In Thailand’s Surrogacy Industry, Profit and a Moral Quagmire

New York Times – August 26, 2014 by Thomas Fuller

PAK OK, Thailand — Soon after the first surrogate mother from this remote village gave birth, neighbors noticed her new car and conspicuous home renovations, sending ripples of envy through the wooden houses beside rice paddies and tamarind groves.

“There was a lot of excitement, and many people were jealous,” said Thongchan Inchan, 50, a shopkeeper here.

In the two years since, carrying babies for foreigners, mainly couples from wealthier Asian nations, quickly became a lucrative cottage industry in the farming communities around Pak Ok, a six-hour drive from Bangkok. Officials say at least 24 women out of a population of about 13,000 people have since become paid surrogate mothers.

“If I weren’t this old, maybe I would have done it myself,” Ms. Thongchan said. “This is a poor village. We make money by day and it’s gone by evening.”

The baby boomlet here was just one of several bizarre and often ethically charged iterations of Thailand’s freewheeling venture into what detractors call the womb rental business, an unguided experiment that the country’s military government now says it is planning to end.

Commercial surrogacy has been available for at least a decade in Thailand, one of only a handful of countries where it is allowed, and one of only two in Asia, making it a prime destination for couples in the region from countries where the practice is banned.

Officials estimate that there are several hundred surrogate births here each year, a number that does not include foreign surrogates, including many hired by Chinese couples, who come to Thailand for the embryo implantation then return home to carry out the pregnancy.

But a pair of recent scandals have focused scrutiny on the largely unregulated industry, raising ethical questions and prompting the government’s crackdown.

In late July, the Thai news media reported that an Australian couple who had paid a woman to carry twins returned home with only one of their children, leaving behind the other, who had Down syndrome. Pleas for assistance by the surrogate mother helped produce a sustained national outcry that was further stoked by comments by the boy’s biological father that were deemed insensitive at best.

The father, David John Farnell, told an Australian television program that he would have preferred that the pregnancy had been terminated. “I don’t think any parent wants a son with a disability,” he said.

He also said that he and his wife had told the agency in Bangkok that served as an intermediary to “give us back our money.”

The Australian news media raised questions about his fitness as a father after finding court records showing that he was convicted and imprisoned for 22 counts of child sex abuse in the 1990s.

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in In the News / International / IVF / Surrogacy  by Anthony Brown 0 comments

Fertility Clinics Scan for the Strongest Embryo

New York Times, July 12, 2014 by Andrew Pollack

Annika Levitt initially resisted the fertility clinic’s suggestion that only one embryo — rather than the usual two or more — be transferred to her uterus because she was too small to risk carrying more than one baby.

“You go through all that and you put only one back in?” she recalled thinking, fearing it would lower her chances of becoming pregnant.

But her embryos had been tested for chromosomal abnormalities, giving a fair degree of confidence that the chosen one was healthy. “Knowing that it was the strongest of the strong was reassuring,” she said. Ms. Levitt, who lives in Morris County, N.J., gave birth to a girl from that embryo and is now pregnant from another single-embryo transfer.

The chromosomal testing is one of the techniques now coming into use to help fertility clinics answer one of their most vexing questions: Which test-tube embryo or embryos will give a woman the best shot at having a baby?

Another new technique uses time-lapse imaging to study the development pattern of the embryo.

Both techniques can potentially provide more information than the approach now used to judge an embryo’s fitness, which is to look at its shape under a microscope.

That could increase the sometimes frustratingly low efficiency of in vitro fertilization. And if clinics can be nearly certain that an embryo is fit, they might feel more comfortable transferring only one embryo rather than two or more, as is common practice. That would reduce the chances of producing twins or triplets, which face greater health risks than single babies.

“What’s really good about this is we get high rates with singletons,” said Dr. Richard T. Scott Jr, clinical and scientific director at Reproductive Medicine Associates of New Jersey, where Ms. Levitt went.

