecology and Reproductive Biology, Michigan State UniversityMary Faith Marshall, Professor of Biomedical Ethics, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1860872022-07-04T13:45:54Z2022-07-04T13:45:54ZEggs and sperm can now be stored for up to 55 years – here’s what that means for donors and people seeking fertility treatment<figure><img src="https://images.theconversation.com/files/472277/original/file-20220704-14-dhlxdy.jpg?ixlib=rb-1.1.0&rect=0%2C16%2C5463%2C3620&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The new storage limits may give people more flexibility when it comes to their fertility treatment.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/embryologist-pulls-out-dewar-liquid-nitrogen-1225484992">Ekaterina Georgievskaia/ Shutterstock</a></span></figcaption></figure><p>The UK government has just extended the period that gametes (eggs and sperm) and embryos can be stored from <a href="https://www.legislation.gov.uk/ukpga/2022/31/schedule/17/enacted">ten years to 55 years</a>. While this change will probably be welcomed by people who wish to have fertility treatment, it could have important implications for egg and sperm donors.</p>
<p>A growing number of people in the UK are choosing to <a href="https://academic.oup.com/humupd/article/22/4/440/2573626">freeze their eggs, sperm and embryos</a> for use in their own fertility treatment. Previously, the storage limit was <a href="https://www.legislation.gov.uk/ukpga/1990/37">ten years</a> – though extensions were permitted for people who could prove a medical need (such as premature infertility) up to 55 years.</p>
<p>But many felt that the storage limits restricted the choices of people who freeze eggs and sperm for their own fertility treatment. If they couldn’t give a medical reason to increase the storage period, these gametes had to be destroyed after ten years. </p>
<p>Cryopreservation techniques – which involve freezing gametes to preserve them – have also improved significantly since the previous storage limits were set. <a href="https://academic.oup.com/humupd/article/22/4/440/2573626">Studies now show</a> that eggs frozen using current preservation techniques are likely to develop in the same way as fresh eggs. Pregnancy rates from frozen embryos are also equivalent to those using fresh embryo transfer. As such, there is no longer a scientific reason for storage to be restricted to a maximum of ten years. </p>
<p>After launching a public consultation in February 2020, the government has now legislated to extend the storage limit for everyone (regardless of medical need) to 55 years. </p>
<h2>Considering donors</h2>
<p>Following the change to the storage limit (which took effect on July 1), people will now need to give consent every ten years to continue storing their gametes and embryos for use in their own fertility treatment. However, egg and sperm donors who aren’t seeking fertility treatment won’t be asked to renew consent every ten years – though they will be able to specify upfront whether or not they want their donation stored for up to 55 years. </p>
<p>There are potentially important consequences of these new storage times for both donors and children born from donated eggs or sperm. Although donors are already offered counselling to make sure that they are comfortable with what they are going to do, counselling will now need to address issues raised by the extended storage period. The most significant of these issues is that some donors’ eggs or sperm will be available for use over a considerably longer period than under the previous rules. The obligation that clinics have to ensure donors fully understand the implications of their decision will become even more important as this extension to storage times is implemented.</p>
<figure class="align-center ">
<img alt="A young couple speaks with their female doctor in her office." src="https://images.theconversation.com/files/472278/original/file-20220704-18-rpfgtg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472278/original/file-20220704-18-rpfgtg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472278/original/file-20220704-18-rpfgtg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472278/original/file-20220704-18-rpfgtg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472278/original/file-20220704-18-rpfgtg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472278/original/file-20220704-18-rpfgtg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472278/original/file-20220704-18-rpfgtg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People seeking fertility treatment should also be made aware of the implications of new storage limits.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-american-millennial-couple-sit-couch-1446009716">fizkes/ Shutterstock</a></span>
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</figure>
<p>For example, if a person donates sperm at age 35 and their sperm is stored for 55 years, children might be born from that donation when the donor is 90 years old. This also means that, for the children born from that person’s donation, they might have donor siblings who are older than their parents. Donor-conceived people should be aware of the possibility that their donor might be a very elderly person – or already deceased – and that they may have donor siblings, and possibly nephews and nieces, who are significantly older than them.</p>
<p>This change takes place in the context that, since the law changed in April 2005, donor-conceived people are <a href="https://www.legislation.gov.uk/uksi/2004/1511/contents/made">entitled at age 18</a> to find out who their donor was. </p>
<p>Fertility professionals are also worried about the speed with which these potentially far-reaching changes are coming into effect – leaving little time for them to prepare. Although the changes have already come into effect, new guidance still needs to be adopted in fertility clinics, and training and instruction provided to staff. Many clinics also haven’t been able to produce updated advice for donors. This is essential for ensuring everyone fully understands what they’re consenting to.</p>
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Read more:
<a href="https://theconversation.com/egg-freezing-the-reality-of-putting-your-fertility-on-ice-101223">Egg freezing: the reality of putting your fertility on ice</a>
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<p>It’s also important to ensure that people seeking fertility treatment with donated eggs and sperm are fully informed about the implications storage-limit changes could have on starting a family this way. Although the <a href="https://pubmed.ncbi.nlm.nih.gov/35178481">European Society for Human Reproduction and Embryology</a> already has information available about what to consider when donating or accessing fertility treatment with donated gametes, it will be important for fertility clinics in the UK to produce their own information reflecting the changes in storage limits. </p>
<p>The effects of this legislative change will play out over many years. There are clearly significant benefits of extending the maximum storage period of eggs and sperm for those needing to use them in their treatment. But attention will need to be paid – sooner rather than later – to the implications these changes have for gamete donors and donor-conceived people.</p><img src="https://counter.theconversation.com/content/186087/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Redhead is a Research Fellow on the ConnecteDNA study which is funded by UKRI ESRC</span></em></p><p class="fine-print"><em><span><a href="mailto:j.kirkmanbrown@bham.ac.uk">j.kirkmanbrown@bham.ac.uk</a> receives research funding from a number of government and commercial funding bodies, further details can be found on his team research website <a href="http://www.spermeggembryo.com">www.spermeggembryo.com</a>. He is affiliated with the University of Birmingham and Birmingham Women's and Children's NHS Foundation Trust. </span></em></p><p class="fine-print"><em><span>Leah Gilman is a Research Fellow on the ConnecteDNA study which is funded by UKRI ESRC.</span></em></p><p class="fine-print"><em><span><a href="mailto:lucy.frith@manchester.ac.uk">lucy.frith@manchester.ac.uk</a> receives funding from UKRI ESRC</span></em></p>Previously, eggs and sperm (gametes) and embryos were typically only stored for a maximum of ten years.Caroline A B Redhead, Research Fellow, Centre for Social Ethics and Policy, The University of Manchester, University of ManchesterJackson Kirkman-Brown, Reader in Human Reproductive Biology, University of BirminghamLeah Gilman, Research Fellow, Centre for Social Ethics and Policy, University of ManchesterLucy Frith, Reader, Bioethics, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1674202021-09-07T15:01:55Z2021-09-07T15:01:55ZEgg freezing: why extending the ten-year limit won’t mean more older mums<figure><img src="https://images.theconversation.com/files/419802/original/file-20210907-24-14v82zs.jpg?ixlib=rb-1.1.0&rect=11%2C0%2C7928%2C5304&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The limit has been extended from ten years to up to 55 years. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/worker-brown-latex-gloves-takes-material-1470930044">bezikus/ Shutterstock</a></span></figcaption></figure><p>The number of women choosing to freeze their eggs is <a href="https://academic.oup.com/hropen/article/2017/1/hox003/3092404">on the rise</a> in Europe, including in <a href="https://www.bbc.co.uk/news/health-48205986">the UK</a>. Even during the pandemic, fertility clinics have seen a <a href="https://www.bionews.org.uk/page_152631">sharp rise</a> in the number of women enquiring about egg freezing. While there are many reasons why a woman may elect to freeze her eggs, regulations in the UK are extremely restrictive, stipulating that eggs frozen for social reasons can only be stored for up to ten years. Then, a person would have to decide whether to use those eggs or destroy them.</p>
<p>Freezing technology has come a long way since regulations were first made, leading <a href="https://www.bionews.org.uk/page_135507">many experts to argue</a> there’s currently no medical reason to limit storage so restrictively. As a result, the UK government plans to extend the storage limit. This will allow people to be able to store frozen eggs, sperm and embryos for <a href="https://www.theguardian.com/science/2021/sep/06/people-able-to-freeze-embryos-sperm-and-eggs-for-up-to-55-years">up to 55 years</a> regardless of the reason for freezing – giving them more choice when it comes to their fertility.</p>
<p>Already, this has seen concerns that more women will <a href="https://www.dailymail.co.uk/health/article-9961003/Freeze-eggs-55-years-Fertility-revolution-sight-new-law-end-10-year-storage-limit.html">delay motherhood</a> until later in life – even into their 50s and 60s. Based on <a href="https://books.emeraldinsight.com/page/detail/Egg-Freezing-Fertility-and-Reproductive-ChoiceEgg-Freezing,-Fertility-and-Reproductive-Choice/?k=9781787564848">my own research</a> and that of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/soc4.12850">others</a>, many women who freeze their eggs do not want to delay motherhood into their 50s and 60s – and instead wish to have children as soon as they are able to. </p>
<p>It’s also worth noting that many UK fertility clinics will not routinely provide fertility treatment of any kind to a women much beyond the age of 50, whether this is with her own eggs or that of a donor. So these practices would also have to change in order for women to delay motherhood into their 50s. </p>
<p>Instead, the extended limit means more women in many different situations will be able to choose to become a mother at a time that is right for them which most often will be in their late 30s or early to mid 40s. </p>
<h2>Egg freezing</h2>
<p>Since 2013, the number of egg-freezing cycles performed by UK clinics has <a href="https://www.hfea.gov.uk/media/2656/egg-freezing-in-fertility-treatment-trends-and-figures-2010-2016-final.pdf">more than doubled</a> as greater numbers of women seek to have children later, even when their natural fertility may have otherwise declined. Women undergo egg freezing for <a href="https://theconversation.com/why-women-choose-to-freeze-their-eggs-new-research-95087">many different reasons</a> including illness or medical treatment (such as chemotherapy) that may leave them infertile, or because they lack a partner.</p>
<p>To <a href="https://theconversation.com/six-things-you-should-know-if-you-are-considering-freezing-your-eggs-94039">freeze their eggs</a>, a woman must undergo hormonal stimulation which helps her to produce more eggs than she would in her normal monthly cycle. Then, these eggs are surgically retrieved and frozen at -196°C for potential future use. </p>
<p>When egg freezing was first legalised and regulated in the UK in 2000, there were many unknowns about who would use the technology, why, and about how long the frozen eggs would remain viable. It’s now widely accepted that once frozen, eggs do <a href="https://www.degruyter.com/document/doi/10.18574/9781479868148/html">not age or decay</a> – so may be viable indefinitely. </p>
