Paying gestational carriers should be legal in all states

Every year, hundreds of thousands of babies are born in the U.S. using assisted reproductive technologies, including the use of gestational carriers, a multibillion-dollar industry that is controversial and largely unregulated.

One of the controversies involves the use of paid gestational carriers, women who agree to carry a fertilized embryo, created from another woman’s egg, give birth, and give the baby to its parents. This is different from tradition (or genetic) surrogates, who provide both their own eggs and their own wombs. Gestational surrogacy now constitutes 95% of all surrogacy in the U.S.gestational carriers

State laws about arrangements for gestational carriers vary widely and are in flux. This kind of surrogacy is currently allowed in 10 states; prohibited but with various caveats and additional legal proceedings in 30; practiced with potential legal obstacles and inconsistent outcomes in five; practiced but with legally unenforceable contracts in two and prohibited in three. Several of the 40 states with real or potential legal hurtles require that couples be married and heterosexual, or allow surrogates to choose at any point to keep the baby.

Commercial surrogacy first gained wide attention in the 1980s through the Baby M case. Elizabeth Stern had multiple sclerosis and feared that pregnancy would worsen it. Through a newspaper ad, she and her husband connected with Mary Beth Whitehead, who agreed to carry a fetus for them as a traditional surrogate, providing both an egg and a womb. But after giving birth, Whitehead decided to keep the child. A New Jersey court awarded the Sterns custody of Baby M, but banned all such future surrogacy contracts.

Since then, practices have changed and the use of gestational carriers has grown dramatically. In many states, however, prospective parents need to travel to other states, like California, to avoid legal obstacles. Some seek surrogates in the developing world, which has its own set of problems.

Competing proposed bills in New York state highlight the conflicts involved in gestational surrogacy.

In June 2019, the New York state Senate voted to legalize gestational surrogacy. The pushback was swift and strong. Noted feminist Gloria Steinem argued strongly against the proposal, raising concerns that poorer women of color would disproportionately serve as gestational carriers. She also pointed out that the bill would require surrogates to be state residents for only 90 days, which could prompt human traffickers to bring women to New York to serve as surrogates. The State Assembly then rejected the proposal. Lawmakers are now considering at least two different revised versions of the bill — one from Gov. Andrew Cuomo and one from the bill’s original sponsor — that address these criticisms.

I believe the state should legalize gestational surrogacy, providing it includes protections to avoid the problems Steinem highlighted.

In the debates in New York, as well as those in other states, both sides have been arguing in the relative absence of data, without acknowledging this deficit. In fact, the limited data available so far do not suggest that women become gestational carriers because of financial distress, nor do the demographics reflect racial disparities.

StatNews.com, by Robert Klitzman, February 12, 2020

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Fresh Eggs For IVF Offer Slightly Better Birth Outcomes

Using fresh donor eggs for in-vitro fertilization (IVF) provides a small but statistically significant advantage in birth outcomes compared to frozen donated eggs, research finds.

The national study in the journal Obstetrics & Gynecology was the largest head-to-head comparison of the two IVF approaches, measuring the likelihood of a good perinatal outcome, defined as a single baby without prematurity and with a healthy birth weight.fresh eggs

“Our study found that the odds of a good birth outcome were less with frozen than with fresh, but it was a small difference,” says lead author Jennifer L. Eaton, medical director of assisted reproductive technology and director of the Oocyte Donation Program at the Duke Fertility Center.

“From a clinical standpoint, given that frozen eggs have many benefits such as ease, cost, and speed, the decision to use fresh or frozen donor eggs should be made on an individual basis after consultation with a physician,” Eaton says.

Eaton and colleagues, including senior author Alex Polotsky of the University of Colorado Advanced Reproductive Medicine, studied three years of data from the Society for Assisted Reproductive Technology. Nearly 37,000 IVF attempts were analyzed, including 8,381 (22.7%) that used frozen eggs and 28,544 (77.3%) using fresh.

