tag:theconversation.com,2011:/us/topics/assisted-reproduction-technology-2983/articlesAssisted reproduction technology – The Conversation2024-02-29T13:40:25Ztag:theconversation.com,2011:article/2244762024-02-29T13:40:25Z2024-02-29T13:40:25ZWhat is IVF? A nurse explains the evolving science and legality of in vitro fertilization<figure><img src="https://images.theconversation.com/files/578412/original/file-20240227-28-67xx7p.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1024%2C683&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some of the eggs and sperm in these tubes stored in liquid nitrogen may go on to form an embryo.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/january-2024-berlin-eggs-and-sperm-are-stored-in-a-liquid-news-photo/1954098470">Jens Kalaene/picture alliance via Getty Images</a></span></figcaption></figure><p><em>Since the <a href="https://www.npr.org/2022/06/24/1102305878/supreme-court-abortion-roe-v-wade-decision-overturn">overturning of Roe v. Wade in June 2022</a> ended the federal right to abortion, legislative attention has extended to many other aspects of reproductive rights, including access to assisted reproductive technologies such as in vitro fertilization, or IVF, after an Alabama Supreme Court ruling in February 2024.</em></p>
<p><em>University of Massachusetts Lowell associate professor and department chair of the school of nursing <a href="https://scholar.google.com/citations?user=6rrHhmUAAAAJ&hl=en">Heidi Collins Fantasia</a> explains how this decades-old procedure works and what its tenuous legal status means for prospective parents.</em></p>
<h2>What is IVF?</h2>
<p>IVF is a type of artificial reproductive technology that allows people with a range of fertility issues to conceive a child. It involves fertilizing an egg with sperm <a href="https://medlineplus.gov/ency/article/007279.htm">outside the body</a> to form an embryo that is then transferred into the uterus to develop.</p>
<p>IVF is used as a treatment <a href="https://asrmcongress.org/asrm-publishes-a-new-more-inclusive-definition-of-infertility/">for infertility</a>, which the <a href="https://asrmcongress.org/asrm-publishes-a-new-more-inclusive-definition-of-infertility/">American Society for Reproductive Medicine</a> defines as an inability to achieve pregnancy “based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing” or the “need for medical intervention.” </p>
<p>While originally developed as a fertility treatment for <a href="https://www.ncbi.nlm.nih.gov/books/NBK562266/">blocked fallopian tubes</a>, IVF is currently used for other conditions such as low sperm count or when the cause for infertility can’t be determined. <a href="https://www.usatoday.com/story/money/2023/06/13/ivf-cost-higher-for-lgbtq-couples/11135417002/">LGBTQ people</a> and <a href="https://www.nytimes.com/2020/05/05/parenting/single-moms-by-choice-photos.html">single parents</a> can also use IVF and other reproductive technologies to grow their families.</p>
<h2>How does IVF work?</h2>
<p>Typically during IVF, a patient takes hormones to stimulate the ovaries to produce eggs. Once a health professional retrieves the eggs using an ultrasound and a thin needle, they either incubate the sperm with the egg or <a href="https://www.ncbi.nlm.nih.gov/books/NBK562266/">inject the sperm into the egg</a> in the lab to fertilize it. Which specific type of IVF procedure a patient undergoes is determined on an individual basis with a health care provider.</p>
<p>Scientists began to develop IVF in the 1930s, beginning with the <a href="https://doi.org/10.1387/ijdb.180364mj">live birth of rabbits and mice</a> through the procedure. This research eventually led to the birth of the <a href="https://time.com/5344145/louise-brown-test-tube-baby/">first “test-tube baby”</a> in 1978. Physiologist Robert Edwards received the <a href="https://www.nobelprize.org/prizes/medicine/2010/press-release/">2010 Nobel Prize in physiology or medicine</a> for his research on IVF.</p>
<p>The technology has rapidly expanded since the first live human birth from IVF. The <a href="https://doi.org/10.1016/j.bbagen.2011.05.001">development of cryopreservation</a>, or the freezing of human eggs and embryos, has enabled people to pursue pregnancy later in life. <a href="https://doi.org/10.1016/j.bbagen.2011.05.001">Genetic screening</a> of cells from a developing embryo can identify genetic diseases and abnormalities.</p>
<p>The chance of a successful live birth through assisted reproductive technologies varies. <a href="https://www.cdc.gov/art/artdata/index.html">Success rates</a> depend on many factors, such as underlying cause of infertility, age and type of technology used.</p>
<h2>Who currently has access to IVF?</h2>
<p>Use of IVF has steadily increased since it was first introduced. In 2015, about <a href="http://dx.doi.org/10.15585/mmwr.ss6703a1">2% of all infants</a> in the U.S. were conceived as a result of IVF, and <a href="https://doi.org/10.1007/s10815-022-02687-7">public support for IVF is high</a> overall.</p>
<p>Approximately <a href="https://www.pewresearch.org/short-reads/2023/09/14/a-growing-share-of-americans-say-theyve-had-fertility-treatments-or-know-someone-who-has/">10% of women in the U.S.</a> have used some type of <a href="https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/">fertility service</a> to achieve a pregnancy. This includes fertility advice, medications to increase ovulation, fertility testing, surgery and IVF. </p>
<p>Because infertility increases with age, <a href="https://www.cdc.gov/nchs/fastats/infertility.htm">women older than 35</a> typically use these services more often than younger women. Women in the U.S. who <a href="https://doi.org/10.1016/j.fertnstert.2019.04.044">access infertility care the least</a> are often non-U.S. citizens and uninsured, and they typically have lower income and less education than women who do.</p>
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<a href="https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Clear batches of containers of eggs and embryos in a large, frozen circular container" src="https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&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">Cryopreservation gives prospective parents more time to pursue pregnancy.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/frozen-embryos-and-eggs-in-nitrogen-cooled-royalty-free-image/520157312">Ted Horowitz Photography/The Image Bank via Getty Images</a></span>
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<p><a href="https://www.cdc.gov/art/state-specific-surveillance/2021/figures.html#figure5">Differences in geography</a> also affect IVF access. In 2021, over 5% of all infants in Massachusetts were conceived from IVF, but this dropped to less than 1% in New Mexico, Arkansas and Mississippi.</p>
<p>Service availability and insurance coverage for IVF procedures differ by state, which could account for some of the differences in use. Only a <a href="https://resolve.org/learn/financial-resources-for-family-building/insurance-coverage/insurance-coverage-by-state/">small number of states</a> mandate that private insurers cover IVF. <a href="https://reproductiverights.org/fact-sheet-infertility-and-ivf-access-in-the-united-states-a-human-rights-based-policy-approach/">Public insurance coverage</a> for infertility services is even lower. </p>
<p>The <a href="https://doi.org/10.1186/s12958-022-00984-5">cost of IVF</a> has been the greatest barrier to infertility care. <a href="https://doi.org/10.1186/s12958-022-00984-5">Out-of-pocket costs</a> for people without insurance coverage can range from over US$10,000 to $25,000 per cycle, with rising costs per cycle.</p>
<h2>How do debates about when life begins affect IVF?</h2>
<p>Political views vary around reproductive rights, and <a href="https://www.cbsnews.com/news/republicans-senate-ivf-alabama-ruling/">access to IVF</a> is likely to become an issue in upcoming election cycles.</p>
<p>The <a href="https://www.washingtonpost.com/nation/2024/02/20/alabama-supreme-court-ivf-embryos/">Alabama Supreme Court ruled</a> in February 2024 that frozen embryos created during the process of IVF were people. While the ruling currently applies only to Alabama, it has caused <a href="https://www.theguardian.com/society/2024/feb/23/fertility-doctors-reaction-alabama-embryo-ruling">shock, confusion and concern</a> among health care providers. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/OsbGVgnHLBM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Clinicians and people relying on IVF to expand their families are concerned about U.S. legislation around reproduction.</span></figcaption>
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<p>As a result of the ruling, two major <a href="https://www.pbs.org/newshour/health/a-2nd-alabama-ivf-provider-pauses-parts-of-its-program-after-court-ruling-on-frozen-embryos">IVF providers in Alabama</a> have paused infertility care because of potential legal risk to health care providers. The main concern is whether providers can be held <a href="https://www.cnn.com/2024/02/24/health/alabama-ivf-roe-v-wade/index.html">liable for wrongful death</a> if frozen embryos don’t survive the thawing process. </p>
<p>Since the elimination of federal protection of abortion in 2022 with the overturning of Roe v. Wade, individual states have made their <a href="https://www.americanprogress.org/article/a-year-after-the-supreme-court-overturned-roe-v-wade-trends-in-state-abortion-laws-have-emerged/">own laws regarding abortion access</a>. Many patients, health care providers, researchers and legislators see the Alabama decision regarding IVF as a continuation of the increasing <a href="https://www.pbs.org/newshour/show/how-an-alabama-supreme-court-ruling-that-frozen-embryos-are-children-impacts-ivf">erosion of women’s reproductive rights</a>.</p><img src="https://counter.theconversation.com/content/224476/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heidi Collins Fantasia is the editor for Nursing for Women's Health. </span></em></p>IVF is a decades-old procedure that has allowed increasing numbers of prospective parents to have children. Evolving legislation may put it under threat.Heidi Collins Fantasia, Associate Professor of Nursing, UMass LowellLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2190052023-12-14T19:19:48Z2023-12-14T19:19:48ZEggs from men, sperm from women: how stem cell science may change how we reproduce<figure><img src="https://images.theconversation.com/files/564442/original/file-20231208-17-22yb4u.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C748&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/morula-early-stage-embryo-consisting-cells-776035219">nobeastsofierce/Shutterstock</a></span></figcaption></figure><p>It may soon be possible to coax human skin cells into becoming functional eggs and sperm using a technique known as “in vitro gametogenesis”. This involves the creation (genesis) of eggs and sperm (gametes) outside the human body (in vitro). </p>
<p>In theory, a skin cell from a man could be turned into an egg and a skin cell from a woman can become a sperm. Then there’s the possibility of a child having multiple genetically-related parents, or only one.</p>
<p>Some scientists believe human applications of in vitro gametogenesis are a <a href="https://www.statnews.com/2023/10/02/ivg-ivf-replacement-reproductive-technology-hype/">long way off</a>. </p>
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<p>However, scientists who work on human stem cells are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579208/">actively working</a> on overcoming the barriers. <a href="https://www.statnews.com/2023/04/08/ivf-eggs-hormones-gameto-reproductive-fertilo/">New</a> <a href="https://www.technologyreview.com/2021/10/28/1038172/conception-eggs-reproduction-vitro-gametogenesis/">biotechnology</a> <a href="https://www.newyorker.com/magazine/2023/04/24/the-future-of-fertility">start-ups</a> are also seeking to commercialise this technology.</p>
<p>Here’s what we know about the prospect of human in vitro gametogenesis and why we need to start talking about this now.</p>
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<p>
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Read more:
<a href="https://theconversation.com/explainer-what-are-stem-cells-14391">Explainer: what are stem cells?</a>
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<h2>Is the technology available?</h2>
<p>In vitro gametogenesis begins with “pluripotent stem cells”, a kind of cell that can develop into many different cell types. The aim is to persuade these stem cells to become eggs or sperm.</p>
<p>These techniques could use stem cells taken from early embryos. But scientists have also worked out how to <a href="https://www.eurostemcell.org/stemcellshorts-what-are-induced-pluripotent-stem-cells">revert adult cells</a> to a pluripotent state. This opens up the possibility of creating eggs or sperm that “belong to” an existing human adult.</p>
<p>Animal studies have been promising. In <a href="https://www.nature.com/articles/490146b">2012</a>, scientists created live-born baby mice using eggs that began their life as skin cells on a mouse tail.</p>
<p>More recently, the technique has been used to facilitate same-sex reproduction. Earlier this year, scientists created mouse pups with <a href="https://www.nature.com/articles/d41586-023-00717-7">two genetic fathers</a> after transforming skin cells from male mice into eggs. Mouse pups with <a href="https://www.nature.com/articles/d41586-018-06999-6">two genetic mothers</a> have also been created.</p>
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<figcaption><span class="caption">How scientists bred mice with two fathers.</span></figcaption>
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<p>Scientists have not yet managed to adapt these techniques to create human gametes. Perhaps because the technology is still in its infancy, Australia’s legal and regulatory systems do not address whether and how the technology should be used. </p>
<p>For example, the National Health and Medical Research Council’s <a href="https://www.nhmrc.gov.au/about-us/publications/art">assisted reproduction guidelines</a>, which were updated in 2023, do not include specific guidance for in vitro-derived gametes. These guidelines will need to be updated if in vitro gametogenesis becomes viable in humans.</p>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/the-future-of-stem-cells-tackling-hype-versus-hope-72052">The future of stem cells: tackling hype versus hope</a>
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</em>
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<h2>The potential</h2>
<p>There are three distinct clinical applications of this technology.</p>
<p>First, in vitro gametogenesis could streamline IVF. Egg retrieval currently involves repeated hormone injections, a minor surgical procedure, and the <a href="https://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/symptoms-causes/syc-20354697">risk</a> of overstimulating the ovaries. In vitro gametogenesis could eliminate these problems.</p>
<p>Second, the technology could circumvent some forms of medical infertility. For example, it could be used to generate eggs for women born without functioning ovaries or following early menopause.</p>
<p>Third, the technology could allow same-sex couples to have children who are genetically related to both parents.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/promising-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-208276">Promising 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</a>
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</p>
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<h2>Legal, regulatory and ethical issues</h2>
<p>If the technology becomes viable, in vitro gametogenesis will alter the dynamics of how we create families in unprecedented ways. How we should respond requires careful consideration.</p>
<p><strong>1. Is it safe?</strong></p>
<p>Careful trials, rigorous monitoring, and follow-up of any children born will be essential – as it has been for other <a href="https://theconversation.com/maeves-law-would-let-ivf-parents-access-technology-to-prevent-mitochondrial-disease-heres-what-the-senate-is-debating-176668">reproductive</a> <a href="https://theconversation.com/rest-assured-ivf-babies-grow-into-healthy-adults-23432">technologies</a>, including IVF.</p>
<p><strong>2. Is it equitable?</strong></p>
<p>Other issues relate to access. It might seem unjust if the technology is only available to the wealthy. Public funding could help – but whether this is appropriate depends on whether the state <a href="https://theconversation.com/ideas-for-australia-rethinking-funding-and-priorities-in-ivf-should-the-state-pay-for-people-to-have-babies-57036">ought to support</a> people’s reproductive projects.</p>
<p><strong>3. Should we restrict access?</strong></p>
<p>For instance, pregnancy is rare in older women, largely because egg count and quality <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/age-and-fertility">decline with age</a>. In vitro gametogenesis would theoretically provide “fresh” eggs for women of any age. But helping older women become parents is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566409/">controversial</a>, due to physical, psychological and other factors associated with having babies later in life.</p>
<p><strong>4. We’d still need surrogates</strong></p>
<p>If we took skin cells from each male partner and created an embryo, that embryo would still need a surrogate to carry the pregnancy. Unfortunately, Australia has a shortfall of surrogates. International surrogacy provides an alternative, but carries <a href="https://theconversation.com/its-hard-to-find-a-surrogate-in-australia-but-heading-overseas-comes-with-risks-206182">legal, ethical and practical difficulties</a>. Unless access to surrogacy is improved domestically, benefits to male couples will be limited. </p>
<p><strong>5. Who are the legal parents?</strong></p>
<p>In vitro gametogenesis also raises questions about who are the future child’s legal parents. We already see related legal debates surrounding non-traditional families formed through surrogacy, egg donation and sperm donation. </p>
<p>In vitro gametogenesis could theoretically also be used to create children with more than two genetic parents, or with only one. These possibilities likewise require us to update our current understandings of parenthood.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-may-one-day-grow-babies-outside-the-womb-but-there-are-many-things-to-consider-first-125709">We may one day grow babies outside the womb, but there are many things to consider first</a>
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<h2>How far is too far?</h2>
<p>Of the potential uses already mentioned, same-sex reproduction is the most controversial. The reproductive limitations imposed by being in a same-sex relationship are sometimes seen as a “social” form of infertility the medical profession is not obligated to fix.</p>
<p>The moral stakes, however, are virtually identical regardless of whether in vitro gametogenesis is used by same-sex or opposite-sex couples. Both uses of the technology fulfil exactly the same goal: helping couples fulfil their desire to have a child genetically related to both parents. It would be unjust to deny access to only one of these groups.</p>
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<a href="https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Same-sex female couple cooking in kitchen, one feeding the other fruit" src="https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.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>
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<span class="caption">Who should have access to this technology? How about same-sex couples?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lesbian-couple-cooking-kitchen-together-1071305168">Rawpixel.com/Shutterstock</a></span>
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<p>But same-sex reproduction is only the tip of the iceberg. In vitro gametogenesis could theoretically facilitate “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973109/">solo reproduction</a>” by deriving both eggs and sperm from the same individual. Interestingly, a child created this way would not be a clone of its parent, since the process of gamete formation would shuffle the parent’s genetic material and create a genetically distinct individual.</p>
<p>Or people could engage in “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215291/">multiplex parenting</a>” combining genetic material from more than two individuals. Imagine, for example, that two couples create embryos via IVF. In vitro gametogenesis could then be used to derive eggs and sperm from each of these two separate embryos, which could subsequently be used to conceive a single child that is genetically related to all four adults.</p>
<p>Finally, in vitro gametogenesis could revolutionise prenatal genetic selection. We’d have <a href="https://rmanetwork.com/blog/number-of-eggs-good-ivf-in-vitro-fertilization/">many more embryos</a> than available during regular IVF to screen for genetic diseases and traits.</p>
<p>So it would be urgent to discuss “designer babies”, eugenics, and whether we have a <a href="https://bioedge.org/bioethics-d75/savulescu-interviewed-on-procreative-beneficence/">moral obligation</a> to conceive children with the best chance of a good life.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/worlds-first-synthetic-embryo-why-this-research-is-more-important-than-you-think-188217">World's first 'synthetic embryo': why this research is more important than you think</a>
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</em>
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<h2>We need to start talking about this now</h2>
<p>Both law and ethics can lag behind new technologies, particularly when their implications are as profound and far-reaching as the implications of in vitro gametogenesis.</p>
<p>We need to discuss how this technology should be regulated before it is rolled out. Given how rapidly the science is developing, we should begin this discussion now. </p>
<hr>
<p><em>Laura Smith, a masters student from Monash University, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/219005/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Koplin receives research funding from Ferring Pharmaceuticals for an unrelated project.</span></em></p><p class="fine-print"><em><span>Neera Bhatia receives funding from UKRI Arts and Humanities Research Council for an unrelated project.</span></em></p>The technology may be here sooner than we think. But we have so much to discuss first.Julian Koplin, Lecturer in Bioethics, Monash University & Honorary fellow, Melbourne Law School, Monash UniversityNeera Bhatia, Associate Professor in Law, Deakin UniversityLicensed 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>
<figure class="align-center zoomable">
<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>
<figcaption>
<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>
</figcaption>
</figure>
<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>
<figure>
<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>
</figure>
<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/2010812023-03-08T04:28:16Z2023-03-08T04:28:16ZQld agrees to allow donor-conceived people the right to know the identity of their donor. Here’s why it’s important<figure><img src="https://images.theconversation.com/files/514133/original/file-20230308-172-i3aku7.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6144%2C3456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Last week, the Queensland government accepted in principle recommendations from a 2022 <a href="https://www.parliament.qld.gov.au/Work-of-Committees/Committees/Committee-Details?cid=170&id=4150">inquiry</a> into the rights of donor-conceived people. </p>
<p>Donor conception is a technique to facilitate pregnancy using donated sperm and/or eggs.</p>
<p>Queensland is among the least progressive jurisdictions in Australia on donor conception. To date, it has no legislation governing donor conception, despite a senate <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/Completed_inquiries/2010-13/donorconception/report/index">inquiry</a> recommending in 2011 that jurisdictions which didn’t yet have a statutory scheme in place should establish one “as a matter of priority”.</p>
<p>The government’s response to the inquiry <a href="https://www.theguardian.com/australia-news/2023/feb/28/queensland-moves-to-allow-sperm-donors-to-be-identified-by-those-conceived-via-donation">indicated</a> it supports allowing donor-conceived people to know the identity of their donor and siblings once they turn 18, regardless of when they were born.</p>
<p>In 2016, Victoria <a href="https://aifs.gov.au/research/family-matters/no-98/donor-identification">passed legislation</a> enabling donor-conceived people to access identifying information about their donor. <a href="https://yoursay.sa.gov.au/art-act-amendments">South Australia</a> is also currently considering amendments to improve the operation of its donor conception register, and Western Australia is developing new legislation following a <a href="https://www.health.wa.gov.au/Articles/S_T/Submissions-for-HRT-review">2019 independent review</a>.</p>
<p>Here’s why the Queensland government should move to implement the recommendations of the inquiry as soon as practicable. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1574197222136483840"}"></div></p>
<h2>Changing attitudes</h2>
<p>Donor conception has been practised in Australia since at least the 1940s. Historically, doctors promised donors anonymity and encouraged parents to keep their treatment a secret.</p>
<p>But <a href="https://link.springer.com/article/10.1057/s41292-021-00265-1">attitudes have changed</a>. We now know anonymity isn’t in the best interests of donor-conceived people. Best practice is to allow donor-conceived people to have identifying information about their donors, regardless of when they were born.</p>
<p>Identifying information includes the donor’s full name, and is in addition to non-identifying information already provided such as cultural background, occupation and physical features. Many donors <a href="https://academic.oup.com/humrep/article/23/11/2415/2914062">now also support this</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/victorias-world-first-change-to-share-sperm-or-egg-donors-names-with-children-72417">Victoria's world-first change to share sperm or egg donors' names with children</a>
</strong>
</em>
</p>
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<p>Since 2004, <a href="https://www.nhmrc.gov.au/about-us/publications/art">ethical guidelines</a> by Australia’s peak medical and health research body have prohibited the anonymous donation of sperm and eggs. However, these guidelines don’t have the legal force of legislation and don’t have an impact on those conceived before 2004.</p>
<p>Research <a href="https://journals.sagepub.com/doi/full/10.1177/00380385221091184">with donor-conceived people</a>, and evidence provided to parliamentary inquiries, has shown fertility clinics are often unable and/or unwilling to provide accurate information. This might include, for example, denying donor-conceived people access to donor conception records even when donors have consented, and giving incorrect information about siblings.</p>
<p>Over the years, many donor conception records <a href="https://www.parliament.vic.gov.au/publications/fact-sheets/241-lawreform/inquiry-into-access-by-donor-conceived-people-to-information-about-donors-interim-report-56th-parliament">have been modified or destroyed</a>. This has often occurred to protect anonymity, but is also due to questionable past practices such as sperm mixing, donors’ identities not being verified, and recruitment of medical students in exchange for course credits.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1632907871531991040"}"></div></p>
<h2>5 reasons for urgent reform</h2>
<p>Establishing a centralised, government-held register would bring Queensland in line with other jurisdictions that already recognise the rights of donor-conceived people. This includes Victoria, South Australia, NSW (for those born after 2010), and Western Australia (for those born after 2004).</p>
<p>This will also help pave the way for an equitable national standard and a national donor conception register, an approach <a href="https://www.abc.net.au/news/2023-03-07/donor-conceived-woman-welcomes-reform-proposal-qld-register/102057892">supported by the Fertility Society of Australia and New Zealand</a>.</p>
<p>There are five reasons legislating this as soon as possible in Queensland is essential.</p>
<ol>
<li><p>Legislation needs to respond to technological advances. Donor-conceived people are <a href="https://theconversation.com/dna-test-kits-are-changing-donor-conceived-families-183191">already able to identify donors</a> through informal channels following the rapid growth of direct-to-consumer DNA testing, coupled with social media. But DNA data is highly sensitive and donor-conceived people should have official pathways to information that don’t require them to <a href="https://theconversation.com/its-time-to-talk-about-who-can-access-your-digital-genomic-data-87682">exchange their personal data</a> for information to large corporations.</p></li>
<li><p>Donor-conceived people who find out about their conception during early childhood have <a href="https://www.researchgate.net/publication/339361750_Donor-Conceived_People%27s_Views_and_Experiences_of_Their_Genetic_Origins_A_Critical_Analysis_of_the_Research_Evidence">more positive attitudes towards their conception and better wellbeing</a> compared to donor-conceived people who discover later in life. One of the inquiry’s recommendations was that birth certificates be annotated when a person is donor-conceived. This would discourage deception. The UK government is currently considering <a href="https://www.theguardian.com/science/2023/feb/28/donor-children-could-contact-biological-parents-before-18-under-new-proposals">allowing donor-conceived people to contact their donor before 18</a>. </p></li>
<li><p>Many <a href="https://www.sciencedirect.com/science/article/pii/S1472648321001814">donor-conceived people</a> want to meet their donor and donor siblings. In everyday conversations, we often discuss our families, genetics, and resemblance. It’s unsurprising that donor-conceived people are interested in knowing about their genetic heritage to understand themselves and their cultural background. Knowing who one’s siblings are is also <a href="https://www.progress.org.uk/australian-sperm-donor-fathered-60-children-under-multiple-aliases">important to avoid sexual relationships</a>.</p></li>
<li><p>Dealing with health issues often requires knowledge of one’s genetic heritage. If a donor-conceived person learns of a genetic condition, they may want to notify their donor and siblings.</p></li>