<figure class="align-center ">
<img alt="A woman is speaking with her gynaecologist. The gynaecologist is using a notebook to explain something." src="https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women may choose to freeze their eggs for many different reasons.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-visiting-her-gynecologist-clinic-1351229036">Pixel-Shot/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Before the pending change in regulations, only women who were freezing their eggs for medical reasons – such as chemotherapy – could store their eggs for up to 55 years. Women undergoing the procedure for social reasons (such as lacking a partner) were only able to freeze their eggs for up to ten years – at which point their eggs would have to be used or destroyed. But based on what we know about egg freezing, there was no medical reason for this limit – which is why myself and others argued to change it.</p>
<h2>Freedom to choose</h2>
<p>Currently, the <a href="https://pubmed.ncbi.nlm.nih.gov/26099440/">typical woman</a> who freezes her eggs for social reasons is around 37 years of age, single, and earning above average income. </p>
<p>The women I spoke to in my <a href="https://www.tandfonline.com/doi/abs/10.1080/0167482X.2018.1460352">previous research</a> said their decision to freeze their eggs was often shaped by the fear that they were running out of time to find the right partner and start a conventional family. Many also feared rushing into a relationship with the wrong partner just to have a child. Egg freezing gave these women a chance to find the right partner, and <a href="https://journals.sagepub.com/doi/full/10.5153/sro.4187?casa_token=tiey3sM_-kgAAAAA:JEr1WcrbwzvYdEaQlzwmFpu1ZY1u7xwTOiXVucfwJYjSMAG_Agw3nLvXfCrhe3LfMZTBjqF5LxY">build a secure relationship</a>. </p>
<p>Many of the women had also wanted a child for many years and would have preferred actively trying to conceive over freezing their eggs. Others felt they had not deliberately chosen to delay motherhood. Rather, they hadn’t become a mother for reasons outside their control. </p>
<p>Based on my research and <a href="https://www.tandfonline.com/doi/abs/10.1080/13691058.2014.951881">other studies</a> on the subject, egg freezing often isn’t about putting off motherhood for as long as possible. Rather, it’s about maintaining the possibility to have a child with a chosen partner in the future, or when a person feels they’re ready to have a child.</p>
<p><a href="https://journals.sagepub.com/doi/abs/10.1177/1350506817742929">Research</a> also shows that women who freeze their eggs don’t want to pursue motherhood for the first time in their 50s and 60s. Rather, they want the option to use their eggs in their early to <a href="https://journals.sagepub.com/doi/full/10.1177/0003122418796807">mid-40s with a partner of their choosing</a>. </p>
<p>Egg freezing is expensive, invasive, painful and not without risk. While some women may choose to delay motherhood until much later as a result of these storage limit changes, it’s unlikely large numbers of women will delay childbearing as a result. Instead, increased storage time limits are likely to give women the option to use their eggs to conceive when it best suits them.</p><img src="https://counter.theconversation.com/content/167420/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kylie Baldwin received funding from The Foundation for the Sociology of Health and Illness</span></em></p>Frozen eggs will be stored for up to 55 years in the UK.Kylie Baldwin, Senior Lecturer, De Montfort UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1612782021-06-30T19:55:21Z2021-06-30T19:55:21ZPeople are using their super to pay for IVF, with their fertility clinic’s blessing. That’s a conflict of interest<figure><img src="https://images.theconversation.com/files/407848/original/file-20210623-19-lr0da7.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-female-lgbt-lesbian-couple-best-1987833428">from www.shutterstock.com</a></span></figcaption></figure><p>People can access their superannuation early <a href="https://www.smh.com.au/politics/federal/australians-tap-super-for-500m-outlay-on-ivf-weight-loss-surgery-and-dentistry-20210207-p57086.html">to pay for</a> expensive fertility treatments such as IVF.</p>
<p>They can claim “mental disturbance” if they want part of their funds released early on compassionate grounds.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1358500810137628672"}"></div></p>
<p>However, in our recent paper in the <a href="https://www.unswlawjournal.unsw.edu.au/article/emptying-the-nest-egg-to-fill-the-nursery-early-release-of-superannuation-to-fund-assisted-reproductive-technology/">UNSW Law Journal</a>, we question whether the rules are tight enough to protect future retirement incomes. We also consider whether involvement of fertility clinics and other companies in the process is a conflict of interest.</p>
<p>Here’s how it all works and what needs to change.</p>
<h2>Here’s what happens</h2>
<p>People can apply to the Australian Tax Office to <a href="http://classic.austlii.edu.au/au/legis/cth/consol_reg/sir1994582/s6.19a.html">legally access</a> their super funds early on compassionate grounds for a range of medical procedures, including IVF. Last year, <a href="https://www.smh.com.au/politics/federal/australians-tap-super-for-500m-outlay-on-ivf-weight-loss-surgery-and-dentistry-20210207-p57086.html">tax figures show</a> almost 34,000 people did this, accessing a total of more than A$513 million. That figure has grown considerably since 2015, where 14,000 people accessed $184 million.</p>
<p>If that medical procedure is dentistry or surgery, people need to show the procedure is needed to alleviate pain or to treat a life-threatening injury or illness.</p>
<p>But to access IVF or other fertility treatments, these criteria don’t apply. So the only avenue is for people to claim they are experiencing “acute, or chronic, mental disturbance” that can only be alleviated by the fertility treatment. </p>
<p>People must also submit <a href="https://www.ato.gov.au/Individuals/Super/In-detail/Withdrawing-and-using-your-super/Early-access-on-compassionate-grounds/?page=5#Evidence_required_for_your_application">two medical practitioner reports</a> certifying the treatment is necessary.</p>
<p>The Australian Tax Office did not provide a breakdown of how many people accessed super funds for IVF this way when we requested detailed figures. However, we understand accessing super for IVF is one of the <a href="https://www.releasemysuper.com.au">main medical</a> <a href="https://www.smh.com.au/politics/federal/australians-tap-super-for-500m-outlay-on-ivf-weight-loss-surgery-and-dentistry-20210207-p57086.html">reasons</a>.</p>
<p>We do not advocate a blanket ban on the process. For many people, having a baby is more important than the amount of money they retire with. But to protect individuals and couples seeking fertility treatment, we need to reform the rules surrounding early release of super for IVF.</p>
<p>This is needed so people are aware of the implications of accessing their super early, have enough money to retire on, and that this option is only available after a rigorous assessment process independent of private fertility clinics.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/considering-using-ivf-to-have-a-baby-heres-what-you-need-to-know-108910">Considering using IVF to have a baby? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>What does ‘mental disturbance’ mean?</h2>
<p>Superannuation legislation <a href="http://classic.austlii.edu.au/au/legis/cth/consol_reg/sir1994582/s6.19a.html">does not define</a> the term “mental disturbance”. It’s not a term <a href="https://www.ranzcp.org/news-policy/policy-and-advocacy/position-statements/diagnostic-manuals">used to diagnose</a> mental illness. So it can be interpreted in many ways. </p>
<p>This might mean someone may have an “acute, or chronic, mental disturbance”, such as a diagnosis of severe depression. Or they may not have a diagnosed mental health condition, but nevertheless may be extremely distressed about wanting a baby and not being able to afford IVF.</p>
<p>A 2018 parliamentary paper <a href="https://treasury.gov.au/consultation/c2018-t341625">suggested</a> the term “diagnosed mental illness or behavioural disorder” instead; we agree. These words are consistent with the language psychiatrists and psychologists use and understand; are more specific and clearer; and people would have to meet clearly defined criteria before being diagnosed.</p>
<h2>Who are these medical practitioners?</h2>
<p>The legislation is vague about the qualifications a certifying medical practitioner needs to have, a topic considered <a href="https://jade.io/article/349673">in a case</a> that went to the Federal Court.</p>
<p>So theoretically, it might be possible for a fertility doctor from an IVF clinic to be one of the certifying doctors, which may be a conflict of interest. </p>
<p>If that fertility doctor doesn’t also have psychiatric expertise, this also means the doctor doesn’t have the expertise to certify someone has a “mental disturbance”.</p>
<p>This situation might lead people to think the doctor might not be impartial or objective, whether or not that’s the case. This is because the fertility clinic ultimately profits from the release of any super funds.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/407851/original/file-20210623-15-1osbqjf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A couple on sofa holding hands sitting next to psychologist or therapist" src="https://images.theconversation.com/files/407851/original/file-20210623-15-1osbqjf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/407851/original/file-20210623-15-1osbqjf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/407851/original/file-20210623-15-1osbqjf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/407851/original/file-20210623-15-1osbqjf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/407851/original/file-20210623-15-1osbqjf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/407851/original/file-20210623-15-1osbqjf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/407851/original/file-20210623-15-1osbqjf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A doctor with mental health expertise needs to get involved, not just a fertility doctor.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/patient-couple-consulting-doctor-psychologist-on-1457837060">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>To prevent any perceived or actual conflict of interest, we strongly recommend one of the certifying medical practitioners have clinical expertise in mental health, such as psychiatry, who would then evaluate the person wishing to access their super for IVF.</p>
<p>We recommend this person be independent of the fertility clinic, to be further removed from any actual or perceived conflict of interest.</p>
<p>An appropriately trained mental health practitioner would also ensure the person gets mental health care (in addition to medical advice) before IVF is prescribed and administered. </p>
<h2>Other companies get involved</h2>
<p>Specialist companies <a href="https://www.releasemysuper.com.au">help people</a> <a href="https://mysupercare.com.au/our-services/">access their super early</a> for services, including IVF. Some <a href="https://fertilityfirst.com.au/supercare/">advertise their services</a> on fertility clinic websites.</p>
<p>Some of these third-party intermediaries <a href="https://www.ato.gov.au/Individuals/Super/In-detail/Withdrawing-and-using-your-super/Early-access-on-compassionate-grounds/?page=6">charge a fee</a> to help people prepare and submit their applications to the Australian Tax Office. In some cases, fertility clinics <a href="http://fertilityfirst.com.au/supercare">refer people</a> to them.</p>
<p>And <a href="https://treasury.gov.au/consultation/c2018-t341625">a 2018 parliamentary paper</a> noted a greater awareness of third-party intermediaries may have contributed to an increase in applications for early release of super on medical grounds.</p>
<p>The practice also <a href="https://www.afr.com/wealth/superannuation/calls-for-tougher-consumer-protections-for-early-release-super-20181128-h18h3j">raises ethical concerns</a> about companies that have built their business model on taking a cut of people’s super at a time where they may be vulnerable or their mental health fragile.</p>
<p>This has led some consumer groups and financial planners <a href="https://www.afr.com/wealth/superannuation/calls-for-tougher-consumer-protections-for-early-release-super-20181128-h18h3j">to call for</a> more stringent controls on third-party intermediaries and their involvement in early access to super on medical grounds, especially when medical practitioners are likely to financially benefit.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-business-of-ivf-how-human-eggs-went-from-simple-cells-to-a-valuable-commodity-119168">The business of IVF: how human eggs went from simple cells to a valuable commodity</a>