But some experts say the new techniques, which can add thousands of dollars to the cost of in vitro fertilization, are being heavily promoted without data supporting that they truly improve pregnancy rates. For some women, they say, chromosomal testing, an invasive procedure, might even worsen their chances of getting pregnant.

“A significant portion of women may actually be hurting themselves by doing that,” said Dr. Norbert Gleicher, medical director of the Center for Human Reproduction, a fertility center in Manhattan.

The chromosomal testing is called preimplantation genetic screening, or P.G.S. This is different from a related technique called preimplantation genetic diagnosis, which tests embryos for specific mutations with the goal of preventing the birth of a baby with a genetic disease. With the chromosomal screening, the goal is mainly to improve birthrates, not influence the traits of the baby.

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Positively Dads – These HIV-positive gay men fathered children. Here’s how you can too

By E.J.Graff via Gays With Kids

Aslan always believed he would be a father—if not with a partner, then by teaming up with one of his straight, single female friends. But “at the age of 36, I became infected with the [HIV] virus,” he said. “I thought my whole world collapsed. Everything crashed with that. I believed that there would be no child.” He was gay and single, living in a cosmopolitan city in his southern European country, when a female friend asked him to pair up to make a baby. He had heard that it could be done safely, but when he told her his HIV status, her reaction, he said somewhat morosely, was “very naturally, not very brave.” Unwilling to face that rejection again, he spent years trying to bury his profound desire to parent.

Things were different for Brian Rosenberg and Ferd van Gameren, who were already in their forties by the time they began thinking about having kids. Their early years together focused on keeping Brian, who is HIV-positive, healthy and Ferd negative. But once protease inhibitors emerged and Brian’s health was stable, the couple decided to focus on enjoying life. They moved from Boston into a one-bedroom Chelsea co-op in New York City, started summering in Fire Island, and hopped around their friends’ parties having “a gay old time,” as Brian put it.

After several years, though, all that began to pale. “We started thinking that life had to be more meaningful for us than the next party, the next fabulous vacation.” They wanted a family, and all the responsibility, love, and exhaustion that went with it. They tried adoption first, but when one birthmother backed away, their hearts were broken–so they discussed surrogacy. Given his HIV status, Brian assumed that Ferd would be the biological dad–but Ferd wanted to raise Brian’s bio children. And so in 2009 Ferd went online and found the Special Program for Assisted Reproduction, or SPAR, dedicated to helping HIV-positive men father children safely. The program is run by the Bedford Research Foundation and its director Dr. Ann Kiessling.

Back in southern Europe, by 2011, Aslan was learning about the same option. He was seven months into a new relationship that seemed as if it would stick—and despite himself, he began to imagine having a family with this man. Coincidentally, an American friend forwarded him an article about Circle Surrogacy, which worked with HIV-positive gay men in the States. “And it gave me, like, a wow, big hope, a new window to plan my life again!” Aslan quickly contacted Circle Surrogacy, which connected him with Dr. Ann Kiessling. “She was very kind and explained all the procedures, that it’s completely safe. And this was the start.”

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The Next Frontier in Fertility Treatment

New York Times By SARAH ELIZABETH RICHARDS

ANDY INKSTER, a transgender man, had always wanted biological children. So when he embarked on the transition from female to male at age 18 — changing his name, taking testosterone and eventually undergoing surgery to remove his breasts — he left his female reproductive organs intact.

In his mid-20s, he decided it was time. He stopped taking testosterone and started trying to get pregnant. Eventually, in 2009, after beginning graduate school at the University of Massachusetts at Amherst, he sought fertility treatment at Baystate Reproductive Medicine. Baystate was one of the few clinics in the country with an anti-discrimination policy for gender identity. And yet, it refused to treat him, arguing that it didn’t have enough expertise to treat transgender patients. Mr. Inkster insisted there was no medical reason to deny him; his baby-making parts were the same as any woman’s.