<li><p>Many donors want <a href="https://www.abc.net.au/news/2015-11-27/donor-dad-tracked-down-by-dying-daughter-backs-id-law-changes/6981982">to find out about</a>, and meet, their donor-conceived (adult) children. Many donors <a href="https://www.tandfonline.com/doi/abs/10.1080/14647273.2018.1564156?journalCode=ihuf20">make themselves identifiable</a> to their donor-conceived children. Reasons may include believing the donor-conceived person is entitled to information about their identity, wanting to provide avenues to seek information, or curiosity about how many people were conceived following their donation and their identities.</p></li>
</ol>
<p>Some people have concerns about removing anonymity. But the conditions of anonymity promised by doctors were never legally binding. This legislation is retrospectively being applied to a period when there was no legislation.</p>
<p>Another concern is that it could jeopardise the number of people willing to donate sperm or eggs. But research suggests shifts from anonymous to identifiable donation <a href="https://pubmed.ncbi.nlm.nih.gov/27323639/">aren’t detrimental</a> to donor numbers. Rather, the type of people who donate changes. For example, this may encourage more donors in their 30s rather than late teens or early 20s.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dna-test-kits-are-changing-donor-conceived-families-183191">DNA test kits are changing donor-conceived families</a>
</strong>
</em>
</p>
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<h2>Donor-conceived advocacy</h2>
<p>Donor-conceived people have long been <a href="https://journals.sagepub.com/doi/full/10.1177/1329878X211064646">speaking</a> <a href="https://www.change.org/p/united-nations-making-humans-international-principles-for-donor-conception-and-surrogacy">out</a> to agitate for reform in donor conception.</p>
<p>This reform is the result of <a href="https://www.theguardian.com/australia-news/2023/feb/28/queensland-moves-to-allow-sperm-donors-to-be-identified-by-those-conceived-via-donation">decades of advocacy</a>, and represents a key moment to enshrine donor-conceived people’s rights in legislation.</p>
<hr>
<p><em>If this article raises issues for you and you need support, please contact <a href="https://donorconceivedaustralia.org.au/contact-us">Donor Conceived Australia</a>.</em></p><img src="https://counter.theconversation.com/content/201081/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Giselle Newton received funding under the Australian government's Research Training Program. Giselle holds an appointment as Adjunct Associate Lecturer at the Centre for Social Research in Health at UNSW Sydney. Giselle is a donor-conceived woman and is a member of Donor Conceived Australia. Giselle contributed to the Inquiry into Matters Relating to Donor Conception Information 2022 (QLD). </span></em></p><p class="fine-print"><em><span>Caitlin Macmillan has received Australian Government's Research Training Program funding. Caitlin contributed to the Inquiry into Matters Relating to Donor Conception Information 2022 (Qld) and the Inquiry into Assisted Reproductive Treatment Practices in Victoria 2020 (Vic.)</span></em></p><p class="fine-print"><em><span>Katharine Gelber has received funding from the Australian Research Council and the Academy of Social Sciences in Australia. She contributed to the Inquiry into Matters Relating to Donor Conception Information 2022 (Qld).</span></em></p>There are 5 key reasons why this reform should go ahead.Giselle Newton, Postdoctoral Research Fellow, The University of QueenslandCaitlin Macmillan, Casual Academic, Deakin UniversityKatharine Gelber, Professor of Politics and Public Policy, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1816642022-05-03T13:08:48Z2022-05-03T13:08:48ZFertility treatment use is on the rise – new legislation could increase protections for donors and families in an industry shrouded in secrecy<figure><img src="https://images.theconversation.com/files/460598/original/file-20220429-16-8n7qx3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Assisted reproductive technologies like in vitro fertilization can help expand families, but regulations aren't consistent across states. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/large-group-of-babies-royalty-free-image/77744444">moodboard/Image Source via Getty Images</a></span></figcaption></figure><p>The fertility industry generates approximately <a href="https://www.natlawreview.com/article/state-fertility-industry">US$8 billion in revenue</a> annually and plays a role in the birth of tens of thousands of children each year. Regulations are currently <a href="https://theconversation.com/sperm-donation-is-largely-unregulated-but-that-could-soon-change-as-lawsuits-multiply-174389">limited</a> even as technology evolves and demand increases. But a <a href="https://leg.colorado.gov/bills/sb22-224">new Colorado bill</a> introduced in late April 2022 could help the industry better meet the needs of those who use it. </p>
<p>Fertility treatments take a <a href="https://resolve.org/learn/what-are-my-options/">number of forms</a>. They may include fertility medication, intrauterine insemination, in vitro fertilization, or the use of donor sperm, eggs or embryos. Expenses for each treatment type vary widely, ranging from roughly <a href="https://www.forbes.com/health/family/how-much-does-ivf-cost/">$15,000 to $30,000</a> for a single IVF cycle to <a href="https://theconversation.com/sperm-donation-is-largely-unregulated-but-that-could-soon-change-as-lawsuits-multiply-174389">about $1,000</a> for a vial of sperm. Often, <a href="https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/">multiple tries</a> are needed to achieve a pregnancy, and the costs can add up.</p>
<p>Despite these costs, the <a href="https://www.cdc.gov/art/reports/2019/pdf/2019-Report-ART-Fertility-Clinic-National-Summary-h.pdf">number of people</a> who use reproductive technology is consistently rising. U.S. births assisted by fertility treatments increased <a href="https://www.pewresearch.org/fact-tank/2018/07/17/a-third-of-u-s-adults-say-they-have-used-fertility-treatments-or-know-someone-who-has/">more than threefold</a> from 1996 to 2015. </p>
<p>We are <a href="https://www.law.virginia.edu/faculty/profile/nrc8g/2915359">law professors</a> who <a href="https://www.law.gwu.edu/sonia-m-suter">study reproductive technology</a>. One of us has used these treatments ourselves. The <a href="https://coloradosun.com/2022/04/27/colorado-legislature-donor-conceived/">new Colorado bill</a> we testified in support of would be the first in the U.S. to require the identity of egg and sperm donors to be released upon request of their donor-conceived offspring when they turn 18. In the bill’s current version, it would also set a limit on the number of families per individual donor.</p>
<p>To understand the significance of Colorado’s proposed legislation, it’s worth examining the scope of issues surrounding fertility treatment in the U.S., and how the industry works.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/P27waC05Hdk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In vitro fertilization is one of several types of fertility treatments available.</span></figcaption>
</figure>
<h2>Access to fertility services</h2>
<p>Twelve percent of women in the U.S. have received some form of <a href="https://www.nytimes.com/2020/04/16/parenting/fertility/ivf-long-term-effects.html">medical care</a> for infertility, a condition that affects roughly <a href="https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/">10%</a> to <a href="https://www.cdc.gov/reproductivehealth/infertility/index.htm">20%</a> of heterosexual people. Same-sex couples and single individuals who want to reproduce face <a href="https://www.newyorker.com/culture/annals-of-inquiry/the-case-for-social-infertility">social infertility</a>, where their relationships and social circumstances preclude the ability to conceive a child.</p>
<p>A small but increasing number of states <a href="https://www.ncsl.org/research/health/insurance-coverage-for-infertility-laws.aspx">require insurance companies</a> to offer fertility coverage, although the scope and nature of coverage <a href="https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/">varies by policy and by state</a>. </p>
<p><a href="https://www.wired.com/story/fertility-benefits-work/">More employers</a> are also offering fertility benefits. However, which services they cover vary, the most common being evaluation by an infertility specialist. An <a href="https://www.mercer.us/our-thinking/healthcare/new-survey-finds-employers-adding-fertility-benefits-to-promote-dei.html">increasing percentage</a> of companies are covering <a href="https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/">egg freezing</a> and in vitro fertilization.</p>
<p>While <a href="https://www.kff.org/report-section/medicaid-coverage-of-family-planning-benefits-results-from-a-state-survey-fertility-services/">some Medicaid programs</a> cover fertility testing, only one state covers a few types of treatment. Most states still do not require health insurance policies to cover fertility benefits, and some of those states that do limit benefits to <a href="https://www.reproductivefacts.org/resources/state-infertility-insurance-laws/states/arkansas/">heterosexual married people</a>.</p>
<p>A <a href="https://doi.org/10.1016/j.fertnstert.2017.02.101">lack of fertility specialists</a> in some areas of the U.S. also restricts access to fertility care. For example, as of 2019, <a href="https://www.cdc.gov/art/state-specific-surveillance/index.html">Alaska and Wyoming</a> have no fertility clinics offering assisted reproductive technology such as IVF. Similarly, <a href="https://www.kff.org/report-section/coverage-and-use-of-fertility-services-in-the-u-s-issue-brief/">Black and Hispanic women</a> are less likely than white women to have access to fertility care and to have successful IVF cycles, due in part to socioeconomic barriers.</p>
<h2>Tracking fertility treatment and privacy</h2>
<p>The federal government collects information about the <a href="https://www.cdc.gov/art/artdata/index.html">success rates</a> of fertility clinics. But little is known about one growing segment of that market: egg, sperm and embryo donation.</p>
<p>A 2019 report from the Centers for Disease Control and Prevention states that there were almost <a href="https://www.cdc.gov/art/reports/2019/pdf/2019-Report-ART-Fertility-Clinic-National-Summary-h.pdf">78,000 live births</a> stemming from fertility treatments. These births resulted from a total of 330,773 assisted reproductive technology cycles, 27,131 of which were from eggs and embryos. Because the federal government does not keep track of the number of <a href="https://dx.doi.org/10.1016%2Fj.fertnstert.2019.05.031">children born through sperm donation</a>, it is unclear exactly how many births were a result of egg, embryo or sperm donation.</p>
<p>Secrecy surrounding reproductive cell donation has long been embedded in the culture of the fertility industry, often leading doctors to urge parents <a href="https://www.theatlantic.com/science/archive/2021/10/do-we-have-right-know-our-biological-parents/620405/">not to tell</a> their children that they were donor-conceived. Such secrecy was <a href="https://theconversation.com/donor-conception-secrecy-and-the-search-for-information-44000">believed to be best for everyone</a> by creating the illusion of biological connection. It was also influenced by shame concerning infertility and a desire to prevent interference with the parent-child relationship.</p>
<p>While <a href="https://support.ancestry.com/s/article/Unexpected-DNA-Matches">genetic testing</a>, <a href="https://www.cbc.ca/news/science/sperm-donor-dna-testing-1.4500517">personal information on the internet</a> and <a href="https://store.lexisnexis.com/products/assisted-reproductive-technology-a-lawyers-guide-to-emerging-law-and-science-skuusSku-us-ebook-28407-epub">changing family structures</a> are challenging this culture of secrecy, donor anonymity is still common practice. A 2022 study from the <a href="https://www.dcc-usa.org/">U.S. Donor Conceived Council</a>, a nonprofit advocating for the interests of donor-conceived people, found that despite an increasing number of sperm banks allowing donor-conceived people to access information about their donor, <a href="https://www.dcc-usa.org/2022/04/19/2022-survey-of-us-sperm-banks/">70% still permit anonymous donation</a>.</p>
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<figcaption><span class="caption">What defines a parent or a family has changed over time.</span></figcaption>
</figure>
<h2>Protecting donors, parents and their children</h2>
<p>States are beginning to introduce ways to protect the interests of the parties affected by the fertility industry. Many states already have laws in place that follow some version of the <a href="https://law.justia.com/codes/colorado/2016/title-19/article-4/section-19-4-106#:%7E:text=(1)%20If%2C%20under%20the,of%20a%20child%20thereby%20conceived">Uniform Parentage Act</a>, which provides special rules for parentage when a child is donor conceived. An increasing number of states have enacted <a href="https://righttoknow.us/fertility-fraud-laws/">fertility fraud legislation</a> that criminalizes or provides civil remedies for donor misrepresentation, such as when a fertility doctor uses his own sperm without telling the parents.</p>
<p>Another area of growing interest is providing donor-conceived people and recipient parents <a href="https://www.nytimes.com/2016/04/12/science/extra-marital-paternity-less-common-than-assumed-scientists-find.html">important medical or personally identifying information</a> about their donor.</p>
<p>In 2011, <a href="https://healthland.time.com/2011/07/22/where-do-some-babies-come-from-in-washington-a-new-law-bans-anonymous-sperm-and-egg-donors/">Washington became</a> the first state to allow disclosure of donor-identifying information and medical history to children when they turn 18. Since then, a few other states have adopted the <a href="https://www.uniformlaws.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=e4a82c2a-f7cc-b33e-ed68-47ba88c36d92&forceDialog=0">Uniform Parentage Act</a>, which requires banks and fertility clinics to <a href="https://www.cga.ct.gov/2021/act/pa/pdf/2021PA-00015-R00HB-06321-PA.pdf">collect and release identifying donor information</a> to donor-conceived individuals if the donors had agreed to disclosure.</p>
<p><a href="https://www.nysenate.gov/legislation/bills/2021/s7602">Proposed legislation in New York</a> would require sperm and egg banks to gather, verify and share important information about a donor’s health, education and criminal history with prospective parents and donor-conceived people. Some countries have gone further with bans on donor anonymity, including <a href="https://doi.org/10.1093/humrep/15.9.2052">Sweden in 1985</a>, <a href="https://www.legislation.gov.uk/uksi/2004/1511/regulation/2/made?view=plain">the U.K. in 2004</a> and <a href="https://www.health.vic.gov.au/patient-care/right-to-know">the state of Victoria in Australia in 2016</a>.</p>
<h2>More protections</h2>
<p>Other protections may be coming down the line.</p>
<p>One measure is to limit the number of families using the same donor. This can protect donor-conceived people from feeling <a href="https://www.theatlantic.com/science/archive/2021/10/do-we-have-right-know-our-biological-parents/620405/">commodified and dehumanized</a> if they find that they were conceived in a large group as part of a moneymaking industry.</p>
<p>In the U.K., <a href="https://www.hfea.gov.uk/treatments/explore-all-treatments/using-donated-eggs-sperm-or-embryos-in-treatment/legal-implications-of-using-donated-sperm/">no more than 10 families</a> can use the same donor (excluding the donor’s own family), though there is no limit on the number of children conceived per family. And in Denmark, donor sperm may only be used for <a href="https://www.bbc.com/news/world-europe-19711565">12 inseminations</a>.</p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=science&source=inline-science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p>
<p>No U.S. state currently sets such limits. While <a href="https://www.nytimes.com/2019/06/26/magazine/sperm-donor-questions.html">some sperm banks</a> have tried to impose limits, they are not required to keep track of how many children are born from an individual donor. Moreover, donors can give their sperm to another bank. Any limit would be difficult to monitor, much less enforce. </p>
<p>Lastly, regulations could ensure that donors and parents are fully informed about the <a href="https://leg.colorado.gov/bills/sb22-224">social and legal implications of donor conception</a>, including that other people may be conceived with the same donor’s gametes. Some states may also address the risk of <a href="https://www.fertstertdialog.com/users/16110-fertility-and-sterility/posts/63745-30070">harmful health effects</a> of repeat egg donation by limiting the number of times a person can donate.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sleeping baby holding finger of parent with another parent's hand wrapped around their torso" src="https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.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">Pending legislation would give donor-conceived children and their parents medical and identifiable information about their donor.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mixed-race-family-together-royalty-free-image/1152471162">fitopardo/Moment via Getty Images</a></span>
</figcaption>
</figure>
<h2>Colorado’s bill</h2>
<p>Colorado took a groundbreaking step by <a href="https://leg.colorado.gov/bills/sb22-224">considering a bill</a> that introduces broad regulations that tie together trends across the industry. The law would ensure that donor-conceived people can learn the identity of the donor upon reaching adulthood and sets limits on the number of families to whom any one particular donor can provide their gametes. It would also ensure access to educational materials that guide families and donors through the process, including resources on how to discuss donor conception with children.</p>
<p>While there may be concerns that eliminating donor anonymity would <a href="https://doi.org/10.1093/jlb/lsv045">compromise donor privacy</a> and affect <a href="http://www.bu.edu/law/journals-archive/bulr/documents/bernstein.pdf">donor availability</a>, we believe there is substantial evidence to the contrary. </p>
<p>A <a href="https://doi.org/10.1093/jlb/lsw052">2016 study</a> of 161 sperm donors found that while some might be dissuaded by such laws, more than two-thirds would be willing to donate at an additional price of $60 per donation. In <a href="https://doi.org/10.1016/j.rbms.2021.07.006">Australia</a>, where payment for sperm donation is prohibited beyond <a href="https://www.ivf.com.au/treatments/donor-programme/donating-sperm">expense reimbursement</a>, the number of sperm donors actually <a href="https://pubmed.ncbi.nlm.nih.gov/27323639/">increased after anonymity was removed</a>. Similarly, a 2020 survey of 148 egg donors in South Africa, where donor anonymity is allowed, found that <a href="https://doi.org/10.1371/journal.pone.0226603">79% would have still donated their eggs</a> even if their identity were released.</p>
<p>We believe that the Colorado bill could set a precedent for how other states regulate fertility treatment and protect the interests of all those involved.</p><img src="https://counter.theconversation.com/content/181664/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Naomi Cahn co-wrote testimony in support of CO SB22-224 for the Colorado State Senate hearings.</span></em></p><p class="fine-print"><em><span>Sonia Suter co-wrote testimony in support of CO SB22-224 for the Colorado State Senate hearings.</span></em></p>A pending bill in Colorado would disclose donor information to children and their parents and set limits on how many families can use a single individual’s egg or sperm.Naomi Cahn, Professor of Law, University of VirginiaSonia Suter, Professor of Law, George Washington UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1766682022-02-08T23:37:42Z2022-02-08T23:37:42Z‘Maeve’s law’ would let IVF parents access technology to prevent mitochondrial disease. Here’s what the Senate is debating<figure><img src="https://images.theconversation.com/files/445252/original/file-20220208-23-vygwrj.png?ixlib=rb-1.1.0&rect=0%2C0%2C577%2C445&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Courtesy of Louise Hyslop & Mary Herbert, Univ. Newcastle upon Tyne</span></span></figcaption></figure><p>The Senate is this week debating “Maeve’s law” – a proposal to legalise access to new assisted reproductive techniques that will reduce the risk of parents passing on mitochondrial disease to their children.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/445246/original/file-20220208-36472-1c86l4h.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Maeve and Sarah Hood" src="https://images.theconversation.com/files/445246/original/file-20220208-36472-1c86l4h.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/445246/original/file-20220208-36472-1c86l4h.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445246/original/file-20220208-36472-1c86l4h.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445246/original/file-20220208-36472-1c86l4h.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445246/original/file-20220208-36472-1c86l4h.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445246/original/file-20220208-36472-1c86l4h.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445246/original/file-20220208-36472-1c86l4h.jpeg?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>
<figcaption>
<span class="caption">Maeve with her mother Sarah Hood.</span>
<span class="attribution"><span class="source">Photo courtesy of the Hood family</span>, <span class="license">Author provided</span></span>
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</figure>
<p>The legislation, formally called the <a href="https://www.aph.gov.au/Parliamentary_Business/Bills_LEGislation/Bills_Search_Results/Result?bId=r6697">Mitochondrial Donation Law Reform (Maeve’s Law) Bill 2021</a>, is named after Maeve Hood, a six-year-old Victorian girl who lives with Leigh syndrome – a disorder in which the body’s cells fail to produce enough energy. Tragically, Maeve is unlikely to survive beyond childhood. </p>
<p>This week’s expected vote will be the first conscience vote in the Senate since the historic reforms to allow <a href="https://theconversation.com/australia-has-finally-achieved-marriage-equality-but-theres-a-lot-more-to-be-done-on-lgbti-rights-88488">marriage equality in 2017</a>, and is already being passionately debated. </p>
<p>But the issues raised are unlikely to be new. These reforms have already undergone <a href="https://www.nhmrc.gov.au/mitochondrial-donation-0">extensive community consultation</a> and been <a href="https://www.theguardian.com/australia-news/2021/dec/01/controversial-mitochondrial-donation-legalised-after-conscience-vote">approved by the House of Representatives</a>. </p>
<h2>What is mitochondrial donation?</h2>
<p>Mitochondria are energy-producing structures inside cells, which have their own DNA and are separate from the cell nucleus containing the bulk of the cell’s DNA (called “nuclear DNA”). Mitochondrial DNA is inherited entirely from the mother’s egg, so if a mother has mutations in her mitochondrial DNA she is at risk of passing life-threatening conditions to her baby.</p>
<p>Conceiving a baby via mitochondrial donation involves implanting the mother’s nuclear DNA into a healthy egg from which the nuclear genes have been removed, and using this egg for in-vitro fertilisation (IVF) with a sperm. Alternatively, a procedure called pronuclear transfer can be used early in the fertilisation process a few hours after the sperm has entered the egg, but before the parental genomes come together and the fertilised egg officially becomes an embryo. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/445254/original/file-20220208-27-x3p9ju.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Schematic diagram of mitochondrial donation" src="https://images.theconversation.com/files/445254/original/file-20220208-27-x3p9ju.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445254/original/file-20220208-27-x3p9ju.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=464&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445254/original/file-20220208-27-x3p9ju.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=464&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445254/original/file-20220208-27-x3p9ju.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=464&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445254/original/file-20220208-27-x3p9ju.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=584&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445254/original/file-20220208-27-x3p9ju.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=584&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445254/original/file-20220208-27-x3p9ju.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=584&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="attribution"><span class="source">Mito Foundation</span></span>
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</figure>
<p>A child born via mitochondrial donation would inherit a mixture of their mother’s and father’s nuclear DNA as usually occurs, along with the healthy mitochondrial DNA from the egg donor.</p>
<p>As a result, mitochondrial donation has sometimes been described as creating “three-parent babies”. But “<a href="https://theconversation.com/3-parent-ivf-could-prevent-illness-in-many-children-but-its-really-more-like-2-002-parent-ivf-126591">2.002-parent babies</a>” would arguably be more accurate, given there are only 37 mitochondrial genes, compared with at least 20,000 in our nuclear DNA.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-parent-ivf-could-prevent-illness-in-many-children-but-its-really-more-like-2-002-parent-ivf-126591">3-parent IVF could prevent illness in many children (but it's really more like 2.002-parent IVF)</a>
</strong>
</em>
</p>
<hr>
<p>Australian law currently bans the creation of a human embryo that involves genetic material from more than two people. The ban was introduced almost 20 years ago amid fears IVF and embryo research would lead to “designer babies” and cloning. Maeve’s law would change this situation specifically to allow mitochondrial donation to prevent mitochondrial disease.</p>
<p>Debate around the issue has focused on a range of questions, such as: is there a risk the child could still end up with mutant mitochondrial DNA? Are there ethical issues centred on the unborn baby’s inability to give consent? What are the egg donor’s rights? Does the procedure carry other health or genetic risks?</p>
<h2>The expert view</h2>
<p>In the United Kingdom, where mitochondrial donation research was pioneered, four scientific reviews by the Human Fertilisation and Embryology Authority and an investigation by the Nuffield Council on Bioethics were conducted between 2011 and 2016. These reviews delivered an overall conclusion that the benefits outweigh the harms if regulated appropriately, and Britain <a href="https://theconversation.com/decision-to-allow-three-person-ivf-should-be-welcomed-37192">legalised mitochondrial donation</a> in 2015. </p>
<p>In Australia, mitochondrial donation has been considered by a <a href="https://www.nhmrc.gov.au/mitochondrial-donation-0">series of inquiries</a>, including a 2018 Senate inquiry and a National Health and Medical Research Council (NHMRC) review, which considered these issues with fresh eyes.</p>
<p>In response, the government drafted Maeve’s law, which underwent a series of reviews and public consultations, and gained the support of <a href="https://www.mcri.edu.au/sites/default/files/media/documents/mitochondrial_donation_open_letter.pdf">60 leading Australian experts</a>.</p>
<h2>Does the public support it?</h2>
<p>One challenge in gauging public support is to measure true community sentiment, rather than inviting submissions that merely serve as a forum for people with existing strongly held views either for or against mitochondrial donation.</p>
<p>To address this challenge, researchers convened a <a href="https://academic.oup.com/humrep/article/34/4/751/5377828">citizens’ jury</a> in 2017, and the NHMRC held a <a href="https://www.nhmrc.gov.au/mitochondrial-donation-0#download">citizens’ panel</a> in 2019 to evaluate attitudes to mitochondrial donation. Both offered qualified support for allowing the technology.</p>
<h2>What topics are likely to be contentious in the Senate debate?</h2>
<p>The Senate will likely revisit amendments that were defeated in the House of Representatives in December. These include a proposal only to allow the technique in which the mother’s DNA is implanted into the donor egg <em>before</em> fertilisation with the father’s sperm.</p>
<p>This suggestion is a response to fears that pronuclear transfer would lead to increased rates of embryo destruction.</p>
<p>But these early fertilised eggs – also called zygotes – do not meet the legal or biological definition of an embryo, and most embryologists do not regard this technique as leading to more loss of embryos than other assisted reproductive technologies. What’s more, banning this approach could greatly compromise the development of mitochondrial donation in Australia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/445256/original/file-20220208-32038-1qki08t.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Zygote undergoing pronuclear transfer" src="https://images.theconversation.com/files/445256/original/file-20220208-32038-1qki08t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445256/original/file-20220208-32038-1qki08t.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=469&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445256/original/file-20220208-32038-1qki08t.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=469&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445256/original/file-20220208-32038-1qki08t.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=469&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445256/original/file-20220208-32038-1qki08t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=589&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445256/original/file-20220208-32038-1qki08t.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=589&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445256/original/file-20220208-32038-1qki08t.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=589&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 zygote about to have its nuclear DNA removed and transferred to a donor egg, roughly 20 hours before division to form a two-cell embryo. Arrows show the mother’s and father’s DNA, called ‘pronuclei’. These remain separate until later in the process, hence why the zygote is not considered an embryo.</span>
<span class="attribution"><span class="source">Courtesy of Louise Hyslop & Mary Herbert, Univ. Newcastle upon Tyne</span></span>
</figcaption>
</figure>
<p>Maeve’s law will still require researchers to account to NHMRC for eggs and embryos used in their research, to seek ways to minimise the numbers used, and to report to Parliament on an annual basis.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/disputes-over-when-life-begins-may-block-cutting-edge-reproductive-technologies-like-mitochondrial-replacement-therapies-146254">Disputes over when life begins may block cutting-edge reproductive technologies like mitochondrial replacement therapies</a>