Controlling for factors such as the quality of fertilized eggs and the age of both mother and donor, the researchers found that fresh eggs resulted in a good perinatal outcome in 24% of fertility attempts compared to 22% of the attempts with frozen eggs. Implantation, clinical pregnancy, and live birth rates were all significantly higher among the women using fresh eggs vs. frozen.

“As IVF with donor oocytes has become standard treatment for women with decreased egg supply or advanced reproductive age, there has been an increased demand for donor oocytes, making frozen eggs an attractive option,” Eaton says. “In general, IVF with frozen donor eggs is cheaper and faster than with fresh donor eggs.

Fututiry.org by Sarah Avery-Duke, February 7, 2020

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The Number of Employers Who Offer Fertility Benefits is on the Rise

Fertility benefits rank high on the list of valuable benefits that make recruiting top talent, retaining valuable employees, and reducing turnover easier. Providing coverage for family building options has been shown to increase employee retention and loyalty.

According to a recent FertilityIQ survey, 68 percent of millennials consider fertility benefits when choosing an employer, and 9 out of 10 employees with fertility issues will switch jobs for benefits.fertility benefits

This scenario was very true for millennial, Katie Goad and her husband Adam. They had an 8-year-old daughter and wanted to expand their family. After giving birth to her first child, Katie had surgery that meant she would have to undergo in vitro fertilization (IVF) in order to have another child.

Lacking insurance for IVF, Katie was determined to expand her family without going into debt in the process, so she explored her employment options and discovered that Starbucks offered benefits to cover IVF, even to hourly, frontline workers. Starbucks is revered for being among the first to provide fertility benefits to hourly and part-time employees.

“I was honest with them in my interview about what my goal was, and what my intentions were,” Goad said in a recent interview with Benefit News.

She landed the job and started working as a part-time barista.

In a recent survey, FertilityIQ, author of the extensive Family Builder Workplace Index, found that 73 percent of fertility patient respondents felt more gratitude toward their employer because of fertility benefits, 61 percent said it made them feel more loyal, and 53 percent said it influenced them to stay with a particular employer longer.

“In this tight labor market, millennials are entering the family building years and flooding the workforce. Companies eager to recruit top talent know that offering fertility benefits, paid parental leave, and flexible schedules fosters a great sense of loyalty,” said Patty Stull, Chief Marketing Officer of SGF.

Once Katie qualified for health benefits through Starbucks, she began fertility testing and treatment under the care of Dr. Mark Perloe at Shady Grove Fertility Atlanta.

Why Aren’t There More Rich Foster Parents?

Bureaucracy — no surprise — gets in the way of expanding the pool of volunteers to be foster parents.

Over the past 15 years or so, Pedro Maldonado, Nigel Warren and Brieanna Hayes, all now in their 20s, cumulatively lived in about 39 different foster homes in New York City. Pedro, who is Italian, was lucky: He ultimately settled in with a caring Mexican family for more than a decade before he aged out of the system and began living on his own.foster parents

Nigel and Brieanna had a harder time of it.

In one house, Nigel found himself subjected to a painful and relentless competition with another foster child who was favored for his good grades and athleticism. Once Nigel got into a fight with his foster father that became physical, and the foster father bit him.

Brieanna said that her best foster mother was a drug addict who, despite everything, really cared about her. Brieanna, who is gay, entered the system when she was 14 and immediately faced hostility from the guardians who could not abide her sexuality.

In one situation, Brieanna was not allowed to use the washing machine. During the holidays, she would be asked to leave to create room for extended family, which left her on the streets.

Despite the prevalence of such Dickensian anecdotes, New York City’s foster care system has been considered an enormous success in recent years, a potential model for the rest of the country where thousands of children suspended in the opioid crisis have required an ever greater number of caregivers.

During the past quarter-century, the city’s Administration for Children’s Services has reduced the foster population from 50,000 children to fewer than 9,000, through a focus on preventive services that strives to keep biological families together.

And yet, the broader problem of inequality along with the various hurdles imposed by bureaucracy can collude to impair how and where children might be placed, leaving the project of foster care another social burden assumed largely by the less affluent.

