Third-Party Reproduction


Donated Generation

August 28, 2008

The summer issue of The New Atlantis is now online. As always, there are some terrific articles, including Rita Koganzon's foray into the world of Second Life and James Bowman look at the "dumbest generation."

Your humble blogger also has an article in the issue--it's on donor-conceived children and the rise of open-donor programs. Many, many thanks are in order to DI-Dad blogger Eric Schwartzman and Circle Surrogacy's John Weltman for sharing their stories. Joanna Scheib and Elizabeth Marquardt were both incredibly helpful and generous with their time and knowledge.

An excerpt:

When Eric Schwartzman went in for a medical exam six months before his wedding, he didn't expect to hear he was infertile. After the examination, the doctor suggested Schwartzman have a sperm-count test. Schwartzman thought nothing of it. Then the results came in. He was diagnosed with azoospermia, a condition in which the man produces virtually no sperm. "Don't plan on having kids naturally," his doctor told him. "You can just adopt."

Schwartzman and his wife were devastated. He offered to call off the wedding, but she refused. Instead, they went to a fertility clinic, where Schwartzman underwent two testicular biopsies to retrieve sperm for in vitro fertilization (IVF). As a backup, his doctor suggested the couple select a sperm donor, and they agreed without really taking the possibility seriously. But when two IVF cycles failed, he and his wife reconsidered.

Schwartzman is now the father of two "half-adopted" children, as he calls them, both conceived through donor insemination. Most of the time, he says, he focuses on day-to-day life--"getting them potty trained" and the like. But he sometimes wonders what effect their unusual beginnings will have on them. 

posted by Cheryl Miller | 3:49 pm
File As: Assisted Reproductive Technologies, In Vitro Fertilization, Egg Donation, Sperm Donation, Third-Party Reproduction

Questions for Robert Terenzio, Repro Attorney

Finding the right attorney, handling conflicts, and more

August 25, 2008 • After a long hiatus, Conceptions is finally back with another interview. This month’s subject is Robert Terenzio, a reproductive law attorney in Orlando, Florida. Robert’s practice, Reproductive Alternatives, specializes in surrogacy arrangements and egg donation. He also helps Sharon LaMothe (a former Conceptions interview subject) run Infertility Answers, an educational clearinghouse for fertility issues. He graduated in 1991 from Quinnipiac College School of Law in Connecticut.

In this interview, we discuss how reproductive law has evolved, statutory differences among states, and why it’s so important to have an attorney.

[Interview edited and condensed by Cheryl Miller.]

How did you become interested in reproductive law? Are there many attorneys working in this field?

RT: Generically, most attorneys get involved because they’ve had some contact with it. A lot of us were adoption lawyers, who may or may not have dealt with infertility issues. I’ve never had an infertility issue, but some years ago I was helping a group of clients put together an infertility company and as I grew to understand more aspects of infertility, I started dismissing more parts of my practice. Now, I just focus on infertility.

In the state of Florida, there’s only about eight of us. Most of them came out of the adoption area, and added this on their practice. Nationally, I seem to run into the same people over and over again.

I’m a science geek. It’s interesting being involved in an area where the technology seemingly changes day to day, and by changing, it affects the way that we as attorneys have to look at how this technology is affecting people.

Is there a typical day in your practice? If so, what is it like?


RT: Thankfully, no there’s not. Part of the day could be wrapping up a blog entry for my website—I’m looking at something coming out of the news and trying to extrapolate and challenge people to think about the future. Part of it is educational—looking at Infertility Answers and seeing what information could be added to the website. The biggest bloc of time is talking to clients and filling in the gaps with what they might have heard from their agencies and their doctors.

The joke is that we all, in our own ways, become psychologists, in trying to create a reasonably stable, predictable framework for people who have lost control of something that most of the population takes for granted.

How do you find clients? What is your client base like, and has it changed over the years?


RT: The majority of my clients are referred either by agencies that I’ve worked with in the past or reproductive endocrinologists. I have a wide range of clients. I’m getting more and more people for the U.K. and the European Union, who are fed up with either waiting or with the rather conservative laws. Instead of waiting for three, five, or seven years, they can come to the U.S. and get a process up and running within months.

