The AFA Blog

Insurance coverage for young adult cancer patients to preserve fertility

by Corey Whelan

Around 1.5 million American men and women are diagnosied with cancer annually.  Ten percent of those are under the age of 45 and one percent will be younger than 20.  That translates into around 70,000 young adults, all under the age of 20 years old, who will have to grapple with this disease.  Statistics aside, if you or a loved one are diagnosed with cancer, life may never be the same.  Mind reeling, you may or may not think about options for parenthood later on.  Of course, many cancer treatments including surgery, chemotherapy and radiation may have the effect of rendering the person on the receiving end infertile.  Of course, survival is the number one goal but many cancer patients report that their ensuing infertility was just as devastating to them as their original diagnosis.

Fertility can often be preserved prior to cancer therapy beginning, for both men, women, boys and girls.  These options can be as simple as collecting and freezing sperm, or can become more complicated and expensive, including testicular needle aspiration for young boys or egg freezing for young women.

According to change.org, the vast majority of insurance comapnies and HMO's in the United States do not cover fertility preservation treatments such as those referenced above.

Currently, legislation addressing this issue is being decided upon in California.  Bill AB 428 is being sponsored by Assemblyman Anthony Portantino but your help is needed.  No matter where you live, your name on a petition requesting support of this bill will be meaningful and will not go unnoticed.  

Click here to read the petition letter and to sign it. Please.

For more information on fertility preservation and your options, click here

To watch a short video on fertility preservation, click here

Be the change.

Iowa & Oklahoma “Personhood” Bills Threaten IVF, Birth Control & Abortion – How Can We Respond?

by Theresa Erickson, Esq.

“Personhood” bills are threatening both women’s reproductive rights and access to IVF in all 50 states; however, the two states where they are currently building a great deal of support are Iowa (HF 153) and Oklahoma (HB 1571).  These bills are clearly intended to limit IVF treatment, certain forms (if not almost all) of birth control, as well as protecting all life “from the moment of conception, while removing any and all judicial oversight and interpretation. 

But, it does not stop there - other states such as Colorado, Montana, Nevada, & North Dakota also have petitions being circulated at a rapid rate for inclusion via ballot or legislation.  And, let’s not forget the recent attacks on surrogacy in both Arizona and South Dakota. 

As for Iowa and Oklahoma, be aware that these bills are a clear attempt to provide all rights and protections currently only provided to those functioning outside of a woman’s uterus to a fertilized egg in a petri dish or in a woman’s fallopian tube.  In short, a woman who does become pregnant would not only lose her right to any medical privacy, she will essentially lose any decision-making authority over her own health. 

Some may claim these ramifications of the legislation are both “far-fetched and absurd:” however, one must not forget that many women all over the country have been arrested and charged under the guise of “personhood.”  This bill unequivocally threatens the reproductive rights of women across the entire country. 

And, let’s not forget the impact on IVF - as it is more than a mere slippery slope since the bills intend to impede the ability of those who suffer from the disease of infertility to seek treatment to create their family.  By giving constitutional rights to embryos, the bill will effectively restrict a patient’s right to make any decisions regarding their embryos, while leaving physicians to provide care under the threat of criminal action.  These bills intend for the law to consider all embryos as human, regardless of their ability to either implant in the uterus or develop into a person, and their impact will leave patients and their doctors with the inability to decide what is best for them and their treatment. 

In short, with “personhood” bills being promoted across the country that will restrict a woman’s reproductive rights and restrict the creation of families, what are we to do?  We (as patients, women, men, mothers, fathers, sisters, and brothers) need to stand firm against the legislators that are proposing these bills and supporters who are circulating petitions as they have the potential to impact the human race as we know it.  Stand up and be heard, keep abreast of what is happening in your state, write your legislators, and use the power of your vote to keep these bills off of the docket.  Reaction now needs to become action in the future.  We did it in Colorado in 2009 and 2010, and it can be done again. 

 

 

Live in the Mount Rushmore State? Better not need a donor.

by Steven Snyder, Esq.

"Fertility is an apolitical condition.  It affects those who share political beliefs with independents, liberals, and conservatives alike.  Treating infertility is about creating new families, a quintessentially universal dream that cuts across all political, religious, and social demographics.  Those who succeed in having the children they so desperately want generally become more conscious role models and more involved members of both their communities and society as a whole.  Allowing those who struggle with infertility to exercise their procreative liberty through all medical and social options available to them has only positive benefits for our society and our national stability.

Fertility comes in all shapes and sizes.  Infertility is caused equally by female factor, male factor, and undetermined reasons.  It is caused by genetic anomalies, physiology, disease, and, in all liklihood, our environment.  Sometimes infertility can be successfully treated with medications or straightforward medical procedures using the affected parent(s)' own reproductive components (egg, sperm, and uterus).  Sometimes successful treatment requires the voluntary cooperation and support of third parties who willingly and happily provide one or more of those missing components.  These third parties, these "reproductive saviors," come in the form of sperm donors, egg donors, and gestational carriers.  These people know the value of having a family, and they choose to help those who cannot realize this dream without assistance.

Clearly, the medical and social options to treat infertility have outdistanced the legislative infrastructure that is necessary to support the intended parentage of the children who result from the various treatments.  Although most states have statutes that automatically establish parentage when sperm donors are used, thereby offering a simple solution to male infertility through sperm donation, few states have similar statutory support for egg donation or gestational surrogacy.  Furthermore, the existing sperm donor statutes only apply to a very narrowly defined traditional family, one that no longer necessarily dominates our social structure.  Our current legal framework for fertility clearly discriminates against women who suffer from infertility and non-traditional families, whether intentionlly or inadvertently.  Our overall social and political objective should be to correct this imbalance and facilitate equal opportunity for infertile women and non-traditional families to have children.  It is simply the socially responsible thing to do.