</strong>
</em>
</p>
<hr>
<h2>Independent financial counselling</h2>
<p>We recommend people be required to undertake affordable financial counselling before starting IVF or other fertility treatment, whether or not they’re accessing their super early to pay for it. This should be impartial and independent of any fertility clinic to avoid any potential or perceived conflict of interest.</p>
<p>This should allow people to make informed financial decisions based on their assets and liabilities, and the most effective and equitable funding avenues for treatment. This may or may not involve early access to super. If people do go ahead, they need to understand the short- and long-term costs of doing so. </p>
<p>This is especially important for women, who generally have <a href="https://www.smh.com.au/money/planning-and-budgeting/what-government-can-do-to-reduce-super-gender-gap-20210430-p57nqd.html">lower super balances</a> than men due to lower life-long earnings, gendered pay gaps and career breaks. And it’s women who are <a href="https://www.aph.gov.au/parliamentary_business/committees/senate/economics/economic_security_for_women_in_retirement/report">more likely</a> to access their super early <a href="https://www.mamamia.com.au/superannuation-to-pay-for-ivf/">for IVF</a> or other reasons.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/standard-ivf-is-fine-for-most-people-so-why-are-so-many-offered-an-expensive-sperm-injection-they-dont-need-158227">Standard IVF is fine for most people. So why are so many offered an expensive sperm injection they don't need?</a>
</strong>
</em>
</p>
<hr>
<h2>Where to now?</h2>
<p>For some people, accessing their super early for fertility treatments is their only chance to start or extend their family. So they need better protection to make sure their interests are not compromised by any financial motivations of fertility treatment providers — whether perceived or actual. </p>
<p>We also need to reduce the need for people to rely on their super to pay for IVF in the first place. That’s why we also <a href="https://www.unswlawjournal.unsw.edu.au/article/emptying-the-nest-egg-to-fill-the-nursery-early-release-of-superannuation-to-fund-assisted-reproductive-technology/">recommend</a> greater availability of public funding for fertility technologies, such as IVF.</p>
<p>This would mean people would still be able to access IVF, regardless of whether they are in genuine distress, have a mental health diagnosis, or just want to start or extend their family.</p>
<p>Changes such as these might go some way in providing better security in retirement, greater faith in the fertility industry and fairer provision of treatment.</p>
<hr>
<p><em>Lily Porceddu, a lawyer in private practice in Victoria, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/161278/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Neera Bhatia does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For some people, accessing their super early for fertility treatments is their only chance to start or extend their family. And they need better protection.Neera Bhatia, Associate Professor in Law, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1582272021-04-22T22:40:53Z2021-04-22T22:40:53ZStandard IVF is fine for most people. So why are so many offered an expensive sperm injection they don’t need?<figure><img src="https://images.theconversation.com/files/394939/original/file-20210414-13-10bvrbn.jpg?ixlib=rb-1.1.0&rect=0%2C4%2C1000%2C727&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/intracytoplasmic-sperm-injection-icsi-part-ivf-1394225165">from www.shutterstock.com</a></span></figcaption></figure><p>An expensive IVF technique, routinely offered in fertility clinics around the world, offers no extra benefits to standard IVF in the vast majority of cases, our new research shows.</p>
<p>The technique, known as intracytoplasmic sperm injection or ICSI, was developed to help couples where the man has a low sperm count. But it is now the main fertilisation method clinics use in Australia and New Zealand, even when sperm counts are normal. </p>
<p>In an article published today in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00535-3/fulltext">The Lancet</a> we show that when there’s a normal sperm count, ICSI does not improve the chance of a baby when compared with standard IVF. So why do clinics routinely offer it?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/considering-using-ivf-to-have-a-baby-heres-what-you-need-to-know-108910">Considering using IVF to have a baby? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>What is ICSI?</h2>
<p>In IVF, several thousand sperm compete to be the one to fertilise an egg. However, for the small percentage of couples with what doctors call severe male-factor infertility — for instance, where there is a very low sperm count or the sperm doesn’t look or move normally — IVF is not an option. </p>
<p>In 1992, ICSI <a href="https://pubmed.ncbi.nlm.nih.gov/1351601/">was introduced</a>, where a single sperm was injected into the egg using a glass needle. This allowed the expansion of IVF to people where low sperm counts or poor sperm quality was an issue.</p>
<p>Its introduction across the world has helped thousands of couples have biologically related children, who otherwise would have needed donor sperm or remained childless.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/396213/original/file-20210421-19-1aj9ka7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="IVF versus ICSI" src="https://images.theconversation.com/files/396213/original/file-20210421-19-1aj9ka7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/396213/original/file-20210421-19-1aj9ka7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/396213/original/file-20210421-19-1aj9ka7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/396213/original/file-20210421-19-1aj9ka7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/396213/original/file-20210421-19-1aj9ka7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/396213/original/file-20210421-19-1aj9ka7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/396213/original/file-20210421-19-1aj9ka7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">With IVF, thousands of sperm compete to fertilise an egg. But with ICSI, a single sperm is injected into the egg.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/types-artificial-fertilization-egg-spermotozoydami-plant-1437755195">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<h2>How common is it?</h2>
<p>ICSI was expected to be used only where male infertility was an issue, but over time it has become the most used method of fertilisation even when it isn’t.</p>
<p>In the United States, between 1996 and 2012, ICSI use <a href="https://jamanetwork.com/journals/jama/fullarticle/2091303">increased</a> from 15% to 67% of couples where the male has a normal sperm count; in Europe about <a href="https://pubmed.ncbi.nlm.nih.gov/30032255/">70% of cycles</a> use ICSI.</p>
<p>In <a href="https://npesu.unsw.edu.au/sites/default/files/npesu/data_collection/Assisted%20Reproductive%20Technology%20in%20Australia%20and%20New%20Zealand%202018_0.pdf">Australia</a> around 60% of cycles used ICSI in 2018. This is even though <a href="https://www.auanet.org/guidelines/azoospermic-male-best-practice-statement">only</a> 30% of infertile couples have male infertility and 15% severe male infertility.</p>
<p>Clinics in Australia use ICSI to different extents. For instance, in Victoria in 2019-20, ICSI was used between <a href="https://www.varta.org.au/sites/default/files/2021-01/varta-annual-report-2020.pdf.pdf">34% and 89%</a> of the time, depending on the clinic.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sperm-why-these-secretive-swimmers-are-the-key-to-the-future-of-fertility-and-contraception-81773">Sperm: why these secretive swimmers are the key to the future of fertility – and contraception</a>
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</em>
</p>
<hr>
<h2>What we did and what we found</h2>
<p>Today we report, with our collaborators in Vietnam, the results of a large study in which more than 1,000 infertile couples with a normal sperm count were randomly allocated to ICSI or IVF. We found couples in either group were just as likely to have a baby.</p>
<p>This adds to evidence from other <a href="https://pubmed.ncbi.nlm.nih.gov/29897449/#:%7E:text=What%20is%20known%20already%3A%20The,with%20non%2Dmale%20factor%20infertility">large observational studies</a> in as many as 15,000 women that the widespread use of the more expensive and technically demanding ICSI does not offer any benefit to couples where the man has a normal sperm count. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32896391/">Excellent clinics</a> internationally and in Australia perform ICSI in fewer than 35% of their treatments, while achieving success rates equal to or better than clinics using ICSI more commonly.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fertility-miracle-or-fake-news-understanding-which-ivf-add-ons-really-work-118585">Fertility miracle or fake news? Understanding which IVF 'add-ons' really work</a>
</strong>
</em>
</p>
<hr>
<h2>How did ICSI become so popular?</h2>
<p>There are a <a href="https://www.hfea.gov.uk/treatments/treatment-add-ons/">growing number</a> of fertility treatments that <a href="https://www.fertstert.org/article/S0015-0282(19)32454-9/fulltext">aren’t backed by reasonable evidence</a>. </p>
<p>Some are relatively cheap, such as vitamins and antioxidants. Others are invasive or expensive. These include <a href="https://www.hfea.gov.uk/treatments/treatment-add-ons/endometrial-scratching/">endometrial scratching</a> (where the lining of the uterus is scraped with a thin tube, which is said to improve the chance of an embryo implanting), video microscopy of embryos, and <a href="https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/03/preimplantation-genetic-testing">pre-implantation genetic diagnosis</a> for potential chromosome abnormalities (where an embryo is tested for genetic disease before being implanted).</p>
<p>In fact, ICSI is about A$500 more expensive than standard IVF, although costs vary between clinics, and some costs can be claimed on <a href="http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=13218&qt=item">Medicare</a> under specific circumstances.</p>
<p>So why are these so-called “add-ons” or “adjuvants” so common?</p>
<p>Fertility treatment, especially IVF and ICSI, is overwhelmingly practised in the private sector in Australia and New Zealand. It is strongly marketed to the public and promoted in social media by individual doctors, clinics and corporations. Doctors and clinics also compete for patients, often offering <a href="https://theconversation.com/fertility-miracle-or-fake-news-understanding-which-ivf-add-ons-really-work-118585">unproven therapies</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-business-of-ivf-how-human-eggs-went-from-simple-cells-to-a-valuable-commodity-119168">The business of IVF: how human eggs went from simple cells to a valuable commodity</a>
</strong>
</em>
</p>
<hr>
<p>Couples may overlook a doctor seeking to practise fertility medicine based solely on evidence, and instead find a nearby clinic or doctor <a href="https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/ajo.13321">prepared to offer</a> add-ons they believe will improve their chance of a baby.</p>
<p>In the case of ICSI, doctors may recommend it for fear of patients’ reactions if the eggs don’t fertilise, even if ICSI doesn’t improve the ultimate chance of a baby for those with a normal sperm count.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1191669372747538439"}"></div></p>
<h2>What can we do about it?</h2>
<p>Infertility is distressing and, in most cases, can be easily treated with good advice, simple drugs and, if needed, quality assisted reproductive procedures such as IVF.</p>
<p>However, unrestrained, unnecessary use of ICSI is a salutary example of why we need to act on widely accepted evidence.</p>
<p>Until now, the fertility industry has promoted <a href="https://www.abc.net.au/radio/programs/pm/ivf-specialists-hit-back-at-four-corners-story-on/7464870">self-regulation</a> over being made to follow government-imposed, evidence-based guidelines of which fertility treatments are needed. And there’s a <a href="https://www.fertstert.org/article/S0015-0282(19)32454-9/fulltext">growing concern</a> the industry is not doing enough to combat unproven and expensive treatments.</p>
<p>Couples with infertility belong to a <a href="https://pubmed.ncbi.nlm.nih.gov/18025030/">very vulnerable group</a> who will do almost anything to achieve a pregnancy. They deserve our dedicated care and evidence-based treatment.</p><img src="https://counter.theconversation.com/content/158227/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robert Norman is not involved financially in any IVF or fertility clinic </span></em></p><p class="fine-print"><em><span>Ben W. Mol receives funding from NHMRC (Investigatorgrant GNT1176437) Guerbet, and Ferring.