I’ve seen an increase over time in singles, be they male or female. For every five single males I’m working with, there might be one single female.

Why is it important to have an attorney?

RT: I think it’s foolhardy to move forward with something important as a child and not feel assured that everyone has been represented by an impartial attorney. Conflicts of interest are not taken well by the courts.

We’ve learned over time and experience, both positive and negative, how to create a larger and larger safety net for intended parents and gestational carriers. The more progressive states have figured this out already and created statutes.

How are laws among states different? Are there advantages to contracting for a surrogate or egg donor in a particular state?

RT: When you have a statutory framework, it removes a lot of the unpredictability in the process that might exist in other states. In Florida, surrogacies and egg donations are based on the intention of the parties—everyone intends for a result to occur. The court can then rely on that intention to give you what you want, for example, a birth certificate with your name on it.

In a non-statutory state—even one where you have a very pro-gestational surrogacy environment like California—you’re dealing more with the best interest of the child as the basis for how the courts are going to look at the relationship between the carrier and the parents. When you’re an intended parent and you’ve spent thousands of dollars, you want as much predictability as possible.

If you don’t like what’s going on where you’re at, you vote with your feet. Here in the state of Florida, we can easily assure our clients that they’re going to walk away with a birth certificate. But if we take a ride into Georgia, where they go with the best interest of the child standard, that child is not guaranteed to end up in your home.

How do you handle tensions betweens intended parents and surrogates/donors?


RT: There’s always tension. I like to say to clients that the relationship over the year is going to wax and wane. Some days everyone is going to be nice to each other, and some days you aren’t even going to want to pick up the phone when you know it’s the other person. No one really worries about that unless it becomes adversarial. If it becomes adversarial, the team approach kicks in: the agency, the doctor’s office, and the attorneys have a role.

What should people look for in a reproductive attorney?


RT: You want to be confident that the person has done this before. I get a lot of, “My uncle did adoptions 20 years ago...” or “My neighbor is a family attorney...” Being down in the trenches—talking to the judges who themselves are learning this stuff, resolving problems that arise in the course of a pregnancy, and going to the conferences—those sorts of things give you the ability as an attorney to do two things. First, it gives you the ability to write up a generic contract. But more importantly, it gives you the ability to anticipate the problems that may arise—either in your state because of the way your laws are set up or between the parties because of divergent personalities.

What’s the best part of being a reproductive attorney?

RT: I think the hallmark of this area of the law—which I’ve not seen anywhere else and just reinvigorates me—you’re able to provide an avenue of hope to people who not too long ago had no hope whatsoever. Unlike most areas of law, this always seems to be a regular win-win situation for everyone. The gestational carriers are doing something they absolutely want to do. The intended parents are walking away with the one thing they couldn’t have but for the interaction of all the other professionals.

The best part of my week is when a client calls and says, “Hey, we’re pregnant. Our due date is such-and-such...” You can hear the gratitude and, more importantly, can actually participate in someone’s joy. 

posted by Cheryl Miller | 6:15 pm
File As: Assisted Reproductive Technologies, Surrogacy, Egg Donation, Reproductive Law, Third-Party Reproduction, Conceptions Interviews

ART in the News

July 22, 2008

posted by Cheryl Miller | 3:15 pm
File As: Assisted Reproductive Technologies, Egg Donation, Third-Party Reproduction

Still More on 30 Years of IVF (And Britain's Donor Shortage)

July 22, 2008

The London Telegraph has a series of articles on ART today, including a number of first-hand accounts from patients and donors. There are some great stories, but since I'm working on a piece about donor registries, I was most interested in the ones about the effect of the anonymity ban on donor recruitment. 

The answer is not good — as this U.K. government report recently attested.

Sophie Turner and her partner Karen Harvey have spent two years trying to conceive a child. After learning about the waiting list for sperm donors, the couple turned to a Danish cryobank. The trips did not result in a baby, so the couple returned to the U.K. where they are still waiting for a donor:

After two failed attempts, she's being treated at Barts, where there's a three-month waiting list for British sperm. Any child we have will be able to contact the sperm donor when he or she is 18; I think it's a good thing that children know where they come from, but I'm not sure of the effect it will have on us as a family.