It is one of the essential paradoxes of life in New York that you are much more likely to find a foster parent in a small apartment belonging to the New York City Housing Authority than in a triplex on West End Avenue with its own gym.

How to attract a wider range of people to the work is a perennial question, Kerry Moles told me. Ms. Moles is the executive director of CASA-NYC, an organization whose volunteers are assigned by judges to help children in foster care and those who age out. (Pedro, Nigel and Brieanna are members of the organization’s youth leadership council, working with young people and educating judges and lawyers about the experience of growing up in the system.)

It would be easy to say that the problem lies with the selfish habits of the upper classes; however charitable they might be when it comes to writing checks to well-meaning foundations, they are all too happy to insulate themselves from the messiness of life beyond the bubble.

While there is obviously truth to that kind of judgment, it is also the case that the rigidity of the foster-care system can keep well-meaning people away.

Consider the example of Sara Beth Turner, a photographer in her 30s, who lives alone in a brownstone apartment in Brooklyn with that rarest of assets, an empty second bedroom. Inspired by the mission of her church, Trinity Grace, in Williamsburg, a congregation filled with young, creative people like her, she was moved to foster a teenager. About a third of the city’s foster population is made up of children over 13, and they are always the hardest to place.

NYTimes.com, January 17, 2020 By Ginia Bellefante

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How Men’s Bodies Change When They Become Fathers

Hint: They don’t just get ‘dad bods’ but men’s bodies change.

Men’s bodies change when they become fathers.  As an anthropologist who studies human fatherhood at the University of Oxford, I’ve run up against a widespread and deeply ingrained belief among fathers: that because their bodies haven’t undergone the myriad biological changes associated with pregnancy, birth and breastfeeding, they’re not as biologically and psychologically “primed” for caretaking as women are.men's bodies change

As a result, they feel less confident and question their abilities to parent: Will they be “good” parents? Will they bond with their babies? How will they know what to do?

As my own personal and professional experiences dictate, the idea that fathers are biologically “less prepared” for parenthood is unlikely to be true. Much of the role of parenting is not instinctual for anyone. (I remember the steep learning curve of those first days of motherhood — learning what each of my baby’s cries meant, mastering the quick diaper change and juggling the enormous amount of equipment necessary just to make it out the door.)

And while the biological changes fathers undergo are not as well understood (nor as outwardly dramatic) as those of mothers, scientists are just beginning to find that both men and women undergo hormonal and brain changes that herald this key transition in a parent’s life.

In essence, being a dad is as biological a phenomenon as being a mom.

Testosterone seems to dip

Take testosterone, the stereotypically “male” hormone that plays important roles in male fetal development and puberty. Testosterone is largely responsible for motivating men to find partners and, studies suggest, men with higher levels of testosterone tend to be more attractive to potential mates. But being a successful human father means focusing inward on the family and resisting the drive to seek out another partner. So, experts believe, men have evolved for some of that testosterone to go.

In a pioneering five-year study published in 2011, for instance, Dr. Lee Gettler, Ph.D., an American anthropologist, followed a group of 624 single, childless men in the Philippines from age 21 to 26. Dr. Gettler found that while all men in the study experienced normal, age-related dips in testosterone, the 465 men who became dads during that five-year period experienced a more significant drop — an average 34 percent (when measured at night) — than those who remained single or married.

Globally, study after study — including my own unpublished findings in the United Kingdom — have found similar results, noting that this reduction in testosterone can happen just before and just after the birth of a man’s first child. And while it isn’t clear exactly what prompts this drop, Dr. Gettler said that his own preliminary results suggest that the more dramatic the drop, the bigger effect it seems to have on a man’s caregiving behavior. “We found that if brand new fathers had lower testosterone the day after their babies were born,” said Dr. Gettler, “they did more caregiving and baby-related household tasks months later.”

While news of this drop in testosterone is often greeted with groans of resignation from men — choose fatherhood and choose the road to emasculation, they think — some studies have suggested that the lower a man’s testosterone, the more likely he is to release key reward and bonding hormones, namely oxytocin and dopamine, when interacting with his child. Caring for your child, therefore, produces not only a strong bond but a neurochemical reward, inducing feelings of happiness, contentment and warmth — a welcome trade-off.