When the Baby M decision was issued by the New Jersey Supreme Court in 1987, surrogacy was virtually unknown, and it typically involved a genetically-related carrier, also known as a traditional surrogate.  This combination startled society and lawmakers, and, in the next five years, approximately ten states passed legislation that banned or restricted such arrangements.  Then the medical advances eliminated the surrogate's genetic relationship through IVF, and the California Supreme Court issued its decision in Johnson v. Calvert in 1992 affirming the legal parentage of the intended parents in a gestational surrogacy dispute.  Since then, society has generally accepted surrogacy, and every state that has passed legislation relating to surrogacy has either distinguished it from adoption and/or baby-selling or expressly allowed it.  Things were moving in the right direction.

That brings me back to the apolitical nature of infertility.  Infertiliity legislation should be continuing to move forward in all states to facilitate family building of all varieties, including surrogacy.  Unfortunately, that is not the case.  The fiscal conservatives who have been brought into power are also social conservative who oppose infertility treatment in general and surrogacy specifically.  This is nowhere more evident than in South Dakota (see below) where extremely regressive and onerous legislation to criminalize surrogacy has been introduced.  Physicians, agencies, and persons who participate in "commercial" surrogacy are guilty of felonies, and individuals who participate in non-commercial surrogacy are subject to fines of at least $30,000.  The law says the resulting child is placed with the surrogate as the parent unless the surrogate is unfit, and if the surrogate does not want the child, the child may be placed for adoption.

This proposed legislation is out of place in intent, content, and time.  It ignores the reality and general social acceptance of surrogacy, and it abridges various constitutional rights by trying to inappropriately legislate parentage against the parties' intent.  This will not be the last ill-advised and regressive social policy that comes out of the numerous conservative state legislatures that have been placed in power.  Those who experience infertility should be prepared to make themselves heard to protect and further the rights of the infertile by strenuously lobbying against and soundly defeating such legislation.  They shoud make themselves heard whether they are fiscal conservatives, liberals, or independents.  If this is not done, the rights of many to build stable families will be unfairly and inappropriately impaired."

___________________

State of South Dakota 

EIGHTY-SIXTH SESSION

LEGISLATIVE ASSEMBLY, 2011

592S0685

HOUSE BILL NO. 1218

Introduced by: Representatives Hunt, Bolin, Brunner, Cronin, Feickert, Gosch, Greenfield,

Hansen (Jon), Hickey, Hubbel, Jensen, Kirschman, Kloucek, Kopp,

Munsterman, Nelson (Stace), Russell, Steele, Van Gerpen, Venner, and Wick

and Senators Novstrup (Al), Kraus, and Schlekeway

1 FOR AN ACT ENTITLED, An Act to prohibit surrogate mother contracts, to prohibit

2 enforcement of such arrangements, and to establish standards to award custody of children

3 born as a result of such arrangements.

4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF SOUTH DAKOTA:

5 Section 1. The Legislature finds that:

6 (1) The enforcement of surrogacy agreements and contracts is contrary to the best

7 interests of children, to the State policy that custody of children should be determined

8 based upon the best interests of the children, that such arrangements are exploitive

9 of women, that such arrangements are contrary to a mother’s interest in her

10 relationship with her child, and contrary to the State’s interest in protecting the

11 relationship between a mother and her child; and

12 (2) That surrogacy arrangements and contracts, whether written or oral, are in direct

13 conflict with numerous public policies of the State of South Dakota, including: the

14 State’s policy prohibiting offers of money or payment of money in connection with

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1 an adoption; the State’s policy against trafficking 1 in children; the State’s policy that

2 no surrender of a mother’s parental rights or waiver of her constitutional right to her

3 relationship with her child will be enforced if made prior to the birth of her child; and

4 (3) That surrogacy agreements and contracts are in direct conflict with, and are designed

5 to terminate and destroy, the mother’s parental rights, her relationship with her child,

6 and her fundamental liberty and interest in that relationship, contrary to the

7 established public policy and laws of the State of South Dakota.

8 Section 2. Terms used in this Act mean:

9 (1) "Surrogacy," an arrangement, whether or not embodied in a contract, written or oral,

10 entered into by two or more persons, including the mother, sometimes referred to as

11 the "surrogate" or "gestational carrier" or "surrogate uterus", and an intended rearing

12 parent or parents, who agree, prior to insemination, or in the case of an implanted

13 embryo, prior to embryo transfer or embryo implantation, to participate in the

14 creation of a child, with the intention that the child will be reared as the child of one

15 or more of the intended parents, other than the mother;

16 (2) "Commercial surrogacy," a surrogacy arrangement involving the payment, or

17 agreement to pay, money or any valuable consideration to a broker/intermediary, or

18 the payment, or agreement to pay, money or any valuable consideration (other than

19 payment or reimbursement of medical and hospital expenses currently allowable

20 under adoption law) to a mother;

21 (3) "Broker/intermediary," a person, or an agency, association, corporation, partnership,

22 institution, society or organization, which knowingly seeks to introduce or to match

23 a prospective mother with a prospective biological father, or other intended parent,

24 for the purpose of initiating, assisting, or facilitating a surrogacy arrangement;

- 3 - HB 1218

1 (4) "Intended parent," a person, whether male or female, whether or not genetically

2 related to the child born as a result of a surrogacy arrangement, who is intended to

3 be the person or one of the persons who would raise the child following birth;

4 (5) "Mother," the woman who carries and gives birth to the child, whether or not she is

5 genetically related to the child.