</strong>
</em>
</p>
<hr>
<h2>If not now, when?</h2>
<p>While we need to respect differing attitudes to IVF and embryo research, we believe most experts and members of the public recognise the importance of giving couples who are at risk of mitochondrial disease the best chance of having a healthy child.</p>
<p>Maeve’s law has been carefully written to ensure a cautious introduction and evaluation of mitochondrial donation technology. The technology will be in a clinical trial setting for at least ten years, during which time the health of babies born using these techniques will be carefully monitored. </p>
<p>The science supports it. The community support it. People who are affected by mitochondrial disease have long supported it. We call on Senators to support it.</p><img src="https://counter.theconversation.com/content/176668/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Thorburn receives funding from NHMRC, MRFF, the US Department of Defense Congressionally Directed Medical Research Program, the Royal Children's Hospital Research Foundation and the Mito Foundation for research on mitochondrial and other rare diseases. He is a founding Director of the Mito Foundation and a former Chair of its Scientific & Medical Advisory Panel. He was a member of the NHMRC Expert Working Committee on Mitochondrial Donation and engaged with the reviews referred to in this article.</span></em></p><p class="fine-print"><em><span>Megan Munsie receives funding from ARC, MRFF, the Novo Nordisk Foundation. She is the Vice President of the Australasian Society for Stem Cell Research, non-executive director of the National Stem Cell Foundation of Australia and a member of ethics and policy advisory committees for several national and international organisations including the International Society for Stem Cell Research (ISSCR). She co-authored recently published ISSCR Guidelines that support clinical research for mitochondrial donation.</span></em></p>Parents at risk of passing on genetic disease to their children via mutations in the mother’s mitochondrial DNA could soon use a new IVF-based treatment involving healthy donor mitochondria.David Thorburn, co-Group Leader, Brain & Mitochondrial Research, Murdoch Children's Research InstituteMegan Munsie, Professor Emerging Technologies (Stem Cells), The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1743892022-01-18T13:40:25Z2022-01-18T13:40:25ZSperm donation is largely unregulated, but that could soon change as lawsuits multiply<figure><img src="https://images.theconversation.com/files/440766/original/file-20220113-19-14yu4a4.jpg?ixlib=rb-1.1.0&rect=101%2C14%2C1895%2C1302&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Freezing and storing sperm vials has proved easier than regulating artificial insemination.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/lab-technician-jessica-kenyon-puts-sperm-vials-into-liquid-news-photo/1290396268">MediaNews Group/Boston Herald via Getty Images</a></span></figcaption></figure><p>When Wendy and Janet Norman decided to have a baby, they went sperm shopping through Xytex Corp., a <a href="https://www.mayoclinic.org/tests-procedures/sperm-donation/about/pac-20395032">sperm bank</a>.</p>
<p>The couple chose Donor #9623. Xytex, the Normans later claimed, told them the man <a href="https://www.gpb.org/news/2020/09/28/georgia-supreme-court-rules-sperm-donor-case-falls-in-line-consumer-fraud">spoke multiple languages</a> and was <a href="https://www.gasupreme.us/wp-content/uploads/2020/09/s19g1486.pdf">pursuing a doctorate</a>.</p>
<p>Xytex had also assured them that it carefully screened all donors by reviewing their family health history and criminal records and that it subjected donors to intensive physical exams and interviews to <a href="https://www.gasupreme.us/wp-content/uploads/2020/09/s19g1486.pdf">verify the information</a>.</p>
<p>But after Wendy Norman gave birth to a son in 2002, the couple learned their child had inherited a genetic blood disorder for which Wendy was not a carrier. He would, much later, require extended hospitalizations because of suicidal and homicidal thoughts.</p>
<p>Even later, they learned that the donor, James Christopher Aggeles, had <a href="https://scholar.google.com/scholar_case?case=2684447592603399491&hl=en&as_sdt=6&as_vis=1&oi=scholarr">lied to the sperm bank</a> about his background and that the sperm bank had not verified the information he provided. Nor did it make him supply his medical records or sign a release that would have made it possible to obtain them.</p>
<p>As <a href="https://www.law.virginia.edu/faculty/profile/nrc8g/2915359">law professors</a> who study <a href="https://www.law.gwu.edu/sonia-m-suter">reproductive technology</a>, we see this case and others like it as showing why the government should tighten regulations over sperm and egg donation so that prospective parents and <a href="https://doi.org/10.1093/hropen/hoaa057">donor-conceived adults</a> receive accurate and complete details about their donors’ medical, academic and criminal history. </p>
<h2>A ‘wrongful birth’?</h2>
<p>Aggeles wasn’t pursuing an advanced degree when he began donating sperm. He didn’t even have a college degree at that point. He also failed to disclose his diagnosis of <a href="https://www.mayoclinic.org/diseases-conditions/schizophrenia/diagnosis-treatment/drc-20354449">schizophrenia</a>, a severe mental health condition requiring lifelong treatment. Schizophrenia has a <a href="https://www.healthline.com/health/is-schizophrenia-hereditary">high level of heritability</a> in families. He had also been arrested at the time of his donation and was later <a href="https://scholar.google.com/scholar_case?case=2684447592603399491&hl=en&as_sdt=20000006&as_vis=1">incarcerated for burglary</a>.</p>
<p>When the Normans sued Xytex, a local court initially dismissed <a href="https://scholar.google.com/scholar_case?case=2684447592603399491&hl=en&as_sdt=6&as_vis=1&oi=scholarr">almost all claims in</a> their case. They appealed to Georgia’s Supreme Court, which in 2020 <a href="https://www.gasupreme.us/wp-content/uploads/2020/09/s19g1486.pdf">allowed several of their claims to go forward</a>. </p>
<p>The Normans could, for instance, seek financial compensation, partly to cover the additional expenses they might have avoided had they learned about the donor’s medical history sooner. The court also told the Normans they could try to recover the price difference between what they paid for the sperm they received and <a href="https://www.nytimes.com/2021/01/08/business/sperm-donors-facebook-groups.html">its market value</a>.</p>
<p>Finally, the Normans were allowed to allege under the state’s <a href="https://law.justia.com/codes/georgia/2010/title-10/chapter-1/article-15/part-2/">Fair Business Practice Act</a> that the sperm bank had misrepresented to the public the quality of its sperm and its screening process.</p>
<p>The Supreme Court of Georgia did not, however, permit the couple to sue over what is known as a “<a href="https://lawdigitalcommons.bc.edu/jlsj/vol34/iss2/8/">wrongful birth</a>” claim. These claims are negligence actions brought by parents based on the birth of a child with disabilities or genetic disorders because of a provider’s failure to identify the risk.</p>
<p>The case is still pending.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/440478/original/file-20220112-25-14gowjp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Blue-tinted sperm swim in a liquid." src="https://images.theconversation.com/files/440478/original/file-20220112-25-14gowjp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/440478/original/file-20220112-25-14gowjp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440478/original/file-20220112-25-14gowjp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440478/original/file-20220112-25-14gowjp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440478/original/file-20220112-25-14gowjp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440478/original/file-20220112-25-14gowjp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440478/original/file-20220112-25-14gowjp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&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">Screening sperm donors is often limited to seeing if they have communicable diseases.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/human-sperm-royalty-free-illustration/674416385">Sebastian Kaulitzki/Science Photo Library</a></span>
</figcaption>
</figure>
<h2>Limited regulation</h2>
<p>The Normans’ lawsuit is hardly unique.</p>
<p>Other families have <a href="https://www.nytimes.com/2012/05/15/health/in-sperm-banks-a-matrix-of-untested-genetic-diseases.html">sued sperm banks</a> after having donor-conceived children who wound up with a variety of <a href="https://www.riverfronttimes.com/newsblog/2019/02/08/st-louis-dad-sues-sperm-bank-after-baby-is-born-with-genetic-disorder">genetic disorders</a>.</p>
<p>In many of those cases, the sperm banks said they routinely test sperm and exclude donors who could pass along genes that cause genetic diseases. In those instances, the families have grounds for accusing the sperm banks of fraud and negligence.</p>
<p>Some <a href="https://apnews.com/article/lifestyle-technology-health-new-york-lawsuits-3c4280eb72f05f9b5f33238b0b608da6">donor-conceived adults</a> are also <a href="https://www.voiceofsandiego.org/topics/news/dna-testing-is-unearthing-local-fertility-fraud-cases/">suing doctors</a> who lied to the plaintiffs’ parents about <a href="https://apnews.com/article/a86db8b20d5a36213dfbb169a5a031fe">whose sperm</a> they were receiving and instead <a href="https://apnews.com/article/lifestyle-technology-health-new-york-lawsuits-3c4280eb72f05f9b5f33238b0b608da6">used their own</a>. Several states now ban this kind of “<a href="https://khn.org/news/conceived-through-fertility-fraud-she-now-needs-fertility-treatment/">fertility fraud</a>.” </p>
<p>This <a href="https://www.wsj.com/articles/a-grieving-family-wonders-what-if-they-had-known-the-medical-history-of-sperm-donor-1558-11641119405">litigation is on the rise</a> because of the growing popularity of direct-to-consumer DNA testing, which makes it <a href="https://www.cbsnews.com/news/woman-finds-sperm-donor-after-using-dna-test-raising-questions-about-donor-anonymity/">easier to identify previously anonymous</a> sperm donors and to learn about genetic risks donor-conceived people may have inherited from them. </p>
<p>It’s also happening because of the <a href="https://www.nytimes.com/2021/02/01/health/sperm-donor-fertility-meijer.html">absence of clear rules and laws regulating</a> sperm banks. There is <a href="https://theconversation.com/the-fertility-industry-is-poorly-regulated-and-would-be-parents-can-lose-out-on-having-children-as-a-result-163792">little regulation of reproductive technologies</a> of any kind, including in <a href="https://theconversation.com/40-years-after-the-birth-of-ivf-researchers-push-boundaries-to-preserve-fertility-in-women-men-and-children-99485">vitro fertilization</a>, a procedure that fertilizes the egg with sperm in the laboratory instead of the body, at the state or federal level.</p>
<p>Because the <a href="https://dx.doi.org/10.1016%2Fj.fertnstert.2019.05.031">government does not track artificial insemination</a>, the number of donor-conceived people is unknown.</p>
<p>The federal government requires only that donated sperm and eggs be treated like other human tissue and <a href="https://www.fda.gov/vaccines-blood-biologics/tissue-tissue-products/donor-eligibility-final-rule-and-guidance-questions-and-answers">tested for communicable diseases</a> – <a href="https://www.dhs.wisconsin.gov/disease/communicable.htm">infectious conditions</a> that spread through viruses, bacteria and other means – but not genetic diseases.</p>
<p>There are also <a href="https://ilr.law.uiowa.edu/print/volume-106-issue-2/dr-i-dont-want-your-baby-why-america-needs-a-fertility-patient-protection-act/">no federal requirements</a> that sperm banks obtain and verify information about a donor’s medical history, educational background or criminal record.</p>
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<figcaption><span class="caption">The movie ‘Delivery Man’ revolves around what happens when a sperm bank uses a single donor’s sperm to make hundreds of babies.</span></figcaption>
</figure>
<h2>What is the basis for these lawsuits?</h2>
<p>The allowable grounds for fertility negligence vary by state.</p>
<p>Some states let families sue clinics that <a href="https://casetext.com/case/paretta-v-med-offices-for-human-reproduction">fail to screen donors</a>, even when the parents seek damages associated with the birth of the child with a dangerous genetic condition. This would essentially allow a wrongful birth claim to go forward.</p>
<p>But a growing number of states, at least 14 so far, <a href="https://faculty.westacademic.com/Book/Detail?id=320412">prohibit such claims</a>. That is leading many courts, like the Supreme Court of Georgia, to define the injury as distinct from the birth of the donor-conceived child.</p>
<h2>The end of anonymity</h2>
<p>One complication in terms of resolving these disputes is that <a href="https://dx.doi.org/10.1093%2Fjlb%2Flsw052">most sperm donations are anonymous</a>.</p>
<p>At odds with the donor’s interest in keeping their his identity a secret, we argue, are <a href="https://repository.law.umich.edu/mjgl/vol16/iss1/4/">donor-conceived people’s strong interests</a> in learning about their donors, including their medical, educational and criminal history – and <a href="https://scholarlycommons.law.hofstra.edu/hlr/vol42/iss4/3">even identity</a>.</p>
<p>DNA tests, including direct-to-consumer kits like 23andMe, are rendering <a href="https://pubmed.ncbi.nlm.nih.gov/28697325/">donor anonymity impossible to maintain</a>. And internet searches, as the Normans discovered, can make it possible to see whether a donor, once identified, has misrepresented their personal information.</p>
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<figcaption><span class="caption">The movie ‘The Kids Are All Right’ hinged on the complications that can arise when a family gets to know a sperm donor.</span></figcaption>
</figure>
<h2>States are beginning to set rules</h2>
<p>Because Congress has taken <a href="https://www.cdc.gov/art/nass/policy.html">no action regarding assisted reproductive technology since 1992</a>, states have slowly begun to step in.</p>
<p>In 2011, Washington required the disclosure of <a href="https://app.leg.wa.gov/RCW/default.aspx?cite=26.26A.820">donor-identifying information and medical history when a child turns 18</a>. </p>
<p>On Jan. 1, 2022, Connecticut enacted the <a href="https://www.uniformlaws.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=e4a82c2a-f7cc-b33e-ed68-47ba88c36d92&forceDialog=0">Uniform Parentage Act</a>, which is based on model legislation drafted by a national nonpartisan commission to fill widespread legislative gaps. The measure requires that fertility clinics <a href="https://www.cga.ct.gov/2021/act/pa/pdf/2021PA-00015-R00HB-06321-PA.pdf">collect identifying information from donors</a> and indicate whether donors have agreed to disclosure.</p>
<p>Another pending measure in <a href="https://www.nysenate.gov/legislation/bills/2021/s7602">New York</a> would require sperm and egg donor banks “to collect and verify medical, educational and criminal felony conviction history information” from any donor. That legislation would also provide prospective parents who purchase eggs or sperm and donor-conceived people with the right to obtain such information without personally identifying the donor. This option could make it possible to preserve donor anonymity, at least theoretically.</p>
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<p>The bill was drafted at least partially in response to the experience of Laura and David Gunner, <a href="https://www.wsj.com/articles/a-grieving-family-wonders-what-if-they-had-known-the-medical-history-of-sperm-donor-1558-11641119405">whose donor-conceived son died of an opioid overdose</a>. After their son’s death, the Gunners learned that a few years earlier, the donor himself had died and that he had been diagnosed with schizophrenia. The donor had not disclosed his mental illness or hospitalizations for behavioral issues.</p>
<h2>Costs are not a barrier</h2>
<p>It’s possible that measures like the one pending in New York state would make fertility treatment somewhat more expensive.</p>
<p>Currently, a vial of donor sperm may <a href="https://www.marketplace.org/2019/10/24/the-cost-of-building-a-family-using-donor-sperm/">cost close to $1,000</a>, with the <a href="https://www.marketplace.org/2019/10/24/the-cost-of-building-a-family-using-donor-sperm/">donor often being paid up to $150</a>.</p>
<p>Genetic testing, however, might not add much to the cost because it would only be done once, rather than each time a patient obtains a vial of sperm. With artificial insemination, it’s <a href="https://www.verywellfamily.com/donor-insemination-4685684">rare for a pregnancy to occur on the first or second try</a>.</p>
<p>As we learned from <a href="https://www.adoptionnetwork.org/news-events/archive.html/article/2021/03/25/adoption-network-cleveland-supports-fertility-fraud-legislation">Tyler Sniff</a>, an advocate for the New York bill and a director of the nonprofit <a href="https://www.dcc-usa.org/2021/11/14/what-donors-need-to-know/">U.S. Donor Conceived Council</a>, DNA testing companies offer relatively inexpensive options that can cost less than $300. </p>
<p>To be sure, disclosure requirements might overpromise how much <a href="https://www.wsj.com/articles/a-grieving-family-wonders-what-if-they-had-known-the-medical-history-of-sperm-donor-1558-11641119405">prospective parents can learn about their future children</a>. But we are certain that <a href="https://bioethics.umn.edu/news/who-am-i-ethics-sperm-and-egg-donation">these issues will become even more critical</a> as technology continues to outpace its regulation – and as both <a href="https://www.wearedonorconceived.com/">donor-conceived adults</a> and an increasing number of people who used sperm banks advocate for their interests.</p><img src="https://counter.theconversation.com/content/174389/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>Many people are filing lawsuits after discovering that sperm banks failed to verify information from donors about their medical and personal backgrounds.Naomi Cahn, Professor of Law, University of VirginiaSonia Suter, Professor of Law, George Washington UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1637922021-08-23T18:37:26Z2021-08-23T18:37:26ZThe fertility industry is poorly regulated – and would-be parents can lose out on having children as a result<figure><img src="https://images.theconversation.com/files/416106/original/file-20210813-22-wv89iu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Louise Brown, who was the world's first baby to be born from in vitro fertilization (IVF) in 1978, poses with equipment used in early IVF treatments.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/louise-brown-who-in-1978-became-the-worlds-first-baby-to-be-news-photo/1004176610?adppopup=true"> Daniel Leal-Olivas/ Getty</a></span></figcaption></figure><p>When embryologist <a href="https://www.courthousenews.com/lab-workers-were-devastated-by-tank-failure-that-destroyed-human-embryos/">Joseph Conaghan arrived at work</a> at San Francisco’s Pacific Fertility Center on March 4, 2018, nothing seemed awry. He did routine inspections of the facility’s cryogenic tanks, which store frozen embryos and eggs for clients who hope to someday have biological children. </p>
<p>But what he found was not routine; it was an emergency. Almost all of the liquid nitrogen inside Tank 4 had drained out. Conaghan and his staff tried to save 80 metal boxes of frozen reproductive material, but it was too late. The contents had warmed, damaging or destroying 1,500 eggs and 2,500 embryos. </p>
<p>Some belonged to a couple who traveled cross-country from their farm in Ohio, hoping to build their family from frozen embryos. A single woman in her early 40s was hoping to soon use her preserved eggs with “Mr. Right.”</p>
<p>For many, infertility is a significant challenge: In 2018, 12.7% of American women sought infertility services, according to a <a href="https://www.cdc.gov/nchs/nsfg/key_statistics/i_2015-2017.htm#infertilityservices">U.S. Centers for Disease Control and Prevention report</a>. As experts on regulation of the fertility industry, we are concerned about protecting those who need these interventions. There is little oversight in the U.S. of the industry, with <a href="https://www.fertstertreports.org/action/showPdf?pii=S2666-3341%2820%2930039-8">no requirement</a> that clinics report problems – including tank failures. As Professor Dov Fox of the University of San Diego Law School told a reporter: “<a href="https://www.washingtonpost.com/health/2021/06/11/fertility-clinic-egg-embryo-verdict/">These tanks specifically, they’re not regulated any better than kitchen appliances or farm tools</a>.”</p>
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<figcaption><span class="caption">The science behind making a baby in a lab.</span></figcaption>
</figure>
<h2>Reproductive innovations</h2>
<p>The current age of reproductive technology dates to 1944, when lab technician <a href="https://www.bbc.com/future/article/20200103-the-female-scientist-who-changed-human-fertility-forever">Miriam Menkin</a> successfully fertilized a human egg in a petri dish. She made history, creating a new method of human conception.</p>
<p>That year, 30 fertility experts founded the <a href="https://www.asrm.org/about-us/history-of-asrm/">American Society for Reproductive Medicine</a>. Today it is a global organization of <a href="https://www.asrm.org/news-and-publications/news-and-research/announcements/asrm-task-force-on-diversity-equity-and-inclusion-issues-statement-recommendations/">about 8,000</a>, including doctors, nurses, health care professionals and others.</p>
<p>But it wasn’t until 1978 that in vitro fertilization emerged as a groundbreaking and controversial technology. That year marked the birth of <a href="https://time.com/5344145/louise-brown-test-tube-baby/">Louise Brown</a>, the first “test tube baby.”</p>
<p>Since then, the procedure has produced more than <a href="https://www.sciencedaily.com/releases/2018/07/180703084127.htm">8 million children</a> worldwide. Some <a href="https://www.cdc.gov/art/artdata/index.html">80,000 children</a> are born yearly in the U.S. through IVF, accounting for <a href="https://www.cdc.gov/art/artdata/index.html">1.9% of births.</a></p>
<h2>Little regulation</h2>
<p>Assisted reproduction is now a multibillion-dollar industry, with more than <a href="https://www.cdc.gov/art/nass/index.html">440 U.S. clinics</a>. In other industrialized nations, including the U.K., fertility treatment is <a href="https://www.hfea.gov.uk/about-us/">monitored</a> by independent, comprehensive regulators. In the U.S., government regulation is so light that the U.S. fertility industry has been called the “<a href="https://www.nytimes.com/roomfordebate/2011/09/13/making-laws-about-making-babies/fertility-industry-is-a-wild-west">Wild West</a>.” U.S. lawmakers have largely steered clear: The contentious battle over abortion has created a political minefield around any issue concerning conception or embryos.</p>
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<p>Minimal <a href="https://www.asrm.org/globalassets/asrm/asrm-content/about-us/pdfs/oversiteofart.pdf">regulations</a> are scattered among <a href="https://www.today.com/health/lack-oversight-regulations-may-lead-ivf-mishaps-t157872">federal, state and professional entities</a>. Meanwhile, the U.S. Centers for Disease Control and Prevention offers limited oversight, <a href="https://www.cdc.gov/art/nass/index.html">auditing or inspecting</a> only a sample of clinics each year, mostly to validate data. </p>
<p>Under a 1992 <a href="https://www.govinfo.gov/content/pkg/STATUTE-106/pdf/STATUTE-106-Pg3146.pdf">U.S. federal law</a>, clinics must <a href="https://www.cdc.gov/art/nass/index.html">report assisted reproduction success rates</a> to the CDC. Labs can be <a href="https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/3/18/states-not-eager-to-regulate-fertility-industry">certified</a> by <a href="https://www.cap.org/laboratory-improvement/accreditation/reproductive-accreditation-program">one</a> of <a href="https://www.jointcommission.org">two</a> <a href="https://www.cdc.gov/art/nass/policy.html">accrediting, nonprofit organizations</a>. While some states <a href="https://www.washingtonpost.com/news/to-your-health/wp/2018/03/14/faq-are-my-frozen-embryos-safe-everything-you-need-to-know-given-two-fertility-clinics-recent-problems/">require fertility labs to be accredited,</a> others do not; certification <a href="https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/cryostorage_of_reproductive_tissues.pdf">requires the monitoring of tanks</a>.</p>
<p>Without comprehensive monitoring, there is little known about problems within this industry. Some of the most complete information on frozen embryo mishaps comes from a <a href="https://www.google.com/url?sa=D&q=https://www.fertstertreports.org/action/showPdf%3Fpii%3DS2666-3341%252820%252930039-8&ust=1627324440000000&usg=AOvVaw3blyWRCntiDd2el33sY9SB&hl=en&source=gmail">study</a> analyzing lawsuits from 2009 through 2019. </p>
<p>The authors reported 133 cases of embryo loss. More than half were related to two catastrophic freezer failures, including the San Francisco event and another that occurred, in a bizarre coincidence, on the same day at Ohio’s <a href="https://www.cleveland.com/news/2019/09/uh-freezer-malfunction-update-more-than-150-families-settle-lawsuits-in-loss-of-embryos.html">Ahuja Medical Center</a>. The Ohio malfunction thawed 4,000 eggs, affecting more than 900 women or families.</p>
<p>But this study only includes cases that can be tracked because of legal filings. Clinics often require patients to sign arbitration agreements that keep cases out of court and out of the public eye. </p>
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<h2>The Pacific Fertility Center case</h2>
<p>Cryogenic tank failures should never happen. Although they store often irreplaceable genetic material, this equipment is minimally regulated. </p>
<p>The <a href="https://www.ecfr.gov/cgi-bin/text-idx?SID=13f55385af12d02f3c7cf85f833911fb&mc=true&node=se21.8.884_16120&rgn=div8">U.S. Food and Drug Administration</a> categorizes these tanks as Class II devices and exempts them from <a href="https://www.fda.gov/medical-devices/premarket-submissions/premarket-notification-510k">premarket</a> scientific and regulatory <a href="https://www.fda.gov/medical-devices/premarket-submissions/premarket-approval-pma">review</a> on safety and effectiveness. </p>
<p>There is also little oversight on the equipment while it’s in use. The American Society for Reproductive Medicine issued <a href="https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/cryostorage_of_reproductive_tissues.pdf">guidance</a> on best practices for cryopreservation in 2020, noting that a “known” source of potential mishaps included “human errors,” such as a “lack of quality control including liquid nitrogen filling schedule” and “inadequate inventory records.”</p>
<p>Basic federal standards for the manufacturing and use of cryopreservation tanks would prevent future storage tank failures and the loss of frozen eggs and embryos. In lieu of federal action, New Jersey became the <a href="https://abovethelaw.com/2020/03/new-jersey-is-the-first-state-to-regulate-the-storage-of-human-embryos/">first state</a> to regulate embryo storage through a law enacted in December 2019. </p>
<p>But ultimately, we believe only federal regulations can ensure uniformity so that standards don’t vary from state to state. Clinics also need greater government oversight to ensure prompt communication about errors. </p>
<p>Many who hope to someday have a genetically related child — like the couple from Ohio and that single woman looking for the right partner — must place their trust in fertility specialists, clinics and equipment manufacturers that provide needed services and devices. Even minimal regulation would help ensure that others are spared from devastating losses in the future. </p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/163792/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dena Sharp's law firm, Girard Sharp, worked on the cases relating to the tank failure at Pacific Fertility that are discussed in this article. </span></em></p><p class="fine-print"><em><span>Naomi Cahn 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>An unknown number of people have lost their dreams of parenthood because of storage disasters at fertility clinics. These experts note poor government oversight and the need for stronger regulation.Naomi Cahn, Professor of Law, University of VirginiaDena Sharp, Guest lecturer, University of California College of the Law, San FranciscoLicensed 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>
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<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>
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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>
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</em>
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<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/1600072021-05-03T20:08:22Z2021-05-03T20:08:22ZAre chemicals shrinking your penis and depleting your sperm? Here’s what the evidence really says<figure><img src="https://images.theconversation.com/files/398259/original/file-20210503-13-ocd03y.jpg?ixlib=rb-1.1.0&rect=14%2C0%2C4977%2C3323&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>A doomsday scenario of an end to human sperm production has been <a href="https://www.theguardian.com/commentisfree/2021/mar/18/toxic-chemicals-health-humanity-erin-brokovich">back in the news recently</a>, now with the added threat of shrinking penises.</p>
<p>Professor Shanna Swan, a US epidemiologist who studies environmental influences on human development, recently published a <a href="https://www.shannaswan.com/countdown">new book</a> called Countdown.</p>
<p>In it, she suggests sperm counts <a href="https://www.theguardian.com/society/2021/mar/28/shanna-swan-fertility-reproduction-count-down">could reach zero by 2045</a>, largely owing to the impact of a range of environmental pollutants used in manufacturing everyday products: phthalates and bisphosphenol A (BPA) from plastics, and per- and poly-fluoroalkyl substances (PFAS) used, for example, in waterproofing. Under this scenario, she says, most couples wanting to conceive would need to rely on assisted reproductive technologies.</p>
<p>She has also warned these chemicals are shrinking penis size.</p>
<p>Such extraordinary claims require extraordinary evidence. I would argue the evidence is not strong enough.</p>
<h2>Correlation doesn’t equal causation</h2>
<p>Epidemiologists find associations between disease and potential contributing factors, like lung cancer and smoking. But their work can’t identify the causes of disease — just because two things are associated doesn’t mean one is causing, or caused by, the other.</p>