Brains seem to change

The brain also appears to undergo structural changes to ensure that fathers exhibit the key skills of parenting. In 2014, Dr. Pilyoung Kim, Ph.D., a developmental neuroscientist at The University of Denver, put 16 new dads into an M.R.I. machine: once between the first two to four weeks of their baby’s life, and again between 12 and 16 weeks. Dr. Kim found brain changes that mirrored those previously seen in new moms: Certain areas within parts of the brain linked to attachment, nurturing, empathy and the ability to interpret and react appropriately to a baby’s behavior had more gray and white matter between 12 and 16 weeks than they did between two and four weeks.

NYTimes.com, By Anna Machin, June 13, 2019

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More LGBTQ millennials plan to have kids regardless of income, survey finds

 The price of parenthood can be costly for LGBTQ millennials, and all LGBTQ families, especially those dependent on assisted reproductive technology.LGBTQ millenials

Since they married in 2015, LGBTQ millennials, Jonathan Hobgood, 37, and his husband, Kerry Johnson, 36, have wanted to be dads. At first, the couple saw adoption as the best path to parenthood, but South Carolina, where they live, is one of 10 states with religious exemption laws that make it more difficult for same-sex couples to foster and adopt, and they worried that adopting would set them up for a legal nightmare down the road.

“Our concern was that if we did a private adoption and the birth mother decided a couple of years later that she wanted her child back, we would be in for a rather extensive legal battle to try to keep the child,” Hobgood told NBC News. “So we just decided, ‘Well, let’s take ourselves down the surrogacy path from there.’”

In reality, a court-ordered private adoption would have provided the secure, legal parent-child relationship Hobgood and Johnson were looking for, but it is common for prospective parents to have misconceptions about how the law treats parental rights, according to Denise Brogan-Kator, chief policy officer at Family Equality.

The couple did their research. The cost of hiring a female surrogate, they learned, would be steep — $120,000 to $150,000, a price that Hobgood, a project specialist for a medical insurance company, and Kerry, a management analyst with the U.S. Department of Veteran Affairs, could hardly afford. But it did not deter them.

“I knew I wanted to be a child’s father,” Hobgood said. “I really just wanted to go through and enjoy bringing up this wonderful child who is a part of our family.”

Hobgood and his husband are among an increasing number of lesbian, gay, bisexual, transgender and queer people in the U.S. planning to have children, according to data released this year by Family Equality, a national nonprofit that advocates for LGBTQ families. And despite the additional financial barriers for many prospective parents in this group, this increased desire to have children was found across income levels, according to a report the group released this month, “Building LGBTQ+ Families: The Price of Parenthood.”

Family Equality polled LGBTQ millennials -500 LGBTQ and 1,004 non-LGBTQ adults, and found that the desire to become parents is nearly identical among both lower- and higher-income lesbian, gay, bisexual, transgender and queer people. Forty-five to 53 percent of LGBTQ people between the ages of 18 and 35 are planning to become parents for the first time or add another child to their family (compared to 55 percent for their non-LGBTQ counterparts, a gap that has narrowed significantly compared to older generations).And those making less than $25,000 a year plan to have children at a similar rate to those making over $100,000, according to the report.

Amanda Winn, the organization’s chief program officer, was surprised by the findings.

“I was expecting that folks who were living at the poverty line would report lower rates of wanting to bring children into the home knowing that finances were tight, but that’s not the case,” Winn told NBC News. “That innate, strong desire to have families exists regardless of income levels.”

LGBTQ prospective parents are more likely to face financial hurdles than their heterosexual peers, according to the report. Reasons include their relatively lower annual household incomes and the additional costs associated with having a child using an option other than sexual intercourse, which is considered by only 37 percent of LGBTQ people planning to start their families or have more children.