6 Section 3. No physician, licensed by the State of South Dakota, or agent or employee of such

7 a physician shall assist in the process of insemination or embryo transfer or implantation that

8 is in connection with, or is in any way associated with, a surrogacy arrangement. A physician

9 or other person who knowingly or in reckless disregard violates this section is guilty of a Class

10 6 felony. The prosecutor who prosecutes such violation, and the court before whom the violation

11 is brought, shall, separately and independently of each other, report such violation and

12 conviction to the Board of Medical and Osteopathic Examiners.

13 Section 4. Other than the mother and the intended parents, any person, agency, association,

14 corporation, partnership, institution, society or organization, their agents and employees, which

15 engage in, promote, profit from, solicit a woman for, or otherwise assist in, commercial

16 surrogacy arrangements in the State of South Dakota, is guilty of a Class 5 felony.

17 Section 5. Any person or entity who acts as a broker/intermediary in connection with a

18 surrogacy arrangement, whether or not the person is paid or receives other consideration, is

19 guilty of a Class 6 felony.

20 Section 6. Any person, agency, association, corporation, partnership, institution, society or

21 organization, and their agents and employees, who offers, gives, or receives any money or other

22 consideration or thing of value in connection or association with a surrogacy arrangement is

23 guilty of a Class 6 felony.

24 Section 7. A surrogacy contract or arrangement, whether entered into in South Dakota, or in some other state,

- 4 - HB 1218

1 is unenforceable in South Dakota. A custody dispute concerning a child

2 born as a result of a surrogacy arrangement shall be resolved under South Dakota law.

3 Section 8. The mother of a child born as the result of a surrogacy arrangement has the right

4 to primary physical custody of the child following birth. If the child is in her custody following

5 birth, the mother shall keep the custody of the child if she so chooses, before and during the

6 pendency of any legal action to determine custody, unless there is proof by clear and convincing

7 evidence, that she is unfit or she poses a substantial harm to the child. If the child is not in her

8 custody following birth, the mother may exercise her right to take custody of the child, by

9 notifying the person or entity in whose custody the child then resides, in writing, anytime within

10 one hundred twenty days of the date of the child’s birth. Upon proof that such intention was

11 delivered to one or more persons in whose custody the child then resides, the court shall enter

12 an order awarding pendente lite custody to the mother. Any claim that the mother is unfit or

13 otherwise presents a likelihood that she will harm the child can only be made after the child is

14 placed with the mother, and all proof of such allegations shall be established by clear and

15 convincing evidence.

16 Section 9. At a final hearing to determine placement of the child born as a result of a

17 surrogacy arrangement, there is a legal presumption that custody of the child should be placed

18 with the mother. This presumption may be overcome by a demonstration, based on clear and

19 convincing evidence, that the mother fails to meet minimal parenting standards necessary to

20 satisfy the basic needs and welfare of the child. Such determinations may not be based on

21 consideration of economic or social class.

22 Section 10. The intended parent in a surrogacy arrangement which is not a commercial

23 surrogacy arrangement and who is not in violation of the provisions of any of sections 3, 4, 5

24 and 6 of this Act is not guilty of a crime, but is subject to civil penalties of not less than thirty

- 5 - HB 1218

1 thousand dollars and not more than fifty thousand dollars for a first offense, and not less than

2 fifty thousand dollars and not more than eighty thousand dollars for a second offense. An

3 intended parent who is guilty of a third offense is guilty of a Class 1 misdemeanor.

4 Section 11. The intended parent or parents has a duty to provide financial support for a child

5 born as a result of a surrogacy arrangement, whether or not the intended parent has custody of

6 the child. There is a presumption that the noncustodial parent of the child born as a result of a

7 surrogacy arrangement should be given parenting time or visitation, unless it is demonstrated

8 that such visitation would be contrary to the best interests of the child. The parenting time

9 should be liberal, based on the facts of the particular case, consistent with the child’s best

10 interests.

11 Section 12. If a surrogacy arrangement is repudiated by either party, the mother is entitled

12 to have all medical and hospital expenses, including prenatal care, and the medical and hospital

13 expenses of the child incurred during child birth and for treatment for any condition of the child

14 immediately following birth, paid for by the intended parent or parents, even though the

15 surrogacy arrangement is unenforceable and the mother has custody of any child born as a result

16 of the surrogacy arrangement.

17 Section 13. If neither the intended rearing parent or parents, nor the mother are willing or

18 able to assume custody of the child, the child shall be placed for adoption in accordance with

19 statute. Until such time as adoption of the child is final, both the intended rearing parent or

20 parents and the mother are obligated consistent with their respective financial abilities, to pay

21 financial support for the child.

22 Section 14. In disputed multi-state surrogacy arrangements within the jurisdiction of the

23 South Dakota courts, South Dakota law applies.

Steven H. Snyder, Esq., is the founding and principal partner of STEVEN H. SNYDER & ASSOCIATES, ATTORNEYS AT LAW in Maple Grove, Minnesota.  Mr. Snyder is Chair of the Reproductive & Genetic Technology Committee of the Family Law Section of the American Bar Association and  chair of the legal advisory group for the American Fertility Association.

Photo: CBS News

 

 

 

 

 

 

 

 

 

 

 

Vote!

by Ken Mosesian

November 2nd is Election Day. The day that Americans go to the polls - if they haven't already cast their ballots by mail - and vote for the people we'd like to represent us, as well as the many ballot measures that are also up for consideration. 

In a time of unprecedented apathy and anger, voting is all the more important. There are too many issues, particularly for those who are contemplating assisted reproduction, adoption or other family building options, for anyone to stay home. 

