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Surrogacy


Questions for Robert Terenzio, Repro Attorney

Finding the right attorney, handling conflicts, and more

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

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

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

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

Two Bits of Good News

Here's a welcome development: India is working on legislation to address the recent boom in surrogate motherhood there:

Concerned with an increasing number of foreigners coming to India to rent a womb, the government is planning to come out with regulations to ensure legal and medical rights to surrogate mothers and children born to them.

"We have seen that couples fly to India, persuade a woman here to rent out her womb for money and then they happily take the child to their country. How do they get the child's passport?" an agitated Women and Child Development Minister Renuka Chowdhury told reporters here Wednesday.

...As of now, there is no law on surrogacy in India. There are certain guidelines issued by the Indian Council of Medical Research (ICMR) on surrogacy and Assisted Reproductive Technologies (ART), she said.

For experts, the major concern is the number of young girls opting for surrogacy, which is also affecting the Maternal Mortality Rate (MMR). Thus, issues like the minimum age limit and health conditions that need to be considered will come up for discussion. 

The most premature twins born in Britain just celebrated their first birthday:

Mikey and Gracie Swindell were born dead at 24 weeks.

Medics spent an hour battling to bring the twins — who each weighed 1 pound, 9 ounces — back to life.

[...] "We call them our little miracles," said Lisa Swindell, 28, of Chatham, Kent, who conceived the babies through in-vitro fertilization after she and her husband, Paul, tried to conceive naturally for five years.

posted by Cheryl Miller | 11:12 am
File As: Assisted Reproductive Technologies, In Vitro Fertilization, Surrogacy, Reproductive Law

ART in the News

Solo "daddies," too posh to adopt?, and more

posted by Cheryl Miller | 9:22 am
File As: Assisted Reproductive Technologies, In Vitro Fertilization, Surrogacy, Older Mothers/Fathers, Sperm Donation, Third-Party Reproduction

ART in the News

Million-dollar babies, embryo adoption, and more

posted by Cheryl Miller | 9:09 am
File As: Assisted Reproductive Technologies, In Vitro Fertilization, Eugenics, Contemporary, Surrogacy, Egg Donation, Embryo Adoption, Frozen Embryos, Third-Party Reproduction

ART in the News

Is sex necessary? Soldiers going to Iraq bank their sperm. And more...

posted by Cheryl Miller | 2:22 pm
File As: In Vitro Fertilization, Surrogacy, ART in popular culture, GLBT Parents, Older Mothers/Fathers, Sex Selection

Conceptions Special Guest: Donna Dickenson

Body Shopping, God-bothering, and more

Donna DickensonDonna Dickenson is one of Britain’s leading experts on medical ethics. As professor of medical ethics and humanities at Birkbeck College in London, Dickenson has written on a variety of topics, including death and dying, assisted reproductive technology, the patenting of the human genome, and women’s health. In 2006, she became the first woman to win the prestigious Spinoza Lens prize for her contribution to the public debate on ethics.
 
Professor Dickenson’s latest book is Body Shopping: The Economy Fuelled By Flesh and Blood, a look at the rapidly growing trade in the human body. She kindly agreed to discuss her new work in an interview with Conceptions. Those in New York can see Prof. Dickenson in the flesh during her book tour on June 18-19. (For more details, see her website, www.donnadickenson.net.)
 
[Interview conducted, edited, and hyperlinked by Cheryl Miller.]
 
"Body Shopping" by Donna DickensonWhat is “body shopping”?
 
DD: I use the term "body shopping" to refer to the way in which human tissue, genes, gametes and organs are becoming consumer items like any other.

In your recent op-ed in the London Times, you write that the "'God vs. science' has become a dangerous distraction." How so? What kind of debate should we be having?
 
DD: In the Sunday Times article, I argued that the vituperative slanging match into which our debate on the Human Fertilisation and Embryology Bill has descended is diverting attention from serious ethical, economic and political issues about the widespread commercialisation of biotechnology. Debate has centred almost exclusively on "human admixed embryos," created from an enucleated cow or rabbit egg and a human somatic (body) cell, with religious figures lining up against this development and scientists insisting it's necessary for somatic cell nuclear transfer stem cell research. But there are many other important issues centring on the activities of biotechnology firms, such as the clinically dubious "product" offered by private umbilical cord blood banks, or the defensive patenting of human genes with an adverse effect on patient care. The 'God versus science' cliché, however, means that even a secular bioethicist like me risks being branded either a 'Luddite' or a 'God-botherer' for daring to pose ethical questions about scientific developments and their commercialisation.

The medical research community has long argued that ceding any ownership rights over tissue to donors will lead to patients buying and selling their own body parts. Should we own our own bodies? And if not, who should?