<p>An article written by environmental activist Erin Brockovich in <a href="https://www.theguardian.com/commentisfree/2021/mar/18/toxic-chemicals-health-humanity-erin-brokovich">The Guardian</a> in March leads by referring to “hormone-disrupting chemicals that are decimating fertility”. But causation is <a href="https://pubmed.ncbi.nlm.nih.gov/33385395/">far from established</a>. </p>
<p>It’s reasonable to expect chemicals that <a href="https://pubmed.ncbi.nlm.nih.gov/33385395/">affect hormone function</a> in our bodies, like BPA and PFAS, could affect reproduction in males and females, given available evidence. But we don’t have irrefutable proof.</p>
<figure class="align-center ">
<img alt="A man and a pregnant woman outside with their dog." src="https://images.theconversation.com/files/398265/original/file-20210503-17-fzbt4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398265/original/file-20210503-17-fzbt4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398265/original/file-20210503-17-fzbt4d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398265/original/file-20210503-17-fzbt4d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398265/original/file-20210503-17-fzbt4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398265/original/file-20210503-17-fzbt4d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398265/original/file-20210503-17-fzbt4d.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">Could environmental pollutants be leading to infertility? Establishing cause and effect isn’t clear-cut.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Selective reporting</h2>
<p>In 2017, Swan and several colleagues published <a href="https://pubmed.ncbi.nlm.nih.gov/28981654/">an exhaustive review study</a> showing an apparent drop in men’s sperm counts of 59.3% between 1973 and 2011. This research informs the arguments Swan makes in Countdown and those we’ve seen in the media.</p>
<p>What’s not often mentioned is the fact the researchers only observed a decline in sperm count in groups of men from North America, Europe, Australia, and New Zealand, but not in groups of men from South America, Asia or Africa.</p>
<p>When Swan and her colleagues combined the data from all countries, they saw a decline because the studies of “Western” men outweigh those of men elsewhere (in the number of studies and participants).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/huge-drop-in-mens-sperm-levels-confirmed-by-new-study-here-are-the-facts-81582">Huge drop in men's sperm levels confirmed by new study – here are the facts</a>
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</em>
</p>
<hr>
<p>Swan and her colleagues worked hard to avoid bias when conducting their study. But <a href="https://pubmed.ncbi.nlm.nih.gov/9455838/">selection bias</a> (related to how study participants are chosen), <a href="https://pubmed.ncbi.nlm.nih.gov/2406472/">publication bias</a> (resulting from researchers’ tendency to report only observations they think will be of interest) and other limitations of the original work used as the basis for their investigation could be influencing the results of the larger study.</p>
<p>Many studies from different parts of the world show declining sperm counts, which is concerning, but we don’t fully understand the <a href="https://pubmed.ncbi.nlm.nih.gov/32168194/">reasons for the apparent decline</a>. Blaming chemicals in the environment overlooks <a href="https://pubmed.ncbi.nlm.nih.gov/29774489/">other important factors</a> such as chronic disease, diet, and obesity, which people can act on to improve their fertility.</p>
<h2>The problem with extrapolation</h2>
<p>Swan’s 2017 study boils down to a straight descending line drawn between sperm counts of groups of men studied at different times between 1973 and 2011.</p>
<p>Just because a straight line can be drawn through the data, this doesn’t justify extrapolation of that line beyond its earliest and latest data points. It’s unscientific to assume trends in data exist outside the range of observations.</p>
<p>We know sperm counts of men in the early 1940s were around <a href="https://pubmed.ncbi.nlm.nih.gov/1393072/">113 million sperm per ml of semen</a>, not the roughly 140 million/ml you get from extrapolating backwards from Swan’s research. Concluding sperm counts will reach zero in 2045, based on extrapolating forward from the available data, is just as likely to be incorrect. </p>
<p>When Swan told <a href="https://www.axios.com/newsletters/axios-future-e58ada65-1a84-4550-afd8-79d698bb7d38.html?stream=future&utm_campaign=newsletter_axiosfutureofwork&utm_medium=email&utm_source=newsletter">news website Axios</a> “If you look at the curve on sperm count and project it forward” she was encouraging unjustifiable and unscientific interpretation of her data — even though she acknowledged it was “risky” to extrapolate in this way. Unfortunately this caution is too often unmentioned.</p>
<p>For example, <a href="https://www.theguardian.com/commentisfree/2021/mar/18/toxic-chemicals-health-humanity-erin-brokovich">Brockovich writes</a>: “That would mean no babies. No reproduction. No more humans.” That’s hyperbole. It’s just not science.</p>
<figure class="align-center ">
<img alt="An illustration of sperm." src="https://images.theconversation.com/files/398266/original/file-20210503-23-8j0tma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398266/original/file-20210503-23-8j0tma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398266/original/file-20210503-23-8j0tma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398266/original/file-20210503-23-8j0tma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398266/original/file-20210503-23-8j0tma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398266/original/file-20210503-23-8j0tma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398266/original/file-20210503-23-8j0tma.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">Swan has extrapolated from recent data to predict sperm counts could reach zero by 2045. But this isn’t necessarily accurate.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Relax, your penis isn’t shrinking</h2>
<p>Claims of shrinking penises are obvious clickbait. But only <a href="https://pubmed.ncbi.nlm.nih.gov/30403786/">a single study</a>, of 383 young men from the Veneto region in northeastern Italy, links men’s penis size to the types of chemicals Swan attributes to declining sperm counts.</p>
<p>Within Veneto there are <a href="https://figshare.com/articles/figure/Supplemental_Figure_1/7016234">geographic zones</a> with varied levels of PFAS contamination. A group of 212 men who live in areas with high or intermediate PFAS exposure and have high levels of these chemicals in their bodies, had an average penis length of 8.6cm, about 10% lower than the average of a group of 171 men from an area without exposure (9.7cm).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/science-or-snake-oil-do-men-need-sperm-health-supplements-84379">Science or Snake Oil: do men need sperm health supplements?</a>
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</p>
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<p>But a few features of this study affect the reliability of the observations and whether we can generalise them to other populations.</p>
<ol>
<li><p>men were grouped according to where they lived, not where they were born. Since genital size is <a href="https://pubmed.ncbi.nlm.nih.gov/30403786/">determined before birth</a>, the environment during their mothers’ pregnancies is more relevant to penis size than where the men lived at the time of the study. Some men will likely have relocated from their place of birth but how many, and where they may have moved to and from, we don’t know</p></li>
<li><p>the levels of PFAS exposure for men living in the contaminated regions of Veneto are extreme, because of <a href="https://pubmed.ncbi.nlm.nih.gov/29108835/">decades of industrial pollution</a>. How the potential effect of such large exposures relates to smaller and more common exposures to pollutants, like from plastic food wrap, we don’t know</p></li>
<li><p>the study is missing details about its subjects and the conditions under which measurements were made. It’s <a href="https://pubmed.ncbi.nlm.nih.gov/33748967/">usual</a> to exclude people with conditions that might affect study outcomes, such as congenital abnormalities, but it’s not clear whether this happened in the study. Variables that <a href="https://pubmed.ncbi.nlm.nih.gov/31171853/">influence penile measurements</a> (such as room temperature, posture, and whether the penis is held straight or hanging) are not mentioned.</p></li>
</ol>
<p>And from a semantic perspective, for penises to be “shrinking” they must be getting shorter over time, on either an individual or population basis. I cannot find any reports of men’s penises shortening as a consequence of environmental pollution. <a href="https://pubmed.ncbi.nlm.nih.gov/31171853/">Available data</a> <a href="https://pubmed.ncbi.nlm.nih.gov/25487360/">don’t suggest</a> a decline in penis size over the past few decades.</p>
<p>While environmental pollution is a pressing concern, the evidence suggests the catastrophic collapse of human reproduction and accompanying penis shrinkage is thankfully a pretty unlikely prospect.</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>
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</p>
<hr>
<img src="https://counter.theconversation.com/content/160007/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Moss is Health Content Manager at Healthy Male (formerly Andrology Australia). He is the current President of The Perinatal Society of Australia and New Zealand. </span></em></p>Warnings of an end to human sperm production have been making headlines recently, now with the added threat of shrinking penises. Is this science or sensationalism?Tim Moss, Adjunct Associate Professor, Department of Obstetrics and Gynaecology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1462542020-10-22T12:24:25Z2020-10-22T12:24:25ZDisputes over when life begins may block cutting-edge reproductive technologies like mitochondrial replacement therapies<figure><img src="https://images.theconversation.com/files/363766/original/file-20201015-17-tcjd72.jpg?ixlib=rb-1.1.0&rect=275%2C66%2C5207%2C3234&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A computer illustration of a cross-section of a mitochondrion and its internal structure with DNA (gray), ribosomes (light green), granules (yellow) and ATP synthase particles (light blue).</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/internal-structure-of-a-mitochondrion-3d-royalty-free-illustration/1249064176?adppopup=true">TUMEGGY/SCIENCE PHOTO LIBRARY/Getty Images</a></span></figcaption></figure><p>The nomination of Judge Amy Coney Barrett to the U.S. Supreme Court has once again pushed the debate over when life begins into the headlines, which could have far-reaching effects on access to both current and emerging reproductive technologies. In 2006, Judge Barrett was <a href="https://www.theguardian.com/us-news/2020/oct/01/amy-coney-barrett-supported-group-fertilization">one of the signatories</a> on a newspaper ad sponsored by an anti-abortion group that not only believes life begins at fertilization but also hopes to criminalize discarding extra embryos created during in vitro fertilization.</p>
<p>As legal scholars, <a href="https://scholar.google.com/citations?user=WNsa-isAAAAJ&hl=en">we</a> <a href="https://isearch.asu.edu/profile/2712805">are</a> closely watching how jurisdictions regulate emerging reproductive technologies, including a set of techniques called mitochrondial replacement therapies which can prevent some heritable diseases. But because they use IVF methods, and some (but not all) of the techniques <a href="https://doi.org/10.1007/s11019-017-9772-3">require discarding an embryo</a>, law codifying the belief that life starts at fertilization could restrict access to mitochondrial replacement therapies and derail productive conversations about how to regulate them properly.</p>
<h2>Implications for assisted reproduction</h2>
<p>Last week, the medical journal <a href="https://els-jbs-prod-cdn.jbs.elsevierhealth.com/pb/assets/raw/Health%20Advance/journals/fns/oyez.pdf">Fertility & Sterility ran an editorial</a> arguing that confirming Judge Barrett could result in restrictions not only on reproductive rights to contraception and abortion, but also on IVF. One <a href="https://abovethelaw.com/2020/10/is-amy-coney-barrett-the-beginning-of-the-end-for-ivf/">concern</a> is that future legal decisions could forbid IVF clinics from discarding extra embryos – even ones unlikely to start a pregnancy – or limit the number of embryos which can be formed. That could raise treatment costs or make efforts to start a healthy pregnancy with IVF <a href="https://www.statnews.com/2018/07/24/are-embryos-people-the-answer-will-determine-the-future-of-reproductive-medicine/">much harder</a>. </p>
<p>The nomination of Judge Barrett also comes just as new technologies look almost ready to help parents have children free of certain heritable diseases. Children can inherit mitochondrial diseases from their <a href="https://www.nytimes.com/2016/06/24/science/mitochondrial-dna-mothers.html">biological mother</a> (and <a href="https://doi.org/10.1073/pnas.1810946115">possibly their father</a>) caused by dysfunctional mitochondria – which generate energy molecules for the cell. These tiny structures in the cell carry their own special DNA; but those that carry mutations can cause disease. A new type of reproductive technology called mitochondrial replacement therapies offers the possibility of preventing children from inheriting these diseases. </p>
<h2>Mitochondrial replacement therapies</h2>
<p>Estimates suggest <a href="https://my.clevelandclinic.org/health/diseases/15612-mitochondrial-diseases">1,000-4,000 children</a> in the U.S. alone are born each year with a heritable mitochondrial disease.</p>
<p>These complex diseases can affect <a href="https://www.cdc.gov/ncbddd/autism/mitochondrial-faq.html">many different organs</a> – especially those with high energy needs like the brain, eyes or heart. There are no cures and few treatment options exist, so children often die in severe cases. Having a child with mitochondrial diseases can place huge emotional and financial tolls on families, with significant economic costs for <a href="https://www.legislation.gov.uk/ukia/2015/138/pdfs/ukia_20150138_en.pdf">health care systems</a>.</p>
<p>With limited treatment options, some experts place more hope in preventing children from inheriting mitochondrial diseases altogether. Sometimes called “<a href="https://theconversation.com/how-can-a-baby-have-3-parents-97991">three parent IVF</a>,” <a href="https://www.hfea.gov.uk/treatments/embryo-testing-and-treatments-for-disease/mitochondrial-donation-treatment/">mitochondrial replacement therapies</a> make this possible by replacing the unhealthy mitochondria in an egg cell or embryo with healthy ones from a donor woman. Using this technique, couples at high risk of having children with mitochondrial diseases can then have a healthy child who is biologically related to them.</p>
<p>Mitochondrial replacement therapies do, however, raise a few concerns. Health problems could arise from <a href="https://doi.org/10.1038/nrm.2018.3">molecular mismatches</a> between the parents’ nucleus and donor mitochondria or from a treated embryo <a href="https://doi.org/10.1016/j.stem.2016.04.001">reverting</a> to an unhealthy state, though these risks are hypothetical for now. And female children born through mitochondrial replacement therapies could, theoretically, pass these conditions to their children.</p>
<p>Because mitochondria carry 37 of their own genes, children born from mitochondrial replacement therapies technically have DNA from three people – the couple and the woman who donated her healthy mitochondria. The donor contributes a <a href="https://theconversation.com/3-parent-ivf-could-prevent-illness-in-many-children-but-its-really-more-like-2-002-parent-ivf-126591">minuscule amount</a> of DNA – less than 1% – but this does raise questions about their “parenthood.” Another concern is that swapping out mitochondria (and their DNA) in embryos makes for a slippery slope to designer babies, especially now that <a href="https://www.sciencemag.org/news/2019/12/chinese-scientist-who-produced-genetically-altered-babies-sentenced-3-years-jail">three births</a> have occurred after gene editing.</p>
<h2>Regulating mitochondrial replacement therapies</h2>
<p>These safety and ethical concerns call for policy to investigate and minimize risks, while answering questions like what the legal status of the third “parent” should be.</p>
<p>In 2015, the United Kingdom became the first jurisdiction in the world to expressly <a href="https://www.legislation.gov.uk/ukdsi/2015/9780111125816/contents">legalize and regulate</a> mitochondrial replacement therapies, creating a system to license clinics for this service. This move came after an extensive <a href="https://www.hfea.gov.uk/media/2618/mitochondria_replacement_consultation_-_advice_for_government.pdf">public engagement</a> process. Regulation is overseen by the Human Fertilisation and Embryology Authority, which governs all human fertility treatments and research within the U.K. Two other countries, Australia and Singapore, are considering legislative amendments to follow in the U.K.’s footsteps.</p>
<p>While brand-new regulatory systems for mitochondrial replacement therapies may seem ideal, <a href="https://doi.org/10.1017/S1867299X00002105">lessons learned</a> from other emerging technologies suggest most countries probably won’t adopt this approach – since existing rules often apply already, though maybe not in an ideal way. The trick then becomes making sure existing rules can still cover concerns with the new technology. However, this reality has led to critics raising the alarm about “unregulated” mitochondrial replacement therapies, especially since medical tourism is <a href="https://theconversation.com/the-next-frontier-in-reproductive-tourism-genetic-modification-67132">already happening</a>.</p>
<p>Even if most countries don’t enact new laws, many already have rules which should apply to mitochondrial replacement therapies. For example, the U.S. won’t need a new regulatory system if it removes its current <a href="https://www.statnews.com/2019/04/16/mitochondrial-replacement-three-parent-ivf-ban/">ban</a> on the technology. The Food and Drug Administration <a href="https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/therapeutic-cloning-and-genome-modification">already plans</a> on regulating mitochondrial replacement therapies with the same tools it uses for “biologics,” a broad category of medical products ranging from vaccines to gene therapy.</p>
<p>Mexico got a bad reputation for having “no rules” after a child was born there via mitochondrial replacement therapies, but <a href="https://doi.org/10.1093/jlb/lsw065">legal scholars</a> have pointed out that Mexico’s regulations on health research likely prohibit this use of mitochondrial replacement therapies. However, these rules weren’t triggered because doctors modified the embryos in the U.S., before sending them to Guadalajara for the treatment. Instead, the <a href="https://www.fda.gov/media/106739/download">U.S. FDA intervened</a>, informing the clinic that they had violated U.S. law in several ways.</p>
<p>In Greece, regulators already approved a <a href="http://www.isrctn.com/ISRCTN11455145">clinical trial</a> for mitochondrial replacement therapies using their existing rules for fertility treatments – although the trial addresses the success of fertility treatments instead of preventing mitochondrial diseases. And in Ukraine, though the details are murky, health officials appear to have similarly approved a <a href="https://www.npr.org/sections/health-shots/2018/06/06/615909572/inside-the-ukrainian-clinic-making-3-parent-babies-for-women-who-are-infertile">clinical trial</a> for mitochondrial replacement therapies.</p>
<h2>Moving forward</h2>
<p>Reproductive technologies have allowed <a href="https://www.cnn.com/2018/07/03/health/worldwide-ivf-babies-born-study/index.html">millions of families</a> around the world to conceive healthy children over the last 42 years. For the first time, recent advances in mitochondrial replacement therapies could allow families who otherwise couldn’t have a healthy child of their own to do so. But changes in law that restrict access to IVF could have profound social and medical impacts that would ripple across the country. </p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>Rather than making reproductive technologies like mitochondrial replacement therapies more difficult to access – especially for those with a medical reason for doing so – we believe regulators and governments should be looking for ways to provide individuals access to these technologies in a way that promotes safety and efficacy for everyone involved. That includes those living in the U.S. who wish to access mitochondrial replacement therapies in their own country.</p><img src="https://counter.theconversation.com/content/146254/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Diana Bowman receives funding from the Andrew Carnegie Fellows Program. </span></em></p><p class="fine-print"><em><span>Walter G. Johnson 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>The nomination of Judge Amy Coney Barrett has implications for how assisted reproductive technologies, which can prevent the transmission of disease from parents to child, are regulated.Walter G. Johnson, Research Fellow, Arizona State UniversityDiana Bowman, Associate Dean for International Engagement in the College of Law, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1476082020-10-15T12:41:13Z2020-10-15T12:41:13ZOnly two northern white rhinos remain, and they’re both female – here’s how we could make more<figure><img src="https://images.theconversation.com/files/363666/original/file-20201015-21-tz5vy3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3201%2C2501&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">White rhinos owe their name to the Afrikaans word 'wyd', meaning wide, which refers to the animal's wide mouth.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/northern-white-rhinoceros-ceratotherium-simum-cottoni-1051364828">Vladislav T. Jirousek/Shutterstock</a></span></figcaption></figure><p>There were fewer than 100 southern white rhinoceroses (<em>Ceratotherium simum simum</em>) a century ago. Today, there are over 20,000. Sadly, this success story only stretches as far as the southern subspecies of the white rhino. With the death of the last male in 2018, the northern white rhinoceros (<em>Ceratotherium simum cottoni</em>) has passed the point where it can be saved naturally. With only two females remaining, the subspecies is now classed as functionally extinct.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/225899/original/file-20180703-116132-1wguvty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/225899/original/file-20180703-116132-1wguvty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=604&fit=crop&dpr=1 600w, https://images.theconversation.com/files/225899/original/file-20180703-116132-1wguvty.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=604&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/225899/original/file-20180703-116132-1wguvty.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=604&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/225899/original/file-20180703-116132-1wguvty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=759&fit=crop&dpr=1 754w, https://images.theconversation.com/files/225899/original/file-20180703-116132-1wguvty.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=759&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/225899/original/file-20180703-116132-1wguvty.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=759&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Historical distributions of the northern (red) and southern (green) white rhino.</span>
<span class="attribution"><a class="source" href="https://genome.cshlp.org/content/early/2018/05/16/gr.227603.117">Tunstall et al 2018</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>This is a poignant, but not entirely hopeless, situation. New techniques, such as in vitro fertilisation (commonly known as IVF), enable us to bypass normal reproduction to produce new northern white rhino babies. Sperm samples from deceased males that are preserved in bio-banks solve one side of the equation, but there aren’t frozen stores of northern white rhino eggs that we can rely on as easily.</p>
<p>We established the Rhino Fertility Project at the University of Oxford to help solve this problem. By using ovary tissue from deceased female rhinos to grow lots of eggs for fertilisation in a lab, we think we may have found a way to save the northern white rhinoceros – and potentially, other endangered species – from extinction.</p>
<h2>The first breakthroughs</h2>
<p>A team led by <a href="https://phys.org/news/2019-02-scientists-fine-tune-method-rhinos.html">Professor Thomas Hildebrandt</a> from the Leibniz Institute for Zoo and Wildlife Research in Germany had a breakthrough in 2019 when they managed to collect eggs from the last remaining northern white rhinoceros females. After treating the females with hormones the immature eggs were collected, transferred to a lab where they were matured and then fertilised with frozen sperm. </p>
<p>To date, a handful of northern white rhinoceros embryos have been created this way. They’re frozen and awaiting implantation in a surrogate female southern white rhinoceros. Transferring embryos into surrogates to produce baby animals is a process that’s been well established for lots of species, including horses and cows, though it’s still in the development phase for rhinos.</p>
<p>But the biggest constraint on this approach is that hormonal stimulation of female rhinos produces just a few eggs per cycle. Not all of these eggs will fertilise and not all will develop into an embryo. After transfer to a surrogate, only some will complete their development and become baby rhinos. As you might imagine, with only two remaining rhinos to gather these precious eggs from, this limits our ability to revive entire populations.</p>
<p>So what if we had the means to produce more eggs? While eggs collected from female rhinos are in short supply, generating eggs from ovarian tissue from deceased rhinos could fill the gap.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coral-sex-how-reproducing-species-in-the-lab-could-be-key-to-restoring-reefs-in-the-wild-143776">Coral sex: how reproducing species in the lab could be key to restoring reefs in the wild</a>
</strong>
</em>
</p>
<hr>
<h2>Petri dish rhinos</h2>
<p>As in humans, every female rhinoceros is born with thousands, if not millions, of immature ovarian follicles. At the centre of each of these sits an immature egg, also known as an oocyte. The follicle grows over months until it’s ready to ovulate. At this point, these contain fluid and secrete hormones which influence the menstrual cycle. Ovaries contain lots of these immature follicles that are just waiting to be activated – in fact, far more follicles than are actually needed. As follicles grow and some are selected for ovulation, many are lost.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/361920/original/file-20201006-20-1lbm16f.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A mass of white tissue (the follicle) within the surrounding pink ovarian tissue." src="https://images.theconversation.com/files/361920/original/file-20201006-20-1lbm16f.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/361920/original/file-20201006-20-1lbm16f.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/361920/original/file-20201006-20-1lbm16f.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/361920/original/file-20201006-20-1lbm16f.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/361920/original/file-20201006-20-1lbm16f.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/361920/original/file-20201006-20-1lbm16f.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/361920/original/file-20201006-20-1lbm16f.JPG?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"></a>
<figcaption>
<span class="caption">A follicle situated in the ovarian tissue of a southern white rhinoceros.</span>
<span class="attribution"><span class="source">Ruth Appeltant</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Rhinos don’t undergo the menopause and so the ovaries of older animals still contain small follicles. Our goal is to grow these from the ovarian tissue of a deceased rhinoceros in the lab. We’re experimenting with techniques that maximise the number of follicles we can grow in a culture dish.</p>
<p>By harnessing the full potential of rhino ovaries, we aim to grow as many eggs as possible. We’re developing our method using ovarian tissue from different rhino species, including the southern white, Indian and black rhinoceros. Since all rhino species are either threatened or endangered, this technology could help more species than just the northern white, including the rare Javan and Sumatran rhinos.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/361921/original/file-20201006-16-3qi24r.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A schematic that visualises the process described in the text, from deceased ovarian tissue, to new offspring." src="https://images.theconversation.com/files/361921/original/file-20201006-16-3qi24r.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/361921/original/file-20201006-16-3qi24r.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/361921/original/file-20201006-16-3qi24r.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/361921/original/file-20201006-16-3qi24r.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/361921/original/file-20201006-16-3qi24r.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/361921/original/file-20201006-16-3qi24r.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/361921/original/file-20201006-16-3qi24r.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">How oocytes in follicles can develop into offspring by using in vitro ovarian tissue culture.</span>
<span class="attribution"><span class="source">Ruth Appeltant</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>But as you can imagine, there aren’t many rhinoceros ovaries available for laboratory research in the UK. Shipping tissue from threatened or endangered species in Africa to the UK in a timely manner is impossible, with many legal hurdles and mountains of paperwork. Collaboration between zoos, wildlife parks and research institutes is of the utmost importance here, to allow us to obtain this precious ovarian tissue. </p>
