Infertility? Could a Uterus Transplant Help?

ethicsUterus Transplants May Soon Help Some U.S. Women Struggling With Infertility Become Pregnant

Infertility affects millions of women worldwide and in Cleveland within the next few months, surgeons at the Cleveland Clinic expect to become the first in the United States to transplant a uterus into a woman who lacks one, so that she can become pregnant and give birth.

Six doctors swarmed around the body of the deceased organ donor and quickly started to operate. The kidneys came out first. Then the team began another delicate dissection, to remove an organ that is rarely, if ever, taken from a donor. Ninety minutes later they had it, resting in the palm of a surgeon’s hand: the uterus.

The operation was a practice run. The recipients will be women who were born without a uterus, had it removed or have uterine damage. The transplants will be temporary: The uterus would be removed after the recipient has had one or two babies, so she can stop taking transplant anti-rejection drugs.

Uterine transplantation is a new frontier, one that pairs specialists from two fields known for innovation and for pushing limits, medically and ethically — reproductive medicine and transplant surgery. If the procedure works, many women could benefit: An estimated 50,000 women in the United States might be candidates. But there are potential dangers.

The recipients, healthy women, will face the risks of surgery and anti-rejection drugs for a transplant that they, unlike someone with heart or liver failure, do not need to save their lives. Their pregnancies will be considered high-risk, with fetuses exposed to anti-rejection drugs and developing inside a womb taken from a dead woman.

Eight women from around the country have begun the screening process at the Cleveland Clinic, hoping to be selected for transplants. One, a 26-year-old with two adopted children, said she still wanted a chance to become pregnant and give birth.

“I crave that experience,” she said. “I want the morning sickness, the backaches, the feet swelling. I want to feel the baby move. That is something I’ve wanted for as long as I can remember.”

She traveled more than 1,000 miles to the clinic, paying her own way. She asked that her name and hometown be withheld to protect her family’s privacy.

She was 16 when medical tests, performed because she had not begun menstruating, found that she had ovaries but no uterus — a syndrome that affects about one in 4,500 newborn girls. She comes from a large family, she said, and always assumed that she would have children. The test results were devastating.

Dr. Andreas G. Tzakis, the driving force behind the project, said, “There are women who won’t adopt or have surrogates, for reasons that are personal, cultural or religious.” Dr. Tzakis is the director of solid organ transplant surgery at a Cleveland Clinic hospital in Weston, Fla. “These women know exactly what this is about,” he said. “They’re informed of the risks and benefits. They have a lot of time to think about it, and think about it again. Our job is to make it as safe and successful as possible.”

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New York Times, by Denise Grady – November 12, 2015

in Ethics / In the News / Science  by Anthony Brown 0 comments

Should A Same Sex Couple Get Fertility Benefits?

Are A Same Sex Couple Entitled to Fertility Benefits?

Same sex couple Sarah Soller-Mihlek, a Brooklyn guitar instructor, and Jill Soller-Mihlek say, “We want to start a family,” speaking into a camera focused on Sarah and “We’ve always dreamed of becoming parents,” adds her wife, Jill.

The couple made the video last year and posted it to Indiegogo, a crowdfunding website, in hopes of raising enough money to pay for fertility treatments. Jill Soller-Mihlek, now 33, was hoping to get pregnant via a sperm donor and intrauterine insemination, which can costs tens of thousands of dollars depending on how long it takes to conceive.

Although the couple’s insurance plan typically covers fertility treatment, their insurer, United Healthcare, would not cover the cost. The reason? Jill Soller-Mihlek didn’t meet its definition of infertility because she did not have sex with men.

The couple’s insurance policy defines infertility as an “inability to achieve pregnancy after 12 months of unprotected heterosexual intercourse.” But women who use sperm donors must pay for costly, physician-supervised therapeutic donor insemination for 12 months before they meet the definition of infertility. (Women 35 and older need to go through six failed attempts before meeting the clinical definition of infertility.)

After the Soller-Mihleks paid $13,507 out of pocket for nine unsuccessful cycles of insemination, they decided to chronicle their travails on Indiegogo and Change.org. While the United Healthcare policy tacitly acknowledges single women and same-sex couples, many policies do not. Some even exclude unwed women. Notably, major insurers like United Healthcare often do cover insemination treatments when the issue is male infertility.

The Soller-Mihleks believe their plan’s criteria for granting medical coverage of fertility treatment reveals a subtle form of discrimination against lesbians. (Needless to say, gay men face even greater obstacles in attempting to gain coverage, given that coverage wouldn’t extend to the woman who’d be carrying for them.)

The Soller-Mihleks say their concern is that a female same sex couple, by definition, is incapable of getting pregnant through heterosexual intercourse and requires medical intervention to conceive. They say the subtext of the United Healthcare policy is that a lesbian could get pregnant by having sex with a man, she just chooses not to.

Shannon Price Minter, head of the legal division at the National Center for Lesbian Rights in San Francisco, said: “To me, the central injustice is that when a person has a known condition that precludes them from becoming pregnant, such as a woman who has had her ovaries removed, there is no requirement to go through a period of unprotected intercourse before being recognized as requiring fertility treatments. The same should be true for same-sex couples.”