Assisted reproductive technology: ‘an impossible barrier’ for some

Thanks to advancements in assisted reproductive technology (ART), such as artificial insemination, in vitro fertilization and surrogacy, more LGBTQ people can have children through nontraditional methods, and interest is growing. Forty percent of LGBTQ people are considering such technology to conceive children, according to a Family Equality survey published in February — but many of these prospective parents will pay for it out of their own pockets, and the technology can be expensive.

“Most LGBTQ+ individuals will learn that their health insurance plan does not cover the cost of fertility treatments at all, and, if they do, the individual or family unit must prove that they have been ‘trying’ to conceive for 6-12 months before coverage begins,” the Family Equality report states. “This stipulation in the policy results in high monthly expenses for some and creates an impossible barrier for others.”

nbcnews.com, by Julie Compton December 27, 2019

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Opinion – What Happened to All Those Frozen Eggs?

Frozen Eggs was supposed to be as revolutionary as birth control. It hasn’t lived up to the hype — but it has still changed women’s lives.

Frozen eggs – The potential for egg freezing to allow women to pause their biological clocks is one of the most astonishing developments of recent fertility science. The promise was thrilling: Women could enjoy more time to find the right partners, break up with the wrong ones and become emotionally and financially ready to become mothers.Egg Donations

Enthusiasts even fantasized the technology would promote gender equality by giving women control over their fertility so that they wouldn’t have to scale back their career ambitions during their 20s and 30s. “Freeze Your Eggs. Free Your Career” blared a 2014 cover of Bloomberg Businessweek.

When Facebook and Apple announced that same year that they would pay for egg freezing for employees in a “game-changing perk,” Apple said in a statement, “We want to empower women at Apple to do the best work of their lives as they care for loved ones and raise their families.”

Egg freezing was an act of self-care — and professional advancement — for the modern woman.

“All the talk in the beginning was about how egg freezing would be as big as the birth control pill and liberate women,” said Janet Takefman, a reproductive health psychologist at McGill University in Montreal, who has counseled more than 200 women considering egg freezing.

And women responded to this promise. In 2009, the first year the Society for Assisted Reproductive Technology started collecting egg freezing data, 475 women went through the procedure, in which an average of 10 eggs are surgically removed and preserved in liquid nitrogen after 10 days of hormonal stimulation. In 2017, more than 9,000 women froze their eggs.

Now we have a chance to look back and ask: Did egg freezing live up to its hype?

The most obvious question is whether egg freezing worked by allowing women to have children later. Although SART collects data on pregnancy rates using frozen eggs, it doesn’t break out whether women had frozen them as part of in vitro fertilization treatment or fertility preservation during illness, or to delay childbearing. So I contacted four fertility clinics that have been in the field the longest to find out. (I froze my eggs at two of them and haven’t yet thawed.)

nytimes.com, by Sarah Elizabeth Roberts, December 21, 2019
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Taiwan Surrogacy – After gay marriage law passes, Taiwan emerges as new market for LGBT+ surrogacy

Taiwan Surrogacy – After gay marriage law passes, Taiwan emerges as new market for LGBT+ surrogacy

On Geoffrey Li’s 40th birthday last year, he put aside his dream of an early retirement on an idyllic island and instead decided to raise a child in Taiwan with the assistance of surrogacy in Southeast Asia.Taiwan surrogacy

Li and his husband — whose twin boys are now three months old — are among an increasing number of gay couples in Taiwan becoming parents through surrogacy even though the procedure is illegal on the self-ruled island deemed a wayward province by China.

 

Taiwan became the first place in Asia to legalize gay marriage in May and more than 2,000 same sex couples have since wed, prompting a rush of commercial surrogacy agencies to head to Taiwan to help more LGBT+ couples seeking to start families.

“Having a child in the world to care for, who will return our love unconditionally, is an amazing experience we did not expect to have,” Li said.

Globally, the popularity of surrogacy — where a surrogate mother is either implanted with a sperm and egg or becomes pregnant using her own egg — is soaring, particularly among LGBT+ couples who want to become parents.

Global fertility services were estimated in an initial valuation to be worth about $21 billion in 2018 with the industry forecast to grow to $41 billion by 2026, according to India-based market research firm Data Bridge.