</span></em></p>Our new study shows a widely used fertility treatment, known as ICSI, is no better than standard IVF for most people. Yet, it’s being routinely offered around the world.Robert Norman, Professor of Reproductive and Periconceptual Medicine, The Robinson Institute, University of AdelaideBen W. Mol, Professor of Obstetrics and Gynaecology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1528282021-02-01T16:06:47Z2021-02-01T16:06:47ZEgg freezing is on the up – but new research raises questions about how clinics advertise<figure><img src="https://images.theconversation.com/files/377568/original/file-20210107-23-2t4nfx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/test-tube-sperm-eggs-samples-cryopreservation-612340154">Elena Pavlovich/Shutterstock.com</a></span></figcaption></figure><p>More women in the UK than ever before are considering freezing their eggs, with the sharp rise in inquiries at some of London’s largest clinics attributed to the <a href="https://www.bionews.org.uk/page_152631">COVID-19 pandemic</a>. No wonder perhaps, since social restrictions have impacted single people wishing to couple-up, making it significantly more difficult to go on dates or meet potential partners.</p>
<p>The current prolonged uncertainty about the future has exacerbated the concerns that many single childless women – especially those in their mid-30s – were already reporting, including anxieties about the ticking of their biological clocks and fears over age-related fertility decline. </p>
<p>Sarah, a 36-year-old HR manager who recently came out of a four-year relationship, feels the pandemic could not have come at a more costly time in her personal life. She told me: “I have this constant underlying worry that by the time this all blows over and I can finally meet someone, I might have missed the boat to become a mother.” </p>
<p>It is easy to see why women like Sarah might opt for egg freezing. Yet while this technology can certainly be useful for some women, new research reveals that it may not always be as straightforward as it appears.</p>
<p>Many aspects of egg freezing have been discussed in the media, yet to date, there has been almost no attention paid to the ways in which fertility clinics advertise, market and promote their egg freezing services on their websites, and the quality of information that is available to potential patients considering their options. </p>
<p>In order to address this gap, my colleague Emily Tiemann and I analysed the websites of the UK’s 15 largest fertility clinics offering egg freezing. Our <a href="https://www.sciencedirect.com/science/article/pii/S2405661820300289#!">recently published</a> findings make uncomfortable reading.</p>
<h2>Misleading websites?</h2>
<p>Our research suggests that fertility clinic websites in the UK, taken in general, provide a poor standard of information and, we argue, need to be urgently improved, for reasons of both medical ethics and consumer rights. Of course, as websites are dynamic entities some of them may have already improved or changed since we took our “snapshot” (in June 2019), but our findings nevertheless raise concerns for potential patients.</p>
<p>We found that most of the clinics we looked at presented what we believe is an unbalanced view of egg freezing on their websites, highlighting its potential benefits and failing to adequately discuss its potential risks. Clinics’ websites were also not sufficiently clear and transparent about the cost of an egg freezing cycle, with the average “true” cost exceeding the advertised costs by approximately a third (on average an additional £923).</p>
<p>Finally, we came to the view that clinics did not always provide accurate data or success rates. In fact, of the 15 analysed, we only rated one clinic website as “good” in terms of its quality of information.</p>
<p>We reached out to all 15 clinics for comment. Harley Street Fertility Clinic responded: </p>
<blockquote>
<p>We welcome the Gurtin and Tiemann paper because it aims to improve the quality of information provided to patients. However, we do not necessarily agree with all the metrics and indicators used by the authors as part of their review […] As a clinic, we strive to be clear and transparent in our communications. Hence, we will use the suggestions made in the paper to improve our communications with patients.</p>
</blockquote>
<p>IVI Midland responded by pointing out that since 2019, the clinic had been acquired by CARE Fertility and therefore the website we analysed is no longer active. CARE Fertility, meanwhile, replied:</p>
<blockquote>
<p>The number of egg freezing cycles we carry out is very small, and as success rate data is only available once a woman returns for fertility treatment (often many years later), we have even less success rate data […] At the time of the study in June 2019, the egg freezing page of our website could have more clearly explained the costs involved with egg freezing, but we have since updated the page to further help patients access the information they need.</p>
</blockquote>
<p>The other clinics we approached for comment did not respond. But it is welcome news that some have been working to improve their website content.</p>
<h2>Potential risks</h2>
<p>We have issued an <a href="https://www.sciencedirect.com/science/article/pii/S2405661820300289#!">urgent recommendation</a> for clinic websites to be improved, but it is difficult for the Human Fertilisation and Embryology Authority (HFEA) to enforce such changes when much of the economic or commercial aspects of fertility treatments fall outside its remit. </p>
<p>But the issue is pressing, since we contend that the lack of good quality information compromises the ability of women like Sarah to make truly informed decisions, and leaves them inadequately informed or misinformed about crucial aspects, such as costs to plan for or potential risks to weigh up.</p>
<p>Justine*, a journalist who lives in London, froze her eggs two years ago, aged 38. She told me that although she went to some lengths to research the technology, she still felt unprepared for the reality of how it would feel to freeze her eggs.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1344573536019640320"}"></div></p>
<p>Justine found herself in considerably more physical discomfort than she had expected, feeling bloated, uncomfortable and in pain despite having been told she would be able to go about her normal life before the procedure. Her physical discomforts continued and even worsened after egg collection: </p>
<blockquote>
<p>As the hours passed, I still felt incredibly weak, bloated and short of breath. I called the clinic who just said if you continue to feel bad, then go to A&E. It was at that point I felt very alone. </p>
</blockquote>
<p>She felt that the clinic had relinquished all responsibility. “I went to A&E and was admitted overnight, with a series of tests and observations confirming that I had OHSS,” she said.</p>
<p>While Justine was unlucky to suffer from <a href="https://www.nhs.uk/conditions/ivf/risks/">ovarian hyperstimulation syndrome</a> (OHSS), a rare complication of the IVF and egg freezing processes caused by the production of too many eggs, she felt she lacked information about this potential risk and that the clinic didn’t offer adequate follow-up care.</p>
<h2>Patients or profit?</h2>
<p>The fertility industry is becoming increasingly commercialised, a consideration that is particularly pertinent in the case of egg freezing, which takes place primarily in the private sector. This is an aspect that Lucy van de Wiel, a researcher at Cambridge University’s Reproductive Sociology Research Group, focuses on.</p>
<p>Her new book, <a href="https://nyupress.org/9781479817900/freezing-fertility/">Freezing Fertility</a>, draws attention to the potential conflicts between clinical decision-making or patients’ best interests on the one hand and business and profit motives on the other. Market forces in the fertility industry, political interests underlying regulations, and age-old cultural narratives of gender and motherhood play a role in our reproductive decision-making.</p>
<p>Given this, I would urge women considering egg freezing to look beyond the information on clinic websites. In particular, women may wish to ask clinics for specific and verified data regarding the number of cycles they have performed each year or their success rates.</p>
<p>They may want to ask questions about exactly what is and is not included in advertised pricing, and to consult the HFEA website for an unbiased discussion of the benefits and risks of the technology. It can also be extremely helpful to discuss egg freezing with others who have been through the process, to gain a realistic impression of what it involves.</p>
<p>Despite her difficulties, overall Justine feels “a sense of comfort” knowing that she has frozen eggs in storage, but she does offer a note of caution: </p>
<blockquote>
<p>While the process is presented as being fairly straightforward, it does have powerful physical, emotional and psychological impacts so it is important not to gloss over it as a ‘procedure’ and make sure you have support available.</p>
</blockquote>
<p>*Name and identifying details have been changed.</p><img src="https://counter.theconversation.com/content/152828/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zeynep Gurtin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>COVID-19 has led to a sharp rise in inquiries at some of London’s largest fertility clinics.Zeynep Gurtin, Lecturer in Women's Health, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1385102020-06-08T13:48:21Z2020-06-08T13:48:21Z5 things not to say to someone struggling with infertility<figure><img src="https://images.theconversation.com/files/339402/original/file-20200603-130903-rddsyd.jpg?ixlib=rb-1.1.0&rect=0%2C85%2C4749%2C3794&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Unhelpful comments can be a source of stress for people struggling with infertility, and can mean that seeking social support can result in more, rather than less, distress. </span> <span class="attribution"><span class="source">(Unsplash)</span></span></figcaption></figure><p>One in six Canadian couples <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279129/">experience infertility</a>, defined as being unable to achieve pregnancy despite 12 or more months of attempts to conceive. </p>
<p>Infertility is stressful. In fact, research tells us that distress levels among individuals with infertility are comparable to those of <a href="https://europepmc.org/article/med/8142988">cancer patients</a>. Rates of depression and anxiety are high, especially <a href="https://doi.org/10.1016/j.ijnurstu.2015.05.004">in women</a>, who bear the greatest physical burden associated with <a href="https://www.lhsc.on.ca/the-fertility-clinic/ivf-phases">fertility treatments</a>: near-daily ultrasounds and self-injection of hormones, among other invasive and painful procedures. </p>
<p>As a clinical psychologist and researcher who specializes in women’s mental health, <a href="https://www.wmhresearch.ca/our-research/infertility-research/">my focus</a> has been on helping women with infertility cope with their condition. </p>
<p>In my work, it’s become clear that one huge source of stress is the barrage of unhelpful comments and suggestions made to individuals struggling with infertility. Supporting this idea, findings from our most <a href="https://doi.org/10.1007/s00737-020-01029-9">recent study</a> suggest that when women seek social support to cope with their infertility, they typically feel more, rather than less, distressed. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/339410/original/file-20200603-130929-12ic4oj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/339410/original/file-20200603-130929-12ic4oj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/339410/original/file-20200603-130929-12ic4oj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/339410/original/file-20200603-130929-12ic4oj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/339410/original/file-20200603-130929-12ic4oj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/339410/original/file-20200603-130929-12ic4oj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/339410/original/file-20200603-130929-12ic4oj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fertility treatments may involve invasive or painful procedures such as self-injection of hormones.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Clearly, some public education is needed. So, with the help of my team’s Infertility Research Advisory Panel — a group of six women who have personal experience with infertility — I’ve identified the following five things not to say to someone struggling with infertility. </p>