<p>The experience and knowledge we’re gaining by developing this technique could even be useful in conservation efforts for other species. By freezing ovarian tissue and sperm from other endangered species and developing methods to cultivate follicles in labs, we could prevent further losses of some of Earth’s most iconic wildlife and revive ecosystems rich in biodiversity.</p><img src="https://counter.theconversation.com/content/147608/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ruth Appeltant receives funding from Fondation Hoffmann via The Rhino Fertility Project.</span></em></p><p class="fine-print"><em><span>Suzannah Williams established and leads the Rhino Fertility Project, which is funded by Foundation Hoffmann.</span></em></p>By unlocking the full potential of rhino ovaries, we hope to produce enough eggs to revive the northern white rhino in the wild.Ruth Appeltant, Postdoctoral Researcher in the Conservation of Endangered Species, University of OxfordSuzannah Williams, Associate Professor in Ovarian Physiology, Lead for Ovarian Cryopreservation and Fertility Preservation Research, Lead of Rhino Fertility Project, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1393142020-07-21T14:32:41Z2020-07-21T14:32:41ZNew technologies mean states must reconsider what ‘reproductive rights’ are<figure><img src="https://images.theconversation.com/files/346022/original/file-20200707-194405-1hl9dcx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New technologies are helping people to choose when and how to have children.</span> <span class="attribution"><span class="source">MidoSemSem/Shutterstock</span></span></figcaption></figure><p>A number of technological advances have revolutionised human reproduction in the past few decades. One example is in vitro fertilisation (IVF), the process of fertilising a woman’s eggs with a man’s sperm in the laboratory. This can be a solution when men and women have problems conceiving. It also allows infertile couples to use donor sperm or eggs. </p>
<p>Other examples include embryo transfer and pre-implantation genetic testing. The first means embryos created outside the body can be frozen, stored and later transferred into a womb. The second allows prospective parents who have or carry genetic diseases to run genetic tests on their stored embryo. Such technologies are often strictly regulated because of ethical misgivings about their use. </p>
<p>Some countries <a href="https://academic.oup.com/hropen/article/2020/1/hoz044/5715201#198801773">do not permit pre-implantation genetic testing at all</a>. Many others, among them Australia, Belgium, Canada, France, Germany, Italy, the Netherlands, Spain, Switzerland and the UK, do not permit it for the purpose of <a href="https://cbhd.org/content/g12-country-regulations-assisted-reproductive-technologies">choosing the baby’s sex</a>. </p>
<p>Some people view such technologies as against the “natural order”, or are concerned about the “commodification” of human life. But for others, laws based on these views limit their freedom to choose to use reproductive technologies as they wish. </p>
<p>I set out <a href="https://www.tandfonline.com/eprint/2AFINJTU359GRIEUVIBW/full?target=10.1080/02587203.2020.1776632">to examine</a> whether the limitations are justified from a legal perspective, in light of the rich history that freedom of choice has in international human rights.</p>
<p><a href="https://www.tandfonline.com/eprint/2AFINJTU359GRIEUVIBW/full?target=10.1080/02587203.2020.1776632">I did this</a> by studying the history of reproductive rights. These are a fixture in international human rights documents, including the <a href="https://www.un.org/en/universal-declaration-human-rights/">Universal Declaration of Human Rights</a>. They are also enshrined in the laws of liberal democracies like South Africa, the US and Canada. I concluded that reproductive rights are based on the fundamental freedom of individuals to found a family, regardless of how they do so. They are entitled to use new reproductive technologies to create a family. Their rights should not be limited by moral indignation.</p>
<p>The issue has received little attention so far. But it will likely become increasingly relevant as new reproductive technologies like <a href="https://theconversation.com/what-is-crispr-gene-editing-and-how-does-it-work-84591">CRISPR</a> heritable genome editing expand the choices prospective parents may make. It is also very likely that legal challenges will be raised by individuals who stand to benefit from using these technologies. That’s why a deeper understanding of the history, meaning and future of reproductive rights is so important. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-crispr-gene-editing-and-how-does-it-work-84591">What is CRISPR gene editing, and how does it work?</a>
</strong>
</em>
</p>
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<h2>Where do reproductive rights come from?</h2>
<p>The <a href="https://www.un.org/en/universal-declaration-human-rights/">Universal Declaration of Human Rights</a>, which was proclaimed in 1948, was the first international instrument agreement on the fundamental and inalienable rights of all humans. It does not refer directly to reproductive rights. However, its <a href="https://www.humanrights.com/course/lesson/articles-12-18/read-article-16.html">Article 16</a> does speak to the freedom of individuals to found a family with a partner of their choice.</p>
<p>In the years following the declaration, the world experienced <a href="https://www.jstor.org/stable/1965194?seq=1">accelerated growth</a> in population, leading to concerns about socio-economic development.</p>
<p>As a result, some states took drastic measures to control population numbers. One example was China’s <a href="https://theconversation.com/as-china-ends-the-one-child-policy-what-is-its-legacy-49975">“One-Child Policy”</a>. The international community viewed such policies as a violation of fundamental human rights. It resolved that state population control policies should be guided by <a href="https://undocs.org/pdf?symbol=en/a/res/2211(XXI)">the principle</a> that</p>
<blockquote>
<p>the size of the family should be the free choice of each individual family.</p>
</blockquote>
<p>The next distinct phase in developing reproductive rights began in 1975 with the United Nations’ first <a href="https://www.unwomen.org/en/how-we-work/intergovernmental-support/world-conferences-on-women#mexico">World Conference on Women</a>. From this point, reproductive rights became a tool to overcome obstacles faced by women. In particular, they were used to promote safe termination of unwanted pregnancies.</p>
<h2>The shifting future</h2>
<p>Reproductive rights have always focused on protecting the autonomy of individuals in determining whether, when and how to have children.</p>
<p>If they are to continue to accomplish this, individual states must acknowledge that reproductive rights are more than just the right not to have the government dictate what women can and cannot do with their bodies.</p>
<p>Unfortunately they have often failed to do so. For instance, the Constitutional Court of South Africa in the case of <a href="http://www.saflii.org/za/cases/ZACC/2016/43.html">AB v Minister of Social Development</a> ruled that the right to make decisions concerning reproduction only applies to the use of one’s own body. Though surrogacy is legal in South Africa, it is limited to people who can use their own eggs and sperm. In this case, the court did not allow a surrogate pregnancy using another woman’s eggs.</p>
<p>The law both in South Africa and elsewhere on the continent may need to be re-examined to keep up with technological developments – and with people’s interest in accessing these to have children when and how they choose. Evidence shows demand for these services is high, and steadily increasing. The most recent statistics by the <a href="http://anara-africa.com/#:%7E:text=Assisted%20Reproductive%20Technology.-,The%20African%20Network%20and%20Registry%20for%20Assisted%20Reproductive%20Technology%20brings,reproductive%20technology%20on%20the%20continent">African Network and Registry for Assisted Reproductive Technology</a>, for instance, showed 4,368 attempts at assisted reproduction in South Africa. </p>
<p>Adopting more permissive laws, partnered with <a href="https://health-e.org.za/2019/10/28/ten-years-later-the-nhi-must-prioritise-sexual-and-reproductive-health/">prioritising sexual and reproductive</a> health within national healthcare insurance schemes, would bring countries like South Africa in line with other liberal democracies on the issue of reproductive rights and technologies. </p>
<h2>Rethinking rights</h2>
<p>Reproductive rights have historically recognised that individuals should be free to make choices relating to reproduction. States should be mindful of this when regulating new reproductive technologies. </p>
<p>In countries like South Africa, the right to reproductive autonomy, and to access reproductive healthcare, turns on whether one chooses to have a child the “good old fashioned way”. This unfairly discriminates against those whose only hope at forming a family is through non-traditional means.</p><img src="https://counter.theconversation.com/content/139314/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bonginkosi Shozi receives funding from the National Research Foundation, and the University of KwaZulu-Natal's African Health Research Flagship.. </span></em></p>As more choices become theoretically available to prospective parents, it’s important to understand their rights.Bonginkosi Shozi, Doctoral Fellow with the UKZN African Health Research Flagship, University of KwaZulu-NatalLicensed 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">
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<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>
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<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">
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<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>
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</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/1268392019-11-25T01:12:12Z2019-11-25T01:12:12ZGenetic testing IVF embryos doesn’t improve the chance of a baby<figure><img src="https://images.theconversation.com/files/302547/original/file-20191119-111663-1cc8lwc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Genetic testing costs around A$700 per embryo.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/new-born-baby-boy-resting-mothers-663728050">KieferPix</a></span></figcaption></figure><p>If you’re going through IVF, you may be offered a test to look at your embryos’ chromosomes. </p>
<p><a href="https://www.fertstert.org/article/S0015-0282(19)32454-9/fulltext">Pre-implantation genetic testing</a> for aneuploidy (chromosome abnormalities), known as PGT-A, is an “add on” used to help choose embryos with the right number of chromosomes. It’s promoted by IVF clinics as a way to increase the chance of success, especially for women over 35. </p>
<p>But the <a href="https://www.ncbi.nlm.nih.gov/pubmed/30085138">evidence shows</a> that in most cases, PGT-A doesn’t improve the chance of a baby.</p>
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<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>
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<h2>What is aneuploidy?</h2>
<p>Human cells usually contain 46 chromosomes. Aneuploidy is a term that describes a chromosome number that is different from 46 – either too many or too few chromosomes. </p>
<p>In human embryos, most aneuploidies are lethal, resulting in miscarriage, or do not result in pregnancy at all. </p>
<p>The chance of aneuploidy increases with the age of the woman; by the time a woman reaches age 40, <a href="https://journals.sagepub.com/doi/full/10.1177/2058915816653277">approximately 80%</a> of her embryos are aneuploid. </p>
<h2>What is PGT-A?</h2>
<p>All couples produce some aneuploid embryos, whether they conceive naturally or with IVF. The idea behind PGT-A is that if the aneuploid embryos can be identified they can be discarded, so that only embryos capable of producing a healthy pregnancy are used. </p>
<p>PGT-A involves the woman having fertility drugs to produce several eggs. When they are mature, they are retrieved and mixed with sperm to create embryos. </p>
<p>Embryos are grown in the laboratory for five to six days. At this time, two types of cells are distinguishable: the cells that will develop into the placenta and the cells that will become the baby. </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>
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<p>A few cells are removed from the future placenta for testing and the embryos are frozen until test results are available. </p>
<p>If the test shows there are normal embryos, one is thawed and transferred to the woman’s uterus. Any remaining normal embryos will be kept frozen for transfer later if the first transfer is unsuccessful. </p>
<p>Importantly, PGT-A doesn’t “correct” chromosomally abnormal embryos, it simply allows couples to avoid transferring them.</p>
<h2>Who might be offered PGT-A?</h2>
<p>Many clinics recommend PGT-A for women over 35 (<a href="https://npesu.unsw.edu.au/sites/default/files/npesu/data_collection/Assisted%20Reproductive%20Technology%20in%20Australia%20and%20New%20Zealand%202017.pdf">more than half of women who have IVF</a>) and those who have had repeated miscarriages or failed IVF treatments. This is because women over 35 and women with previous losses are more likely to produce aneuploid embryos. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/302799/original/file-20191121-502-z5l5id.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/302799/original/file-20191121-502-z5l5id.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/302799/original/file-20191121-502-z5l5id.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/302799/original/file-20191121-502-z5l5id.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/302799/original/file-20191121-502-z5l5id.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/302799/original/file-20191121-502-z5l5id.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/302799/original/file-20191121-502-z5l5id.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">Women over 35 are more likely to have embryos with chromosomal abnormalities than younger women.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/510591736?src=f8b1f75f-c3ae-4a42-8efa-9e5cf579abc3-1-20&size=huge_jpg">Natalia Lebedinskaia/Shutterstock</a></span>
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<h2>Does PGT-A work?</h2>
<p>While the theory behind PFT-A makes sense, randomised controlled trials (the gold standard evidence to tell us if an intervention makes a difference) have not demonstrated a clear benefit. </p>
<p>Of the two <a href="https://www.ncbi.nlm.nih.gov/pubmed/30085138">most recent trials</a> of PGT-A, one reported fewer embryo transfers and fewer miscarriages in the PGT-A group but <a href="https://www.ncbi.nlm.nih.gov/pubmed/31551155">neither showed benefits</a> in terms of improving the live-birth rate. </p>
<h2>The pitfalls of PGT-A</h2>
<p>PGT-A actually has the potential to <em>reduce</em> <a href="https://doi.org/10.1111/ajo.12960">the chance of a baby</a>. It can do this in two ways. </p>
<p>First, <a href="https://doi.org/10.1111/ajo.12960">PGT-A is not 100% accurate</a>. This means that inevitably, some embryos that have the capacity to form a healthy baby will be discarded. </p>
<p>The most common reason for these “false positive” results is that a proportion of embryos are “mosaic” – they have a mix of normal and abnormal cells. Surprisingly, mosaic chromosome abnormalities are <a href="https://www.rbmojournal.com/article/S1472-6483(19)30599-1/fulltext">quite common</a> in early human embryos, and do not seem to prevent the embryo developing into a healthy baby. </p>
<p>However, if abnormal cells are removed and tested, the embryo will be misclassified as abnormal and discarded – a lost opportunity for a healthy pregnancy. </p>
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<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>
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<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/31236830">Many healthy babies have been born</a> to people who have elected to have mosaic embryos transferred because they were the only embryos they had. </p>
<p>In a <a href="https://doi.org/10.1016/j.fertnstert.2018.10.001">recent study of 98 women</a> who had mosaic embryos, 32 (33%) elected to have at least one transferred. Of these, 11 (34%) had a successful pregnancy with apparently healthy babies born.</p>
<p>Second, while the <a href="https://www.fertstert.org/article/S0015-0282(18)30002-5/fulltext">risk is small</a>, embryos can be damaged in the biopsy procedure and some embryos don’t survive the freezing and thawing process. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/302800/original/file-20191121-474-1o2hsdf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/302800/original/file-20191121-474-1o2hsdf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=407&fit=crop&dpr=1 600w, https://images.theconversation.com/files/302800/original/file-20191121-474-1o2hsdf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=407&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/302800/original/file-20191121-474-1o2hsdf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=407&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/302800/original/file-20191121-474-1o2hsdf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=512&fit=crop&dpr=1 754w, https://images.theconversation.com/files/302800/original/file-20191121-474-1o2hsdf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=512&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/302800/original/file-20191121-474-1o2hsdf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=512&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">Some women elect to have mosaic embryos transferred.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/749056846?src=ea47bcd4-7675-4022-927d-8b4cff73b144-1-14&size=huge_jpg">Rawpixel.com/Shutterstock</a></span>
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<h2>To have or not to have PGT-A?</h2>
<p>PGT-A costs around A$700 per embryo which adds up to A$2,800 if there are four embryos to test.</p>
<p>While doctors likely offer their patients detailed and individualised information about different treatment options, information about the possible benefits of PGT-A on clinic websites can be difficult to interpret. </p>
<p>That’s why independent information about the pros and cons of PGT-A is needed to help people make informed decisions. The Victorian Assisted Reproductive Treatment Authority (VARTA) has developed a <a href="https://www.varta.org.au/resources/publications/pros-and-cons-pre-implantation-genetic-testing-aneuploidy-pgt">downloadable resource</a> about the current state of knowledge about PGT-A. </p>
<p>Some clinics are now offering a less invasive technique where, rather than removing cells from the embryo, they test the fluid that the embryo is grown in to <a href="https://www.pnas.org/content/116/28/14105.short">determine if the embryo has the right number of chromosomes</a>. Time will tell of this will improve the chance of having a baby with IVF. </p>
<p>In the meantime, it may help to ask the five questions recommended by <a href="http://www.choosingwisely.org.au/resources/consumers/5-questions-to-ask-your-doctor">Choosing Wisely</a>: </p>
<ul>
<li>do I really need this test?</li>
<li>what are the risks?</li>
<li>are there safer, simpler options?</li>
<li>what happens if I don’t do anything?</li>
<li>what are the costs?</li>
</ul>
<p>And in the case of IVF: how will this improve my chance of a live birth?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/your-questions-answered-on-donor-conception-and-ivf-45715">Your questions answered on donor conception and IVF</a>
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<img src="https://counter.theconversation.com/content/126839/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karin Hammarberg is affiliated with the Victorian Assisted Reproductive Treatment Authority.</span></em></p><p class="fine-print"><em><span>David Amor 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 aged over 35 are sometimes offered genetic testing of their IVF embryos to rule out abnormalities. But it’s expensive and doesn’t increase their chance of a baby. In fact, it could reduce it.Karin Hammarberg, Senior Research Fellow, Global and Women's Health, School of Public Health & Preventive Medicine, Monash UniversityDavid Amor, Lorenzo and Pamela Galli Chair in Developmental Medicine, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1257092019-11-10T18:57:09Z2019-11-10T18:57:09ZWe may one day grow babies outside the womb, but there are many things to consider first<figure><img src="https://images.theconversation.com/files/300419/original/file-20191106-88403-1g6r0ys.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C997%2C744&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Researchers are developing artificial wombs as we speak. So we need to talk about the pros and cons before science fiction becomes reality.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/fetus-tank-54671101">from www.shutterstock.com</a></span></figcaption></figure><p><em>This is one of our occasional Essays on Health. It’s a long read. Enjoy!</em></p>
<p>The idea of growing babies outside the body has inspired <a href="https://daily.jstor.org/on-the-history-of-the-artificial-womb">novels and movies</a> for decades.</p>
<p>Now, research groups around the world are exploring the possibility of artificial gestation. For instance, one group <a href="https://www.nature.com/articles/ncomms15112">successfully grew</a> a lamb in an artificial womb <a href="https://www.huffingtonpost.com.au/2017/04/26/an-artificial-womb-has-successfully-grown-a-lamb-for-four-weeks_a_22055661/">for four weeks</a>. Australian researchers have also experimented with <a href="https://www.gizmodo.com.au/2019/03/artificial-wombs-are-getting-better-and-better/">artificial gestation for lambs</a> and <a href="https://www.wired.com/2011/09/artificial-shark-uterus/">sharks</a>. </p>
<p>And in recent weeks, researchers in The Netherlands <a href="https://www.theguardian.com/society/2019/oct/08/artificial-womb-dutch-researchers-given-29m-to-develop-prototype">have received €2.9m</a> (A$4.66m) to develop a prototype for gestating premature babies.</p>
<p>So it’s important to consider some of the ethical issues this technology might bring.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-frozen-ovaries-to-lab-grown-babies-the-future-of-childbirth-59912">From frozen ovaries to lab-grown babies: the future of childbirth</a>
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<h2>What is an artificial womb?</h2>
<p>Growing a baby outside the womb is known as ectogenesis (or exogenesis). And we’re already using a form of it. When premature infants are transferred to humidicribs to continue their development in a neonatal unit, that’s partial ectogenesis.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.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">When premature infants are transferred to humidicribs to continue their development in a neonatal unit, that’s partial ectogenesis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/incubator-sick-newborn-baby-neonatal-intensive-1532105090">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>But an artificial womb could extend the period a fetus could be gestated outside the body. Eventually we might be able to do away with human wombs altogether.</p>
<p>This may sound far-fetched, but many scientists working in reproductive biotechnology believe that with the necessary scientific and legal support, full ectogenesis is a real possibility for the future.</p>
<h2>What would an artificial womb contain?</h2>
<p>An artificial womb would need an outer shell or chamber. That’s somewhere to implant the embryo and protect it as it grows. So far, animal experiments have used <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/zoo.2042">acrylic tanks</a>, <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/zoo.2042">plastics bags</a> and uterine tissues removed from an organism and artificially kept alive.</p>
<p>An artificial womb would also need a synthetic replacement for amniotic fluid, a shock absorber in the womb during natural pregnancy. </p>
<p>Finally, there would have to be a way to exchange oxygen and nutrients (so oxygen and nutrients in and carbon dioxide and waste products out). In other words, researchers would have to build an <a href="https://www.ncbi.nlm.nih.gov/pubmed/811007">artificial placenta</a>. </p>
<p>Animal experiments have used complex <a href="https://www.newscientist.com/article/mg13418180-400-japanese-pioneers-raise-kid-in-rubber-womb">catheter and pump systems</a>. But there are plans to use a mini version of <a href="https://www.mja.com.au/journal/2009/191/3/extracorporeal-membrane-oxygenation">extracorporeal membrane oxygenation</a>, a technique that allows blood to be oxygenated outside the body.</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>
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</em>
</p>
<hr>
<p>Once these are in place, artificial gestation could one day <a href="https://www.sciencedaily.com/releases/2018/07/180703084127.htm">become as common as IVF</a> is today, a technique <a href="https://www.theguardian.com/society/2013/jul/12/story-ivf-five-million-babies">considered revolutionary</a> a few decades ago. </p>
<p>And just as in the case of IVF, there are many who are concerned about what this new realm of reproductive medicine might mean for the future of creating a family.</p>
<p>So what are some of the ethical considerations?</p>
<h2>Artificial wombs could help premature babies</h2>
<p>The main discussion about artificial wombs has focused on their potential benefit in increasing the survival rate of extremely premature babies. </p>
<p><a href="https://jme.bmj.com/content/44/11/75">Currently</a>, those born earlier than 22 weeks gestation have little-to-no hope of survival. And those born at 23 weeks are likely to suffer a range of disabilities. </p>
<p>Using a sealed “<a href="https://www.theguardian.com/science/2017/apr/25/artificial-womb-for-premature-babies-successful-in-animal-trials-biobag">biobag</a>”, which mimics the maternal womb might help extremely premature babies survive and improve their quality of life.</p>
<p>A biobag provides oxygen, a type of substitute amniotic fluid, umbilical cord access and all necessary water and nutrients (and medicine, if required). This could potentially allow the gestational period to be prolonged outside the womb until the baby has developed sufficiently to live independently and with good health prospects.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/dt7twXzNEsQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Premature lambs survived for four weeks in a ‘biobag’ at the Children’s Hospital of Philadelphia (Tech Insider/YouTube).</span></figcaption>
</figure>
<p>An artificial womb might provide an optimum environment for the fetus to grow, providing it with the appropriate balance of hormones and nutrients. It would also avoid exposing the growing fetus to external harms such as infectious diseases. </p>
<p>The technology might also make it easier to <a href="https://academic.oup.com/medlaw/advance-article/doi/10.1093/medlaw/fwz014/5510054?fbclid=IwAR1WMf6ZzWD5YgbQZBWHNDuCznVrNEMnL-a-8mlhrTb7Ar_jhWVBBb2rk5">perform surgery on the fetus</a> if needed.</p>
<p>And it could see the end of long-term hospital stays for premature infants, saving health care dollars in the process. This is particularly noteworthy considering some of the <a href="https://www.medibank.com.au/livebetter/newsroom/post/medibank-reveals-its-most-expensive-claims">largest private insurance payments</a> are currently for neonatal intensive care unit expenses.</p>
<h2>Artificial wombs could help with infertility and fertility</h2>
<p>This emerging reproductive technology may allow women who are infertile, either due to <a href="https://www.theguardian.com/lifeandstyle/2017/sep/04/artifical-womb-women-ectogenesis-baby-fertility">physiological or social reasons</a>, with the chance of having a child. It may also offer opportunities for transgender women and other women born without a uterus, or those who have lost their uterus due to cancer, injury or medical conditions, to have children. </p>
<p>Similarly, it could allow single men and gay male couples to become parents without needing a surrogate.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Artificial wombs could allow gay men to become parents without needing a surrogate.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/gay-couple-using-laptop-kitchen-522801235">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Will this lead to a broader discussion about <a href="https://www.theguardian.com/commentisfree/2017/may/01/artificial-womb-gender-family-equality-lam">gender roles and equality</a> in reproduction? Will it remove potential risks and expectations of pregnancy and childbirth currently only affecting women? Will this eliminate commercial surrogacy? </p>
<p>Equally, artificial wombs could help fertile women who for health or personal reasons choose not to be pregnant. It would allow those whose career choices, medication or lifestyle might otherwise expose a developing fetus to malformation or abnormality. </p>
<h2>Artificial wombs may harm women, reinforce inequality and lead to discrimination</h2>
<p>The prospect of artificial wombs might offer hope for many, but it also highlights a number of potential hazards.</p>
<p>For some women, using an artificial womb for gestation to continue might seem like a welcome alternative to terminating a pregnancy. But there are fears that other women thinking about an abortion might be compelled to use an artificial womb to continue gestation.</p>
<p>Whether artificial wombs should be allowed to influence a woman’s right to choose <a href="https://www.ncbi.nlm.nih.gov/pubmed/2904469">is already under debate</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-mothers-day-if-youve-been-born-in-a-machine-and-raised-by-robots-58631">What's Mother's Day if you've been born in a machine and raised by robots?</a>
</strong>
</em>
</p>
<hr>
<p>Artificial wombs might also further increase the gap between rich and poor. Wealthy prospective parents may opt to pay for artificial wombs, while poorer people will rely on women’s bodies to gestate their babies. Existing disparities in nutrition and exposure to pathogens between pregnancies across socio-economic divides could also be exacerbated.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/300425/original/file-20191106-88394-g7i272.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/300425/original/file-20191106-88394-g7i272.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/300425/original/file-20191106-88394-g7i272.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/300425/original/file-20191106-88394-g7i272.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/300425/original/file-20191106-88394-g7i272.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/300425/original/file-20191106-88394-g7i272.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/300425/original/file-20191106-88394-g7i272.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Artificial wombs might further increase the gap between rich and poor.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/image-gap-between-rich-poor-1108746449">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>This raises issues of distribution of access. Will artificial wombs receive government funding? If it does, who should decide who gets subsidised access? Will there be a threshold to meet? </p>