Surrogacy laws around the world vary.

For example, Taiwan, France and Germany prohibit all forms of surrogacy, while Britain, Canada and New Zealand allow some forms of altruistic surrogacy but it is illegal to pay a woman for her services.

Taiwan’s Assisted Reproduction Act forbids any form of surrogacy and any attempts to amend laws, as recently as 2017, have failed due to opposition from women and children’s rights groups.

Conservative groups, such as the Coalition for the Happiness of Our Next Generation, have actively campaigned against LGBT+ parenting and marriage equality.

But although two-thirds of Taiwanese voters — about 7 million people — opposed changing the country’s civil code to recognize same-sex marriage in a 2018 referendum, parliament in May passed a law legalizing gay marriage.

New frontier

Under current laws, same-sex couples can only adopt children who is biologically related to at least one of them, with activists marking this as one of the next frontiers in the fight for LGBT+ equality on the island of 23 million people.

The Taiwan LGBT Family Rights Advocacy (TLFRA) group said they are in contact with at least 300 “rainbow families” and expect the number of same-sex parents to rise as the new gay marriage law spurred visibility and acceptance.

“Part of the (LGBT+) community is celebrating, while part of the community has a lot of fighting to do,” said Chu Chiajong, administrative secretary of the TLFRA.

This has been encouraged by the arrival of commercial surrogacy agencies, mainly from the United States, in Taiwan where hundreds of gay couples are willing to pay up to $140,000 to start a family — almost 10 times the average annual salary.

There is no legislation concerning surrogacy at the federal level in the United States and some states allow commercial surrogacy arrangements.

Men Having Babies, a New York-based non-profit that helps gay men become fathers through surrogacy, hosted its first conference for prospective Asian gay parents in Taipei in March.

About 320 people attended, forcing the organizers to request a space twice the size of the room originally booked.

“People were revelling in it. They were proud of the fact this was happening,” said group founder Ron Poole-Dayan, who was part of one of the first same-sex couples in the United States to father children through gestational surrogacy.

American Fertility Services, San Diego Fertility Center and International Surrogacy Center were among the sponsors of the event, which included a panel on budgeting, testimonies from parents and surrogates and on-site consultations with clinics.

Stonewall House, New York City’s First Ever LGBT-Welcoming Senior Housing, Opens Its Doors

Stonewall House in Brooklyn is New York City’s first LGBT-welcoming senior housing. Its population will be roughly 50 per cent LGBT and 50 per cent straight—and it opens today.

Stonewall HouseDiedra Nottingham is getting ready to move into her new apartment at Stonewall House, and she could not be more excited.

The 69-year-old lesbian will be one of the first tenants of Stonewall House, the first ever LGBT-welcoming senior housing development in New York City. This historic building will be declared officially open today, Tuesday, with the first residents expected to move into the 145-unit building near Fort Greene Park in Brooklyn before Christmas, with the rest of the residents moving in throughout January. 

The Daily Beast exclusively reported on the construction of Stonewall House in March. It is the largest such development in the country, and its construction has been overseen by BFC Partners, the developer of Stonewall House, in partnership with SAGE, the world’s largest and oldest organization dedicated to improving the lives of LGBT older people. The stars and stripes and the rainbow flag both fly proudly at the top of Stonewall House.

“In 2019, in this 50th anniversary year of the Stonewall uprising, we couldn’t think of a better name for the first building of this kind,” Michael Adams, CEO of SAGE, told The Daily Beast. “People will be able to live their lives freely and openly in this building. We see our elders as heroes and want them to be treated as such when living in their own homes. That’s what we want to accomplish with this building.”

“I’m moving in in the first week of January,” Nottingham, who presently lives in the Bronx, told The Daily Beast. “I always wanted to be in a gay-friendly environment without discrimination, and the glares and looks you can get from people. It’s a great community and area. I’m looking forward to meeting new people and joining new groups. I have been an advocate for the LGBTQ community even back when we were illegal.”