Sue Adlam is a school teacher. She waited a year for an egg donor to conceive her first child, and is now searching for another donor to conceive a sibling:

I feel as if I've spent half my life waiting, but as anyone who's ever suffered from infertility knows, what keeps you going through all the sadness is the prospect of the amazing miracle of a baby at the end of it all. Many women are faced with the prospect of a wait of at least two years, but my hope is that things will begin to improve in the long term.

posted by Cheryl Miller | 2:41 pm
File As: Assisted Reproductive Technologies, In Vitro Fertilization, Egg Donation, GLBT Parents, Sperm Donation, Third-Party Reproduction

IVF: The Next 30 Years

July 18, 2008Nature magazine's July issue has a special feature on the 30th anniversary of IVF. After discussing the legacy of IVF (subscrip. req'd), Nature asked a group of scientists what the next 30 years of IVF research will look like. Among the predictions:

  • Scientists will be able to create sperm and egg cells for anyone. Using sperm and egg cells derived from induced pluripotent stem cells, scientists will end infertility. Newborns and hundred-year-olds could become parents.
  • Embryo research will become a "fact of life": "They would become objects and would be used as objects...Maybe 20–30 years from now we'll read in newspapers that someone made 20,000 embryos and studied their development, and we'll decide it's OK."
  • IVF for less than $100: Cheap IVF will soon be made available in developing countries.
  • Healthy babies will be assured with the use of "genetic cassettes." Scientists will insert the cassettes into embryos to correct for diseases like Huntington's.
  • But people will still have sex: "IVF is expensive and uncomfortable. The old-fashioned way is cheaper and more fun and that won't change in 30 years."
  • Artificial wombs will change the abortion debate: "If an artificial womb were developed, the government could pass a law that requires people who have a termination of pregnancy to put the fetus into one of these wombs."
  • Alert the trial lawyers: There will be litigation over the health of IVF babies. "With the increasing availability of IVF, there will be more emphasis on safety. Not enough is known about the long-term health of the Louise Browns of this world — if there is a problem, it will be unexpected."

posted by Cheryl Miller | 10:20 am
File As: Bioethics and Medicine, Stem Cell Research, Assisted Reproductive Technologies, In Vitro Fertilization, Cloning, Third-Party Reproduction

Women Who Have Sold Their Eggs

July 18, 2008 • If you are in New York, you might want to stop by Lolita Bar next Tuesday, July 22nd. They'll be hosting a panel, "Women Who Have Sold Their Eggs," at 8 p.m. Panelists include graduate students Valerie Bronte and Diana Fleischman, Reason senior editor Kerry Howley, and "finance whiz" Marie Huber. The event is free. More details can be found at organizer Todd Seavey's website.

Can't make it to the Big Apple? Check out Kerry Howley's Reason article on selling your eggs.

posted by Cheryl Miller | 9:57 am
File As: Assisted Reproductive Technologies, Egg Donation, Third-Party Reproduction

ART in the News

Affordable IVF, Older Dads, and The World's Oldest Mother

July 9, 2008

posted by Cheryl Miller | 8:26 am
File As: Assisted Reproductive Technologies, In Vitro Fertilization, Surrogacy, Frozen Embryos, Older Mothers/Fathers, Third-Party Reproduction

Two Studies About Donor-Conceived Offspring

July 7, 2008

Much ado about nothing? A study by scientists at Cambridge University found that children conceived by a surrogate mother or by donor conception are as "psychologically well" as their naturally-conceived counterparts. The children were only seven years old at the time so I'm skeptical as to how much this survey really tells us. What's more, most of them don't know they are donor-conceived:

In a press release, Casey added that she found a majority of parents of children born through assisted reproduction delayed telling the child about how he or she was conceived.

"At the time of the child's seventh birthday, only 39% of egg-donation parents, 29% of donor-insemination parents and 89% of surrogacy parents had told their children about the nature of their conception."

These figures contrast markedly with what the parents said they would do when they were questioned at the child's first birthday.

Another Cambridge study suggests that these seven-year-olds might not be so "psychologically well" in the future:

The children of sperm donors should be told of their origins as young as four, a new study suggests.