The more than 700,000 transgender people living in the United States have long faced discrimination by health care providers. Over the past 15 years, activists have fought to compel insurers to cover transgender-related health care — from hormone therapy to gender reassignment surgery — or at least be prevented from excluding transgender clients from buying policies for basic services. Finally, starting this month, thanks to the Affordable Care Act, “transsexualism” can no longer be considered a pre-existing condition. What’s been left out of the spotlight: having babies. Many Americans have come to accept gay parents; the transgender community is next in line for recognition.

Mr. Inkster eventually found another clinic that helped him conceive via in vitro fertilization and donor sperm, and in October 2010, he gave birth to a daughter, Elise. A month later, he sued Baystate for sexual discrimination.

According to court documents, he was denied treatment after failing to comply with a clinic counselor’s request that he supply information from his current therapist that he was emotionally ready to handle pregnancy and parenting. Mr. Inkster argued that nontransgender patients weren’t asked to do the same. This fall, the Massachusetts Commission Against Discrimination — the state’s civil rights agency — found probable cause for Mr. Inkster. The case will next move on to a conciliation conference, and then to a possible settlement.

Admittedly, the idea of a “pregnant man” makes many people uncomfortable, and photos of Mr. Inkster caressing his bulging belly are startling. The issue is controversial even within the transgender community. “Some people believe if you’re a trans man you shouldn’t be wanting to bear kids,” Jamison Green, the author of “Becoming a Visible Man,” told me. “That’s not something men do. Others think, If you have a body part that does something, why can’t you use it? It’s your body.”

The issue brings up unprecedented questions: Do you use your genetic material to reproduce, and at what time during your transition? Before or after hormone therapy? Before undergoing reassignment surgery that will make you sterile? Should a transgender man like Mr. Inkster keep his breasts so he can nurse later? Is it generally psychologically healthier for someone like him to freeze his eggs and have them inseminated and the embryos transferred to a female partner or surrogate, rather than leave his female reproductive parts intact? How might years of estrogen or testosterone therapy affect eggs and sperm?

To read the entire article, go to http://www.nytimes.com/2014/01/13/opinion/the-next-frontier-in-fertility-treatment.html?src=rechp

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Fla. Supreme Court Settles Lesbian Custody Battle

By BRENDAN FARRINGTON Associated Press for ABC.com

The Florida Supreme Court has ruled that a woman who donated an egg to her lesbian partner has parental rights to the child.

The court issued its ruling Thursday and ordered a lower court to determine custody and visitation rights.

The case involves two lesbians who began raising the child together. One donated an egg that was fertilized and implanted in the other. That woman gave birth in 2004.

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Fertility Clinics Help More Gay Couples Have Kids

By MARILYNN MARCHIONE 10/16/13

BOSTON — BOSTON (AP) — Fertility clinics have put a new twist on how to make babies: A “two-mom” approach that lets female same-sex couples share the biological role. One woman’s eggs are mixed in a lab dish with donor sperm, then implanted in the other woman, who carries the pregnancy.

A New York doctor described 18 of these cases Tuesday at a fertility conference in Boston that featured other research on ways to help same-sex couples have children. Dr. Alan Copperman is medical director of Reproductive Medicine Associates, a New York City clinic that does the “two-mom” approach.

A New York couple — Sarah Marshall, 40, a recruiter for law firms, and Maggie Leigh Marshall, 35, a real estate broker — used it to have their daughter, Graham, now 18 months old. Maggie’s eggs were used to make embryos that were implanted in Sarah, and both women are listed as parents on the birth certificate.

“It allowed us both to participate,” Sarah Marshall said. “I had to mentally and psychologically give up the idea of, is she going to look like me or my family. But from the time I started carrying her up to now, she is definitely mine.”

Maggie Marshall said she had no interest in being pregnant, but “Sarah really wanted to have the experience. We also thought it would be a great way to bond with a kid that ultimately would look a lot like me.”

It wasn’t cheap — the couple spent nearly $100,000 on multiple failed attempts before the last one worked. A single in vitro fertilization attempt can run $15,000 to more than $20,000, depending on how much embryo testing is done and whether some embryos are frozen to allow multiple attempts from one batch.

