Showing posts with label assisted reproduction. Show all posts
Showing posts with label assisted reproduction. Show all posts
Thursday, June 18, 2009
Some articles on our radar screen this past week...
Autonomy and Authenticity of Enhanced Personality Traits
Abstract: There is concern that the use of neuroenhancements to alter character traits undermines consumer's authenticity. But the meaning, scope and value of authenticity remain vague. However, the majority of contemporary autonomy accounts ground individual autonomy on a notion of authenticity. So if neuroenhancements diminish an agent's authenticity, they may undermine his autonomy. This paper clarifies the relation between autonomy, authenticity and possible threats by neuroenhancements.
Tech-assisted reproduction growing worldwide:
Worldwide report shows increase in assisted reproduction: 250,000 babies (approximately) born in 1 year.
Assisted reproductive technology (ART) is responsible for an estimated 219,000 to 246,000 babies born each year worldwide according to an international study. The study also finds that the number of ART procedures is growing steadily: in just two years (from 2000 to 2002) ART activity increased by more than 25%. As this technology becomes more accessible to more people, will this encourage the ART industry to go further in their efforts and should more regulation be considered?
Boy or Girl? As early as 10 weeks gestation, a new at-home test has an 80% accurate predication rate. But will this result in more female fetuses being terminated?
Tuesday, February 17, 2009
IVF may increase risk of genetic disorders
Assisted reproduction is in the headlines again: today's NYT reports on a study that indicates that babies conceived through IVF may have a slightly higher risk of serious health problems. Here's the abstract for the scientific paper, in case you want to read more.So: in light of recent discussions about the Suleman case (specifically the question of whether there should be an enforceable maximum number of embroys that can be transferred into a woman's uterus), how much additional risk is too much? At what point ought the state step in?
Saturday, February 07, 2009
Octuplets Mother Speaks Out
Nadya Suleman, mother of the recent octuplets born in California, has done her first interview with a major news outlet. (Although Suleman was seeking USD 2 million for the interview, NBC maintains that they did not pay her. However, that doesn't rule out "compensation" in other forms.)
Unfortunately, Suleman's interview has continued to raise, rather than answer, questions. Foremost among them, for me, is her claim that she had six embryos implants per IVF procedure. This... simply does not ring true. Or at least plausible, if she was using a US fertility expert.
Consider this: in order to have done so, this means Suleman would have needed to find, at age 26, a fertility doctor who would implant six embryos. ASRM guidelines are no more than 3 embryos for a woman under the age of 35, and that's if she has a history of problems with conception. With a 'clean' history, only 2 embryos are recommended. Now, it sounds like Suleman might have qualified as having difficulty conceiving, with several ectopic pregnancies and miscarriages prior to IVF. But even accounting for that, it's double the recommended standard. For each pregnancy.
But stop to do the math. While one vial of donor sperm would be more than enough for all of this, it means that they collected at least 36 eggs from Suleman, and that all of those eggs were viable enough to implant once fertilized. Realistically, not every egg retrieved is going to be mature, and not every egg is going to fertilize (unless you're using something like ICSI). Realistically, you're looking, at the very least, at 1/3rd more eggs than that being pulled out (and even that is a very, very low number - remember, they're saying that there were six viable eggs to implant per cycle. A quick web search shows that 1/3 of the eggs removed at any time are not mature, and of the ones that are mature, only half reach the point of being "good enough" to implant).
Now let's go over to CDC stats. While the last data is from 2005, which was going on 5 years ago, Suleman started her IVF course in 2001, so some of this data is specifically applicable (and some of it only extrapolation). According to the CDC, only 35% of ART cycles resulted in a pregnancy, and of those, 82% resulted in a live birth. So again, Suleman seems to have defied the odds. A lot. And as the CDC says about frozen eggs, "[b]ecause some embryos do not survive the thawing process, the percentage of thawed embryos that resulted in live births is usually lower than the percentage of transfers resulting in live births." While only 15% of embryos transferred were frozen, of those 15%, only slightly more than 1/4 ended up in live births.
Again, the odds make this seem incredibly unlikely.