DD: It's quite odd for the medical research community to make this argument, when they see nothing wrong with commercial firms buying and selling intangible property rights in genetic sequences, or stem cell lines derived from donors of somatic cells and oocytes. The law has been equally contradictory: traditionally the common law viewed tissue taken from the body as res nullius, no one's thing, and therefore refused to allow patients like John Moore to exercise any rights over cell lines made from their tissue. If res nullius is taken to its logical conclusion, however, it should mean that no one, including researchers, universities and biotech firms, has any rights over cell lines of other forms of tissue either. But I don't actually advocate that we should own our bodies unreservedly: instead I favour more communal systems, such as the PXE model in which patient groups and biotech firms share rights over gene patents.

If we do “own” our own bodies, why aren’t we entitled to sell off an egg or kidney if we so choose?

DD: As I say, I don't believe that we do own our bodies straightforwardly, although I do think that in cases where considerable labour has been expended--first and foremost, egg donation, which has been estimated to require up to 60 hours' labour--the donor should have some rights on a Lockean basis of having 'mixed one's labour'. Even if we did own our bodies, ownership rights in our common law are generally seen as a 'bundle of sticks', from which certain forms of control are chosen appropriate to the need in hand. You might have a right to donate your tissue but not to sell it, for example, as these are separate sticks in the bundle.

Many have argued that without payment, there would be a shortage of sperm and egg donors--as there is of kidney donors. If we use altruism as a principle for all tissue donation, how can we avoid a shortage of available gametes, or determine a fair way of rationing available resources?

DD: This seems to me to be a rather narrow outlook. Only the United States, so far as I know, operates a full-fledged system of egg and sperm sale, but other countries manage perfectly well with a more altruistic system. European countries generally pay expenses only, although the amount varies quite widely--but nothing like the exaggerated amounts paid for 'desirable' eggs in the US, up to $100,000 per cycle from blonde, tall, musical and athletic young women. Where there are shortages of eggs and sperm in European systems, they have more typically been caused by changes in regulations about donor anonymity than by any failure of altruism.

In your book, you note the different ways in which egg donation and sperm donation are treated under the law. You observe, "The assault on freedom is only noticed when it begins to apply to men." Are women more vulnerable to biotech predation? How so?

DD: That point doesn't arise from my discussion of egg or sperm donation; rather, in the last chapter, I argue that we all have 'feminised' bodies now insofar as all bodies are increasingly assumed to be open-access. The tremendous publicity given to the patenting of the human genome--one in five genes are now patented, affecting both sexes equally--contrasts with the very minimal publicity given to the demand for women's eggs in 'therapeutic cloning'--in some cases under conditions which may welll have been coercive, as in the Hwang Woo Suk scandal. Female tissue is still more valuable, but both sexes are vulnerable to 'body shopping'.

You have warned that women who donate their eggs for stem cell research could be at risk from life-threatening side effects. Do you think egg-harvesting and stem cell technologies will become more effective and safe in the future, and would that dispel some of your present concerns?

DD: We are seeing good scientific evidence that low-dosage ovarian stimulation regimes produce just as good overall results in IVF as high-dose ones, even though fewer eggs are 'harvested'. But research in somatic cell nuclear transfer research still requires very high numbers of eggs because the technology is very wasteful (Hwang used over 2,200 eggs to create precisely zero stem cell lines). I am more hopeful about the possibility that SCNT [somatic cell nuclear transfer] will be bypassed altogether, if induced pluripotent stem cell lines do indeed fulfil their promise, since that technique doesn't require human or animal eggs. Last week, by contrast, the upper house of the Western Australian parliament voted against a bill to allow SCNT research on scientific grounds, that the technology had failed to deliver on its earlier promise and the ethical issues around taking eggs from women were too overwhelming. This can be seen as a victory for the attempts made by activists and academics such as Marcy Darnovsky, Sarah Sexton, Diane Beeson, Cathy Waldby and myself to ensure that the risks to women became better known.

Critics argue against organ selling and surrogacy on the grounds that the poor are more likely to be sellers, and that the procedures in question are risky. Yet we allow people to take on dangerous jobs. Further, many argue that serving as a surrogate or selling an organ is their best available option. One Indian surrogate explained her decision thus: "This is not exploitation. Crushing glass for 15 hours a day is exploitation." Are organ selling and surrogacy somehow different from other "exploitative" work?

DD: Freedom of choice is not a knock-down argument. Even where we allow people to 'choose' dangerous jobs, we retain health and safety laws to limit the risk. But few such protections exist for commercial surrogates, particularly in the developing world. In addition, we need to look at the massive difference between what the surrogate is paid--even if it seems a lot to a poor Indian woman--and the profits of the commercial agency arranging the transaction. One US agency, for example, pays surrogates $25,000 but charges $100,000. Most of that $75,000 difference is pure profit. Unless you really think the agency has contributed three times as much of the 'value' of the baby as the birth mother, you would have to classify that as exploitation because the rightful contributor of the value has been shortchanged.