One Canadian study suggests that more lesbian couples have been seeking fertility services in Ontario since same-sex marriage was legalized in the province a decade ago. Some doctors think interest also is up in the U.S. For male couples, many clinics offer egg donors and surrogate moms, using one or both men’s sperm.

“The modern family is created in a way that would be humbled by traditional fertility treatments,” said Copperman. “We’re seeing more and more couples come in and want to share the parenting experience,” and their medical forms more often say “wife” rather than “domestic partner.”

“This is something that a lot of lesbian couples choose to do” if they can afford it, said Melissa Brisman, a reproductive law specialist in Montvale, N.J., who has advised many such couples. “Some doctors really have a problem doing this for non-medical reasons” because any medical procedures carry risks of infections or other complications, she added.

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It Is Time for the U.S. to Cover IVF (for Gays and Lesbians Too)

Huffington Post, March 18, 2013 – Dov Fox and I. Glen Cohen

This week the United Kingdom joined the ranks of countries like Israel and Canada that provide in vitro fertilization (IVF) treatment to citizens under a certain age (42 in the U.K.) who can’t have children without it. That includes gays and lesbians. When it comes to helping people form the families they long for, the United States is woefully behind. The U.S. has among the lowest rates of IVF usage of any developed country in the world, owing in part to boasting the highest cost for the procedure, on average $100,000 per successful pregnancy.

Among the handful of states that require insurers to cover IVF, many carve out exclusions for same-sex couples and people who aren’t married. These singles, gays, and lesbians are sometimes called “dysfertile” as opposed to “infertile” to emphasize their social (rather than just biological) obstacles to reproduction. The U.S. should expand IVF coverage for the infertile and include the dysfertile too.

The U.S. Supreme Court has held that the inability to reproduce qualifies as a health-impairing disability under the Americans with Disabilities Act. The commitment to universal health care that we renewed in President Obama’s health reform act invites us to understand the infertile and dysfertile alike as needing medicine to restore a capacity–for “[r]eproduction and the sexual dynamics surrounding it”–that is, in the words of the Supreme Court, “central to the life process itself.”

It is true that dysfertility fits less comfortably within the medical model. But why should that alone make less worthy the desires of gays and lesbians to have a genetic child? Joe Saul, the protagonist in John Steinbeck’s 1950 play Burning Bright, put it best:

A man can’t scrap his bloodline, can’t snip the thread of his immortality. There’s more than . . . the remembered stories of glory and the forgotten shame of failure. There is a trust imposed to hand my line over to another.

My impulse to create a biological family, to raise “my own” children, to “hand my line over to another” is shared by people single or married, black or white, gay or straight. And the arguments against IVF subsidies fall short.

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NOM compares potential gay parents to rapists, sexual predators

By: Tuesday October 9, 2012 Pams House Blend

Pay attention, gay folks. There is seems to be a quiet war going on against our rights to be surrogate parents.

Via the NOM blog, I found this highly offensive piece, The New Sexual Predators. In it, the author, Alana S. Newman compares gay couples and older woman to human traffickers out to steal the eggs of younger women.

Every portion of this piece is gag-worthy drivel:

Young women now have to defend themselves not only from stereotypical sexual predators, but also from older women and gay men who seek their eggs.

. . . there are new predators on the scene, for whom we do not have a script. There are new characters eager to exploit our daughters’ bodies, who enjoy unsullied reputations, passing detection even as they blatantly hunt for eggs and wombs with checkbooks in hand. And historically they have been the people women should fear the least. These new players vying for access to young women’s bodies are older or infertile women, and gay men—quite often our friends and members of our family.