<p>Other issues concern potential discrimination individuals born via an artificial womb may face. How do we prevent discrimination or invasive publicity and ensure individuals’ origin stories are not subject to negative public curiosity or ridicule?</p>
<p>Others might consider artificial wombs to be deeply repugnant and fundamentally against the natural reproductive order.</p>
<h2>Preparing for future wombs</h2>
<p>Currently, there is no prototype of an artificial womb for humans. And the technology is very much in its infancy. Yet we do need to consider ethical and legal issues before rushing headlong into this reproductive technology.</p>
<p>Not only do we need to ensure the technology is safe and works, we need to consider whether it’s the right path to take for different circumstances.</p>
<p>It might be easier to defend using artificial wombs in emergency situations, such as saving the lives of extremely premature neonates. However, using them in other circumstances might need broader social and policy considerations.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-must-develop-techno-wisdom-to-prevent-technology-from-consuming-us-91656">We must develop 'techno-wisdom' to prevent technology from consuming us</a>
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<hr>
<p>Without first establishing clear regulatory and ethico-legal frameworks, the development and release of artificial wombs could be problematic. We need to clearly outline pregnancy termination rights, parenthood and guardianship issues, limitations to experimentation, and other issues before the technology is fully realised and available. We need to do this soon rather than allowing the law to lag behind the science. </p>
<p>We recommend:</p>
<ul>
<li><p>approved protocols for testing artificial wombs that gradually extend the gestation period </p></li>
<li><p>funding that prevents discrimination on socio-economic grounds. This might be in the form of government funding to ensue a wide range of groups have access to the technology </p></li>
<li><p>clear legal guidelines for the status of ectogenetic embryos and fetuses, including what happens if prospective parents die, divorce or disagree on how to proceed</p></li>
<li><p>guidelines for access that calm public fears about misuse of emerging reproductive technologies.</p></li>
</ul>
<p>It is easy to get carried away with visions of utopian or dystopian societies. As radical and futuristic as artificial wombs might sound, it is important to pause and reflect on the present. </p>
<p>While this technology may solve some existing problems concerning inequality in reproduction, there are many other issues that demand our immediate attention.</p>
<p>Improving maternal health services, equal opportunity in the workplace, and reducing the impact of poor social determinants of health on fetal outcomes are all pressing concerns we must address now before we can consider what the future of reproductive biotechnology might hold.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/where-we-come-from-determines-how-we-fare-the-fetal-origins-of-adult-disease-3581">Where we come from determines how we fare – the fetal origins of adult disease</a>
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<img src="https://counter.theconversation.com/content/125709/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 organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Yes, there are pros and cons of this new reproductive technology. But there are many other issues about maternal and child health we need to tackle first.Neera Bhatia, Associate Professor in Law, Deakin UniversityEvie Kendal, Lecturer in Bioethics and Health Humanities, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1226252019-09-02T19:52:16Z2019-09-02T19:52:16ZIVF changes babies’ genes but these differences disappear by adulthood<figure><img src="https://images.theconversation.com/files/290479/original/file-20190902-175710-b1zk9d.jpg?ixlib=rb-1.1.0&rect=125%2C41%2C5456%2C3698&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Adults born via IVF are as healthy as their naturally conceived peers. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/">Shutterstock</a></span></figcaption></figure><p>Around <a href="https://www.smh.com.au/healthcare/australia-ivf-rates-revealed-one-in-every-25-births-an-ivf-baby-20180908-p502ja.html">one in 25 Australian children</a> are now conceived through use of assisted reproductive treatments such as IVF. </p>
<p>These reproductive technologies appear to leave a biological “signature” on several genes that can be measured at birth. </p>
<p>This may explain why assisted conception <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30312-X/fulltext">increases the chance</a> of early delivery, low birth weight and congenital abnormalities – and the question has remained about why this might be so. </p>
<p>But the good news, according to our research <a href="https://www.nature.com/articles/s41467-019-11929-9">published today in the journal Nature Communications</a>, is these “epigenetic” changes largely disappear by adulthood. </p>
<p>In fact, people born via IVF are <a href="https://research.monash.edu/en/publications/health-of-adults-aged-22-to-35-years-conceived-by-assisted-reprod">as healthy</a> as their naturally conceived peers. </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>
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</p>
<hr>
<h2>First, a quick lesson on epigenetics</h2>
<p>Epigenetics is the process by which an organism interacts with the environment, switching genes on and off. This process controls which proteins the genes make and the type of cells they become, whether muscle, brain, skin, or something else. </p>
<p>The time around conception is associated with widespread epigenetic remodelling of the embryo, switching genes on and off, and producing the different types of cells needed to establish life. </p>
<p>Environmental influences such as diet around the time of conception and in pregnancy <a href="https://www.ncbi.nlm.nih.gov/pubmed/16876341">can influence</a> the health of the offspring for many years. The biological processes associated with this remain largely unclear, but epigenetic changes are suspected. </p>
<p>It’s possible that conception by assisted reproductive technology disrupts the epigenetic process, resulting in a <a href="https://academic.oup.com/humrep/article/23/12/2826/612248">greater liklihood</a> of congenital abnormalities caused by epigenetic changes.</p>
<h2>Our studies</h2>
<p>As part of a world first study, our team measured the epigenetic profile of 158 people conceived with assisted reproductive therapies and 75 people conceived without. </p>
<p>We studied two types of assisted reproductive therapies: in vitro fertilisation (IVF), where fertilisation occurs in a lab, and gamete intrafallopian transfer (GIFT), where fertilisation occurs in the woman’s fallopian tube. </p>
<p>Both techniques require ovarian stimulation – medication to stimulate the ovaries to release multiple eggs.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/290482/original/file-20190902-175678-1rkyvir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/290482/original/file-20190902-175678-1rkyvir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/290482/original/file-20190902-175678-1rkyvir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/290482/original/file-20190902-175678-1rkyvir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/290482/original/file-20190902-175678-1rkyvir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=523&fit=crop&dpr=1 754w, https://images.theconversation.com/files/290482/original/file-20190902-175678-1rkyvir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=523&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/290482/original/file-20190902-175678-1rkyvir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=523&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One in 25 Australian children are conceived using assisted reproductive technologies such as IVF.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1197127018?src=-1-30&size=huge_jpg">Trenkov/Shutterstock</a></span>
</figcaption>
</figure>
<p>With our participants’ permission, we compared their newborn heel prick blood spot, which had been routinely collected at birth, with their blood sample collected as adults, when they were aged 22 to 35 years. </p>
<h2>What we found</h2>
<p>We <a href="https://research.monash.edu/en/publications/health-of-adults-aged-22-to-35-years-conceived-by-assisted-reprod">recently published</a> an analysis of clinical assessments on these same adults, which showed no adverse health outcomes related to their growth, their risk of heart disease, diabetes, stroke or respiratory problems, and their psychological and social status. </p>
<p>In other words, their results were similar to the group conceived without assisted reproductive technologies. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/epigenetics-what-impact-does-it-have-on-our-psychology-109516">Epigenetics: what impact does it have on our psychology?</a>
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<hr>
<p>In this <a href="https://www.nature.com/articles/s41467-019-11929-9">latest research</a>, we found clear epigenetic changes in the blood samples of babies born via assisted reproductive treatments, including in several previously studied genes. </p>
<p>Reassuringly, however, the majority of this epigenetic variation was not detectable by adulthood. This suggests these differences resolve over time. </p>
<p>We also found some of these changes in newborn samples collected in a completely independent group of babies conceived via assisted reproductive technologies in America. This was done to provide confidence that the changes were real.</p>
<p>Interestingly, the changes occurred in those conceived via both IVF (in a lab) and GIFT (in the fallopian tube). </p>
<p>So it appeared that ovarian stimulation – or infertility itself – seemed to be the main driver of change in epigenetic profile, rather than the process of growing the embryo in the lab. </p>
<h2>What does it mean?</h2>
<p>This is the first study internationally to examine the epigenetic profile of people born via assisted reproductive therapies from birth through to adulthood. </p>
<p>The results suggest being conceived via assisted reproduction is not likely to influence gene activity over a person’s lifetime – any such changes associated with assisted reproduction appear to disappear over time. </p>
<p>But further studies are needed to work out when the changes begin to disappear and when they are no longer present.</p>
<p>It will also be important to understand how specific assisted reproductive technology processes, such as ovarian stimulation, impact the developing epigenetic profile.</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>
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<img src="https://counter.theconversation.com/content/122625/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Halliday receives funding from NHMRC.</span></em></p><p class="fine-print"><em><span>Boris Novakovic and Richard Saffery do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research suggests that while babies conceived via IVF experience changes to their genes, these differences disappear by adulthood.Jane Halliday, Professor and Group Leader, Reproductive Epidemiology, Murdoch Children's Research InstituteBoris Novakovic, Team Leader/Senior Research Officer, Cell Biology, Murdoch Children's Research InstituteRichard Saffery, Professor and Group Leader, Cancer and Disease Epigenetics, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1185662019-06-13T17:15:07Z2019-06-13T17:15:07ZWho’s your daddy? Don’t ask a DNA test<figure><img src="https://images.theconversation.com/files/279196/original/file-20190612-32335-l4jcax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What are the rules that make a man a father?</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/eFmLuPyzgxI">Slava Potik/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>“<a href="https://nypost.com/2017/07/23/man-ordered-to-pay-65k-in-child-support-for-kid-who-isnt-his/">Man Ordered to Pay $65K</a> in Child Support for Kid Who Isn’t His.” “<a href="https://www.news4jax.com/news/investigations/father-hopes-to-change-state-paternity-law-after-losing-custody-of-daughter">Father Hopes to Change State Paternity Law</a>” after losing custody of his biological daughter to another man. The headlines are lurid and seemingly nonsensical. How can a man bear financial responsibility for a child that is not “his”? How can he be denied legal paternity of a child whom he conceived?</p>
<p>The gist of these stories is that such outcomes are not only ludicrous but unjust. Such tales not only appear in the mainstream media but provide fodder for <a href="https://mensrights.com/texas-child-support-paternity/">men’s rights websites</a> and <a href="https://www.nj.com/news/2012/03/nj_legislator_proposes_measure.html">have even inspired bills to</a> <a href="http://www2.ljworld.com/news/2011/feb/12/bill-kansas-house-would-require-paternity-testing-/">make DNA testing mandatory at birth</a>, though none has actually become law.</p>
<p>But <a href="http://www.hup.harvard.edu/catalog.php?isbn=9780674980686">history suggests</a> such cases are not so strange. In fact, they follow from a long tradition in which paternity was a social and legal relationship, not a biological one.</p>
<p>After all, it was only in the 1980s that DNA testing emerged, with its <a href="https://www.nytimes.com/1989/07/21/us/the-law-dna-test-dooms-paternity-trials-lawyers-say.html">promise to reveal the identity of the biological father</a>. For most of human history, no such technology existed – nor was it missed. Paternity was based on presumption, deduced from social behaviors and legal conventions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/279198/original/file-20190612-32361-1gtbj17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/279198/original/file-20190612-32361-1gtbj17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/279198/original/file-20190612-32361-1gtbj17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/279198/original/file-20190612-32361-1gtbj17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/279198/original/file-20190612-32361-1gtbj17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/279198/original/file-20190612-32361-1gtbj17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/279198/original/file-20190612-32361-1gtbj17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/279198/original/file-20190612-32361-1gtbj17.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">Is a baby’s father set by social, legal, biogenetic factors… or a combination of all?</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/Mx2f4psEnvU">Minnie Zhou/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>Father, by tradition</h2>
<p>Historically, the father was defined by marriage. Pater est quem nuptiae, in the Roman formulation: The father is he whom marriage indicates, even in circumstances when, well, he could not be. The tradition carried forward over the centuries. According to 17th-century English common law, for example, if a husband was located anywhere within the “Four Seas” of the King of England at the time of his wife’s conception, he was legally presumed the father of her child.</p>
<p>As for children born out of wedlock, courts, especially those operating in the civil law tradition, <a href="https://www.dukeupress.edu/children-of-fate">deduced paternity from a man’s actions or public reputation</a>. The father was he who cohabited with the mother or kissed the baby in public, the man whom a neighbor saw paying the wet nurse. Paternity was performative.</p>
<p>Such definitions of fatherhood did not mean it was less certain or less true: It was simply that the truth of paternity was social, not physical.</p>
<p>This situation contrasted with the logic of maternity. Mater certissima est – the mother is always certain, in the Roman formulation. Maternal identity could presumably be known by the physical facts of pregnancy and birth.</p>
<h2>A more muddled modern landscape</h2>
<p>Today, according to some observers, reproductive technologies like <a href="https://heinonline.org/HOL/LandingPage?handle=hein.journals/ylr96&div=17&id=&page=">surrogacy and egg donation have disrupted the certainty</a> of the Roman dictum on maternity. After all, maternal identity is not so obvious when the gestational mother who births the child and the genetic one whose egg creates it can be two different people.</p>
<p>By contrast, <a href="https://doi.org/10.1001/jama.1983.03340180090038">DNA was supposed to make biological paternity certain</a>. And yet the older reasoning that long defined paternity as a social relationship endures.</p>
<p>Today, family law in the U.S. and elsewhere continues to <a href="https://scholarship.law.cornell.edu/cjlpp/vol14/iss1/1/">recognize nonbiological lines of reasoning</a>. A man’s behavior, intent, the nature of his relationship with the mother, stability in a preexisting parent-child relationship – all these criteria, rather than biology, may define the father. If anything, reproductive technologies like sperm donation and new family forms, like those born of the frequency of divorce, have only multiplied the scenarios in which biology may take a backseat to social criteria.</p>
<p>But in some contexts, the biological continues to prevail. This is often the case in immigration and citizenship law. Kin relations play a central role in immigration proceedings in the U.S. and other countries because <a href="https://digitalcommons.law.yale.edu/ylj/vol120/iss4/5">citizens can sponsor close relatives to immigrate</a>, and under certain circumstances refugees have a <a href="https://scholarship.law.umassd.edu/umlr/vol8/iss2/4">right to join family members</a> in their adopted country.</p>
<p>Increasingly, countries that are migration destinations use DNA to verify family relationships. In May 2019, for instance, the U.S. Department of Homeland Security began a <a href="https://www.cnn.com/2019/04/30/politics/homeland-security-dna-testing-immigration/index.html">pilot program to test Central American migrant families</a> at the southern border.</p>
<p>As critics have noted, this practice <a href="https://www.washingtonpost.com/outlook/2019/05/13/rapid-dna-promises-identify-fake-families-border-it-wont/">imposes a narrow, biological definition of family</a>. Kinship practices like adoption, stepparenthood and relationships based on a social understanding of parentage are considered perfectly legitimate when practiced by natives but are vilified as fraudulent and criminal when practiced by foreigners.</p>
<p>These apparently contradictory definitions of parentage reflect the fact that paternity’s definition varies depending on whose parentage is at stake – and how much power they hold.</p>
<p>Law and custom have always purposefully obfuscated the fatherhood of certain categories of men: the slave owner, the priest, the colonizer, the soldier. <a href="https://www.upress.virginia.edu/title/2650">Thomas Jefferson’s paternity</a> of Sally Hemings’ children was publicly obscured for two centuries. In an entirely different historical context, <a href="https://press.princeton.edu/titles/8048.html">German women after World War II</a> found it impossible to bring paternity suits against American soldiers who had fathered their children.</p>
<p>The fact that some fathers, like Jefferson and the GIs, have remained strategically uncertain suggests the very notion of paternal uncertainty is not a biological axiom but a political idea.</p>
<h2>Life’s too complicated to rely on DNA</h2>
<p>Over the last century, the distinction between legitimate and illegitimate children has <a href="https://doi.org/10.2307/838374">lost much of its social and legal significance</a> in the West. The once markedly different criteria for proving maternity versus paternity have largely, though not entirely, disappeared. Under U.S. law, children born abroad to unmarried citizen fathers <a href="http://www.slate.com/articles/news_and_politics/jurisprudence/2010/11/sexing_citizenship.html">still do not enjoy the same rights to citizenship</a> as those born to citizen mothers, for example.</p>
<p>At the same time, stratification has been reinforced in other contexts, as in the contrasting definitions of parentage among citizens and foreigners. New dynamics of discrimination have also arisen as assisted reproductive technologies and same-sex couples produce new permutations of family.</p>
<p>Take the <a href="https://www.nytimes.com/2019/05/21/us/gay-couple-children-citizenship.html">recent conundrum</a> faced by two dads and their young daughter. Both men are U.S. citizens and are legally married; their daughter was born abroad to a surrogate. Drawing on a tortured combination of both biological considerations – the fact that child was not genetically related to both parents – and social ones – nonrecognition of the couple’s marriage – the State Department denied their child U.S. citizenship. What such a case shows is not that old laws have failed to keep pace with new family forms, but how the state can generate new forms of stratification even as older ones fade.</p>
<p>With the dawn of the DNA era, many observers predicted that, by revealing the truth of paternity, <a href="https://doi.org/10.1001/jama.1983.03340180090038">genetic science would one day abolish ambiguity</a> and deliver equality and justice. Today science can indeed find a father, but its impact has been rather more complex than once anticipated. Instead of sweeping away older social and legal definitions with a new biogenetic one, it has actually heightened the tensions between different ways of defining paternity. </p>
<p>Who’s your daddy? Perhaps science isn’t best positioned to answer, because this question arises from society, not nature. It might not be the right question anyway. A better one is, what does society want a father to be?</p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklysmart">You can get our highlights each weekend</a>.]</p>
<p><strong>Editors Note: A picture was been removed from this article after a request from the photographer</strong></p><img src="https://counter.theconversation.com/content/118566/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nara Milanich has received funding from American Council of Learned Societies (ACLS).</span></em></p>Before the advent of genetic testing, definitions of paternity were primarily social and legal. Science has destabilized these older definitions, but it has not replaced them.Nara Milanich, Professor of History, Barnard CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1138172019-03-21T18:04:02Z2019-03-21T18:04:02ZA new procedure may preserve fertility in kids with cancer after chemo or radiation<figure><img src="https://images.theconversation.com/files/265022/original/file-20190321-93028-tlxss5.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C788%2C592&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A 12-week-old baby female macaque, named Grady, was born from frozen testicular tissue. </span> <span class="attribution"><span class="source">Oregon Health and Science University</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Cancer in children was often a death sentence in decades past, but new therapies are saving lives. Many of these treatments such as chemotherapy and radiation, however, make children infertile. Now, new research is showing one strategy to preserve their fertility so that someday they can have their own biological children.</p>
<p>Many childhood cancer survivors have remained beyond the reach of current assisted reproductive technologies because they are not able to produce mature sperm or eggs. Adult patients have the option to freeze eggs or sperm before treatment and use those samples in the future to achieve pregnancy using assisted reproductive technologies. Unfortunately, those options are not available to children who are not yet able to produce mature eggs or sperm.</p>
<p>Now <a href="http://orwiglab.org.s104505.gridserver.com/lab-members/kyle-orwig/">I</a> and my colleagues in <a href="http://orwiglab.org">the Orwig lab</a> at the Magee-Womens Research Institute of the University of Pittsburgh Medical Cancer have developed a next-generation reproductive technology by figuring out <a href="http://science.sciencemag.org/cgi/doi/10.1126/science.aav2914">how to preserve fertility in pediatric cancer patients</a> who might face infertility after chemotherapy or radiation.</p>
<h2>Pediatric cancer therapies</h2>
<p>About <a href="https://curesearch.org/Childhood-Cancer-Statistics">40,000 kids undergo cancer treatments</a> each year, and 80 percent of children will survive and can look forward to a full and productive life. The bad news is that treatment comes at a cost: About 30 percent of adult survivors of these childhood cancers discover that their lifesaving cancer treatment had an unintended side effect – infertility. Cancer survivors report that fertility is important to them, and while adoption or other family building options are available, those options are not always accessible or desired. </p>
<p>In our current study, we used a juvenile male macaque to test whether it was possible to collect and then freeze immature testicular tissues – which produce mature sperm only after puberty. </p>
<p>We began our experiment by surgically removing this tissue from macaques, which we immediately froze. As the animals neared puberty, the testicular tissue was thawed and grafted just under the skin of the same monkey’s back or scrotum. </p>
<p>The grafts matured during the next several months under the influence of pubertal hormones from the brain. The grafts grew and produced testosterone, which is required for sperm production. We retrieved the testicular tissues eight to 12 months after the grafting procedure, dissected it and discovered that all of the grafted tissue produced mature sperm. </p>
<p>My team then collected this sperm and sent it to our collaborators in the <a href="https://www.ohsu.edu/xd/research/centers-institutes/onprc/research-services/research-support/art-esc.cfm">Assisted Reproductive Technology Core of the Oregon National Primate Research Center</a> at the Oregon Health and Science University, who injected it into an egg from a female macaque – a procedure called <a href="https://www.cdc.gov/art/key-findings/icsi.html">intracytoplasmic sperm injection</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/265043/original/file-20190321-93044-1o3ckd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/265043/original/file-20190321-93044-1o3ckd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=278&fit=crop&dpr=1 600w, https://images.theconversation.com/files/265043/original/file-20190321-93044-1o3ckd9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=278&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/265043/original/file-20190321-93044-1o3ckd9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=278&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/265043/original/file-20190321-93044-1o3ckd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=349&fit=crop&dpr=1 754w, https://images.theconversation.com/files/265043/original/file-20190321-93044-1o3ckd9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=349&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/265043/original/file-20190321-93044-1o3ckd9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=349&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">In the intracytoplasmic sperm injection process, a single sperm is injected directly into an egg. This is how the team at the Oregon Health Sciences University created Grady.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendering-icsi-intracytoplasmic-sperm-injection-745613476">medistock/Shutterstock.com</a></span>
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<p>We then checked the eggs to see which ones were successfully fertilized by the sperm. Eleven of the resulting embryos were transferred into six surrogate female macaques, resulting in one pregnancy that produced a healthy baby girl that we named Grady, which stands for graft-derived baby. </p>
<p>This is the first study to prove that sperm from frozen and thawed primate testicular tissue grafts were able to fertilize eggs and produce a healthy baby. </p>
<h2>Implications for the human fertility clinic</h2>
<p>The freezing and thawing aspect is important because a prepubertal cancer patient may need to keep their testicular or ovarian tissue in frozen storage for years or even decades before they need them for reproductive purposes. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/265040/original/file-20190321-93032-uh3ayv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/265040/original/file-20190321-93032-uh3ayv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/265040/original/file-20190321-93032-uh3ayv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=874&fit=crop&dpr=1 600w, https://images.theconversation.com/files/265040/original/file-20190321-93032-uh3ayv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=874&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/265040/original/file-20190321-93032-uh3ayv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=874&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/265040/original/file-20190321-93032-uh3ayv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1098&fit=crop&dpr=1 754w, https://images.theconversation.com/files/265040/original/file-20190321-93032-uh3ayv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1098&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/265040/original/file-20190321-93032-uh3ayv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1098&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">Grady, here at 11 months, was born from frozen testicular tissue.</span>
<span class="attribution"><span class="source">Oregon Health and Science University</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>Combined with nearly two decades of work by other researchers in <a href="http://doi.org/10.1038/nature00918">mice</a>, <a href="https://doi.org/10.1371/journal.pone.0070989">pig</a> and <a href="http://doi.org/10.1095/biolreprod.103.025536">monkey</a> models, we believe that <a href="http://science.sciencemag.org/cgi/doi/10.1126/science.aav2914">our results provide important preclinical safety and feasibility</a> data to justify translating this technique to the human fertility clinic in the next two to five years. </p>
<p>I believe we owe this to our patients who have already accepted the risk of testicular biopsy surgery and trusted us to develop next-generation reproductive therapies.</p>
<p>Academic centers around the world, including the <a href="https://mageewomens.org/research/research-centers/fertility-preservation-program/">Fertility Preservation Program of UPMC</a>, are freezing testicular tissues for boys and ovarian tissues for girls in anticipation that those tissues can be matured in the future to produce sperm or eggs and biological offspring. </p>
