Assisted Reproductive Technologies


Conceptions Special Guest: Donna Dickenson

Body Shopping, God-bothering, and more
May 12, 2008

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.

May 8, 2008

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

Repro-Tech Tunes

May 6, 2008

Sperm Bank Love logoThis is probably old news, but I can't resist: rock songs about ART (no, really). "Dark Days" is about sex selection; "Headless Hens," genetic engineering; and "Sperm Bank Love"...well, see for yourself. They are actually pretty catchy.

The songs are the work of Mark Oshinskie, an attorney, amateur bioethicist, and prolific letter writer. You can buy Mark's album, "Elephants in the Room," on iTunes.  

Via QuestionTechnology.

posted by Cheryl Miller | 1:31 pm
File As: Bioethics and Medicine, Assisted Reproductive Technologies, ART in popular culture

Questions for Sharon LaMothe, Real-Life Baby Mama

Part Two: "Baby Mama," third-world wombs for rent, etc.
May 5, 2008

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

Questions for Sharon LaMothe, Real-Life Baby Mama

Part One: Choosing surrogacy, money matters, etc.
May 5, 2008

I'm pleased to introduce a new feature here at Conceptions: a monthly interview with someone from the ART world. I hope to get a variety of perspectives: doctors, attorneys specializing in reproductive law, agency owners, bioethicists, activists, would-be parents, and many more. If you're interested in participating, please drop me a line at cmiller [at] thenewatlantis [dot] com.

For our inaugural interview, we have Sharon LaMothe, a real-life "baby mama." Sharon is a two-time gestational surrogate, giving birth to twins each time in March 2000 and January 2005. She also runs her own surrogacy agency and is the proprietress of Infertility Answers, Inc. At her super-informative blog, Surrogacy 101, she dispenses advice to surrogates, donors, and would-be parents.

[Interview edited and condensed by Cheryl Miller. Part two to follow.]

How did you first learn about surrogacy?

Sharon LaMotheSL: I knew a couple—they were really more acquaintances than anything else. They lived in Florida, and I was living in Rochester, New York at the time. The husband came to me and just said casually, “We’re thinking about adopting.” He had a son from a previous marriage, and they had a daughter who was a day younger than my youngest daughter. 

I actually talked to my husband even before I approached the couple. We had secondary infertility so that came into play with me personally. You have women out there who say, “I don’t want to be a surrogate for someone who already has children.” I felt more of a connection with my first couple. 

How old were you for your first surrogacy? Why did you choose to do a second surrogacy?


SL: I was 36 for my first surrogacy. My second surrogacy was for a gay couple in New York. They had been together for 16 years. I had met them through another client of mine. I talked to them for about a year.

I realized that doing this for a gay couple wasn’t as “popular” a choice for women. I think that made a huge difference to me. And to be perfectly honest, my age came into play. I had wanted to be a surrogate one more time, and I was 39 when we first started talking. I was 40 when I got pregnant, and I ended up giving birth at 41. Do I recommend giving birth at 41? No, it was a little harder than I thought.

When you do this for someone, I know a lot of people focus on the intended parent, but the grandparents are just as excited. You’re making uncles; you’re making aunts; in some cases, you’re adding siblings to the family. You’re adding a branch to that family tree.

How important is the money?

SL: A first-time surrogate with insurance, she may sign a contract for $18,000-$20,000—realizing that she’s not going to get more than a $1,000 until she’s actually pregnant. That’s a confirmation of pregnancy, which is usually via heartbeat and is 4-6 weeks after transfer. So money-wise, it’s really not a heckuva a lot. When I talk to surrogates, if the number one question is “how much can I get paid?” that’s a red flag for me.

What I do hear a lot of is women mostly have all the children that they want but they love being pregnant and they know someone who has struggled with infertility. They feel they have something to offer another couple. They have children, they love family, and they want other people to experience that as well.

[But] you’re not going to do this for nothing. You don’t want that resentment of “Oh, I have to pay my co-pays.” It’s not an easy thing to go through a pregnancy even for yourself. The intended parents should be the ones to take care of you. And in taking care of you, it is a form of bonding. It’s a form of claiming that baby as your own; it’s a way of saying [to their future child], “I may not have carried you for the nine months, but I was there every step of the way.” And there’s a sense of pride and ownership with that.

So if it’s not the money, what motivates surrogates?


SL: When you get to add to a family tree, when no one else has stepped up to the plate—not a sister, not a cousin, not a friend—it makes you feel like you were chosen to help them. Which is why people do it more than once—you want to recapture that feeling of being important. Families tend to take moms for granted, but when you step out of that circle, you aren’t taken for granted. You are special, more special than anyone else for that nine months or more. That can be an addictive feeling, maybe not the most healthy. It’s really a natural high.