Finally, fertility clinics are required by law to report their ART data, under the Fertility Clinic Success Rate and Certification Act. This gives us a decent way of tracking ART results - and also who is doing ART. In 2005, eleven clinics in California did not report their ART data (which would include embryo transfers/live birth data/etc). Of those eleven places, it looks like seven were within an hour of her home (keeping in mind her back injury likely limited the distance she could travel). Of the clinics that did report their data, 35 are within an hour of Whittier, California. However, given these clinics are compliant with reporting their data, it seems safe to eliminate them from immediate suspicion. (As for the potential Mexcio connection, Tijuana is approximately two hours away. Certainly not out of the question; an hour was a random number drawn from thin air. Suleman has certainly shown herself to be willing to go to significant length, and pain, to achieve her goals.)
All in all, what does this mean? Not much. Over 300 pages of records on Suleman have been released to the press, under a public records request to California's Division of Workers' Compensation. While it doesn't appear that the fertility clinic (or doctor) that treated her is in those records, there is ample evidence to support that she did have problems conceiving, and that she had known psychiatric issues, including what was diagnosed as either postpartum depression or PTSD. Issues that should have limited, if not prevented, future implantations.
Ultimately, until Suleman names her doctor, or said doctor speaks out, little will be conclusively known. But the facts remain simple: the facts do not add up.
-Kelly Hills
Unfortunately, Suleman's interview has continued to raise, rather than answer, questions. Foremost among them, for me, is her claim that she had six embryos implants per IVF procedure. This... simply does not ring true. Or at least plausible, if she was using a US fertility expert.
Consider this: in order to have done so, this means Suleman would have needed to find, at age 26, a fertility doctor who would implant six embryos. ASRM guidelines are no more than 3 embryos for a woman under the age of 35, and that's if she has a history of problems with conception. With a 'clean' history, only 2 embryos are recommended. Now, it sounds like Suleman might have qualified as having difficulty conceiving, with several ectopic pregnancies and miscarriages prior to IVF. But even accounting for that, it's double the recommended standard. For each pregnancy.
But stop to do the math. While one vial of donor sperm would be more than enough for all of this, it means that they collected at least 36 eggs from Suleman, and that all of those eggs were viable enough to implant once fertilized. Realistically, not every egg retrieved is going to be mature, and not every egg is going to fertilize (unless you're using something like ICSI). Realistically, you're looking, at the very least, at 1/3rd more eggs than that being pulled out (and even that is a very, very low number - remember, they're saying that there were six viable eggs to implant per cycle. A quick web search shows that 1/3 of the eggs removed at any time are not mature, and of the ones that are mature, only half reach the point of being "good enough" to implant).
Now let's go over to CDC stats. While the last data is from 2005, which was going on 5 years ago, Suleman started her IVF course in 2001, so some of this data is specifically applicable (and some of it only extrapolation). According to the CDC, only 35% of ART cycles resulted in a pregnancy, and of those, 82% resulted in a live birth. So again, Suleman seems to have defied the odds. A lot. And as the CDC says about frozen eggs, "[b]ecause some embryos do not survive the thawing process, the percentage of thawed embryos that resulted in live births is usually lower than the percentage of transfers resulting in live births." While only 15% of embryos transferred were frozen, of those 15%, only slightly more than 1/4 ended up in live births.
Again, the odds make this seem incredibly unlikely.
Finally, fertility clinics are required by law to report their ART data, under the Fertility Clinic Success Rate and Certification Act. This gives us a decent way of tracking ART results - and also who is doing ART. In 2005, eleven clinics in California did not report their ART data (which would include embryo transfers/live birth data/etc). Of those eleven places, it looks like seven were within an hour of her home (keeping in mind her back injury likely limited the distance she could travel). Of the clinics that did report their data, 35 are within an hour of Whittier, California. However, given these clinics are compliant with reporting their data, it seems safe to eliminate them from immediate suspicion. (As for the potential Mexcio connection, Tijuana is approximately two hours away. Certainly not out of the question; an hour was a random number drawn from thin air. Suleman has certainly shown herself to be willing to go to significant length, and pain, to achieve her goals.)
All in all, what does this mean? Not much. Over 300 pages of records on Suleman have been released to the press, under a public records request to California's Division of Workers' Compensation. While it doesn't appear that the fertility clinic (or doctor) that treated her is in those records, there is ample evidence to support that she did have problems conceiving, and that she had known psychiatric issues, including what was diagnosed as either postpartum depression or PTSD. Issues that should have limited, if not prevented, future implantations.