<p>There is one documented case of an adult survivor of a childhood cancer who had a <a href="http://doi.org/10.1093/humrep/dev128">baby after her frozen ovarian tissues were transplanted</a> back into her body. There are no documented births from frozen testicular tissues. Our group has been <a href="https://fertilitypreservationpittsburgh.org/">freezing testicular tissue for boys and ovarian tissues for girls</a> since 2011 and has preserved tissues for nearly 250 patients (206 testicular tissues and 41 ovarian tissues). </p>
<p>Therefore, <a href="http://orwiglab.org/">our laboratory</a> is committed to responsibly developing the next generation of assisted reproductive technologies that will allow our patients to use their tissues to achieve their reproductive goals. </p>
<p>All patients should be informed about the reproductive side effects of their medical treatments and about <a href="https://fertilitypreservationpittsburgh.org/">options to preserve their fertility</a> immediately at the time of diagnosis. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/C_F5awyrums?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Kyle Orwig describes how this team harvested tissue, froze and thawed it, and used it to produce mature sperm that successfully fertilized an egg.</span></figcaption>
</figure><img src="https://counter.theconversation.com/content/113817/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kyle Orwig receives funding from the Eunice Kennedy Shriver National Institute for Child Health and Human Development.</span></em></p>Children with cancer not only endure chemotherapy or radiation treatment but they may also face infertility in adulthood. Now a new procedure, just proven in monkeys, may be close to use in humans.Kyle Orwig, Professor of OB/GYN and Reproductive Sciences, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1076932018-11-27T00:14:44Z2018-11-27T00:14:44ZResearcher claims CRISPR-edited twins are born. How will science respond?<figure><img src="https://images.theconversation.com/files/247388/original/file-20181126-140507-159c1qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Chinese scientist He Jiankui of Shenzhen claims he helped make the world’s first genetically edited babies.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/compilation-six-ultrasound-scans-baby-twins-326022782?src=bE9JQBLryIVJYlvmSM1tLg-1-3">from www.shutterstock.com </a></span></figcaption></figure><p>Gene editing technology is revolutionising biology – and now twin human baby girls <a href="https://www.apnews.com/4997bb7aa36c45449b488e19ac83e86d">may be a living part of this story</a>. </p>
<p>Today several media outlets <a href="https://www.nature.com/articles/d41586-018-07545-0">report</a> that a team of scientists in China has <a href="https://www.technologyreview.com/s/612458/exclusive-chinese-scientists-are-creating-crispr-babies/">used CRISPR</a> to modify the DNA of healthy human embryos to genetically “vaccinate” against HIV infection.</p>
<p>This is the first reported case of humans born with CRISPR-modifed DNA. </p>
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Read more:
<a href="https://theconversation.com/what-is-crispr-gene-editing-and-how-does-it-work-84591">What is CRISPR gene editing, and how does it work?</a>
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<p>The molecular scissors known as CRISPR (<a href="https://theconversation.com/what-is-crispr-gene-editing-and-how-does-it-work-84591">CRISPR/cas9</a> in full) allow scientists to modify DNA with high precision and greater ease than previous technologies. There are high hopes these molecular scissors may aid in curing diseases such as <a href="http://stm.sciencemag.org/content/10/449/eaao3240">cancer</a> or <a href="https://www.nature.com/articles/nature25164">other conditions</a> – but scientists around the world had agreed careful regulation was required before the technology was used in humans. </p>
<p>Now with this news, all eyes will be on the <a href="http://www.nationalacademies.org/gene-editing/2nd_summit/index.htm">Second International Summit on Human Genome Editing</a> taking place this week in Hong Kong. This meeting will hopefully lead to a renewed consensus for tighter control of CRISPR editing in human embryos.</p>
<h2>How has the babies’ genome been modified?</h2>
<p>According to <a href="https://www.technologyreview.com/s/612458/exclusive-chinese-scientists-are-creating-crispr-babies/">several reports</a>, researchers at the Southern University of Science and Technology in Shenzhen (China) have created the first gene-edited babies. </p>
<p>It’s important to note here the science has not been posted on a preprint server or published in a peer-reviewed journal – the usual standard applied to confirm new research is valid and ethically sound. However, Chinese medical documents posted online <a href="http://www.chictr.org.cn/showprojen.aspx?proj=32758">support the notion that a trial had been set up</a>, and the lead scientist involved (He Jiankui) has made a video statement. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/th0vnOmFltc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Scientist He Jiankui of Shenzhen says he said he has altered DNA in human embryos, and that healthy twin girls are now at home with their parents.</span></figcaption>
</figure>
<p>In China the prevalence of HIV infection is high, and access to health care a serious public health concern. According to the <a href="http://www.chictr.org.cn/showprojen.aspx?proj=32758">medical document published online</a>, the study recruited HIV-positive men with HIV-negative female partners, and who were willing to participate in an IVF program and allow embryos to be edited with CRISPR. </p>
<p>The team led by Jiankui He focused on removing a gene called CCR5, critical for the HIV virus to enter into the cells. The goal was to genetically “vaccinate” the babies against HIV infection. They modified the DNA of the embryos, verified the molecular scissors were truly on target and implanted edited embryos in the mother’s body. </p>
<p>Reports indicate that gene-edited <a href="https://www.apnews.com/4997bb7aa36c45449b488e19ac83e86d">twin girls have now been born</a>. In one of the twins both copies of the CCR5 gene are said to be modified, and for the other one only one copy is modified.</p>
<p>We have little to no details on how this was performed and we must take these reports with a lot of caution.</p>
<h2>Serious ethical concerns</h2>
<p>CRISPR is easier to use and more precise than previous methods, but it is not a perfect technology. It can lead to unintended consequences, such as affecting other genes (“off-target” effects) or making multiple modifications of the gene we are aiming to modify (“on-target” effects). There is an <a href="https://theconversation.com/crispr-cas9-gene-editing-scissors-are-less-accurate-than-we-thought-but-there-are-fixes-100007">ongoing discussion as to how widespread “off target” and “on-targets” modifications</a> are, and what the unintended consequences of these effects may be.</p>
<p>Modifying embryos may have lasting consequences: not only would affected children have had their genome modified, but their future offspring could also carry these genetic modifications. To date we do not know what the long term effects of CRISPR-modification of human DNA are.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/worlds-first-gene-edited-babies-premature-dangerous-and-irresponsible-107642">World's first gene-edited babies? Premature, dangerous and irresponsible</a>
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</em>
</p>
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<p>Given the massive, multi-generational implications of editing embryos, we argue it should only be considered in cases where the modification would cure an existing disease and for which no other, lower-risk solution is available and when potential side effects are known.</p>
<p>Controversially, in the study being discussed, the edit does not cure a pre-existing disease, and we already have existing alternatives to prevent HIV infection and limit its clinical progression to AIDS. </p>
<p>The reports fall in the grey area between attempts to cure diseases, and the dreaded “<a href="https://www.theguardian.com/science/2017/jan/08/designer-babies-ethical-horror-waiting-to-happen">designer baby</a>” scenario, where humans could be modified for benefits unrelated to health (potentially expanding to include intelligence, aesthetics and more).</p>
<h2>An important, broader discussion is taking place</h2>
<p>As soon as CRIPSR technology was widely available, it was a matter of when, rather than if, it would be used on humans. The <a href="https://link.springer.com/article/10.1007/s13238-015-0153-5">first modification of human embryos</a> was reported by another Chinese team in May 2015. Those embryos were not viable, but it sparked an intense debate about the ethics of such modifications.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/human-embryo-crispr-advances-science-but-lets-focus-on-ethics-not-world-firsts-81956">Human embryo CRISPR advances science but let's focus on ethics, not world firsts</a>
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<p>This led to the the Chinese Academy of Sciences (CAS), the Royal Society (RS), and the U.S. National Academy of Sciences (NAS) and U.S. National Academy of Medicine (NAM) coming together to organise an International Summit on Human Gene Editing in December 2015 in Washington, DC.</p>
<p>Editing human embryos was the topic discussed at that meeting. At the time, <a href="http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12032015a">a published conclusion stated</a> that: </p>
<blockquote>
<p>it would be irresponsible to proceed with any clinical use of human embryos editing unless and until (i) the relevant safety and efficacy issues have been resolved, based on appropriate understanding and balancing of risks, potential benefits, and alternatives, and (ii) there is broad societal consensus about the appropriateness of the proposed application.</p>
</blockquote>
<p>The committee also noted: </p>
<blockquote>
<p>these criteria have not been met for any proposed clinical use: the safety issues have not yet been adequately explored; the cases of most compelling benefit are limited.</p>
</blockquote>
<p>CRISPR pioneers Jennifer Doudna and Emmanuelle Charpentier rightly noted <a href="http://science.sciencemag.org/content/346/6213/1258096">the need for a rational public discourse</a> on the use of the technology. However, this rational debate can only take place if all scientists play their part and ensure that all experiments are done in the public interest. </p>
<p>In Australia human embryo editing for reproductive purpose <a href="https://nhmrc.gov.au/about-us/publications/embryo-research-licensing-key-terms">is strictly prohibited</a>.</p>
<h2>A race for attention</h2>
<p>Based on the information currently available, it is difficult not to consider this latest experiment as anything but an attempt to win a “race” and grab attention. </p>
<p>The Southern University of Science and Technology has now <a href="https://www.sustc.edu.cn/news_events_/5524">released a statement</a> that it gave no permission to Jiankui He for his experiment, that he has been on leave since February, and that they believe the experiment violates academic ethics and academic norms. </p>
<p>Rice University has also <a href="https://www.statnews.com/2018/11/26/rice-university-opens-investigation-into-researcher-who-worked-on-crisprd-baby-project/">opened an investigation</a> into Michael Deem (a bioengineering professor at Rice and previous supervisor of He) and his possible role in the study.</p>
<p>Whether He’s claims are true or not, this whole situation is a disservice to the entire field of research, and to potential future recipients of CRISPR-based therapies.</p><img src="https://counter.theconversation.com/content/107693/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dimitri Perrin receives funding from the Australian Research Council (ARC).</span></em></p><p class="fine-print"><em><span>Gaetan Burgio receives funding from the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), the National Collaborative Research Infrastructure Strategy (NCRIS) via the Australian Phenomics Network (APN) and the Natural Science Foundation in China (NSFC).</span></em></p>We don’t know anything about the health of the baby girls who are reported to have been born. But it’s clear scientists around the world are shocked.Dimitri Perrin, Senior Lecturer, Queensland University of TechnologyGaetan Burgio, Geneticist and Group Leader, The John Curtin School of Medical Research, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1047542018-11-07T21:53:18Z2018-11-07T21:53:18ZMeet the men who donate sperm on Facebook<figure><img src="https://images.theconversation.com/files/244171/original/file-20181106-74757-6gnjp0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While media portrayals of online sperm donation often portray "rogue breeders" or "super sperm," research reveals that the real men who do this are motivated to help others. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>George (not his real name) is 24 and single. In the past four years, he has helped three couples get pregnant. The first couple had two sons. The second couple had a girl. And the third couple just found out they are expecting. A participant in my research, he said: </p>
<blockquote>
<p>“I’m making a huge impact on these people’s lives. Why not keep helping them out?”</p>
</blockquote>
<p>Like George, an increasing number of men are going online to make arrangements to donate sperm through Facebook or connection websites. <a href="https://doi.org/10.3109/14647273.2014.881561">Online sperm donation</a> gives donors ultimate freedom in selecting who they will help, engaging with the recipients and negotiating the terms and conditions of the donation.</p>
<p>Just as Uber transformed the taxi business and Airbnb shook up the hotel world, online sperm donation is the sperm bank, reinvented. Yet, as more people turn to the accessibility and convenience of online sperm donation, surprisingly little is known about the men who donate.</p>
<p>Media portrayals of online sperm donation are often coloured by fiery references to <a href="http://nymag.com/news/features/trent-arsenault-2012-2/">dangerous rogue breeders</a>, <a href="https://www.mirror.co.uk/news/us-news/sperm-donor-who-advertises-facebook-12889072">“super” seed</a> and <a href="https://abovethelaw.com/2016/09/i-want-to-put-a-baby-in-you-extreme-sperm-donation/">sperm donation scandals</a>, highlighting dramatic cases that would be well-suited for reality TV programs.</p>
<p>Certainly, the potential risks of online sperm donation — like any online activity — should not be understated. However, a more balanced perspective of online sperm donation is important to better understand the practice and its implications for the men, women and children who are part of it. </p>
<p>To address this need, I developed a research project with fellow PhD candidate Celine Delacroix as part of our doctoral program at the University of Ottawa. The results are <a href="https://doi.org/10.1080/09581596.2018.1492704">published in the journal <em>Critical Public Health</em></a>. </p>
<h2>A way to help others</h2>
<p>We gathered the stories of six men who participate in online sperm donation. In a Skype interview lasting 45 to 75 minutes, we discussed their expectations, motivations and experiences as donors. </p>
<p>The men, aged 24 to 67, were from Australia, Canada, England, France, the Netherlands and the United States. The details of their experiences of donating sperm were unique and personal. However, certain common themes emerged.</p>
<p>Overwhelmingly, the men in our study viewed sperm donation as a way to help others.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/244172/original/file-20181106-74760-1lfhjba.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/244172/original/file-20181106-74760-1lfhjba.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/244172/original/file-20181106-74760-1lfhjba.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/244172/original/file-20181106-74760-1lfhjba.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/244172/original/file-20181106-74760-1lfhjba.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/244172/original/file-20181106-74760-1lfhjba.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/244172/original/file-20181106-74760-1lfhjba.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">Each of the men in this research study had at least two donor children; one had up to 1,000 children.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>George is on a break from college and works a job at a warehouse. He hopes to eventually transition to another line of work that involves helping people. But for now, he’s making an impact during his off hours, meeting potential parents online and helping them conceive.</p>
<p>The online forum gave sperm donors a sense of control over the process. This enabled the donor to make the experience personal and meaningful.</p>
<p>Simon Watson, a donor from England, said: </p>
<blockquote>
<p>“When you help people privately it makes you feel like a person. You talk to someone on the phone and then you meet up.”</p>
</blockquote>
<p>Alex (not his real name) first began donating sperm about five years ago to help lesbian couples in Europe who were barred from accessing sperm banks. </p>
<blockquote>
<p>“At that time lesbians were somewhat marginalized… they didn’t have the right to get married and they didn’t have the right to access IVF (in vitro fertilization).”</p>
</blockquote>
<h2>Up to 1,000 donor children</h2>
<p>Procreation was a meaningful part of why men chose to donate sperm.</p>
<p>The men in our study each had at least two donor children. Simon Watson, who viewed donating sperm as a job, estimated that he had 500 to 1,000 donor children. </p>
<p>Donors like George saw sperm donation as a sort of plan B: It satisfied his urge to reproduce without the responsibilities of being a parent.</p>
<p>The men spoke about their involvement in decisions surrounding insemination.</p>
<p>Insemination occurs either naturally (through sexual intercourse) or artificially (using some variation of a cup and syringe). The men acknowledged that donors who advertise a preference for natural insemination were often viewed as predatory. For this reason, they all preferred the artificial method.</p>
<p>Men had complex and sometimes unresolved feelings about their attachment to their donor children. Alex said:</p>
<blockquote>
<p>“Even though I don’t consider myself their father I do consider that there’s a little part of me, and a little part of my family out there.”</p>
</blockquote>
<h2>Risk of disapproval</h2>
<p>Men accepted some risks in choosing to participate in online sperm donation. They had personal costs and inconveniences, for example, when meeting with the recipients. Men spoke about risking disapproval from others, including their family.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/244173/original/file-20181106-74760-tz7u5j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/244173/original/file-20181106-74760-tz7u5j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/244173/original/file-20181106-74760-tz7u5j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/244173/original/file-20181106-74760-tz7u5j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/244173/original/file-20181106-74760-tz7u5j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/244173/original/file-20181106-74760-tz7u5j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/244173/original/file-20181106-74760-tz7u5j.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">All of the men interviewed preferred artificial insemination, to avoid being viewed as predatory.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Traditional sperm banks have strict requirements and protocols for donors, but online sperm donation is difficult to regulate and track, especially when donations occur across international borders. </p>
<p><a href="https://doi.org/10.1016/j.rbms.2017.02.001">Unclear or conflicting legal environments</a> may provide online sperm donors with a layer of protection. The men in our study said they were not concerned about the legal implications of donating sperm informally.</p>
<p>As societies bid farewell to the traditional sperm bank and increasingly turn online to find “the one,” we are confronted with important questions about the future of assisted reproduction and how to best protect the interests of everyone involved. </p>
<p>Moving forward, let’s be sure the answers to these questions reflect the many stories and experiences of online sperm donation.</p><img src="https://counter.theconversation.com/content/104754/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Bergen 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>Sperm donation websites are the Ubers and Airbnbs of the fertility world. But why are they so popular? New research explains the reasons why some men donate.Nicole Bergen, PhD Candidate, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/994852018-07-25T10:37:23Z2018-07-25T10:37:23Z40 years after the birth of IVF, researchers push boundaries to preserve fertility in women, men and children<figure><img src="https://images.theconversation.com/files/228910/original/file-20180723-189310-2w8wfl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New procedures are enabling men and women to preserve their fertility until they are ready or able to have children.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-feet-mother-hands-mom-her-1136185604?src=q7zw41WslLC8iOnEF9-gBw-1-1">By kristiillustra/shutterstock.com</a></span></figcaption></figure><p>Tears are a regular occurrence in a fertility clinic. Tears of joy, tears of frustration, tears of loss happen almost daily. For some, those tears are the tears of “what if.” What if I had tried to get pregnant sooner? What if I had known then what I know now? </p>
<p>Hope is the incredible gift that <a href="https://doi.org/10.1016/S0140-6736(83)91148-0">Robert Edwards and Patrick Steptoe, the pioneers who made in vitro fertilization (IVF) possible</a>, gave to the generations that followed them. They continued experiments, even though society feared that “test-tube babies” pushed past boundaries never meant to be crossed.</p>
<p>Now 40 years after Louise Brown, the first child born through IVF (where the egg is fertilized with sperm in the laboratory instead of the body), this gift affects millions. The astonishing breakthrough has gone beyond initial, seemingly insurmountable steps and moved into realms that include routine egg and embryo freezing for patients uncertain if they are ready to pursue childbearing. Even further, we as a society are now entering frontiers that include experimental fertility preservation for prepubescent girls and boys through freezing ovarian and testicular tissue. These methods, like those of Edwards and Steptoe 40 years ago, hold a promise for generations for the future.</p>
<p>However, with this hope comes fear and anxiety. Patients may fear that this is the last time to try, that it will not work, or that someone or something will make a mistake or interfere at the last minute. For society, many wonder if new technologies are pushing us too far as we again explore how far people should push past our natural boundaries. </p>
<p>I am a reproductive endocrinologist at <a href="http://www.upmc.com/locations/hospitals/Magee/Pages/default.aspx">UPMC Magee-Womens Hospital</a> and the University of Pittsburgh. Here at our institution, we are dedicated to seeking innovative ways to preserve fertility. Our patients range from those about to undergo cancer therapies that may harm their reproductive potential to transgender patients ambivalent regarding their desire to conceive with their own sperm and eggs. They are faced with this decision at far earlier age than most of us would ever contemplate. </p>
<h2>The science and art of preserving fertility</h2>
<p>My own research focus has been improvement of access to care for these patients, and I am humbled by the methods we have available and in development. As we continue to bridge the gap in experimental models, we are seeking to improve methods for ovarian transplant in patients who are ready to attempt pregnancy with previously preserved ovarian tissue. At the Magee-Womens Research Institute, we have scientists and clinicians work relentlessly to improve access to ovarian transplant as well as develop ways for boys and men with frozen testicular tissue to achieve their reproductive potential. The world of reproduction is an exciting and ever growing field.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/229111/original/file-20180724-194155-1y7e1ge.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/229111/original/file-20180724-194155-1y7e1ge.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/229111/original/file-20180724-194155-1y7e1ge.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/229111/original/file-20180724-194155-1y7e1ge.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/229111/original/file-20180724-194155-1y7e1ge.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/229111/original/file-20180724-194155-1y7e1ge.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/229111/original/file-20180724-194155-1y7e1ge.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In vitro fertilization: An egg is collected from the donor and fertilized with a single sperm and allowed to grow in a Petri dish. The embryo is then implanted into the mother.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Blausen_0060_AssistedReproductiveTechnology.png">Blausen.com staff (2014). Medical gallery of Blausen Medical 2014.</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Fertility preservation is a powerful example of how hope does not have to be blind. Although made widely accessible through IVF technology, research in fertility preservation began early as the 1600s, when <a href="https://www.newscientist.com/article/mg16622344-600-in-from-the-cold/">Dr. Harry Brown first placed a jar of vinegar eels</a> outside his window and thawed them the next day only to discover they were still alive. In the 1940s, investigators <a href="http://doi.org/10.1038/164666a0">discovered that compounds called cryoprotectants</a> could be used to freeze sperm. In the 1950s, the first baby was born after conception with <a href="http://doi.org/10.3390/jcm6090089">frozen sperm</a>.</p>
<p>The reproductive field subsequently exploded. Babies were born after conception from sperm extraction from the human body and births following conception from frozen embryos and frozen eggs were reported in the 1980s, soon after Louise Brown. Now both men and women had options for preserving their fertility. The experimental label was removed from egg freezing in 2013 and now women routinely wonder, “Should I freeze my eggs?” </p>
<h2>It’s all about having the choice</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/229092/original/file-20180724-194128-1pau81o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/229092/original/file-20180724-194128-1pau81o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/229092/original/file-20180724-194128-1pau81o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/229092/original/file-20180724-194128-1pau81o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/229092/original/file-20180724-194128-1pau81o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/229092/original/file-20180724-194128-1pau81o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/229092/original/file-20180724-194128-1pau81o.jpg?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">For many couples just knowing their options for family planning make all the difference.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-psychologist-patient-couple-consulting-on-1140431531?src=VUQgHETnUQpK6lBYkHK_Sg-1-0">By Chinnapong/shutterstock.com</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>The answer is deeply personal. Although no longer experimental, egg freezing is not currently indicated for elective use. While some insurance companies or employers may cover the significant costs associated with the process, the likelihood is much less than that of, for example, in vitro fertilization for infertility. That said, age-associated fertility decline is a real phenomena and the number of women in the U.S. delaying the age of first birth is steadily increasing. Since women are born with all the eggs they will ever have, age-associated fertility decline is a steady process that accelerates in a woman’s 30s. What should you do? </p>
<p>For those with a medical condition that will result in a high probability of loss of fertility, the answer is also not simple. Although males may produce a specimen, the urgency of that person’s chemotherapy may still dictate the number of attempts. Even without this urgency males facing therapy toxic to reproduction will still need to ask, “How many times should I try to freeze sperm before I start my chemotherapy?” For women, the question includes the need to delay medical therapy, e.g. chemotherapy or surgery, by approximately two weeks for hormonal treatment and the possibility that the treatment itself may cause risk. </p>
<p>None of these decisions are easy, but all still give hope and choice. For some, this is all that is necessary. Women who I see at Magee-Womens Hospital do frequently elect not to preserve eggs or embryos, but most are glad for the opportunity to discuss the option. Males may freeze several samples, but then subsequently discard them when the post-therapy analysis shows no effect on their semen parameters. Fertility preservation through these methods, and the hope they bring, are now a common, accepted practice. </p>
<h2>Preserving the fertility of sick children</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/229118/original/file-20180724-194137-1wviddi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/229118/original/file-20180724-194137-1wviddi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/229118/original/file-20180724-194137-1wviddi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/229118/original/file-20180724-194137-1wviddi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/229118/original/file-20180724-194137-1wviddi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/229118/original/file-20180724-194137-1wviddi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/229118/original/file-20180724-194137-1wviddi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Talia Pisano stands in her bed at Lurie Children’s Hospital in Chicago, where she is receiving tough treatment for kidney cancer that spread to her brain. Researchers are trying use experimental methods like removing and freezing immature ovary and testes tissue so that she and children like her have a chance at having babies of their own someday.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/APTOPIX-Children-Cancer-Fertility/06a72c4097694b8fae2c17daa822dcd4/113/0">Christian K. Lee/AP Photo</a></span>
</figcaption>
</figure>