What fears did you have? Were you ever worried you’d grow attached to the baby?

SL: I absolutely never thought of growing attached. You know what the biggest problem with surrogates is? They’re attached to the intended parents. Their feelings are hurt when they’ve had constant email/telephone contact—even, if the intended parents live close, weekly contact—especially toward the end of the pregnancy when you have all those appointments when you’re meeting at the OB’s office and you have lunches out after.

All that kind of intimacy, and then the parents go home with the babies. They’re not getting any sleep. They’re adjusting to having one or two little lives in their home. They don’t have time to get on the computer and e-mail you every day anymore. Even once a month is a struggle. That kind of separation is the downer of it all.

Even if you remain friends, it’s really not the same because they have what they wanted. As grateful as they are to you, as wonderful as the whole relationship is, they don’t need you the way they used to.

What kind of problems might arise between surrogates and IPs?

SL: As petty as these may seem, they’re important. For instance, I would have an intended parent call, “I just had lunch with Suzy Q. and she had three iced teas, and we’re worried about her caffeine intake.” Or “she’s about to go on this trip and she’s 28 weeks pregnant. We’re not comfortable.” I’m not making this up. These are calls that I actually have gotten. “She’s a nail tech and we’re concerned about the fumes. We’d like her to quit work sooner than we agreed.” And here’s my favorite: “So-and-so’s pregnant; she’s about 30 weeks. Can we stop her from having sex?”

An agency’s job is to calm the concerns and find out where these concerns are coming from. You can say, for the sexual issue, “Call your OB or your surrogate’s OB and ask her these questions.” What you can do is to guide them to the professional who can answer the question better than you. The agency's role is to smooth out what the expectations are. Whatever the expectations are at the beginning, they are going to change.

[Part two to follow.]

posted by Cheryl Miller | 5:30 pm
File As: Assisted Reproductive Technologies, Surrogacy, Conceptions Interviews

"Having sex to get pregnant -- how last season!"

May 5, 2008

Somehow, I missed this, but South African blogger Tertia Albertyn (mentioned in my article, "Blogging Infertility") has advice on how to stay sane while trying to conceive:

Know that IVF is nothing to be embarrassed about.
In fact my husband and I are actually damn proud that we did IVF. It shows our strength and determination to reach our goal. I mean, really, having sex to get pregnant--how last season! And don't be embarrassed about how many IVFs you've done. Who cares?! Some people might think you are obsessive (so what?) or that you don't know when to stop. Wrong. You might not know exactly when you will stop, but you know it is not with this IVF. You do as many as you want to do. If you only want to do one, that's your choice.

posted by Cheryl Miller | 5:02 pm
File As: Assisted Reproductive Technologies, In Vitro Fertilization

ART in the News

Surrogacy-Gone-Right, the "Male Pill," and more

May 5, 2008

posted by Cheryl Miller | 9:50 am
File As: Assisted Reproductive Technologies

Articles of Note

May 1, 2008

More women over 40 are having babies, reports the Cape Cod Times:

Kim Cabral of Brewster thought she was in early menopause. Instead, she found out she was pregnant. In April 2006, Cabral gave birth to her third child, William, at age 45.

She marvels: "Each child is special, but when you're older, you cherish each little thing. My husband and I were at the playground the other day and he said, 'What would we be doing now without William?' I answered, 'We'd be home watching TV.'

An Australian man explains why he became a sperm donor:

“I chose to be a known donor – that can mean seeing the child only four times a year, or it can mean having more involvement if the mothers would like. Or, like in the case of a couple I helped, my interaction with the child will be through photos and via the webcam,” Mayger said.

“It’s not so much for my benefit, though I do greatly enjoy the contact I have with my gift children. It is for the child’s benefit, so they can know their biological heritage.

A family celebrates the 25th anniversary of Strong Fertility Center:

Despite low odds, the Kohls had a triple success on the first try, becoming the parents of the first triplets born through the Strong Fertility Center.

As the program, which is part of the University of Rochester Medical Center, celebrates its 25th anniversary this week, the Kohls reflect on their experience and fertility specialists review how much has changed.

Worldwide, IVF first led to a baby in 1978 in England. The first such baby in the United States was born in 1981.

"I do remember feeling like wow, if this doesn't work, then what?" Annette Kohl, now 51, recalls. "It was our last resort to having a biological child."