Although it is easy to say that "all politicians are alike", we know that not to be the case. There will be consequences for our lives depending upon who gets elected. Candidates hold vastly different views on issues from stem cell research to IVF to marriage equality.

And as we learned in races from 2000, 2004 and 2008, your vote does matter. A few hundred votes can change the outcome of an election.

Young men and women throughout the history of this country have fought, bled and died for our right to vote. Some will lose their lives today. So on Tuesday the 2nd of November, do the most patriotic thing possible: vote.  

 

ASRM 2010: Just Say NO

by Merry Armentrout

ASRM leaders took advantage of this year's gathering in Colorado to sound off about the state's proposed Amendment 62.  If passed, Amendment 62 would give legal rights to fertilized eggs, which means a fertilized egg would have equal rights to a human being.  ASRM held a press conference this morning to state their fervent opposition against Colorado's Personhood Amendment, calling it a "deceptive and dangerous measure." 

ASRM President Dr. William Gibbons started off the press conference by saying the organization represents the doctors who care for the 1 out of 8 couples in the U.S. suffering from infertility, and applying personhood to any human being from the beginning of biological development is denying those infertile couples the solution to help build their families.  ASRM is bringing $12 million to Denver this year, and Gibbons indicated if the amendment was passed it would effect any future decisions to hold this meeting in the state of Colorado.  He went on to acknowledge the irony between this upcoming vote on 62 on November 2nd, and the recent recognition of Robert Edwards, who helped develop IVF, as a Nobel Prize recipient. 

Dr. William Schlaff, a board member for ASRM, focused on the dangers of this amendment on infertility treatments, including embryo transfers.  If an embryo is considered human, than a woman undergoing IVF would have to transfer all her embryos into her uterus- this would be very dangerous for not only the women's health, but also greatly increase the number of multiple births.  Schlaff also talks about an anticipated increase in genetic diseases because an embryologist wouldn't be able to discard abnormal embryos, and would be forced to implant them into the woman's uterus. The decision about which and how many embryos to transfer should remain in the hands of the physician and couple undergoing IVF, and be based on hard scientific evidence. 

Schlaff gives an example from Shady Grove Fertility, the largest U.S. fertility clinic, of the how many embryos could be effected by the passage of this amendment.  From 2005-2008, Shady Grove did 14,500 IVF cycles, producing 200,000 eggs from those cycles.  57% of those eggs were fertilized, and only 7.5% of the fertilized eggs would go on to become children.  He says this amendment isn't about protecting every person, but a direct assault on Colorado's efforts to build families in a safe manner. He goes on to discuss how unused embryos are often donated towards the studies for cures for such diseases Alzheimer's, diabetes and spinal diseases. 

ASRM member Dr. Nanette Santoro spoke about how the personhood amendment could effect family planning and emergency contraception.  She says 43 million sexually active adults in the United States, and of those, 89% are practicing safe sex with the use of birth control pills. There are 2.9 million youths having sex, and 54% of those use birth control pills to prevent pregnancies.  Santoro says the amendment has a far reaching effect on women's health and autonomy.

ASRM, along with The AFA, are urging Colorado residents to vote NO to Amendment 62 on November 2nd.

A chance to listen, learn and speak at PET's Debate: Paying Egg Donors - A Child At Any Price?

by Lisa Marsh, The AFA's London Correspondent

There are times when I feel very fortunate to live within easy commuting distance of central London and last night was one of those.  Instead of the usual household chores and evening TV shows, I popped into London to attend a debate organized by the Progress Educational Trust (PET) at the Royal Society of Medicine: "Paying Egg Donors: A Child At Any Price." It was well worth the effort, to be privy to the information and opinion of several eminent speakers on the panel, as well as those audience members from the fields of medicine, counselling, government, related charities and scientific research.

One thing about which there is no debate is the extreme shortage of egg donors in the UK. The Human Fertilisation and Embryology Authority (HFEA), which currently regulates the providers of fertility treatment such as IVF using donor eggs, will be considering various models of compensation in January, 2011, as a possible means of boosting supplies of donor eggs. as well as reversing the increasingly popular choice among British residents to travel abroad for fertility treatment.  At the last HFEA Open meeting on the 8th of September, 2010, which I attended, its chair, Prof. Lisa Jardine, made no bones about the fact that she is concerned that fertility treatment providers in foreign countries may not be subject to the same stringent oversight as in the UK, therefore creating a risk to patients. Others' objections to "fertility tourism" may be equally concerned about the loss of revenue to UK fertility clinics, exploitation of egg recipients' desperation for a baby, and the trading of human, genetic tissue (gametes) as a moral issue.

Currently, in the UK, egg donors are only compensated for their expenses, which include loss of earnings for days of work missed; a daily maximum of £61.28 or a total of £250.  The questions regarding payment were these:

1. Should compensation merely compensate for lost earnings, or for additional factors such as risk to the donor, drug treatment, sexual abstinence and/or pain and discomfort? If the latter, then how much compensation is reasonable, to leave the donor no worse off than she was before the egg donation, but no better off financially?
2. Is egg sharing morally favourable because the donor is giving her eggs to another woman, or is it merely a financial transaction (trading of human eggs for financial gain) by another name (donors receive a discount on their IVF)?
3. Should egg sharing be limited to altruistic donation in which the donor has no expectation of any financial payment, or other compensation?
4. If there is no legal barrier to a woman giving her eggs to someone else, why shouldn't she be able to sell them?