. . . Our gay friends and family members may now also be after our daughters’ bodies. These are the only men in the world we thought we could trust because they weren’t interested in our bodies. That is, until they grew older and discovered they wanted to be parents. Today, more and more often, gay men are using egg donors and surrogates to create motherless children on purpose. Toleration of these attempts to create families follows a timeline of slipped slopes and fallen barriers. If heterosexual couples can use sperm donors to create children who are separated from their biological fathers, so the logic goes, then lesbians should be able to do the same thing. To them, it’s not biology that matters—kids just need two parents. And if lesbians use sperm donors to create fatherless children, then it’s only equal and fair for gay men to be able to use egg donors and surrogates to create motherless children too. Because again, it’s not biology that matters; kids just need two parents. At present, all those who believe in gender equality rather than gender complementarity are being urged to accept this often violent (against women) form of third-party reproduction.

It’s not just the the piece itself which we should be paying attention to but also who is promoting it. Yet again, the National Organization for Marriage undercuts its false claim of simply attempting to protect marriage and continuous whine about “falsely” being called bigots. By promoting this piece on its blog,  it is now even more apparent that NOM has declared war on same-sex families.

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Create a Baby From Stem Cells? Research Suggests Possibility

BY Trudy Ring – The Advocate

October 05 2012

A breakthrough in fertility research lays open the possibility that gay and lesbian couples could someday have children who are completely their own, genetically speaking.

Researchers at Kyoto University in Japan have created eggs from stem cells in mice and used them to produce healthy offspring, NPR reports. They first used embryonic stem cells, then repeated the results stem cells created from adult cells, such as blood or skin. The same team previously created sperm from stem cells. “Stem cells can morph into any cell in the body,” observed NPR reporter Rob Stein.

If the results from mice could be duplicated in humans — a far-off possibility, granted, but scientists say mice are sufficiently similar to humans that it could happen — same-sex couples could create their own sperm and eggs and join them to have a child.

“There are lots of lesbian and gay couples who would be very excited about the possibility for the first time of being able to have children who are genetically their own,” Hank Greely, a bioethicist at Stanford University, told Stein.

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IVF embryos that were frozen may result in healthier babies

The Guardian – by Ian Sample

Women who become pregnant with previously frozen IVF embryos tend to have healthier babies and fewer complications than those who have fresh embryos implanted, research suggests.

Fertility doctors found that mothers had a lower risk of bleeding in pregnancies with embryos that had been frozen and thawed, and went on to have fewer pre-term and low birthweight babies.

Fertility clinics in Britain usually transfer fresh embryos into women several days after they have been given hormone injections that stimulate their ovaries to release eggs. These are extracted and fertilised before being implanted. Any embryos that are not used straight away can be frozen for use months or years later.

The new results raise questions about the way fertility treatment is offered in the UK. If mothers and babies fare better with previously frozen IVF embryos, it may make sense to freeze more or most embryos for transfer into women later on.

The findings appear in a review of 11 published studies that covered more than 37,000 pregnancies in women who had either fresh or previously frozen IVF embryos implanted in their wombs.

The doctors who led the work suspect that IVF embryos that were frozen make for healthier babies because they are implanted long after the woman’s ovaries were stimulated with drugs, so hormone levels in the womb have had time to return to normal. This means the embryos implant in a more natural environment.

Another theory is that only high-quality embryos survive the freeze and thaw process, though survival rates for frozen embryos are now more than 90% in some clinics.

Abha Maheshwari, a senior lecturer at Aberdeen University and consultant in reproductive medicine with NHS Grampian, described the results at the British Science Festival in Aberdeen. The report appears in the journal Fertility and Sterility.

“If pregnancy rates are equal and outcomes in pregnancies are better, our results question whether one should consider freezing all embryos and transfer them at a later date, rather than transferring fresh embryos,” Maheshwari said. The practice has already been adopted by some clinics in Japan.

Maheshwari said the case to switch to frozen-only embryos was not yet strong enough, because the full consequences are unclear. Her study did not look at pregnancy rates, for example.

According to Alison Murdoch, head of Newcastle University’s fertility centre, a shift from fresh to frozen embryos would see birth rates from IVF fall because the latter still result in fewer pregnancies overall, despite improvements in freezing and thawing techniques in recent years.

“We have to explore further what is the cause of frozen embryos giving us better pregnancies or lesser complications in the pregnancy,” Maheshwari added.

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