Ultimately, until Suleman names her doctor, or said doctor speaks out, little will be conclusively known. But the facts remain simple: the facts do not add up.
-Kelly Hills
Saturday, December 13, 2008
The Dignity of a Person
The Catholic Church released their Dignitatis Personae on Friday, which is an update of the 1987 Donum Vitae. Dignitatis Personae is the most up-to-date view of the Catholic Church on assisted reproductive technologies, and it spells out clearly what and why the Vatican approves (or in this case, largely disapproves) of most modern reproductive options.
It's been 21 years since Donum Vitae, and technology has made incredible leaps forward: IVF, intracytoplasmic sperm injection, all kinds of surrogate motherhood, PGD, etc. And most of these leaps are condemned by the Church.
It's my own personal opinion that it's necessary for everyone involved in bioethics to understand the Catholic position, regardless of your personal or professional inclinations. The Church has a powerful lobbying group, especially in states in the northeast of the United States, and this document has the ability to affect many people simply because it does clear up a lot of the grey areas that existed in Catholic doctrine.
Reading the Dignitatis Personae is an exercise in patience and self-control; it's hard to resist the urge to go wake someone up to have someone to discuss such wince-inducing logic as this: This ethical principle, [ed- that life begins at conceptions] which reason is capable of recognizing as true and in conformity with the natural moral law, should be the basis for all legislation in this area. I can tell you with full certainty that such 'reasoning' (a term I use loosely) would fail a philosophy 101 test. But if you can get through the document, you'll learn that the fresh-off-the-newstands update to Catholicism forbids any reproductive act that does not result in fertilization and implantation happening as a result of the sexual act between a married couple. Or put more simply: if the technology assists in intra-uterine conception, YAY! If conception occurs outside the uterus, BOO!
For better or for worse, the Catholic position is at least internally consistent - and for this I certainly give credit where it's due. There's very little cherry-picking of preferences; life begins at conception, all conceived embryos deserve full moral status of a human, etc. But aside from theological and philosophical differences, two things in the Dignitatis Personae stand out to me as worthy of further discussion and debate.
The first is the idea that
The second, and much larger issue, is the chapter on "The use of human “biological material” of illicit origin". This chapter discusses the obligation of researchers to refuse to use materials of illicit origin - that is, human cell lines obtained from stem cells, aborted fetuses, etc. Many, if not most, news outlets are reporting this to mean that the Vatican has said that Catholics may not use vaccines which are grown on human cell lines created from the lung tissues of aborted fetuses (the Meruvax rubella vaccine, at the very least).
Reading the chapter, though, instead of relying on news reports, gives a slightly different interpretation. While the document is clearly against researchers using any biological material of so-called illicit (theologically) origin, and suggests that ethical researchers will refuse to use these mediums, it draws a different line for the general public. The document allows that
As I said, more questions. But in all fairness, I can't say more questions than answers, since the document clearly gives answers that people have been wondering about for the last 21 years.
Give it a read this morning over your coffee, tea, breakfast, and see what you think the impact of this document will be.
-Kelly Hills
It's been 21 years since Donum Vitae, and technology has made incredible leaps forward: IVF, intracytoplasmic sperm injection, all kinds of surrogate motherhood, PGD, etc. And most of these leaps are condemned by the Church.
It's my own personal opinion that it's necessary for everyone involved in bioethics to understand the Catholic position, regardless of your personal or professional inclinations. The Church has a powerful lobbying group, especially in states in the northeast of the United States, and this document has the ability to affect many people simply because it does clear up a lot of the grey areas that existed in Catholic doctrine.
Reading the Dignitatis Personae is an exercise in patience and self-control; it's hard to resist the urge to go wake someone up to have someone to discuss such wince-inducing logic as this: This ethical principle, [ed- that life begins at conceptions] which reason is capable of recognizing as true and in conformity with the natural moral law, should be the basis for all legislation in this area. I can tell you with full certainty that such 'reasoning' (a term I use loosely) would fail a philosophy 101 test. But if you can get through the document, you'll learn that the fresh-off-the-newstands update to Catholicism forbids any reproductive act that does not result in fertilization and implantation happening as a result of the sexual act between a married couple. Or put more simply: if the technology assists in intra-uterine conception, YAY! If conception occurs outside the uterus, BOO!