One panel member, Brenda Almond of the Philosophical Society of England, likened the trading of genetic material, cells, to the slave trade.  She cited libertarianism, as a philosophy holding that the vulnerable should be protected, to support her assertion that human eggs, which could one day become embryos and eventually, a living child, need protection. I assume what she meant is that the children who are born of those eggs are not able to assert free will over how the transaction takes place.  She also posed the question of whether, by performing donor egg IVF, clinicians are violating the "do no harm" rule, as there is inevitably emotinal impact upon the donor, the recipient, the donor's children and the recipient's child.

While I don't doubt that Ms Almond holds sincere views on the subject, these controversial views, were, in my opinion, stated for effect last night. While I don't subscribe to her views, I was very open to hearing everyone, but found her to be the least persuasive of all the speakers. My belief is that the slave trade argument doesn't apply, as :

1. the egg is not "human flesh;"
2. if produced by the donor, but unused to create a pregnancy, it would otherwise go to waste; and
3. there is no human child, if the egg is not fertilized with the intended father's sperm and carried in the intended mother's womb.

Opinions diverged widely during the debate, much of it focusing on what the donor could reasonably expect to receive for giving her eggs to intended parents. In egg sharing a woman, who is already planning to have an egg retrieval for her own IVF, can expect to receive £2 - 3,000 worth of fertility treatment as a benefit.Several people present last night voiced opinions that egg sharing is really egg trading because of the value of the benefit received, making it a financial transaction by another name.

But, what of the healthy, fertile woman who doesn't need IVF? She may want to give her eggs to a specific woman; a sister, friend or stranger, completely from a place of generosity. There are avenues for making this gift, such as Altrui - an egg donation scheme that matches donors and recipients. One such woman, Laura Witjens, Chair of the National Gamete Donation Trust, and a mother, sat on last night's panel, personally advocating a payment to egg donors of approximately £700.  She believes that amount would be enough to cover the donor's costs, and constitute a gesture of appreciation for the value attached to the donation, without being potentially exploitative....not enough money to change the donor's life, pay off their debt, etc... Interestingly, while Witjens' twins were naturally conceived, she stated that if she had been infertile, she absolutely would have paid for eggs to become a mother.

Some of the people present at the PET debate, both on the panel and in the audience, batted back and forth the idea that knowing their biological mother received payment for the egg that created them would be psychologically damaging. Some people may have difficulty coping with the knowledge that they sprung from a donated egg, regardless of the issue of payment. How is this scenario any different from adoption, where adoptive parents must prepare themselves for educating their child about their origins in a sensitive and understandable way? Raanan Gillon, Chair of the Institute of Medical Ethics, countered that argument in the best way possible; saying "the alternative to having a donor-conceived child be upset about the egg being bought, would be that they don't exist at all." Quite right. How many people would wish they had never existed and their parents never having had children, rather than any payment being made to the donor?

In regard to the argument of almost-inevitable harm, I have to ask: "so what?" The donor should be provided with counselling prior to carrying out the egg retrieval and donation, to ensure that she understands the physical risks and emotional ramifications involved.  Her existing or future children can be raised with the message that Mom did something generous to allow another woman to have a child who would not otherwise have been able to do so. The recipient is surely informed about all of the angles of the process and should be counselled up until she conceives, if not afterward as well. The donor-conceived child is the one who needs the most attention and sensitivity.  Yes, there is a risk, especially in cases of anonymous egg donation, when there will be a loss of genetic connections with biological maternal relatives. This could cause feelings of not belonging, incomplete sense of identity.  However, anonymous donation was not the topic of the evening.

In the case where the donor-conceived child will have the right to seek their biological mother at the age of 18, his parents have the responsibility of preparing their child adequately for what he may discover. Prof. Brian Lieberman, Medical Director of Manchester Fertility Services, called for all of the exchanges taking place in egg donation to be open and transparent. I believe it was he who said that his overriding concern for the donor-conceived child is that they are able to feel proud of who they are and how they are created. That, to me, is the goal in raising any child, conceived naturally, through assisted reproduction techniques or adopted. That message is one of love and belonging.

Much was made of the US free-market model for egg donation, the range being quoted as anywhere from £8 to £19,000.  While Prof. Gillon did not see payment for eggs, in itself, morally objectionable, the consensus of most panel members and speakers from the audience was that if payment was made it should be a regulated, fixed fee, rather than a market-driven fee like in the US.  Among that group, a lump-sum fee of an amount between the current £250 and Laura Witjen's suggested £700 seemed to be favoured; the amount resting on the difference between inducement and coercion.  For those willing to embrace a fee at all, this amount was sufficient as an inducement to give something of value, the egg, to someone else which requires the donor to experience some physical risk and inconvenience. Anything more, in their opinion, could make a change in the donor's lifestyle, therefore running the risk of coercing that person to do something which they might otherwise believe immoral or otherwise wrong. Dr Sue Avery, Director of the Fertility Centre at the Birmingham Women's Hospital and a panel member, felt that the "lump sum argument is fallible, because any amount will be an incentive to someone to do something they would not otherwise wish to do."

You may be interested to hear my contribution to the debate. I had had no intention, whatsoever, of speaking; however at the end of the evening, I felt it necessary to point out that it was all well and good debating ethics in a vacuum, but it should not be forgotten that real people are involved here.  The British government, associated with the Church of England, promotes family values. The evidence is undeniable that most people want to create families and they are not willing to let a diagnosis of infertility come between them and a baby. The country is proud of the breakthroughs in medical science that have occurred here, and more money has been made available for fertility treatment through the National Health Service (NHS). However, there are still many couples who find themselves shut out, some by the severe shortage of donor eggs available.