Luis Lizardi from Puerto Rico lost everything due to Hurricane Maria when it struck in September 2017. The 67-year-old gay man told The Daily Beast he had faced homophobia on the island, and had suffered a heart attack as he tried to survive there after Maria

Lizardi has been living in shelters in New York City since June of this year, and more recently has slept on a friend’s sofa. He is finalizing his lease to move into Stonewall House.

“If I could, I wish I could move in tomorrow,” Lizardi told The Daily Beast. “I’m dying to be there, you have no idea. It means peace of mind, being able to take my clothes out of my bags, and be in a place more or less permanently. I hope to be there for the rest of my life, and find new friends.”

The DaileyBeast.com, by Tim Teeman, December 17, 2019

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Opinion – The Big IVF Add-On Racket

IVF Add Ons – This is no way to treat patients desperate for a baby.

There are few things as unsettling as sitting in an in vitro fertilization clinic hearing you need a team of experts — embryologists, lab techs and nurses along with a reproductive endocrinologist — to help you become pregnant.embryo

What comes next can be a blur. First, you meet with the clinic’s financial counselor to assess whether you have enough money for a complex, invasive $15,000-$20,000 IVF cycle. What follows are drug injections, blood tests, invasive ultrasounds, surgical egg retrieval, and fertilization ahead of an embryo transfer. Before your first hormone shot, you’re well into head-spinning, unfamiliar territory.

Then the doctor tells you there are “add-ons” you might want to consider.

Might you have interest in endometrial scratching? What about vasodilation, human growth hormones, intralipids, assisted hatching, oocyte activation, physiological intracytoplasmic sperm injection, or embryo glue? Post-fertilization, there is also embryo pre-implantation genetic testing to consider. Interested?

These extras come with price tags ranging from hundreds to thousands of dollars. All are presented as ways to increase your chances of a pregnancy. What are you willing to try? What can you afford? The ball is in your court.

This is no way to treat patients at their most vulnerable.

That’s the conclusion my colleagues and I arrive at in a new paper on the ethics and regulation of IVF add-ons.

An add-on is anything that is not essential to carry out an IVF cycle. Such measures, patients are told, will improve the likelihood of a live birth — and yet our examination revealed a startling absence of robust research into the effectiveness and the safety of these add-ons. Despite this, their use is widespread, and regulation of them is minimal.

The most expensive add-on category is pre-implantation genetic testing. These tests were originally developed to identify embryos at risk for genetic diseases. Today, however, they are primarily sold, at a cost of $6,000 to $12,000, as a way to screen for chromosomal abnormalities that could lead to failed implantation or miscarriages.

In October, however, a large study found that a single abnormal cell does not doom an embryo and determined that one of the tests, PGT-A, made no difference to rates of live births. Worse still, patients who opted not to transfer embryos based on the test’s results may have lost potentially viable ones.

There is also endometrial scratching, a procedure, sometimes costing as much as $500, that purposely irritates the endometrium, the innermost lining of the uterus, before IVF While it’s promoted as increasing the chance of an embryo implanting, a recent large randomized trial found no benefit. Beyond significant patient discomfort, risks include bleeding, infection and uterine perforation.

Then there are intralipids, an emulsion of soybean oil, egg phospholipids and glycerin administered intravenously and described as a way to decrease natural killer cell activation in the immune system and ostensibly aid in embryo implantation. This emulsion is priced around $400 per infusion; typically several are recommended. Side effects include headache, dizziness, flushing, nausea and the possibility of clotting or infection. A meta-analysis last year found that intralipids and other forms of immunotherapy should not be used in routine clinical practice.

Such procedures are often presented to patients in the form of a stack of papers, written in legalese or medical jargon. Resourceful patients might take to the internet to learn more, where searches might deliver densely written scientific articles, and ads might direct them to companies or clinics eager to promote their own brands of add-ons.

Why is all this happening? It’s because IVF remains an under-regulated arena, and entrepreneurial doctors and pharmaceutical and life science companies are eager to find new ways to cash in on a growing global market that is projected to be as large as $40 billion by 2024.

NYTimes.com, December 12, 2019 by Pamela Mahoney Tsigdinos

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