For better or for worse, the Catholic position is at least internally consistent - and for this I certainly give credit where it's due. There's very little cherry-picking of preferences; life begins at conception, all conceived embryos deserve full moral status of a human, etc. But aside from theological and philosophical differences, two things in the Dignitatis Personae stand out to me as worthy of further discussion and debate.
The first is the idea that
"The origin of human life has its authentic context in marriage and in the family, where it is generated through an act which expresses the reciprocal love between a man and a woman. Procreation which is truly responsible vis-à-vis the child to be born “must be the fruit of marriage”.Put plainly, and as I said above, children must be conceived through sexual intercourse. Their conception at fertilization in the woman's body is when they become ensouled. What then, does this mean, theologically, for the multitudes of people now being born outside of this very narrow definition of procreation? It's not an answer I have, it's not an answer that is clear in the Dignitatis Personae, and it's definitely not an answer that anyone my local Catholic Conference has been able to answer. So it is a lingering question, and one that should be answered.
The second, and much larger issue, is the chapter on "The use of human “biological material” of illicit origin". This chapter discusses the obligation of researchers to refuse to use materials of illicit origin - that is, human cell lines obtained from stem cells, aborted fetuses, etc. Many, if not most, news outlets are reporting this to mean that the Vatican has said that Catholics may not use vaccines which are grown on human cell lines created from the lung tissues of aborted fetuses (the Meruvax rubella vaccine, at the very least).
Reading the chapter, though, instead of relying on news reports, gives a slightly different interpretation. While the document is clearly against researchers using any biological material of so-called illicit (theologically) origin, and suggests that ethical researchers will refuse to use these mediums, it draws a different line for the general public. The document allows that
Grave reasons may be morally proportionate to justify the use of such “biological material. Thus, for example, danger to the health of children could permit parents to use a vaccine which was developed using cell lines of illicit origin, while keeping in mind that everyone has the duty to make known their disagreement and to ask that their healthcare system make other types of vaccines available.Unfortunately, this again raises more questions than it solves. If there is such a thing as a single grave reason that may be morally proportionate to justify the use of illicit biological material - vaccinating your child from a deadly disease - then why are there not other grave reasons? Isn't this suddenly a large degree of "wiggle room" that will allow individuals an out, who can say that this document is not intended for the lay Catholic but the scientist Catholic, the researcher who spends their life in this and thus needs to consider ethics and morality at a different level than the average person (or at least average Catholic)?
As I said, more questions. But in all fairness, I can't say more questions than answers, since the document clearly gives answers that people have been wondering about for the last 21 years.
Give it a read this morning over your coffee, tea, breakfast, and see what you think the impact of this document will be.
-Kelly Hills
Wednesday, December 03, 2008
Gestational surrogacy in the NYT
I'm surprised none of my fellow bloggers has posted this yet, so here goes. The cover story of last Sunday's NYT Magazine was "Her Body, My Baby," style reporter Alex Kuczynski's account of her experience hiring a gestational surrogate to bear a child conceived with Kuczynski's own egg and her husband's sperm.The story has raised quite a flap in the blogosphere. On one side are ardent defenders of Ms. Kuczynski. Their comments tend to express sympathy for the writer's struggle with infertility, IVF, and miscarriages; support the absolute right to self-determination in matters of reproduction, assisted reproduction included; gratitude for the author's open and honest description of her experiences; and encouragement of the "you go, girl" type. On the other side are sharp critics, who question Kuczynski's motives and values, seeing her decision as driven by "narcissism" and fueled by "too much money," and in some cases, drawing parallels with Kuczynski's adventures in cosmetic surgery.
What should we make of all this? And what accounts for the vehemence of the commentary, on both sides?
The most obvious answer, in my mind, lies in the featured photos. The one on the left is of the author, babe in arms (not facing the camera), and the baby's brown-skinned, uniformed nurse, standing outside the author's well-appointed home. The one on the right is of Cathy Hilling, the gestational surrogate, barefoot and pregnant, sitting with her dog on the front porch of her home, which could use some new paint and maybe some landscaping help. The images clearly juxtapose differences in class and race.
I don't want to start (yet another) flame war about the article--there are enough of those out there already. (Maybe this is why the NYT has shut down comments on the article, having received 404 since Sunday.) I do think there is still room for civil discussion of some more important questions, though ... Anybody game?
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