<p>We fertility researchers still have challenges in front of us. Experimental options, such as ovarian tissue or testicular tissue preservation, are performed at academic centers such as Magee-Womens Hospital for those who can not use conventional technology. These are almost exclusively for patients with a medical reason to suspect their future fertility is in jeopardy. Pre-pubertal males who might face loss of future reproductive function due to planned chemotherapy might seek testicular tissue freezing as their only option. </p>
<p>For a 10-year-old child with lymphoma, the decision to freeze tissue for the possibility future children of his or her own is almost inconceivable. Although no births have resulted from testicular cryopreservation, current research by pioneers such as <a href="https://mageewomens.org/investigator/kyle-orwig-phd/">Dr. Kyle Orwig</a> at the Magee-Womens Research Institute works on multiple potential methods ranging from transplant to use of <a href="http://doi.org/10.1016/j.fertnstert.2013.10.052">stem cells to restore a patient’s fertility</a> in the future. </p>
<p>For women who cannot go through the hormonal process to stimulate the production of eggs for freezing, freezing ovarian tissue is possible. Although ovarian tissue cryopreservation is still experimental, the first live birth from ovarian tissue transplant was reported in 2004. Once we see enough healthy children born after this procedure, the experimental label will likely be removed. </p>
<p>However, when women suffer from ovarian cancer or another cancer spreads to the ovaries, there are concerns that transplanting frozen tissue could reseed the malignancy back in the patient. Women with ovarian cancers are often not candidates for transplant. These patients still wait and hope that fertility preservation will overcome this next hurdle. </p>
<p>Four decades after the birth of Louise Brown through IVF, we have an opportunity to focus again on hope. Although the spotlight has recently shined on genetic manipulation of embryos, using CRISPR, and the ethical fears and concerns, we should pay equal attention to the work of researchers who are currently striving to preserve fertility for those who might otherwise lack this option. My research is primarily focused on access to care and approaches that work best for patients with less traditional reasons for seeking fertility preservation, e.g. transgender patients. We have found that a multi-disciplinary approach that builds in time to absorb the overwhelming amount of information we provide to patients works best for both short- and long-term care.</p>
<p>As a society we have, by and large, accepted that this important work provides advancement in a positive direction. A gift that keeps giving, the research of Edwards and Steptoe has set the bar high for persevering to develop options for patients who otherwise might lack choices.</p><img src="https://counter.theconversation.com/content/99485/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marie Menke has received funding from the NIH</span></em></p>For women and men not ready to have children, there are new ways to preserve fertility. And experimental techniques offer hope for sick children whose treatments jeopardize future childbearing.Marie Menke, Assistant Professor of Obstetrics, Gynecology & Reproductive Sciences, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/995892018-07-10T20:02:40Z2018-07-10T20:02:40ZInformed consent, individual care vital to ensure reproductive rights of transgender Australians<figure><img src="https://images.theconversation.com/files/226882/original/file-20180710-70054-47a28u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's hard to plan for future fertility. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/diverse-group-people-hands-together-partnership-620220920">from www.shutterstock.com </a></span></figcaption></figure><p>For any person needing medical care, informed consent is vital. Yet for transgender people, informed consent may be hindered by how medical professionals share information. This is especially the case in the context of reproductive health, where speaking about reproductive materials is often highly gendered. </p>
<p>Both the World Professional Association for Transgender Health <a href="https://www.wpath.org/publications/soc">Standards of Care</a> and the Royal Children’s Hospital’s <a href="https://www.rch.org.au/uploadedFiles/Main/Content/adolescent-medicine/australian-standards-of-care-and-treatment-guidelines-for-trans-and-gender-diverse-children-and-adolescents.pdf">Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents</a> emphasise the importance of discussing fertility preservation as an option for transgender people. </p>
<p>Yet little guidance is given on how to do so in ways that are inclusive. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rethinking-how-we-represent-transgender-children-in-the-media-63722">Rethinking how we represent transgender children in the media</a>
</strong>
</em>
</p>
<hr>
<h2>Barriers to informed consent</h2>
<p>How medical professionals share information about fertility preservation can be distressing for some transgender people. This is because the terms typically used may be seen as referencing gender. </p>
<p>Sperm are typically associated with men. Eggs are typically associated with women. For women who produce sperm, or men who produce eggs, these terms can be distressing. Such distress can mean disengagement from information.</p>
<p>Further compounding issues of terminology are assumptions about people’s desire to reproduce. In countries such as Australia, <a href="https://theconversation.com/what-the-baby-bonus-boost-looks-like-across-ten-years-81563">population growth is considered important</a>. This places an expectation on all people to reproduce. This is especially true for people who are assigned female at birth. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/227059/original/file-20180711-70042-fdyzy2.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/227059/original/file-20180711-70042-fdyzy2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/227059/original/file-20180711-70042-fdyzy2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=479&fit=crop&dpr=1 600w, https://images.theconversation.com/files/227059/original/file-20180711-70042-fdyzy2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=479&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/227059/original/file-20180711-70042-fdyzy2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=479&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/227059/original/file-20180711-70042-fdyzy2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=602&fit=crop&dpr=1 754w, https://images.theconversation.com/files/227059/original/file-20180711-70042-fdyzy2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=602&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/227059/original/file-20180711-70042-fdyzy2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=602&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Role of professionals in fertility discussions.</span>
<span class="attribution"><span class="source">Damien Riggs</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>As a result, transgender men in particular may feel pressured to preserve their fertility. In our <a href="https://twitter.com/DrDamienRiggs/status/985673090964140032">recent study</a> of Australian transgender and non-binary people and fertility preservation, some of our trans masculine participants reported they had been told, in essence, that “if you have a uterus, you should want to use it”. </p>
<p>Certainly <a href="https://transpregnancy.leeds.ac.uk">growing numbers of transgender men are bearing children</a>. It is heartening that <a href="http://www.starobserver.com.au/news/national-news/50-men-australia-given-birth/159965">Medicare now treats pregnancy and birth-related items as non-gender-specific</a>. But this does not mean that all men want to bear children, nor that they should be expected to do so. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/commercial-surrogacy-in-australia-rethinking-notions-of-natural-31423">Commercial surrogacy in Australia: rethinking notions of 'natural'</a>
</strong>
</em>
</p>
<hr>
<p>Some of our participants also reported that medical professionals <a href="https://twitter.com/DrDamienRiggs/status/1004150882282323968">insisted they preserve their fertility</a>. This was an especially concerning form of gatekeeping. Gatekeeping occurs when access to medical care is restricted to transgender people who conform to a standard narrative of what it means to be transgender.</p>
<h2>Facilitating informed consent</h2>
<p>In our work on sexuality education for transgender young people, we highlighted <a href="https://www.theaustralian.com.au/news/nation/call-to-strip-gender-talk-from-sexed-classes/news-story/6605824c8c957ab087889a2178f80707">the importance of gender-neutral language</a>. We suggested that speaking about <a href="https://www.britannica.com/science/gamete">gametes</a>, rather than sperm and eggs, is one way of ensuring that transgender young people do not experience distress. This does not prevent making distinctions between different types of gametes, and how they come together in the process of conception.</p>
<p>In the context of fertility preservation, it is also possible to speak about gametes or reproductive organs. As noted above, it is also important not to presume that all people want to reproduce. Many of our participants reported that, should they wish to become parents in the future, they might do so through adoption or foster care. </p>
<p>Discussions about fertility preservation are important for any person whose fertility may be compromised by particular forms of medical care. But this does not mean that agreeing to fertility preservation should be mandatory in order to access particular forms of medical care. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/transgender-kids-get-their-own-health-care-guidelines-98308">Transgender kids get their own health-care guidelines</a>
</strong>
</em>
</p>
<hr>
<p>Particular care is indicated <a href="https://twitter.com/DrDamienRiggs/status/993271692905648128">with regard to young people</a>. Parents of transgender children may hope to have grandchildren. They may encourage a young person to preserve fertility when that is not necessarily the young person’s desire. For young children unable to give consent, medical professionals should ensure that the family receives adequate counselling prior to a decision being made so as to ensure that children’s voices are heard. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/227060/original/file-20180711-70039-i80p2t.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/227060/original/file-20180711-70039-i80p2t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/227060/original/file-20180711-70039-i80p2t.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=534&fit=crop&dpr=1 600w, https://images.theconversation.com/files/227060/original/file-20180711-70039-i80p2t.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=534&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/227060/original/file-20180711-70039-i80p2t.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=534&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/227060/original/file-20180711-70039-i80p2t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=671&fit=crop&dpr=1 754w, https://images.theconversation.com/files/227060/original/file-20180711-70039-i80p2t.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=671&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/227060/original/file-20180711-70039-i80p2t.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=671&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Experiences with clinics when undertaking fertility preservation.</span>
<span class="attribution"><span class="source">Damien Riggs</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Transgender people’s reproductive rights</h2>
<p>The area of fertility preservation represents an important aspect of reproductive rights for transgender people. Transgender people should absolutely have the right to undertake fertility preservation. This should be provided in a timely and affordable manner, mindful of how informed consent may be undermined if medical professionals do not approach the topic in an inclusive way. </p>
<p>At the same time, however, assumptions are not helpful. It should not be assumed that all transgender people want to preserve their fertility. It should also not be assumed that all transgender people want to access forms of medical care that might negatively impact their fertility (i.e., not all transgender people will wish to commence hormone therapies or undertake gender affirming surgeries).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-australian-trans-stories-on-our-tv-screens-please-88556">More Australian trans stories on our TV screens, please</a>
</strong>
</em>
</p>
<hr>
<p>Conversely, it is important to acknowledge that some transgender people might experience infertility unrelated to gender transition, and may wish to access reproductive services – as is true for any person who experiences infertility.</p>
<p>For transgender people who do choose to have children, their rights as parents must be protected. This includes as a society challenging the discrimination that many transgender parents face. More broadly, ensuring transgender people’s reproductive rights must include access to services related to reproductive health (such as pap smears for transgender men), and access to abortion services.</p>
<p>Transgender communities are diverse, and there is no one right outcome for medical care other than ensuring that the individual’s needs are met. Medical professionals must acknowledge the diverse desires and needs of transgender people. This means opening up conversations about reproduction, but also respecting when people do not wish to reproduce. </p>
<hr>
<p><em>The author is presenting <strong><a href="https://adelaidefestivalofideas.com.au/sessions/futurity-and-fertility-in-transgender-peoples-lives/">Futurity and fertility in transgender people’s lives</a></strong> at the 2018 Adelaide Festival of Ideas, Sunday 15 July 2018 (free entry).</em></p><img src="https://counter.theconversation.com/content/99589/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Damien Riggs receives funding from the Australian Research Council for a project focused on family diversity. </span></em></p>Conversations about reproduction should be a routine part of medical care for transgender people – but assumptions and non-inclusive language can act as barriers to informed consent.Damien Riggs, Associate Professor in Social Work, Australian Research Council Future Fellow, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/964592018-05-15T20:20:01Z2018-05-15T20:20:01ZAcupuncture during IVF doesn’t increase chances of having a baby<figure><img src="https://images.theconversation.com/files/218722/original/file-20180514-178757-x4ridg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Acupuncture might alleviate stress for women undertaking IVF. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Acupuncture has become a <a href="https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1479-828X.2007.00702.x">frequently used</a> treatment prior to and during in-vitro fertilisation (IVF). Women hope it will increase their chances of having a baby, but also provide support with reducing stress, and feeling relaxed and well while undergoing treatment. </p>
<p>Several small clinical trials
<a href="https://www.ncbi.nlm.nih.gov/pubmed/11937123">have</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/16616748">previously suggested</a> acupuncture improved outcomes of stressful and unpredictable fertility treatments. But our <a href="https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.5336">new study</a> has found this is not the case. </p>
<p>The study of more than 800 Australian and New Zealand women undergoing acupuncture treatment during their IVF cycles has failed to confirm significant difference in live birth rates. </p>
<p>The findings published today in the Journal of the American Medical Association (<a href="https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.5336">JAMA</a>) support recent guidelines from the <a href="https://www.ncbi.nlm.nih.gov/pubmed/28366416">American Society for Reproductive Medicine</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/23814102">two</a> high-quality <a href="http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD006920.pub3/abstract;jsessionid=3F6D129E2C3EE0F3DBF183828B1A1293.f03t02">meta-analyses</a> (which combine data from multiple studies to identify a common effect).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/modern-acupuncture-panacea-or-placebo-8102">Modern acupuncture: panacea or placebo?</a>
</strong>
</em>
</p>
<hr>
<h2>What the study found</h2>
<p>We examined the effects of a short course of acupuncture administered during an IVF cycle. We were not able to show that acupuncture increased live births, clinical pregnancy or having fewer miscarriages.</p>
<p>Undertaken across 16 IVF centres in Australia and New Zealand, the randomised controlled clinical trial (that compares the effects of an experimental treatment on one group with those of a placebo or alternative treatment in another group) aimed to increase live births and pregnancies among 848 women aged 18 to 42, undergoing an IVF cycle using fresh embryos, over a four year period.</p>
<p>The first acupuncture treatment was given at the start of the IVF process when medication is given to stimulate the ovary to produce follicles. </p>
<p>Following successful fertilisation, acupuncture to recognised acupuncture points was performed prior to, and immediately following, the transfer of the embryo to the woman’s womb. </p>
<p>The control group in this study was sham acupuncture. This looks like real acupuncture but does not involve insertion of the needle through the skin. For both groups the needle is held in place by a plastic tube, but as the practitioner places the needle on the skin, for the control group the shaft of the needle disappears into the handle, while in the treatment group the needle pierces the skin.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-traps-to-be-aware-of-when-reading-success-rates-on-ivf-clinic-websites-68806">Five traps to be aware of when reading success rates on IVF clinic websites</a>
</strong>
</em>
</p>
<hr>
<p>The results showed a clinical pregnancy was achieved in 25.7% of women who received acupuncture and 21.7% of women in the sham control, and that a live birth was achieved for 18.3% of women who received acupuncture compared to 17.8% who received the control.</p>
<p>While a 4% increase might sound hopeful, given the low percentage of successful IVF births to begin with, this is not a big enough increase for scientists to conclude there is a difference. This means the study does not support that acupuncture can improve pregnancy or live birth rates for women undergoing IVF.</p>
<p>However, in clinical practice, acupuncture may include more sessions prior to an IVF cycle starting. Whether this would make a difference hasn’t been tested.</p>
<h2>Why is this important?</h2>
<p>Despite recent technological improvements to IVF, the success rate is still low. Consequently, new drugs, laboratory techniques and other treatments need to be developed and rigorously tested to explore their effects on producing healthy babies for women undergoing IVF. </p>
<p>Acupuncture has long been used for gynaecological and obstetric problems. In 2002, the <a href="https://www.ncbi.nlm.nih.gov/pubmed/11937123">first randomised controlled trial</a> of acupuncture administered a specific form of IVF acupuncture at the time of embryo transfer. The results indicated the chance of achieving a pregnancy from acupuncture was twice that of women undergoing IVF treatment alone. </p>
<p><a href="http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD006920.pub3/abstract;jsessionid=3F6D129E2C3EE0F3DBF183828B1A1293.f03t02">Further clinical trials were conducted</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/23814102">to examine</a> if these results could be replicated. Some trials found acupuncture had some effect and others found it had none.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&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 is an emotionally tumultuous time.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/gFlxfX545BY">k b unsplash</a></span>
</figcaption>
</figure>
<h2>Where did the acupuncture belief come from?</h2>
<p>An adequate blood flow to develop immature eggs, and the endometrium (the lining of the uterus), is important to female fertility and pregnancy. Studies on a stronger form of acupuncture, electro-acupuncture, found it may influence central sympathetic nerve activity, <a href="https://www.ncbi.nlm.nih.gov/pubmed/8671446">and may</a>
<a href="https://www.ncbi.nlm.nih.gov/pubmed/16514000">increase blood flow</a> in parts of the body, including improved blood flow and oxygenation to ovarian and uterine tissue. </p>
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Read more:
<a href="https://theconversation.com/your-questions-answered-on-donor-conception-and-ivf-45715">Your questions answered on donor conception and IVF</a>
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<p>Stress is <a href="https://www.ncbi.nlm.nih.gov/pubmed/22698634">thought to play a role</a> in infertility. Among women undertaking IVF treatment, <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0063743">previous research has found</a> an association between lower levels of stress and anxiety and increased pregnancy. </p>
<p><a href="https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-9-50">In our</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/16600225">earlier research</a>, acupuncture was shown to reduce the emotional stress and burden experienced by women during IVF treatment.</p>
<p>We hope the new findings will enable women and practitioners to make evidence-formed decisions about the use of acupuncture to achieve a pregnancy and live birth. </p>
<p>But unpublished findings from our trial highlight a supportive role from acupuncture with reducing stress, increased relaxation and improving how women feel about themselves while undergoing the demands of IVF treatments. These findings suggest while it probably won’t improve a woman’s chance of having a baby, acupuncture could help women deal with the emotional turmoil of IVF.</p><img src="https://counter.theconversation.com/content/96459/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Smith received funding for this study from the National Health and Medical Research Council (NHMRC) Grant/Award number APP1003661; and needles were supplied from Helio Supply Co.
Caroline Smith declares as a medical research institute, NICM Health Research Institute receives research grants and donations from foundations, universities, government agencies and industry. Sponsors and donors provide untied and tied funding for work to advance the vision and mission of the Institute. </span></em></p><p class="fine-print"><em><span>Robert Norman is a shareholder with FertilitySA.</span></em></p>A new study has countered old reports acupuncture can improve your chances of having a baby when going through IVF.Caroline Smith, Professor Clinical Research, Western Sydney UniversityRobert Norman, Professor of Reproductive and Periconceptual Medicine, The Robinson Institute, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/941972018-04-02T22:18:05Z2018-04-02T22:18:05ZPaying surrogates, sperm and egg donors goes against Canadian values<figure><img src="https://images.theconversation.com/files/212772/original/file-20180401-189804-15d9agr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A Canadian politician has announced he plans to introduce a private member’s bill to remove the legal prohibitions on payments to surrogate mothers and to sperm and egg donors.
</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>In Canada, it’s illegal to pay for the services of a surrogate mother or to purchase human gametes — sperm and eggs. These prohibitions are entrenched in the <a href="http://laws-lois.justice.gc.ca/eng/acts/a-13.4/">Assisted Human Reproduction Act</a>. Some Liberal members of Parliament want to change this.</p>
<p><a href="http://www.ourcommons.ca/Parliamentarians/en/members/Anthony-Housefather">Anthony Housefather</a>, MP for Mount Royal and chair of the House of Commons Standing Committee on Justice and Human Rights, recently held a <a href="https://www.facebook.com/anthonyhousefather/videos/1877831872257893/">news conference</a> to announce that he plans to introduce a private member’s bill to remove the legal prohibitions on payments.</p>
<p>Flanked by fertility doctors, lawyers, intended parents, surrogates and fertility agents, Housefather argued that Canadians should be able to pay — and be paid — for surrogacy, as well as human sperm and eggs.</p>
<p>But the planned private member’s bill is <a href="http://www.cbc.ca/player/play/1197697091796">ill-conceived</a> (pun intended) <a href="https://impactethics.ca/2018/04/02/lets-ask-a-different-question-about-surrogacy/">for several reasons</a>.</p>
<h2>‘Sound ethical reasons’</h2>
<p>At the outset, it’s important to remember there are sound ethical reasons to prohibit “<a href="http://laws-lois.justice.gc.ca/eng/acts/a-13.4/page-1.html#h-2">trade in the reproductive capabilities of women and men and the exploitation of children, women and men for commercial ends</a>,” as stated in the Assisted Human Reproduction Act. </p>
<p>Among these reasons are the need to avoid both the commodification of the human body and the twin risks of exploitation and coercion. That’s why the federal government introduced criminal prohibitions on payment for surrogacy as well as human sperm and eggs in 2004. </p>
<p>Why criminal prohibitions? Because according to our Constitution, the only mechanism available to the federal government to enforce a ban on payment is criminal law. The division of powers between the federal and provincial governments is such that health is a provincial responsibility and criminal law is a federal responsibility. </p>
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<img alt="" src="https://images.theconversation.com/files/212771/original/file-20180401-189821-1fju5u7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/212771/original/file-20180401-189821-1fju5u7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/212771/original/file-20180401-189821-1fju5u7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/212771/original/file-20180401-189821-1fju5u7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/212771/original/file-20180401-189821-1fju5u7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/212771/original/file-20180401-189821-1fju5u7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/212771/original/file-20180401-189821-1fju5u7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&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">Anthony Housefather, MP for Mont Royal, says he plans to introduce a private member’s bill to remove the legal prohibitions on payments to surrogate mothers or for sperm or eggs.</span>
<span class="attribution"><span class="source">Liberal.ca</span></span>
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<p>The Assisted Human Reproduction Act was carefully drafted to ensure that access to reproductive technologies would not be a gateway to commerce in the body. This was a challenging piece of legislation to craft, involving considerable study, consultation and compromise. </p>
<p>The process began in the mid-1980s with the call for a <a href="http://www.thecanadianencyclopedia.ca/en/article/new-reproductive-technologies-royal-commission-on/">Royal Commission on New Reproductive Technologies </a> and continued through the 1990s and into the 2000s. It included numerous consultations with stakeholders and the public, several failed attempts at legislation and very careful consideration of how this issue should move forward.</p>
<h2>Act outdated?</h2>
<p>When the act finally passed 14 years ago, there was all-party agreement that payment for surrogacy and sperm and eggs was not the way forward. </p>
<p>Housefather suggests that the act is outdated; that it did not anticipate the creation of non-traditional families. But this is inaccurate. </p>
<p><a href="https://www.dailyxtra.com/gay-bloc-mp-real-menard-leaves-federal-politics-35895">Réal Ménard,</a> for example, one of the first openly gay MPs, worked with members of the LGBTQ community to ensure that sexual orientation would not be a barrier to access. It’s important not to ignore or misrepresent the intense challenges of a legislative process that was nearly 30 years in the making. </p>
<p>Housefather also suggests that Canadian values have changed since the act came into force. However, recent public commitment to <a href="http://www.cbc.ca/radio/thesundayedition/the-sunday-edition-march-4-2018-1.4559064/canadian-blood-services-ceo-responds-to-listener-mail-1.4559077">keeping payment out of the blood supply system</a> indicates that Canadian values about payment for bodily tissues may not have changed all that much.</p>
<p>The Assisted Human Reproduction Act permits reimbursement of receipted expenditures for surrogates and gamete donors in accordance with regulations. The problem with this feature of the act, however, is that there are no published regulations. This is finally about to change. </p>
<p>After many years of inaction, Health Canada has made a public commitment to <a href="https://www.canada.ca/en/health-canada/programs/consultation-assisted-human-reproduction/document.html">strengthen the Assisted Human Reproduction Act</a> that includes drafting the regulations for reimbursement. </p>
<p>These long-anticipated regulations will provide much-needed clarity and transparency. Housefather’s proposed bill will undermine the development of the regulations by attempting to eliminate the framework for reimbursement completely. </p>
<p>The federal government has an obligation to address the health and safety of surrogates, sperm donors and egg donors. It also has an obligation to provide clear regulations on reimbursement of expenditures so that Canadians who want to use surrogates and donor sperm and eggs can do so without running afoul of the law. </p>
<p>The governance of assisted human reproduction is too important to the future of Canadian families to be undermined by a private member’s bill calling for an open market in human reproduction.</p><img src="https://counter.theconversation.com/content/94197/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Françoise Baylis has received research funding from CIHR and the Canada Research Chairs program</span></em></p><p class="fine-print"><em><span>Alana Cattapan has received funding from the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, and the Saskatchewan Health Research Foundation. She is on the Board of the Canadian Research Institute for the Advancement of Women. </span></em></p>There are sound ethical reasons behind Canada’s decision to ban payment to surrogate mothers and sperm and egg donors in 2004. A new push to remove the restrictions ignores the risks.Françoise Baylis, Professor and Canada Research Chair in Bioethics and Philosophy, Dalhousie UniversityAlana Cattapan, Assistant Professor, Johnson Shoyama Graduate School of Public Policy, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.