<h2>1. Just relax and it will happen</h2>
<p>This is by far the most highly cited zinger that people struggling with infertility hear but, in fact, there is a lack of clear evidence <a href="https://www.researchgate.net/profile/Joann_Galst/publication/315471215_The_Elusive_Connection_Between_Stress_and_Infertility_A_Research_Review_With_Clinical_Implications/links/591729314585152e19a1031f/The-Elusive-Connection-Between-Stress-and-Infertility-A-Research-Review-With-Clinical-Implications.pdf">that stress</a> contributes to infertility. </p>
<p>On the other hand, research is extremely clear in concluding that a diagnosis of infertility causes stress. So don’t assume that anxiety led to infertility — it’s likely the other way around. In the beginning, the person struggling to conceive likely felt excited and hopeful and it’s only as months (or years) crept by without a positive result that the stress you see now developed. </p>
<h2>2. Have you tried standing on your head during sex? Cutting dairy? Etc, etc, etc.</h2>
<p>Most of these old wives tales have no research backing them up whatsoever. Advice is also often doled out without any knowledge of the receiver’s situation. </p>
<p>Imagine you’ve been diagnosed with a medical condition that makes it very difficult to conceive; you’ve undergone three failed IVF cycles and have had multiple miscarriages. Now imagine how insulting and frustrating it would be to be told that if only you had cut out dairy, you would have been pregnant years ago. </p>
<p>If you don’t know the whole context, abstain from giving advice. And even if you do, let your loved one’s doctor decide what’s going to help them get pregnant. </p>
<h2>3. Don’t worry; my friend so-and-so had infertility and IVF worked for them!</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/338491/original/file-20200529-96727-1x1k3s4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/338491/original/file-20200529-96727-1x1k3s4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338491/original/file-20200529-96727-1x1k3s4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338491/original/file-20200529-96727-1x1k3s4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338491/original/file-20200529-96727-1x1k3s4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338491/original/file-20200529-96727-1x1k3s4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338491/original/file-20200529-96727-1x1k3s4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Predictors of success for assisted reproductive technologies like IVF and ICSI (intracytoplasmic sperm injection) vary with each patient’s circumstances.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>Infertility prognosis varies wildly according to a patient’s particular circumstances: their age, diagnosis, reproductive history and hormone levels are all <a href="https://doi.org/10.1093/humrep/der228">strong predictors</a> of treatment success. So, unfortunately, the fact that a friend of a friend of yours conceived through IVF (in vitro fertilization) means nothing for the person in front of you.</p>
<h2>4. Are you sure you want kids? You can have mine!</h2>
<p>Kids can be exhausting — feel free to vent about this to your other parent-friends. But when you’re with a friend struggling with infertility, be sensitive to the fact that they would give anything to have what you have. Though this is meant to be funny, it’s likely to be perceived as insensitive and ungrateful.</p>
<h2>5. Maybe you should just adopt. There are lots of kids who need a good home.</h2>
<p>There is no “just” adopt. Adoption can be incredibly expensive, time-consuming and emotionally draining. There may be a five- to 10-year waiting list, fees that can exceed $30,000 and multiple evaluations of your fitness to be a parent. Needless to say, it’s a very big decision that requires <a href="http://www.canadaadopts.com/adopting-in-canada/adopting-canada-faqs/">careful consideration</a>. </p>
<h2>So what should you say?</h2>
<p>Infertility involves grieving the existence of a child you may never have. So think of how you might interact with people experiencing other kinds of grief — for example, a friend whose spouse has died. You would never say: “I know you just lost your husband but just try to relax” or “You can have mine!” You would say: “This must be so hard for you” or “Anytime you need to talk, I’m here for you.” </p>
<p>You can also ask the person how you can be most helpful. Some people like to talk about their infertility struggles blow-by-blow; others would prefer to be distracted from them. So it can never hurt to ask how you can be most supportive.</p>
<p>One final “don’t” that applies to anyone is to ask: “When are you having children?” You may be surprised at how many people in your life have struggled with infertility but kept it secret. This seemingly innocent question can be a knife to the heart of someone secretly struggling with infertility, so don’t ask it.</p><img src="https://counter.theconversation.com/content/138510/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer L. Gordon receives funding from the Canadian Institutes of Health Research and the Saskatchewan Health Research Foundation. </span></em></p>Most people don’t intend to be hurtful or insensitive in their conversations with people experiencing infertility — they often just don’t know what to say.Jennifer L. Gordon, Assistant professor, Psychology, University of ReginaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/997542018-08-14T22:25:23Z2018-08-14T22:25:23ZSexist barriers block women’s choice to be sterilized<figure><img src="https://images.theconversation.com/files/231188/original/file-20180808-191019-1jtd39.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Demonstrators rally in support of women’s rights at the Women’s March on Jan. 20, 2018 in Washington, D.C.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Women in Canada and the United States face extraordinary difficulties in seeking the birth control method of sterilization. When going to medical professionals to ask about the procedure, they often hear something like, “You’ll regret it” or “Get your husband to do it.”</p>
<p>The most common reason medical professionals provide for denying women’s voluntary sterilization is potential future regret. </p>
<p>There are many studies on the possibility of women regretting sterilization. The most commonly cited study from the U.S. finds that <a href="https://www.ncbi.nlm.nih.gov/pubmed/10362150">the rate of women’s post-sterilization regret is 20.3 per cent of those 30 or younger and 5.9 per cent of those over 30</a>. </p>
<p>In contrast men who seek sterilization through vasectomy do not appear to be denied the procedure or subjected to the same concerns about regret. The absolute lack of data on how men feel about their sterilization, framed as regret or otherwise, shows a stark contrast. </p>
<p>Likewise, when women decide to seek fertility treatment they are <a href="https://www.ncbi.nlm.nih.gov/pubmed/28442552">not subject to the same level of scrutiny and do not usually have difficulty securing it.</a></p>
<p>The position of a woman opting for sterilization is thus unique. The decision to have children, to not have children or to render oneself unable to have children, has potentially life-changing consequences. However, it is only in the case of women seeking sterilization that regret is seen as a strong reason for denying reproductive choice. </p>
<h2>Womanhood means motherhood</h2>
<p>My research finds that <a href="https://doi.org/10.1111/bioe.12431">women face difficulty in seeking voluntary sterilization because childless women challenge what is viewed as normal</a>. </p>
<p>Currently, the reproductive norm is that women should want to give birth to children and have a duty to do so. </p>
<p>Challenging this idea carries social penalties. Stereotypes of childless women have been <a href="https://www.jstor.org/stable/10.1525/sop.2002.45.1.21">consistently negative since the late 1970s</a>. </p>
<p>Women who are childless <a href="https://link.springer.com/article/10.1007/BF02766268">are viewed as</a> less happy and as having a less rewarding life. They are also seen as socially undesirable, selfish and immature. </p>
<p>Women face discrimination about their decision to be childless at a greater rate than men due to beliefs that <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1755-618X.1994.tb00828.x">motherhood is biological to women (e.g. the maternal instinct), whereas fatherhood is learned for men</a>. Such a belief <a href="https://theconversation.com/do-mothers-really-have-stronger-bonds-with-their-children-than-fathers-do-57590">is not substantiated</a> but still widely held. </p>
<p>This finding is in line with <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/symb.11">studies on abortion regret</a>, where women are often taken to be at high risk of regretting their decision to undergo an abortion due to similar reproductive norms. </p>
<p>Expectations that womanhood means motherhood promotes the belief that women <em>should</em> regret the decision to be childless. This is especially the case with voluntary sterilization, as opposed to other birth control methods, given the relative permanency of the procedure. </p>
<h2>Ignoring women’s desires</h2>
<p>The view that womanhood means motherhood is an inaccurate and harmful definition that excludes trans women. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/231935/original/file-20180814-2897-cnpeva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/231935/original/file-20180814-2897-cnpeva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/231935/original/file-20180814-2897-cnpeva.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/231935/original/file-20180814-2897-cnpeva.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/231935/original/file-20180814-2897-cnpeva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/231935/original/file-20180814-2897-cnpeva.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/231935/original/file-20180814-2897-cnpeva.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cultural expectations that womanhood means motherhood shape us from a young age.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>It also leads to gendered assumptions that impact our medical system, as doctors make decisions based on sexist reproductive norms, rather than a woman’s desires and what is best for her. </p>
<p>For women seeking sterilization, this means they may not have an option for birth control or they may have to use a method that is unsuitable or undesirable to them. </p>
<p>It should be noted, however, that <a href="http://www.unaids.org/sites/default/files/media_asset/201405_sterilization_en.pdf">some women are more likely to receive access to sterilization or be involuntarily sterilized</a> due to colonialism, racism, classism, heteronormativity, cisnormativity and other forms of discrimination. </p>
<p>This makes it even more important to investigate and account for who is granted and who is denied sterilization, and why. </p>
<h2>The freedom to regret</h2>
<p>The risk of regret pervades many of our large decisions, like those of undergoing a medical procedure or having children. </p>
<p>Since we do not have perfect knowledge of the future, the possibility always lingers that an individual may regret their decision. Still, we move on with our lives to the best of our abilities and we are generally free to make decisions that we might regret. </p>
