Tuesday, March 16, 2010

On assisted reproduction and its problems

Pratap Chakravarty's Agence France-Presse article "Gay couples find surrogate mothers in India" caught my attention.

For gay U.S. businessman Brad Fister, experiencing the joy of fatherhood meant flying half way around the world to India where he first held his baby daughter, born to a woman who had signed away any right to her child.

Commercial surrogacy is a booming industry in India, and in recent years the ranks of childless foreign couples have been swelled by gay partners looking for a low-cost, legally-friendly path to parenthood.

In the United States, laws governing adoption and surrogacy vary from state to state, while in India the service is legal, loosely regulated and — so far at least — non-discriminatory on grounds of sexual orientation.

For Fister and his partner Michael Griebe, a crucial attraction is that surrogate mothers in India are generally willing to renounce any legal claim to the child.

"We decided to have a baby a year and a half ago but the problem in the United States is mothers often do not relinquish the rights to the child," Fister told AFP before leaving the southern city of Hyderabad with his baby daughter last month.

"It was all so simple here and if we decide to have another we would return," he said.

[. . .]

Surrogacy Abroad bills each couple around $20,378 Cdn, including medical charges and the payment for the surrogate who receives around $8,151 Cdn.

An initial miscarriage meant Fister and Griebe spent $40,756 Cdn, but that is still far cheaper than in the United States, where multiple attempts can leave couples with bills of more than $101,890 Cdn.

India IVF clinics claim a high success rate as doctors are allowed to implant five embryos into the uterus at one time. In many other countries, such as Britain, only two implants are allowed.

Assisted reproductive technology has allowed for the wholesale reconfiguration of the family and reproduction. In vitro fertilization can allow couples with difficulties to conceive and produce health children; infertile couples can get sperm or eggs from an anonymous donor to conceive; sperm and eggs can be frozen for later conception; same-sex couples and opposite-sex couples alike can contract surrogate mothers to bear their offspring. Before long, it will be possible to engage in, to produce viable human clones, for instance, or to engage in the eugenic genetic engineering of reproductive cells or perhaps even the fetus. Increasingly large numbers of couples are making use of these technologies, like Denmark where "[o]ne study from 2006 found 40 percent of young Danish military recruits had suboptimal sperm levels. In the land of Lego, 7 percent of all live births in 2007 required "assisted" reproduction."

The usage of these reproductive technologies can be expected to increase over time, as individuals continue to delay family formation and parenting. That's why it's alarming that all of these current and future innovations are taking place, incidentally, without much consistent regulation. Different European states have differnet policies, some much more restrictive than others. Here in Canada, as
Alison Motluk wrote in the most recent issue of Walrus Magazine, shady and possible illegal behaviour is the norm.

A long-awaited law, the Assisted Human Reproduction Act, had come into force in April 2004, expressly outlawing the purchase of human eggs. Technically, anyone involved in such a transaction, including doctors and parents, could now be fined $500,000 and be jailed for up to ten years.

In reality, however, the law had done little to stop Canadians from buying human eggs. If anything, with women waiting longer than ever to start their families and gay men increasingly interested in having children, demand had gone up and the market had grown. The law, such as it was, simply forced the activity underground, with unintended and undesirable consequences. Fertility specialists, lacking official guidance from the government, began drawing their own boundaries. Patients had only doctors to rely on for advice. Worst of all, donors became part of a shadow economy, aware they were part of something vaguely illicit and therefore reluctant to come forward when something went wrong. The rare woman who did speak up risked being made the scapegoat of the whole under-the-table arrangement[.]

[. . .]

In the years since the act was passed, however, Canada has found itself in the uncomfortable position of banning the purchase of gametes in principle but not in practice. Other countries, such as the United Kingdom, also ban their purchase but have strict enforcement provisions backing the ban. The Canadian law, by contrast, was never completed. The sections dealing with prohibited activities, like the sale of eggs, are done and in force, but certain parts, dealing with activities that are allowed but “controlled” — including the reimbursement of donor expenses — can’t be proclaimed until regulations are produced setting out the details of how the system will work. Those regulations are still pending six years later.

The unproclaimed sections of the law suggest that reimbursement will only be permitted for very specific expenses and by people expressly licensed for the purpose. However, without the regulations, the various players have been left to interpret the law on their own. Some would-be parents travel to countries where eggs can be legally purchased. Of those who stay in Canada, some still employ egg donors but rely on the grey areas in the law. The $7,000 Heather Cox was paid for her second donation, for instance, was called a reimbursement for concrete expenses — even though, according to her, she negotiated the fee up front and was never asked to provide receipts.

I don't have any easy solutions. Increasing the regulation of these technologies is a good idea, but if costs fall as a result of technological innovation and growing demand, and these routines become easier, how invasive will these regulations have to be? As Motluk recounts, already couples and donors and labs are willing to violate the law for their goals. And what about couples who leave one country to conceive in another--what can be done, should be done, here?

1 comment:

Damien Sullivan said...

Consistent regulation is good only if the regulations are good and sensible. It's one thing to try to make sure people aren't being coercively exploited, but when your 'regulation' is an outright ban on selling eggs, I can only be thankful that such regulations are easy for Canadians to evade.