How can we work towards finding treatments for serious diseases without commodifying our bodies? What policies can lawmakers adopt to protect people from exploitation without impeding medical progress?

DD: We will be much more likely to find treatments for serious diseases if we can rectify the grossest abuses of body shopping. The biotechnology industry has been allowed to claim that it is the greatest promoter of medical progress, when in many cases it is arguably the greatest hindrance. That's particularly true where defensive gene patents or restrictive licensing agreements block researchers from developing alternative, better or cheaper cures. A single company, Myriad Genetics has patented the BRCA1 and BRCA2 genes involved in some breast cancers, meaning that in the United States (though not in Europe) a clinical diagnostic test for those genes can only be afforded by those who can pay the fee. Lawmakers and judges need to be much more sceptical about the abuses of genetic patenting in particular; this process has begun in Europe but is still largely ineffective in the United States.

One chapter in your new book is subtitled "Resistance is not futile." But the rise of medical tourism would seem to make legislating an impossible task. If all you need is a passport to buy an egg or find a surrogate mother, how can we effectively regulate biotechnology?

DD: The globalisation of the biotechnology industry does indeed made regulation more difficult, but it's not impossible. In Europe there is now a tissue directive binding on all EC countries, which makes egg sale for IVF illegal. Some European countries, particularly Germany, prohibit their citizens from buying surrogacy or eggs abroad, as well as on German soil. Similar laws exist in some countries in relation to sex tourism, especially with minors, so where the political will is there, a way can be found.

posted by Cheryl Miller | 7:18 am
File As: Bioethics and Medicine, Assisted Reproductive Technologies, Capitalism/Commerce, Interview, Surrogacy, Egg Donation, Conceptions Interviews

ART in the News

A Phony War on Science, Different Takes on Older Moms, etc.

posted by Cheryl Miller | 9:39 am
File As: Bioethics and Medicine, Assisted Reproductive Technologies, In Vitro Fertilization, Eugenics, Contemporary, Surrogacy

Questions for Sharon LaMothe, Real-Life Baby Mama

Part Two: "Baby Mama," third-world wombs for rent, etc.

Part Two of my interview with Sharon LaMothe below. For Part One, click here.

Surrogacy has been all over the news lately, what with Baby Mama and the recent Newsweek cover story. Why do you think people are suddenly so interested in surrogacy?

SL: People are putting off children later and later in life. I don’t see Mademoiselle or Redbook saying, you know after 32, your egg production is really falling. I don’t see any warnings about how your fertility starts to go downhill in your early 30s. I think that people think as long as they feel healthy, they won’t have a problem. In reality, it doesn’t matter how healthy you are on the outside.

When you can’t get pregnant and want to have a baby, surrogacy seems to be the way to go. There are people who go the adoption route. But with adoption, the mother can change her mind, if the father isn’t on board with it that can be a battle, you don’t know what you are going to ‘get.’ With surrogacy, you’re pretty much guaranteed nobody can change their minds.

Have you seen Baby Mama? What did you think?

SL: I have not, but I’m boycotting it. I saw several previews and read the articles. There’s so much wrong with it: an ignorant, money-grubbing woman from the sticks just out to get what she can from some poor desperate woman who can’t have a baby on her own. Maybe I’ll get it from Netflix, but I’m not going to the movies to see it. 

What do you think about the globalization of surrogacy?

SL: What really bothers me about that is they’re not even meeting their intended parents. Why is that woman a surrogate? She’s a commodity, an incubator. All she knows is she’s getting a paycheck. That sounds like baby-selling to me.

Western women have very different expectations. Here you meet each other and see if you have a connection. And if you have no connection, what makes you [intended parents] think these women are going to watch their diet and their exercise? If you are taking care of something for someone else—anything, even if it’s just a car—you are a little more careful when you know those people.

What do you hope to achieve with Infertility Answers?

SL: Infertility Answers is a website that an attorney, Robert Terenzio, and I are putting together because there are so many questions out there from the novice. The blog, Surrogacy 101, is answering and being really forthright about what I think intended parents need and what surrogates need.  

What would you say to a woman considering surrogacy?

SL: Do your research. Talk to people. Make sure you’re ready to make that time and commitment. You do end up sacrificing your family time. You being pregnant for yourself and your husband is a whole different experience than being pregnant for somebody else. You have all these people on your shoulder that you are accountable to, and that can cause a lot of stress.

posted by Cheryl Miller | 6:40 pm
File As: Assisted Reproductive Technologies, Surrogacy, Conceptions Interviews

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