<p>This freedom does not exist for women seeking voluntary sterilization. These women are viewed as extremely vulnerable to regret, when men seeking sterilization and women seeking fertility treatment are not. </p>
<p>Recognizing this phenomenon allows us to confront our biases against women who choose to be voluntarily childless and to ensure their access to the birth control method most suited to their needs.</p><img src="https://counter.theconversation.com/content/99754/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dianne Lalonde does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Women face extraordinary difficulty in seeking the birth control method of sterilization due to sexist reproductive norms.Dianne Lalonde, PhD Candidate, Political Science, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/843792017-10-08T19:03:27Z2017-10-08T19:03:27ZScience or Snake Oil: do men need sperm health supplements?<figure><img src="https://images.theconversation.com/files/188282/original/file-20171002-19343-1syb0mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is it necessary to take supplements for sperm health, and do they work?</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Infertility, defined as the inability of a couple to conceive after at least 12 months of regular, unprotected sex, affects about <a href="http://www.jurology.com/article/S0022-5347(05)65109-9/abstract">15% of couples worldwide</a>. Several factors can lead to infertility, but specific to men, infertility <a href="http://www.fertstert.org/article/S0015-0282(16)57870-4/abstract">has been linked to lower levels</a> of antioxidants in their semen. This exposes them to an increased risk of chemically reactive species containing oxygen, which can damage sperm.</p>
<p>These reactive oxygen species are naturally involved in various pathways essential for normal reproduction. But uncontrolled and excessive levels of reactive oxygen species results in damage to your cells (or “oxidative stress”). This can affect semen health, and damage the DNA carried in the sperm, <a href="https://www.ncbi.nlm.nih.gov/pubmed/11570956">leading to the onset of male infertility</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/science-or-snake-oil-is-a2-milk-better-for-you-than-regular-cows-milk-62486">Science or Snake Oil: is A2 milk better for you than regular cow’s milk?</a>
</strong>
</em>
</p>
<hr>
<h2>Can supplements improve sperm health?</h2>
<p>Antioxidants have long been used to manage male infertility as they can help alleviate the detrimental role of reactive oxygen species and oxidative stress on sperm health.</p>
<p>Generally speaking, studies have shown favourable effects with supplementation, but results have been rather inconsistent due to large variations in study design, antioxidant formulations, and dosages. </p>
<p><a href="http://www.fertstert.org/article/S0015-0282(16)58514-8/abstract">Several lab studies</a> have <a href="https://www.ncbi.nlm.nih.gov/pubmed/9647554">reported beneficial effects</a> of antioxidants such as vitamins E and C on the mobility of the sperm and DNA integrity (absence of breaks or nicks in the DNA). But these haven’t been able to be replicated in humans.</p>
<p>There is <a href="https://www.ncbi.nlm.nih.gov/pubmed/8862739">some research suggesting</a> six months of supplementation with vitamin E and selenium can increase sperm motility and the percentage of healthy, living sperm, <a href="https://www.ncbi.nlm.nih.gov/pubmed/8957697">as well as pregnancy rates</a>. Other studies have found improvements in sperm volume, DNA damage, and pregnancy rate following treatment with supplements <a href="https://www.ncbi.nlm.nih.gov/pubmed/15193480">l-carnitine</a> (an amino acid), <a href="https://www.ncbi.nlm.nih.gov/pubmed/23289958">Coenzyme Q10</a>, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/23145537">zinc</a>.</p>
<p>But there seems to be an equal number of studies showing no improvements in <a href="https://www.ncbi.nlm.nih.gov/pubmed/15867002">sperm motility</a>, <a href="http://www.fertstert.org/article/S0015-0282(06)00099-9/abstract">sperm concentration</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/24147895">the size or shape of sperm</a>, or <a href="https://www.ncbi.nlm.nih.gov/pubmed/10221237">other measures</a>. Perhaps it’s the inconsistency in results, and the overall desire to improve fertility rates that has led some companies to create their own sperm-saving cocktails.</p>
<h2>The research behind Menevit</h2>
<p><a href="http://www.menevit.com.au/">Menevit</a> is a male fertility supplement aimed at promoting sperm health. It’s a combination of antioxidants, including vitamins C and E, zinc, folic acid, and selenium, formulated to maintain sperm health.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/most-men-dont-realise-age-is-a-factor-in-their-fertility-too-67785">Most men don't realise age is a factor in their fertility too</a>
</strong>
</em>
</p>
<hr>
<p><a href="http://www.elevit.com.au/the-elevit-range/menevit/">The makers of Menevit claim</a> the antioxidants it contains can help maintain normal sperm numbers, improve sperm swimming, improve sperm-egg development, and protect against DNA damage.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/188283/original/file-20171002-28512-umd3zt.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/188283/original/file-20171002-28512-umd3zt.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/188283/original/file-20171002-28512-umd3zt.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=986&fit=crop&dpr=1 600w, https://images.theconversation.com/files/188283/original/file-20171002-28512-umd3zt.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=986&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/188283/original/file-20171002-28512-umd3zt.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=986&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/188283/original/file-20171002-28512-umd3zt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1239&fit=crop&dpr=1 754w, https://images.theconversation.com/files/188283/original/file-20171002-28512-umd3zt.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1239&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/188283/original/file-20171002-28512-umd3zt.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1239&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Menevit is a popular sperm supplement for men, but the one study demonstrating its effectiveness raises ethical questions.</span>
<span class="attribution"><span class="source">Screenshot, My Chemist Website.</span></span>
</figcaption>
</figure>
<p>To date, there has only been <a href="http://trove.nla.gov.au/work/3562828?q&versionId=49401835">one published study</a> conducted on the actual product. The lead author of the study is also the inventor of the product.</p>
<p>Following three months of supplementation, participants taking Menevit recorded a statistically significant improvement in pregnancy rate compared to the control group (38.5% versus 16%). But no significant changes in egg fertilisation or embryo quality were detected between the two groups.</p>
<p>At first glance these findings may seem promising, but a few things warrant attention. As mentioned, the principle investigator of the study is also the inventor of the product, something many would argue is a conflict of interest.</p>
<p>The study also reported no improvements in DNA integrity or sperm motility, the <a href="https://www.ncbi.nlm.nih.gov/pubmed/15867002">two most cited</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/12623744">benefits of supplementing</a> with antioxidants.</p>
<p>Furthermore, the study looked at who was pregnant three months later, not who actually gave birth to a child.</p>
<p>The dosages used in the Menevit product are also much lower than what’s been in previous studies. For example, significant improvements in total sperm count <a href="https://www.ncbi.nlm.nih.gov/pubmed/11872201">have been observed</a> following 26 weeks of supplementation with folic acid and zinc. But this study used 66mg of zinc (compared to 25mg in Menevit) and 5mg of folic acid (compared to 500 micrograms in Menevit). It’s hard to say you would get the same results from the lower doses. </p>
<p>And <a href="https://www.ncbi.nlm.nih.gov/pubmed/15867002">studies showing</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/12623744">improvements</a> in sperm motility and DNA integrity following vitamin E and selenium supplementation used much larger doses than what is found in Menevit. The dosage of vitamin E used in previous studies has ranged from 600-1,490 international units, Menevit has 400 international units. The dose of selenium studied was 225 micrograms, compared to only 26 micrograms in the Menevit product.</p>
<h2>Your best bet for healthy sperm</h2>
<p>Before you stock up on every antioxidant out there, take a quick look at your lifestyle. Sperm health can be affected by unhealthy lifestyle factors like poor diet, alcohol consumption, smoking, and stress.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-handmaids-tale-and-counting-sperm-are-fertility-rates-actually-declining-81826">The Handmaid's Tale and counting sperm: are fertility rates actually declining?</a>
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</p>
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<p>Following a diet comprised of whole foods (not packaged, processed foods), avoiding excessive consumption of alcohol, engaging in regular physical activity, and not smoking <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717046/">can go a long way</a> when it comes to improving the health of your sperm.</p>
<p>As for sperm supplements such as Menevit, there’s a great deal of research that still needs to be done before we can say for sure it’s a worthwhile investment.</p><img src="https://counter.theconversation.com/content/84379/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Krissy Kendall does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Study results examining the effect of antioxidants on sperm health are mixed.Krissy Kendall, Lecturer of Exercise and Sports Science, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/814892017-08-15T14:04:05Z2017-08-15T14:04:05ZCase study in Kenya confirms rare genetic condition in embryo conceived through IVF<figure><img src="https://images.theconversation.com/files/179808/original/file-20170726-27705-17tbqgd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In Vitro Fertilisation has helped people in Africa and around the world to have families.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Infertility is a <a href="http://www.who.int/reproductivehealth/topics/infertility/perspective/en/">global</a> health challenge with distressing psychological and social consequences. Women in Africa pay a <a href="http://www.ijssh.org/papers/120-CH329.pdf">heavy social price</a> including stigma and <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-14-42">depression</a>, for not having children. Sadly, infertility in Africa is mostly <a href="https://books.google.co.ke/books?id=Uk6-w_TTeAoC&pg=PA63&lpg=PA63&dq=infertility+blamed+on+women&source=bl&ots=kfUfxvZKHQ&sig=8rb5z1p5SoWXLxraCHAMDQwjDbk&hl=en&sa=X&redir_esc=y#v=onepage&q=infertility%20blamed%20on%20women&f=false">blamed on the woman</a>.</p>
<p><a href="http://www.who.int/reproductivehealth/topics/infertility/definitions/en/">Infertility</a> is defined as the failure to conceive after one year or more of regular unprotected sexual intercourse. Globally it affects about <a href="https://contraceptionmedicine.biomedcentral.com/articles/10.1186/s40834-017-0044-7">70 million to 80 million </a> couples. In Africa, about <a href="https://www.k4health.org/sites/default/files/Infertility%2520in%2520Kenya%2520Deskreview%5B1%5D.pdf">50 to 60%</a> of all the reproductive health clinic visits are related to infertility. In Kenya, estimates show that infertility could be between <a href="https://www.k4health.org/sites/default/files/Infertility%2520in%2520Kenya%2520Deskreview%5B1%5D.pdf">2 and 20%</a>. </p>