[...] 

Scientists at Cambridge University found that those who were told as adults were three times more likely to feel angry than children.

In total 38 per cent of adults characterised their feelings as anger, compared to 12 per cent of four to 11-year-olds.

Three times as many adults also said that when they found out they were shocked, compared to 27 per cent of children.

posted by Cheryl Miller | 5:05 pm
File As: Assisted Reproductive Technologies, Surrogacy, Egg Donation, Sperm Donation, Third-Party Reproduction

More Controversy Over Britain's Donor Anonymity Law

June 27, 2008

The number of treatments with donor sperm has dropped to record lows since Britain banned donor anonymity in 2005, reports the London Daily Mail:

The first official figures since the Government removed anonymity from donors in 2005 show that the number of women treated with donated sperm fell by about 20 per cent from 2,727 in 2005 to 2,107 in 2006.

The number of donor insemination treatment cycles fell by 30 per cent over the same period.

The amount of women offering to donate eggs has also shrunk dramatically.

The article also provides some helpful data on the surpising (albeit small) increase in the number of donors after the 2005 law took effect. The government and donor-conceived activists had pointed to the rise as evidence that anonymity would not hurt the industry. But, it turns out, most of those new donors are 'known donors,' who are looking only to help a friend or relative:

The figures show that the number of sperm donors rose slightly from 259 in 2005 to 307 in 2006.

But that rise is largely down to an increase in the numbers of 'known donors' - friends and relatives that donate for a couple's exclusive use.

Fewer donors are contributing to sperm banks, from which the donation can be used by up to ten women.

That means that although more donors have registered, the shortage of sperm is becoming more acute.

Ten years ago there were no waiting lists for sperm, but now most clinics have a wait of at least two years for sperm treatment, and a similar trend is affecting egg donation.

A year after the law changed on anonymity, two thirds of clinics said their waiting times for sperm treatment had lengthened.

As a result, many more couples are looking abroad for donor sperm. Naomi Anderson, a fertility patient in the U.K., turned to online purveyors in the U.S. after learning about the 1-2 year wait for a donor:

I found two reputable American sites, xytex.com, and fairfaxcryobank.com, and selected a couple of possible donors. But legislation that came into force at the end of January 2007 means that UK women – despite our national sperm drought – now find it almost impossible to import sperm. A licence must be sought from the HFEA, which among other conditions stipulates that the donor must "only [have] received reasonable expenses or reimbursement for loss of earnings'. This is often not the case with the most high profile foreign clinics. You must also argue convincingly why you believe your child should be fathered by someone from that country.

The first time round the application submitted by my clinic was turned down by the HFEA. But an appeal, in which I stressed my husband's North American background, was successful. Those, however, who have no connection with any other country, are caught in what seems to be a tussle between different people's rights.

posted by Cheryl Miller | 10:35 am
File As: Assisted Reproductive Technologies, In Vitro Fertilization, Egg Donation, Reproductive Law, Sperm Donation, Third-Party Reproduction

More on the Canadian Registry

June 25, 2008

Today in the Globe & Mail, three professors are protesting a decision by the Quebec Court of Appeal to nullify parts of the federal Assisted Human Reproduction Act:

The children of assisted reproduction must be the clear priority because they are the most affected for the longest time. The wishes of many are clear: to know their genetic and gestational parents, the truth about their conception and all their parents' current medical status so that they can take preventative measures to protect their own health. Some adults say that, as long as children are well loved, their deliberate separation from all their parents doesn't matter. One child answered, "All the good intentions and love in the world won't change the definition of right and wrong. It won't change how the kids feel."

Children need adult protection. This is why we urge all levels of government to work together to regulate this field. From the perspective of a child of assisted reproduction, inaction is not just unhelpful, it is a dereliction of duty. As you read this, children are being created in Canadian clinics that no longer have regulatory oversight, or even clear legal obligations to make and preserve records that could enlighten people about their genetic and gestational parents' identities and what disease they are likely to inherit.

posted by Cheryl Miller | 11:08 am
File As: Assisted Reproductive Technologies, Reproductive Law, Sperm Donation, Third-Party Reproduction

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