Internet sperm ban in UK

Recall the story about the sperm shortage in Britain, brought on by the abolishment of anonymity for donors. Some women and couples are getting around the shortage by ordering sperm over the internet from international sources. I raised the issue of how the abolishment of anonymity for donors might become an issue for imported sperm ordered in this manner. Well, it hasn't been directly addressed yet. But a new requirement bans internet sperm companies from supplying fresh sperm. Ostensibly it is to protect recipients from possible diseases. The new requirement, set to go into effect next April, requires the firms supplying the donor sperm to store it for six months prior to sale to ensure that it is disease-free.

Some statistics on Bumrungrad's fertility center

A short news item at Yahoo News about fertility tourism in Thailand gives a few interesting statistics about Bumrungrad's fertility center. According to Phattaraphum Phophong, a fertility specialist at Bumrungrad International hospital, they receive about 500 foreign patients per month at the fertility center, 60% of which are American. They come primarily for IVF treatment, attracted by both the price, which can be one-third of what it costs in the U.S., and also for certain procedures that may be prohibited or restricted in other countries, such as sex selection using pre-implantation genetic diagnosis (PGD).

That is a pretty big number, 500 foreigners per month. And that doesn't include local Thai residents, although at Bumrungrad foreign patients may be the majority. Jetanin Institute for Assisted Reproduction is the largest fertility center in Thailand, and although they treat many foreigners, Thais are probably the majority. I haven't seen numbers for Jetanin but have visited them and Burmrungrad's fertility center as well. Jetanin is a big fertility center and also has complete hospital facilities for delivering babies. Their numbers must be quite substantial.

New Zealand's first birth following PGD

Pre-implantation Genetic Diagnosis (PGD) is something new for New Zealanders. It was first allowed by the government only last year and is subject to tight restrictions. The New Zealand government has budgeted $500,000 to pay for PGD where there is a risk of passing on a serious genetic disorder. PGD for sex selection is not permitted in New Zealand, except to avoid sex-linked conditions such as Duchenne muscular dystrophy.

The first birth following the use of PGD with IVF happened last month for a 39-year old woman who had miscarriages for five years due to a frequently occuring genetic disorder in her embryos. She gave birth to healthy twins.

More on made-to-order embryos

The new service by the San Antonio based adoption and fertility company Abraham Center of Life is starting to get a little more media coverage. An article today on the ReasonOnline website gives some additional background and perspective. One bit of trivia not important to the meat of the story but curiously interesting is pointed out by the author, Ronald Bailey. That is that the name of the center evidently refers to the Bible story of the use of surrogacy by patriarch Abraham who, at his wife Sarah's urging, had a son by his wife's Egyptian slave-girl Hagar. Ok, not all that interesting perhaps.

The article mentions that there is some "ethical hand wringing" about the new service and references a post at Lifesite.net. If you read that post you see they say that Many ethicists have long complained that the use of IVF technology with preimplantation genetic diagnosis, combined with recent breakthroughs in understanding of human genetics, will lead to a nightmare “Brave New World” in which babies are made to order in labs and sold as commodities. But there is little else article, including why this "Brave New World" they refer to is such a nightmare.

Parents want healthy and happy babies born free of genetic defects. Applying diparaging labels like "made to order babies" doesn't implicate the parents' feelings about their new loved one. And being "sold as commodities" is similarly impertinent to the parents, whether they are buying an embryo or buying an adopted child, or don't they critics refer to adoption as buying a baby?

The Reason article points out some of the other obvious conflicts in the ethicists' criticisms.

Made to order embryos

The Abraham Center of Life in San Antonio, Texas is offering made to order embryos. According to Jennalee Ryan, the director, embryos are created with sperm and eggs from rigorously screened donors that meet the specifications of their customers. For $10,000 customers receive two embryos.

Ms. Ryan claims the process is superior to standard IVF and better than using donated eggs or sperm from a traditional IVF clinic. Her reasoning goes like this. The donors she uses are "proven", meaning they don't have any of the fertility problems that bring clients to the fertility clinic in the first place. As a result, she claims they achieve 70% success rate compared to around 30% for standard IVF. She also says their donor men are highly educated, most have PhDs, and the donor women all have some tertiary education. And compared to adoption this method is superior because she says "Babies offered for adoption tend to come from lower class women who often have a history of drug or alcohol abuse."

A couple of interesting assertions are made by Ms. Ryan. The claim of 70% success rate is quite amazing. Is she really asserting that it is the quality of the embryos alone that drive the implantation success rate up that high?

As for the educational level of the parents, I'm not sure the embryo is going to have much sense of whether or not the father obtained a PhD, although it might carry the trait of snobbiness that many PhDs so unattractively exhibit!

An interesting side note. Although this story is about a fertility center in the U.S. I have seen no news about it in the U.S. media. I saw this story on an Australian website and it was picked up by a couple of UK websites. This seems like it would be a lightning rod for moral outrage by religious groups in the U.S.

PGD for sex selection being promoted

Thailand has been a destination for "fertility tourism" for some time. Bumrungrad Hospital's fertility center receives around patients per month from other countries. The primary motivation in the past has been cost; fertility centers like Bumrungrad's and Jentanin Institute, Thailand's largest, provide world class treatment at around one-third the cost of IVF in the west.

Now another feature of Thai IVF clinics is bringing foreigners to the Kingdom, the availability of sex selection through preimplantation genetic diagnosis (PGD). PGD is used world wide to screen for healthy embryos prior to implantation. However, in many countries the use of PGD for selecting the sex of the embryos to be implanted is prohibited by medical code or laws. Thailand's national medical board has advised against the practice of sex selection but there are no laws or codes prohibiting it. And many customers are requesting it, according to Bangkok-based Ramkhamhaeng hospital group which is considering promoting the service.

The arguments against sex selection during IVF ultimately seem to boil down to religious beliefs, something along the lines of "we shouldn't be playing God", or accusations of misogyny in the cases when males are favored. A rational basis for arguing against it seems elusive, however, especially when you consider that the fertility doctor must select some embryos for implantation and some to be left behind, perhaps frozen for future use. Given that there are ample healthy embryos from which to choose one can just as well pick all males or all females. In cultures where the predominant religion is not based on belief in a god but instead on understanding the law of cause and effect (e.g. Buddhism in Thailand) the emotional vitriol against sex selection seems quite irrational.

New rent-a-womb service

A Singapore adoption center has expanded its offerings to include a rent-a-womb service, surrogate mothers for hire in China. Greenhouse Adoption Agency has experienced a dramatic slow-down in its adoption business since the Singapore government clamped down on adoptions from China. Private adoption agencies have all but been forced out of bringing adopted children from China to Singaporean parents. Now all adoptions are required to go through two designated voluntary welfare organisations. As a result, many adoption agencies now focus on adoptions from Malaysia and Indonesia. But Greenhouse has taken on the challenge of matching prospective parents in Singapore with surrogate mothers in China.

The process is complex and there are few guarantees. Couples travel from Singapore to China where IVF procedure is performed using the couple's egg and sperm. The embryo is implanted in the surrogate. Since the service is still new there are open questions about how the baby is then treated by immigration authorities. But Greenhouse says they have it all worked out with relationships already established at all the pertinent government agencies.

The cost is significant, 40,000 Singapore dollars, about twice the cost of an adoption. And four times the cost of a round of IVF treatment. And of course there are no guarantees that a single round of IVF will result in a pregnancy. Other questions that come to mind are the costs of delivery, especially if there are complications. And what about multiple births which are somewhat common with IVF.