<p>However, since <a href="http://www.bbc.com/news/health-33599353">1978</a> advances in reproductive medicine have made it possible for men and women with infertility problems to get children through <em>in vitro</em> fertilisation (IVF). During this <a href="http://heybaby.typepad.com/heybaby/files/NEJM-IVF.pdf">treatment</a>, the egg and sperm are manipulated in a laboratory to yield superior quality fertilised eggs which are later planted in the womb.</p>
<p>There’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464561/">no registry</a> in Africa for IVF treatment. But the available evidence shows that <a href="http://www.surgicalattractions.com/articles/how-conceive-style">acceptability</a> of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090591/">fertility treatment</a> has been growing on the continent.</p>
<p>But <a href="https://www.ncbi.nlm.nih.gov/pubmed/19474459/">since 2002</a> there have been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124339/">growing concerns</a> in a number of countries about some infants being born with genetic disorders. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/12439823/">Studies</a> have shown that children who are conceived through IVF are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650450/">more likely</a> to have genetic anomalies. Infants conceived through IVF have a significantly elevated risk of birth defects of about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650450/">30% to 40%</a>, though it’s important to emphasise that the risk of bearing a child with an abnormality in IFV still remains extremely low. </p>
<p>One of the rare conditions that’s been identified is <a href="https://www.google.com/search?q=Beckwith-Wiedemann+syndrome&oq=Beckwith-Wiedemann+syndrome&aqs=chrome..69i57j69i61l3.366j0j7&sourceid=chrome&ie=UTF-8">Beckwith-Wiedemann syndrome</a>, which results in babies being born with some body parts that are larger than normal. Studies have shown that babies conceived through IVF are at <a href="http://www.nytimes.com/2009/02/17/health/17ivf.html">10 times</a> greater risk of having Beckwith-Weidmann syndrome than the expected frequency from normal pregnancies.</p>
<p>We conducted a <a href="https://www.ajol.info/index.php/eamj/article/view/155008">case study</a> on a fetus that had been fertilised by IVF, and that was later aborted because it had multiple genetic disorders. The purpose of the study was to establish whether the fetus had <a href="https://ghr.nlm.nih.gov/condition/beckwith-wiedemann-syndrome">Beckwith-Wiedemann syndrome</a>. We concluded that,that was indeed the case. </p>
<p>The rarity of this genetic condition does not warrant discontinuing IVF for infertile couples. One possible solution to mitigating the risk would be to do a <a href="http://emedicine.medscape.com/article/273415-overview">genetic test</a> to identify defects in embryos before they are transferred to the uterus. Though this has been done <a href="http://emedicine.medscape.com/article/273415-overview">successfully elsewhere</a>, the procedure isn’t yet available in Africa.</p>
<h2>The process</h2>
<p>During IVF, the ovaries are stimulated by hormones known as <a href="http://www.news-medical.net/health/Gonadotrophin-Hormones.aspx">gonadotropins</a> so that they produce multiple eggs. Sperm are also collected to fertilise the eggs, hence the commonly used term “test tube” babies.</p>
<p>The source of the eggs and sperm can be from the couple trying for a child or a donation from a known or anonymous person. </p>
<p>The fertilised eggs, or <a href="http://www.advancedfertility.com/embryos.htm">embryos</a>, are incubated in the laboratory under conditions similar to those of a person’s physiological state to meet the temperature, PH, oxygen and carbon dioxide parameters.</p>
<p>When the embryos are fully developed, one or two embryos are transferred into womb and the excess embryos are frozen for future use or donation to infertile couples. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1180288/">Studies</a> have shown that there is a link between IVF and the occurrence of some congenital malformations.</p>
<p>These genetic disorders include; </p>
<ul>
<li><p><a href="https://medlineplus.gov/ency/article/001186.htm">beckwith-wieldemann syndrome</a>- causes large body size and enlarged organs</p></li>
<li><p><a href="https://ghr.nlm.nih.gov/condition/angelman-syndrome">angelman syndrome</a>- affects the nervous system and causes severe physical and intellectual disability.</p></li>
<li><p><a href="https://ghr.nlm.nih.gov/condition/russell-silver-syndrome">russel-silver syndrome</a>- the infants have poor growth both before and after birth</p></li>
<li><p><a href="https://www.ncbi.nlm.nih.gov/pubmed/16816970">maternal hypomethylation syndrome</a>- the infants are born with diabetes mellitus </p></li>
</ul>
<h2>Case study</h2>
<p>A 32 year-old patient was diagnosed with <a href="http://www.resolve.org/about-infertility/medical-conditions/secondary-infertility.html">secondary infertility</a>. She was unable to fall pregnant – or carry a pregnancy for nine months – after the birth of one or more biological children.</p>
<p>She had a history of miscarriage in 2012 and had surgery a year later to remove fibroids. Her infertility was not treatable through surgery or medical treatment so IVF was advised and she successfully became pregnant.</p>
<p>However, in the fourth month of the pregnancy, a scan showed that the baby had major abnormalities. This meant that the chances of the baby surviving were minimal. She gave consent for an abortion to be done.</p>
<p>The fetus was diagnosed with Beckwith-Wiedmann Syndrome which occurs in one out of every <a href="http://www.sciencedirect.com/science/article/pii/S0015028211006418?showall%3Dtrue">13,700 </a> infants born through IVF . Research shows that the abnormalities happen during the very early <a href="https://genetics.emory.edu/documents/resources/Emory_Human_Genetics_IVF_Birth_Defect_Risks.pdf">developmental phase</a> of the embryo.</p>
<p>The fetus we examined had the following features; </p>
<ul>
<li><p>macroglosia- an enlarged tongue</p></li>
<li><p>neonatal hypoglycaemia- low blood sugar level</p></li>
<li><p>hemihypertrophy- enlargement of one side of the body</p></li>
<li><p>hypoglycaemia- low blood sugars</p></li>
<li><p>exomphalos- a weakness of the baby’s abdominal wall where the umbilical cord joins it</p></li>
<li><p>wilms tumour- cancer of the kidney</p></li>
</ul>
<h2>Way forward</h2>
<p>Kenya’s first IVF baby was born on <a href="https://su-plus.strathmore.edu/handle/11071/3659">8th May 2006</a>. Since then, the number of IVF centres has increased to eight in the private sector and about 2,000 babies have been born. In sub Sahara Africa, <a href="http://www.ismaar.org/PDFs/infertility-global-2015-pasquale-article.pdf">South Africa</a> and Nigeria are the leaders in this field. </p>
<p>A number of things can be done to mitigate the risk of IVF babies developing rare genetic diseases.<a href="https://www.theverge.com/2016/2/1/10885282/gene-edit-dna-crispr-embryo-approval-uk">In Europe</a> research has been done that shows that ensuring laboratory conditions are as natural as possible is important. </p>
<p>And the manipulation of eggs and sperms, and embryos in the laboratory should be minimised.</p><img src="https://counter.theconversation.com/content/81489/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. J. Wanyoike-Gichuhi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Although the number of children conceived through in vitro fertilisation born with abnormalities remains extremely low, a recent study in Kenya shows that the risk of genetic disorders is higher.Dr. J. Wanyoike-Gichuhi, Senior Lecturer in the Department of Obstetric and Gynaecology, University of NairobiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/524252016-03-17T10:07:11Z2016-03-17T10:07:11ZA look inside the Czech Republic’s booming fertility holiday industry<figure><img src="https://images.theconversation.com/files/113908/original/image-20160304-17740-1bjg1c6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Nick Lehr/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>In 2008, a friend sent me a link to a Czech company called IVF Holiday. Clicking the link, I saw images of quaint European towns. These were accompanied by pictures of smiling white babies – and promises of affordable and safe rounds of in vitro fertilization (IVF). </p>
<p>I soon realized I’d stumbled into a new type of tourism: fertility holidays.</p>
<p>As a medical anthropologist, I knew I had to pursue this topic. Here was a perfect example of patients turning to medicine’s global marketplace when high prices of health care back home block access to treatments.</p>
<p>I subsequently conducted three years of fieldwork in the Czech Republic and North America to trace the fertility journeys of 29 American reproductive tourists. Their stories are in my forthcoming book <a href="http://nyupress.org/books/9781479849109/"><em>Fertility Holidays: IVF Tourism and the Reproduction of Whiteness</em></a>. </p>
<h2>A souvenir of a different sort</h2>
<p><a href="http://americanpregnancy.org/infertility/in-vitro-fertilization/">IVF</a> is an assisted reproductive technology that increases the chances of conception for women or couples suffering from infertility. It monitors and stimulates a woman’s ovulation, retrieves a woman’s eggs and fertilizes the eggs with sperm in a lab. The fertilized egg or eggs are then transferred back to a woman’s uterus. For women who suffer age-related infertility, they may need IVF using an egg donor. </p>
<p>However, costs in the United States for IVF can quickly become prohibitively expensive, running in the tens of thousands of dollars.</p>
<p>After looking further into IVF Holiday, I soon learned that it was owned by a married couple named Tom and Hana. Hana, a Czech woman, and Tom, an American from Ohio, learned early in their marriage that they would need IVF. With costs running as high as US$30,000, it was a procedure they simply couldn’t afford in North America. </p>
<p>However, there was a cheaper option: in 1995, in order to counteract a declining birth rate, the Czech government had decided to insure women for three cycles of IVF. </p>
<p>In January 2006, Hana and Tom embarked for Hana’s Moravian hometown and visited a clinic in Zlín. Pictures of their twins hugging one another show they returned home with the souvenir they sought. </p>
<p>Soon, the idea dawned on Hana and Tom to start a company that would help other lower-middle-class Americans travel to the Czech Republic to undergo IVF at a much lower cost. They realized they could act as intermediaries, providing transportation, travel recommendations and translators for all clinic visits. </p>
<p>IVF Holiday was born. </p>
<h2>The typical fertility traveler</h2>
<p>With companies like IVF Holiday paving the way, reproductive travel has become an increasingly popular option for North Americans who can’t afford treatment in the U.S., but still long for babies of their own. </p>
<p>When many first encountered IVF Holiday’s website, they felt empowered by the amount of information available. They spoke of reading endless online testimonials and contacting previous fertility tourists, acting as diligent consumers before making the decision to travel abroad for treatment. </p>
<p>Kay, a lawyer from the Northeast, traveled to the Zlín clinic in 2006 as one of the first North American patient clients seeking IVF. </p>
<p>When I interviewed her, she laughed as she recalled her first impression of the clinic – its large, rickety elevator that she took to the second floor of a former Communist-era building. Fearful of the elevator, she hesitated. Hana encouraged her to take this literal and metaphorical step. Thankfully, the door opened to the clinic that was the same clinic she’d seen on the IVF Holiday website.</p>
<p>So far, the North Americans traveling to the Czech Republic from North America have been predominantly white and lower- to middle-class. (I did interview one Puerto Rican couple and one African-American couple.) They’re typically in their late 30’s and early 40’s, and their age-related infertility often means they need IVF using an egg donor. </p>