A baby mama's take on Baby Mama:

My favorite part would be the happy ending, with both women experiencing motherhood. With surrogacy, a bond develops between the surrogate mother and the intended parent. I am happy that the movie touched on the strength of this type of relationship.

posted by Cheryl Miller | 2:26 pm
File As: Assisted Reproductive Technologies, In Vitro Fertilization

On Other Blogs

Humanzees, Repro-Lit, and Sex-Selection

May 1, 2008

posted by Cheryl Miller | 9:14 am
File As: Assisted Reproductive Technologies, In Vitro Fertilization

My Two Cents on Baby Mama

Beware: Spoilers galore!
April 27, 2008

  

I didn't write too much about the movie Baby Mama in my recent WSJ article as I didn't want to step on their film critic's toes. Now with no such worries, I thought I'd give my two cents on the film. If you haven't seen it yet, beware as there are spoilers galore below.

One thing I found interesting while researching the WSJ piece was that no one in the industry or the infertility and bioethics communities was excited about the movie. Surrogates worried it would perpetuate negative stereotypes of surrogates as "ignorant white trash" just in it for the money. Attorney Theresa Erickson, who handles surrogacy and egg donation cases, feared the movie with its surrogacy-scam subplot would make surrogacy seem unsafe even though the majority of cases pass without incident. Anne Adams of the American Fertility Association agreed: Most surrogate situations are "utterly uninteresting and banal.... Is this what happens most of the time? No. But you obviously wouldn’t make a movie about what happens most of the time."

On the other side, Jennifer Lahl, director of the Center for Bioethics and Culture, was concerned that Baby Mama made surrogacy look too appealing, and left its dark underside unexplored: "In reality, it's not a light-hearted situation.... Americans will watch this movie, and go, 'How sweet!' But wait a minute, let's have a reality check here." Slate critic Dana Stevens had a similar take: The movie, she wrote,

could have been the springboard to investigating (or wickedly satirizing) some of the issues surrounding surrogacy, which, as this excellent Newsweek piece reported, can be a minefield for class, race, and gender tensions. But the conflict between Kate and Angie rarely rises above Odd Couple level: Organic pea soup or Tastykakes? Touchy-feely birthing videos or American Idol karaoke?

Like Stevens, I found the movie rather tame in its approach to the politics of modern parenthood. Naturally, the "mommy wars" make an appearance with laid-back mom Caroline (Maura Tierney) explaining to her sister Kate (Tina Fey), a driven career woman, that motherhood is "not like opening one of your stores. It's not an executive decision." Later, Kate recalls an old flame who wanted to marry her, but she was too focused on her career. "Other women got pregnant. I got promotions," she says ruefully.

Yet the entire career vs. family debate is rendered moot by Kate's diagnosis: a "sucky" T-shaped uterus. Kate's "advanced maternal age" notwithstanding, her eggs are fine, and it's her mother's exposure to DES — not Kate's decision to put family on the backburner — that causes her fertility woes.

To judge from the script, the writers didn't think too hard about this incongruity. Kate's diagnosis is mostly a means of explaining her need for a surrogate (and a source of mostly lame jokes about her mother's liver spot medication). The career vs. family debate is there because...well, that's what movies about career women and infertility are about.

This wouldn't have been hard to work around — Kate could have used an egg donor as well as a sperm donor, for instance — but it's clear the writers wanted Kate to have her own biological child. The press materials for the movie talk of "two kinds of family: the one you're born to and the one you make," yet Baby Mama is very timid when it comes to alternative families.

The movie's conservatism reminded me of two other infertility-related films I recently watched: the truly awful sperm-donor comedy And Then Came Love and Hannah and Her Sisters (which features a DI subplot). In all three movies, the importance of blood ties is reaffirmed. Love might be an important ingredient, but it's biology that really makes a family in these films. In And Then Came Love, Vanessa Williams leaves her successful, long-time boyfriend for her son's donor dad. In Hannah and Her Sisters, Woody Allen finds himself unable to bond with his wife Hannah or their children who are the product of donor insemination. They divorce, but he soon finds romantic bliss with his wife's sister, who despite his extremely low sperm count, becomes miraculously pregnant.

Baby Mama has a similar twist to Hannah and Her Sisters. After a series of plot turns in which Angie may be faking her pregnancy, Kate gets pregnant the old-fashioned way as does her surrogate Angie. Like Woody Allen's character, Kate's pregnancy only comes about after she finds her true love: Greg Kinnear, who plays a sweet single dad. There's an element of wish-fulfillment here, of course, as with all romantic comedies — which makes a strange ending for a movie that seemed to promise an edgy, provocative take on surrogacy and family.

posted by Cheryl Miller | 5:09 pm
File As: Assisted Reproductive Technologies, Surrogacy, ART in popular culture, Older Mothers/Fathers, Single Mothers by Choice, Third-Party Reproduction

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