Tyler Mason, a spokesman for UnitedHealthcare, said the company’s policy is based on the clinical disease of infertility, as defined by the American Society of Reproductive Medicine.

“Our coverage criteria are based on clinical trial data, published literature and recommendations from a wide variety of medical specialty societies and state laws,” Mr. Mason wrote in a statement. “We constantly review and update coverage criteria.”

Aetna also uses the clinical definition of infertility to support its reimbursement policies for fertility treatments.

“It’s not a pregnancy benefit,” said Cynthia B. Michener, an Aetna spokeswoman. “It’s based on the clinical disease of infertility, supported by medical evidence and medical society guidelines, including those set out by the A.S.R.M., and it’s the same for everyone.”

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New York Times, November 2, 2015, by Stephanie Fairyington

in Egg Donation / IVF / Known Donor / Legal / Legislation / Science  by Anthony Brown 0 comments

International Surrogacy Cases; Foreigners Banned

India Surrogacy Cases: Ban booming surrogacy service to foreigners

In International Surrogacy Cases News; India’s government said Wednesday it would ban foreigners from using surrogate mothers in the country, a move likely to hit the booming commercial surrogacy industry. Ranks of childless foreign couples have flocked to the country in recent years looking for a cheap, legal and simple route to parenthood.

Health industry estimates put the size of India’s surrogacy business at nine billion rupees ($138 million) and growing at 20 percent a year. But critics have said a lack of legislation encourages “rent-a-womb” exploitation of young, poor Indian women.

In an affidavit to the Supreme Court on Wednesday the government said it “does not support commercial surrogacy”. “No foreigners can avail surrogacy services in India,” it told the court, which is hearing a petition regarding the industry, adding that surrogacy would be available “only for Indian couples”.

Thousands of infertile couples, many from overseas, hire the wombs of Indian women to carry their embryos through to birth. India, with cheap technology, skilled doctors and a steady supply of local surrogates, is one of relatively few countries where women can be paid to carry another’s child. Surrogacy for profit is illegal in many other countries.

The process usually involves in-vitro fertilization and embryo transfer, leading to a rise in fertility centers offering such services.

A top fertility expert branded the government’s move discriminatory, while a leading women’s activist warned it could push the industry underground and out of reach of regulators. “Banning commercial surrogacy will send some couples onto the black market and deprive other couples of the chance of children,” Ranjana Kumari, director of the Centre for Social Research, told AFP.

“Our research shows many surrogates do not have health insurance and are paid poorly, among other issues,” she said, adding that stronger regulation rather than an outright ban was needed. The private petition to the top court seeks a halt to the importation of human embryos for commercial purposes.

Earlier this month the court in Delhi expressed its concern and ordered the government to spell out measures for regulating the industry. The government’s affidavit, presented to the court by Solicitor General Ranjit Kumar, said it would “require some time to bring the law in place”.

surrogacy cases

India decided surrogacy cases: banning foreigners from surrogate mothers,similar decisions expected internationally by booming commercial surrogacy industry

The surrogacy process usually involves in-vitro fertilisation and embryo “The government will prohibit and penalise commercial surrogacy services,” it said.

The government has been consulting women’s groups and the health industry on a draft bill, the Assisted Reproductive Technology, that seeks to regulate the industry.

– ‘No exploitation’ –

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Yahoonews.com, by Trudy Harris, October 27, 2015
in Ethics / In the News / International / Surrogacy  by Anthony Brown 0 comments

Egg Donations, Should Women Be Paid?

Paying for Egg Donations

In an egg donations situation, should a woman who donates eggs to help people with fertility problems conceive a child be able to charge as much as she can get in a free-market transaction? Or are there ethical reasons to limit her reimbursement?

That is the issue raised in a federal lawsuit that accuses two professional societies and the fertility clinics associated with them of illegal price-fixing that limits donor compensation. A federal judge in northern California has ruled that the claim can move forward and certified it as a class action, which could go to trial next year.

Guidelines issued by the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology suggest that paying a woman more than $10,000 for her eggs is “beyond what is appropriate” and even paying $5,000 or more requires “justification.”

A vast majority of the nation’s fertility clinics follow these the guidelines. The stated rationale behind them is to avoid offering so much money that donors, especially those who are often young and poor, will rush to contribute their eggs without considering the risks.

This payment system is unfair. However well-intentioned, it favors the fertility clinics, which can keep more for themselves if they pay donors less, as well as the women who pay for fertility treatments. Meanwhile, it shortchanges the egg donors, whose wishes are ignored in the equation. And if there are indeed risks, they can be addressed and mitigated by the clinics and the doctors, who can strengthen their screening and counseling procedures and provide more information.

The money that donors get is meant to compensate them for physical and psychological tests; weeks of hormone injections to stimulate egg production; frequent tests and ultrasound examinations to track the developing eggs; repeated visits to the doctor, and minor surgery to remove the eggs when they are ready for retrieval.

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Editorial Board – New York Times, October 21, 2015
in Egg Donation / In the News / Legal  by Anthony Brown 0 comments