I shared with the PET audience that my husband and I never got to the point where I was told I couldn't go any further because of a shortage of donor eggs. We felt let down by the medical system here that moved at a snail's pace in responding to my infertility and then told us I was too old to qualify for IVF under NHS regulations. At 42 years old, with few quality eggs left, using donor eggs would have had to be my next step if we had gone further. (I am one who, like the cliche, miraculously conceived naturally 3 months after my failed IVF cycle.) I have clients who are in the same position now that I was in ten years ago. Faced with the probability that their own sub-standard eggs mean they will never conceive, I believe that most women would be willing to pay something in appreciation for this priceless gift from another woman.

As Laura Witjens pointed out, "patients vote with their feet." If they cannot get access to the assisted reproduction techniques they need to create their families in the UK, they will seek them out elsewhere, even if payment must be made. If the government wants those needing fertility treatment to stay in this country, it has to make concessions to the needs and desires of those concerned. It can't rely upon "in the best of all possible worlds..." but, instead, must make the world we live in as easy to negotiate as possible, in a positive way, aimed at a positive result.

If you have been an egg donor, used donor eggs or just have an opinion about whether payment should be made to an egg donor, and if so, how much, I would like to hear from you.

Lisa Marsh is an American fertility coach who lives and works out of London, U.K. and London correspondent for The American Fertility Association's blog page.  You can find more information about Lisa’s work at http;//yourgreatlife.typepad.com  or follow her fertility and miscarriage-related Tweets on Twitter @yourgreatlife.

Reproductive Health Analysis of the Toxic Chemicals Safety Act (H.R. 5820)

by Kimberly Inez McGuire

It seems like I can’t turn on the news anymore without hearing reports about how toxic chemicals are hurting reproductive health.   A new study has confirmed that girls in the US are entering puberty at earlier and earlier ages, and this early puberty has been linked to chemicals that disrupt the body’s endocrine system. Fortunately, there are already efforts underway to reverse this trend and other alarming declines in reproductive health.

The House recently introduced legislation to improve health outcomes by changing the way we regulate toxic chemicals in this country. This bill, the Toxic Chemicals Safety Act (HR 5820), could be transformative for women’s health, children’s health, and the health of communities of color, who are often the hardest hit by toxic chemical exposure. As part of our commitment to the full spectrum of women’s reproductive health, we are strong supporters of this legislation. 

We all know how tough it can be to track the many legislative priorities that we work on, so we’ve distilled the critical components of this bill into a two-page analysis that focuses specifically on the impacts for reproductive health (below) . The analysis also provides simple suggestions for actions that your organization can take to support this legislation. During a time when it feels like we’re continually fighting back against the opposition, it can be refreshing to work on a positive, proactive effort like reducing toxic chemical exposure. Contact me directly if you’d like to know more about legislative strategy/landscape.

The Toxic Chemicals Safety Act (H.R. 5820)

The Toxic Chemicals Safety Act (H.R. 5820) is legislation to update and overhaul the Toxic Substances Control Act of 1976 (TSCA) in order to protect the health of children, pregnant women, workers, the public, and the environment from toxic chemical exposure from everyday products. The bill was introduced by Chairmen Bobby L. Rush and Henry A. Waxman of the Energy and Commerce Committee. Similar legislation—the Safe Chemicals Act (S 3209)—was introduced in the Senate earlier this year.
Background Facts on Reproductive Health and Toxic Chemicals
In the U.S. today, there is increasing concern that environmental contaminants are harming the reproductive and sexual health and fertility of women and men1:
• At least 12% of women reported infertility, miscarriage, or difficulty conceiving in 2002, an increase of 40% from 1982. The rate has almost doubled in younger women, ages 18–25.
• There have been significant declines in sperm counts in men.
• Studies suggest that exposure (either directly or in utero) to chemicals commonly used in everyday products has been linked to earlier puberty in girls, cancer, and birth defects.
• Reproductive tract abnormalities like undescended testes and hypospadias (a deformity of the penis) are increasing in infants and newborns.
• The Centers for Disease Control and Prevention (CDC) has published data showing that exposures to toxic chemicals like bisphenol A (BPA) and phthalates are common. Almost everyone has these chemicals in their bodies—some at levels near or above those shown to cause adverse effects on reproductive health.
Why We Need Chemical Policy Reform
• There are 80,000 chemicals in commerce today, and the vast majority of them are not tested for safety. Toxic and untested chemicals are commonly found in water and baby bottles, scented candles and air fresheners, vinyl shower curtains and home electronics.
• Major loopholes in current law make it almost impossible for the Environmental Protection Agency (EPA) to require testing or regulate chemicals based on adverse health effects. Consequently, TSCA has never been used adequately to regulate toxic chemicals, despite their potential to harm reproductive health.
1 The Health Case for Reforming the Toxic Substances Control Act, published by the Safer Chemicals, Healthy Families Campaign, 2010 (http://healthreport.saferchemicals.org/reproductive.html).
1020 19th Street NW – Suite 875 – Washington, DC 20036 – 202.530.4401 – fax: 202.530.4404 – www.rhtp.org
• Currently, state laws provide a patchwork of regulations and individual chemical bans. While these efforts are important steps in the right direction, we know that fighting state by state and chemical by chemical will not be enough to protect reproductive health. In addition to providing comprehensive reform at a federal level, this new bill also allows states to enact additional or more progressive chemical reforms on their own.
How H.R. 5820 Will Improve Reproductive Health
• Require Basic Health & Safety Information for All Chemicals: HR5820 would require chemical companies to provide basic health and safety information for chemicals, proving those chemicals safe before they enter the market, our homes, and our bodies. This bill will give the EPA authority to act effectively to regulate or ban chemicals shown to be harmful.
• Protect Reproductive Health from the Worst Chemicals: The bill requires EPA to prioritize safety determinations for some of the most dangerous commonly used chemicals, including reproductive toxicants BPA and phthalates.
• Study and Take Action on “Persistent, Bioaccumulative, and Toxic” Chemicals (PBTs): The bill would mandate immediate action to reduce exposures to PBTs, which build up in the food chain and seriously harm health. One example is mercury, a PBT which is linked to infertility and miscarriage and known to harm early development.
• Protect Disproportionately Affected/Vulnerable Populations: The bill would require that all chemicals meet a safety standard that protects disproportionately vulnerable and affected populations, including infants, children, and adolescents; pregnant women (including effects on fetal development); individuals with preexisting medical conditions; and workers. The bill also includes provisions to reduce the disproportionate burden of toxic chemical exposure placed on people of color, low-income people, and indigenous communities.
• Ensure Environmental Justice: The bill would require the EPA to identify and take action to reduce chemical exposure in “hot spots,” areas of the country facing disproportionate toxic chemical burdens and adverse health effects due to a high concentration of industrial activity, a legacy of pollution, or other factors.
• Use the Best Science to Track the Health Impacts of Toxic Chemicals: This legislation would allow the EPA to require biomonitoring (measuring and tracking the presence of chemicals in our bodies) as part of the data it collects on chemicals. Specifically, the bill requires biomonitoring studies of pregnant women and infants in order to collect data on chemicals likely to harm early development. In addition, the EPA has to use the best methods for determining a chemical’s safety, as defined by the National Academy of Sciences.
What You Can Do to Advocate for Reform
• Contact RHTP: Email Jenn Rogers ([email protected]) to learn about simple, scalable ways your organization can improve reproductive health by reducing chemical exposure.
• Learn More About Toxic Chemicals & Environmental Justice: Check out our newest blog, The Unseen Spill: The Human and Reproductive Health Catastrophe of Toxic “Hot Spots” in the Gulf Region
• Take Action: Ask your Representative to co-sponsor the Toxic Chemicals Safety Act.
• Get Reproductive and Environmental Health Updates on Twitter: twitter.com/rhtporg 1020 19th Street NW – Suite 875 – Washington, DC 20036 – 202.530.4401 – fax: 202.530.4404 – www.rhtp.org