<p>The majority were well-versed in the world of assisted reproductive technologies (ARTs), having undergone several IUIs (<a href="http://americanpregnancy.org/infertility/intrauterine-insemination/">intrauterine insemination</a>) in the U.S., often with the help of fertility drugs. They may have even tried one or more IVF cycles, but couldn’t continue due to financial constraints. North American reproductive tourists were also relatively well-traveled, although some were venturing abroad for the first time. </p>
<p>A number would end up staying at a small bed-and-breakfast in the hills of the town. This quaint bed-and-breakfast became a communal space for IVF travelers, many of whom became immediate friends, bonding over the fact they were undergoing IVF in a foreign country. </p>
<h2>Contrasting costs</h2>
<p>Back in the U.S., the reproductive medical industry is largely unregulated, and many have been critical of the commercial nature of a “baby business” that is largely profit-driven. Currently, there is no limit to the amount an egg donor can be paid – a number that typically ranges from $8,000 to $10,000. Given patient demand for reproductive technologies – and high profit margins – there’s little incentive for clinics to reduce their prices.</p>
<p>Meanwhile, the Czech reproductive medical industry is also profiting. But it’s from a lower price structure and liberal legislation that stipulates that sperm and egg donation must be voluntary and anonymous. While donors cannot be paid for their eggs, they’re offered attractive compensatory payments of approximately 1,000 euros for the discomfort involved in ovarian stimulation and egg retrieval from the clinic. (This amounts to roughly three months’ salary for egg donors.) </p>
<p>For North American patients traveling to the Czech Republic, treatment for IVF was $3,000. For an egg donor cycle, the cost was $4,000. On average, North Americans spent $10,000 for the entire trip. By comparison, a round of IVF with egg donation in the United States <a href="http://ivfcostcalculator.com/">costs between</a> $25,000 and $40,000. </p>
<h2>A shifting business model</h2>
<p>While IVF brokers were initially needed to facilitate travel between North America and the Czech Republic, their role has diminished significantly over the past decade. </p>
<p>Doctors were finding themselves answering too many direct questions through Hana, so in March 2009, the Zlín clinic hired its own coordinators. Previously, patients had to work with IVF Holiday as an intermediary; now they can work directly with the Czech clinic, which has become savvy at offering patient-centered care. </p>
<p>One of the new coordinator hires was a Czech woman named Lenka. The wife of a doctor who also works at the clinic, Lenka is a petite Slovak who has traveled extensively throughout the United States. As someone who also needed in vitro fertilization for her second child, she’s able to empathize with the pain of infertility. Like Hana, she’s able to deftly bridge Czech and American cultural differences. </p>
<p>In 2010, Lenka had been the only coordinator at the Zlín clinic. But when I visited the summer of 2014, I was struck by the cramped quarters of a larger office, where there were eight cubicles facing one another – and eight women typing emails or on the phone speaking Russian, Italian, French and English. Furthermore, the clinic built its own en suite accommodations for foreign patients, cutting the favored bed-and-breakfast out of the profits. </p>
<p>I quickly discovered that North American patients had become a very small piece of the Czech reproductive tourism pie. In a clinic in Prague, there’s a world map in the main conference center with the heading <em>Nase Deti v Svete</em>: Our Children in the World. You can see pins in every country where a recipient couple had IVF using egg donor in the Czech Republic. An estimated 20,000 IVF cycles were completed in the Czech Republic in 2006, a quarter of which were for foreign couples. By 2014, that number had grown to 30,000, with foreign couples accounting for one-third of the total. </p>
<p>Clinics are also opening farther east, in countries like Hungary and the Ukraine. While this may detract from the profits of Czech clinics, with more and more international consumers becoming aware of fertility tourism’s viability and affordability, it’s a market that’s ripe for growth. </p>
<p><em>Editor’s note: to protect the identities of those interviewed, the author changed the names of the people and company in the article.</em></p><img src="https://counter.theconversation.com/content/52425/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Speier receives funding from the National Science Foundation. </span></em></p>Confronted with skyrocketing IVF costs at home, North American couples are packing their bags, making an overseas trip and returning home with a special souvenir.Amy Speier, Assistant Professor of Anthropology, University of Texas at ArlingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/189612013-10-11T05:25:06Z2013-10-11T05:25:06ZNew fertility treatment brings hope, but not for all<figure><img src="https://images.theconversation.com/files/32828/original/gkq9rcfb-1381412624.jpg?ixlib=rb-1.1.0&rect=0%2C3%2C1024%2C764&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Way before the birds and the bees.</span> <span class="attribution"><span class="source">Jpogi</span></span></figcaption></figure><p>It’s Nobel season and who could forget IVF pioneer Sir Robert Edwards who <a href="http://www.nobelprize.org/nobel_prizes/medicine/laureates/2010/press.html">won the accolade</a> for medicine in 2010? More than ever before, reproductive medicine is throwing up new treatments and answers to women’s infertility. In-vitro activation, or IVA, is the latest to make waves after scientists were able to help a woman give birth through a process that involved finding minute follicles in her ovaries. </p>
<p>In women’s ovaries the follicles are responsible for producing the eggs and most of the female hormone oestrogen needed for pregnancy. Women are already born with these follicles and the eggs they contain. But the overwhelming majority of these are at an immature primordial stage which means they aren’t capable of either oestrogen or egg production. To do this they must first develop to a more advanced stage, which happens during ovulation every month. </p>
<p>However, because women already have a set reservoir of follicles when they are born, the follicles - and the eggs within them - succumb to the adverse effects of aging, one notable one being progressive damage to the eggs’ genetic material or DNA as women get older. Another important biological process that comes from this limit is the menopause. </p>
<p>Remarkably, for the vast majority of women the age of the menopause is relatively constant at around the age of 51, indicating that the ovary maintains a tight system of checks and balances on its follicular bank. </p>
<p>And exciting new research is unveiling a complex system of signalling pathways through which the ovary maintains this tight leash on how many primordial follicles are allowed to begin development at any one time in order to ensure a supply of oestrogen and egg sand that the finite supply of follicles aren’t used up too early in adult life.</p>
<p>For some women however, this ordinarily tightly controlled mechanism goes awry and any visible signs of oestrogen and egg production disappear a decade or more earlier than expected. Women with premature ovarian insufficiency (POI or premature menopause as some commonly call it) are unable to produce eggs either naturally or with conventional ovary-stimulating drugs such as used with IVF. </p>
<h2>IVA - a new breakthrough?</h2>
<p>Until now women with POI could still become pregnant but most needed donated eggs to do so. But a team of American and Japanese researchers have reported <a href="http://news.sky.com/story/1148637/baby-breakthrough-infertile-woman-gives-birth">the birth of a baby</a> to a patient with POI using her own eggs and a technique called in vitro activation (IVA). </p>
<p>The study involved 27 women whose ovaries were both removed and dissected into tiny fragments. In 13 of these women, primordial follicles were found when examined under the microscope. The significance of this was that POI wasn’t caused by the absence of eggs and follicles but because follicles were not being coaxed into developing into more advanced stages. </p>
<p>Once “activated”, ovarian tissue was then transplanted back into the patients and a further eight of these women showed signs of follicular development. And after being treated with IVF drugs to stimulate the ovary, mature eggs were successfully harvested in five cases and resulted in one live birth - the source of the news story.</p>
<p>It’s a landmark paper that successfully translated knowledge about IVA from previous lab-based research into practice. And these results undoubtedly bring fresh optimism when hope previously seemed lost. </p>
<p>But as with all ground-breaking research, these findings also bring new challenges and raise important questions about wider applicability. The papers’ authors have been very measured in considering the potential implications of their findings and alluded to many of the points that the findings raise in my mind.</p>
<h2>Working out the maths</h2>
<p>IVA was not possible for 14 of the 27 patients in the study, who showed no viable follicles under the microscope. Also, up to the time of the study report, among the remaining 13 women who had ovarian tissue transplanted, eight showed signs of follicle development, five had mature eggs obtained and went on to produce embryos (the earliest pregnancy stage) and one had the live-birth. </p>
<p>So while it is a major advance that proves that IVA can work, it also illustrates that many POI patients may not benefit from IVA. This probably reflects a number of causes of POI. An important challenge for the future will therefore be devising a method that can be used in clinics to identify suitable candidates and avoid invasive surgery for women unlikely to benefit. Also, women with POI account for a relatively small proportion when compared with the wider infertile population. </p>
<h2>A needle in a haystack</h2>
<p>Can IVA be used to help a wider cross-section of infertile couples? An increasing number of women who seek IVF treatment are well into their forties, when ovarian follicular reserve is known to be very low. One challenge here is actually finding the follicles as they are likely to be few and far between, akin to finding a needle in a haystack. </p>
<p>It also means that IVA is very unlikely to be applicable to post-menopausal women as follicles have all but disappeared by that stage. For older women, IVA will not circumvent genetic and other cellular damage that accumulate in eggs with advancing age and which reduces pregnancy success rates. </p>
<p>A group who could potentially benefit from burgeoning technologies like IVA are young women diagnosed with cancer whose fertility would be jeopardised by the irreversible toxic effects that many cancer treatments have on ovarian follicles. Frozen ovarian tissue biopsies containing primordial follicles obtained from such women before their treatment could theoretically be subjected to IVA and transplanted later in order to obtain eggs.</p>
<p>Notwithstanding these issues, the research is a triumph for translational reproductive research and opens new avenues that brighten the outlook for many whose fertility prospects looked bleak. However, a contracting budget for fertility treatment in the NHS means that even if further evaluation of technologies like IVA validates their use, making them accessible to infertility patients will present an altogether different challenge.</p><img src="https://counter.theconversation.com/content/18961/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hayden Homer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s Nobel season and who could forget IVF pioneer Sir Robert Edwards who won the accolade for medicine in 2010? More than ever before, reproductive medicine is throwing up new treatments and answers to…Hayden Homer, Clinical Senior Lecturer and Consultant in Reproductive Medicine, UCLLicensed as Creative Commons – attribution, no derivatives.