Kimberly Inez McGuire is the Senior Associate, Programs and Policy for the Reproductive Health Technologies Project (RHTP).  For more information on RHTP, click here: http://www.rhtp.org/fertility/default.asp

Until we're all truly equal, no one is equal.

  by Ken Mosesian

In the summer of 2003, I attended my first "Family Week" in Provincetown.  Family Week is the annual week-long event sponsored by the Family Equality Council, an organization dedicated to achieving equality for LGBT (lesbian, gay, bisexual and transgender) headed families. Over 2,000 parents, grandparents and kids gather for seven days of activities and educational events. I was working as a development consultant for the organization, and was incredibly excited to be there for what was described to me as "an experience."

Two memories remain with me from that week. The first was standing off to the side on one of the main streets and closing my eyes. I heard comments like "ask your mom" and "we'll be at the beach in two minutes" and "I thought you brought the diaper bag."  I remember thinking how utterly ordinary it all sounded. The second memory is of walking out to the beach with a group of first-time corporate sponsors. Some of the kids were building sand castles. Others were exploring the water with their moms or dads. Some were playing with each other. 

I looked at the corporate sponsors and said, "this is ultimately what we're all about." 

Now I have the privilege of leading a family building organization that is committed to true inclusion and equality. Family building equality. Marriage equality. Because, as cliche as it may sound, until we're all truly equal, no one is equal. 

And that's why The AFA has expanded our mission to include not only those trying to conceive or adopt, but to support LGBT family building as well. Let me be absolutely clear. The forces that would deny LGBT persons the rights to marriage and family are also the forces that are working diligently to make sure that assisted reproduction becomes a thing of the past. So as an organization that advances family building rights through assisted reproduction for the straight population, it would be the height of hypocrisy not to support the rights of LGBT persons who also long for children. 

June is traditionally celebrated as LGBT Pride Month. Parades and festivals take place in major cities across the United States and internationally, and President Obama has signed a proclamation declaring, among other things, that we "must give committed gay couples the same rights and responsibilities afforded to any married couple, and repeal the Defense of Marriage Act.  We must protect the rights of LGBT families by securing their adoption rights, ending employment discrimination against LGBT Americans, and ensuring Federal employees receive equal benefits.  We must create safer schools so all our children may learn in a supportive environment."  

This week we'll be highlighting LGBT family building in Connect, our e-Newsletter. You can sign up here to receive it. It will also be the focus of our blogging. And we'll be highlighting related articles in our online library. 

So here's to Pride. In ourselves. In each other. In all families in all their diverse forms. And here's to the day when this is no longer an issue. 

ART Legislative Update

by Richard B. Vaughn, Esq.  

For years there has been little legislation directly impacting or regulating assisted reproduction. However, in recent months all across the country, including possibly in the state where you live, there have been an unprecedented number of legislative proposals relating to assisted reproduction that could have both positive and negative impacts on your assisted reproduction journey. These bills, if they become law, could eventually have dramatic consequences, so it’s important to stay up to date! To help you sift through it all, we’ve compiled this legislative update which contains a very brief summary of the proposals and their current status. 

If you think any of these proposals could impact you, be sure to obtain updated legal advice particular to your situation from an experience assisted reproduction law firm, and particularly from an attorney licensed in the state whose laws impact your journey.

 

Arizona

AZ SB 1306 and SB 1307 would regulate the informed consents you sign at a doctor’s office and would restrict stem-cell research.

SB 1306 dictates information to be included as part of the informed consent process, including a list of specific information to be provided to potential egg donors prior to screening or testing them for possible donation.  The initial version of the bill would have banned the purchase, offer to purchase or advertisement for the purchase of human eggs (in effect denying Arizona residents the option of using egg donation), but this was removed from the bill prior to passage. 

SB 1307 places a number of restrictions on stem-cell research. 

Both bills were signed into law in April 2010.

California

CA AB 995 regarding tissue bank licensing. This bill is inactive.

CA AB 1317 would require disclosure of risks and other factors in egg donor advertisements. This bill is inactive.

CA AB 2426 would require non-attorney surrogacy practitioners to deposit their clients' unearned funds (funds for the surrogacy) into either an: (1) independent and bonded escrow company, or (2) a trust account maintained by an attorney. This bill is currently pending.

 

Florida

FL S 7062, the Florida Assisted Reproductive Technology Act, would have defined an agency as any organization or individual who provides a database, matching or third party reproductive service (there were no requirements related to agency training, education, or licensure). The Act would have required agencies to conduct mental health evaluations and criminal background checks on donors, gestational surrogates and intended parents every two years and would prohibit donors or gestational surrogates who are not US citizens or permanent residents. This died in committee but may re-emerge in the next legislative session.

 

Illinois

IL HB 1082 (2009) amends a variety of Illinois statutes and would require an insurer, upon request of an insured intended parent, to provide maternity coverage for a gestational surrogate as a dependent for a term that extends throughout the duration of the expected pregnancy and for 8 weeks after the birth of the child. This is currently assigned to the Insurance Committee of the IL House of Representatives and would be effective immediately if passed; however, it appears this bill has effectively died in committee.

 

Kansas (Editor's Note:  Since the date of this blog posting, KS SB 509 effectively died in committee)

KS SB 509 creates women's health and embryo monitoring program to collect and retain in "perpetuity" 70 data items, much of which is already collected and reported by the CDC.  In addition, this bill requires tracking all eggs retrieved, fertilized, transplanted, frozen, and discarded, the status of all embryos, the number and type of fetal reductions, method for monitoring the health of patients even after they are no longer patients, and a reporting of how clinics are paid (failure to report or falsely reporting can result in felony charges). It is unlikely this bill will be acted upon in the current legislative session.

 

Maryland

MD S 19 proposed reducing the two year wait period to one year for purposes of insurance coverage. This bill failed in committee.

 

MD HB 281 and SB 585 proposed to establish a commission on surrogate parenting to evaluate the health and social well being of children born as a result of surrogacy. This bill failed in committee.

 

Massachusetts

MA S 485 would update the definition of infertility by shortening the time periods for trying to conceive required before for applicability of insurance coverage. This bill is still in committee (it is currently in front of the Ways and Means Committee. The bill must pass through this committed and both houses before July 31 or the bill will likely be prohibited from being reintroduced due to the MA Governor’s proposed 2-year moratorium on expanded mandated benefits.

 

Michigan

MI SB 647-652 and companion bills HB 5129-5134, impose reporting requirements on assisted reproduction clinics in addition to those already in place, including tracking and reporting of all embryos. This bill also proposes to standardize informed consent for ART and restricts stem cell research which was approved last year in a Michigan voters’ referendum.  This bill has passed through the Senate but is still pending in front of the MI House Health Policy Committee.

 

Minnesota  (Editor's Note: Since the date of this blog posting, MN SF 436/HF 890 effictively died in committee)

MN SF 436/HF 890 adds presumption of parentage to paternity/maternity laws in favor of all intended parents in third-party ART matters. This bill has passed through committees in both the MN house and senate and awaits floor votes in each but appears to be stalled as of the date of this publication.

 

Missouri

MO HB 1035 requires group health insurance policies providing coverage for more than 25 employees to also cover the diagnosis and treatment of infertility, including up to four cycles of IVF. This bill is still in committee.

 

Mississippi

MS Initiative Measure No. 26 is a ballot initiative seeking an amendment to the state constitution which would define an unborn child as a human being starting at fertilization.  This initiative is on the Fall 2010 ballot. Under the express terms of the Mississippi Constitution, the Bill of Rights cannot be amended by the initiative mechanism and it will likely be struck down in court.

 

Oklahoma

OK HB 3077 would prohibit compensation to egg donors, but it died for lack of action by the OK senate committee.  This bill is dormant at the moment but is expected to be re-introduced in the next legislative session.

 

Tennessee

TN SB 2136 and HB 2159, the Embryo Donation and Adoption Act, deems a child born from donated embryos as having been adopted and grants the same legal protections without court action. This bill also requires clinics to develop written contracts transferring ownership of embryos from donor to intended parents and to keep records for 21 years. This bill is in front of the judicial committee.

 

Virginia
VA SB 69 reduced the time requirement for a gestational carrier to give her consent to intended parent’s parentage to 3 days (and up to 180 days); allows matching of surrogates and intended parents but only where no compensation is involved; and applies only to married intended parents (single intended parents are not disallowed, they are just not specifically included in the language of this bill).

 

Washington

WA HB 2793 proposed to legalize compensated surrogacy in Washington, but it died for lack of action in the WA senate. This bill is likely to re-appear in the next legislative session.

Richard Vaughn is the latest member of The AFA's blogger team and will be contributing legislative updates on a regular basis.  As Managing Attorney of National Fertility Law Center,  Rich is able to combine his legal background with his passion for his own family (formed through assisted reproduction) and will be blogging for us through that unique lens. RIch's extracurricular pursuits are tied to advocacy for the LGBT community and to the medical, health and wellness industries.  He and his partner, Thomas Woelfel, were married under California law in 2008 and are the proud parents, through egg donation and surrogacy, of twin boys Aiden & Austin.

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