The Cold Truth, Revisited: Egg Freezing as an Employee Benefit

By Nadia Daneshvar

Faced with attracting women to join their predominantly male workforce, Facebook decided to offer an usual benefit: up to $20,000 in coverage toward egg freezing procedure and storage costs for female employees. Apple similarly has plans to offer both full- and part-time female employees the same coverage starting in January 2015. While many say the companies have taken a step toward gender equality in the workplace, others see it as a step in the wrong direction.

The American Society for Reproductive Medicine’s recent revocation of egg freezing’s “experimental” status has caused an increase in the number of women opting to freeze their eggs for social or nonmedical reasons before they reach “advanced maternal ages.” But egg freezing does not come without risks and stigma. Nearly all stages involve risks (e.g., hormone injections and extraction, transfer, and gestation) and after two rounds of egg retrieval, the chance of live birth is just over 20% if eggs are harvested at or before age 25 and decreases with age: only 16% of women who underwent two rounds of egg freezing at age 30 will have live births. Other considerations include the increased risks associated with pregnancy in older ages. Continue reading

The Cold Truth Behind Employer-Covered Social Egg Freezing

Nadia ISLAT

By Nadia Daneshvar

Salary. Health insurance. Long-term disability insurance. Flex benefits. 401(k)…and “baby insurance”? With the advent of egg freezing, women can have children practically whenever they want and with whomever they want, by simply having their viable eggs frozen while they’re still young. Imagine if your employer decided to cover the cost of preserving some of your eggs for you as a part of its benefits package. Some law firms are doing just that for their female employees. Testing, monitoring, and retrieval of eggs can cost anywhere from $6,500 to $12,850, and annual storage fees of retrieved eggs are typically between $400 and $600. But the costs don’t stop there. When a woman decides she is ready to use her eggs, they must be thawed, fertilized, and transferred to a woman’s uterus, which costs anywhere from $4,500 to $7,000. At Specialists in Reproductive Medicine and Surgery, a woman could pay a total of $21,558 if the eggs are stored for only one year. These procedures are rarely covered by health insurance and vary from clinic to clinic, making employer-covered egg freezing a financially enticing option for many women. After all, one-fifth of American women between ages 40 and 44 do not have children, among whom half regret their status wishing they had children. Egg freezing is thought to offer the option to younger women to avoid such future regrets.

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Egg Donation is Made to Look Easy, but Questions and Health Risk Remain

Ryann Summers_1

By Ryann Summers

Recently, a former co-worker and his romantic partner sent me a text message that left me reeling.

It essentially read: Hey, can I have ur eggs? Thx.

Few couples would be better equipped to raise a well-loved child than these two men, and I fully supported their decision to start a family.  But I wondered how we had arrived at the point where this request has become so casual that it can be communicated in fewer than 140 characters.  At least take me out to dinner.

I don’t fault my co-worker; his question mirrors how the issue is presented in our culture.  As a woman in her early 20s, I am bombarded by advertisements seeking my eggs.

Recently when I was riding the T in Boston, I found myself staring at the face of a smiling baby, and a dollar amount.  It seems, well, easy.

Egg donation payments range anywhere from $5,000 to $10,000; some solicitations offer amounts as high as $20,000, or even $100,000, for donors with specific characteristics.  I could definitely benefit from thousands of dollars, and hey, I probably have eggs to spare, right?

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Doe v. Hamburg: Are FDA Regulations to Protect Sperm Donor Recipients and Their Offspring from Disease Unfairly Burdensome?

Laurie Rosenowby Laurie Rosenow

A woman residing in Oakland, CA recently filed a lawsuit against the Food and Drug Administration and Health and Human Services claiming the FDA regulations established to prevent the spread of communicable diseases create an unfair barrier to women who wish to use donor sperm of a known donor of her choice.

The six count lawsuit filed in the U.S. District Court for the Northern District of California alleges that the regulations contained in 21 C.F.R. 2171 infringe on Jane Doe’s, other similarly situated women’s, and individual male donors’ rights to privacy, bodily integrity and autonomy, procreative liberty, and due process.  These regulations require “directed” semen donors (a donor known by the recipient prior to donation) to undergo testing at the time of donation for various communicable disease such as HIV, hepatitis B and C, Creutzfeld-Jacob disease, human t-lymphotropic virus type I and II, chlamydia, and gonorrhea.  However, screening is not required for “sexually intimate partners” of a recipient.  Doe, who is in a same-sex relationship, does not wish to conceive “naturally” and prefers to use an uncompensated known donor outside of a medical setting.

The complaint further claims that treating sperm donors who help women become pregnant via artificial insemination differently from men who impregnate women using “natural” insemination (i.e. sexual intercourse) violates the Equal Protection Clause and creates undue burden and expense by requiring private, individual, uncompensated donors to comply with registration, screening, testing, and record-keeping under the FDA Regulations.

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Should Payments to Egg Donors Be Limited?

Jake Meyer by Jake Meyer

The New York Times published a May 10, 2010 article about payments to women who donate their eggs titled “Payment Offers to Egg Donors Prompt Scrutiny,” and also asked the question of The New York Times readers Should Egg Donors Be Paid?  The process of donating eggs is time consuming, involves discomfort, and carries some physical risks to the donor, so do you compensate the donor?  Donation can cause abdominal swelling, mood swings, hot flashes and ovarian hyperstimulation syndrome, which can cause bloating, abdominal pain, and in some cases, blood clots, kidney failure, and other life-threatening ailments.  And if you do compensate an egg donor, how much do you pay an egg donor? 

The current practice in the U.S. is to allow egg donors to be paid.  The American Society for Reproductive Medicine has set guidelines for payments to egg donors.  The guidelines require justifications for payments over $5,000 and set a maximum compensation at $10,000 and also do not allow for the higher payments for specific traits.  However, advertisers are ignoring these guidelines.

A study by Dr. Aaron Levine at the Georgia Institute of Technology found that out of a sampling of 100 ads from 63 different college campuses, over a quarter of those ads exceeded the $10,000 maximum compensation guidelines set by the American Society for Reproductive Medicine.  The ads also offered higher average payments at schools with higher average SAT scores – ads averaged $2000 more for every 100 point difference in the average SAT scores.  Ads in the newspapers at Yale, Princeton, and Harvard offered $35,000 and an ad in the newspaper at Brown offered $50,000.

Are these guidelines necessary?  Should couples looking to reproduce be allowed to pay whatever price they wish for a donor egg?  Critics fear that young women will see the amount of money offered for egg donation and may overlook or not understand the potential physical and psychological risks.  Should the offers for donated eggs allowed to be higher for specific attributes?  Is an offer asking to pay $50,000 for the eggs of a donor who is tall, athletic, Ivy League educated, and with a score of at least 1400 of 1600 on the SAT appropriate?  Or are offers like this more akin to eugenics, where couples using donated eggs to conceive are paying higher premiums and selectively breeding certain traits.  The ASRM guidelines seem reasonable when the risks that an egg donor undertakes are weighed against the concern that women will donate against their best interests because of a large pay day.  Setting a limit on what an egg donor can be paid allows for an egg donor to be adequately compensated, and also addresses the issue eugenics-like trait selection.  Efforts should be made to ensure that these guidelines are more strictly followed.

Irish Supreme Court Says Sperm Donor is Legal Dad: Will the U.S. Follow Suit?

Lori Andrews by Lori Andrews

Last week, the Supreme Court of Ireland stunned the reproductive technology community by holding that a sperm donor had legal rights as a father.  Four of the five justices wrote separate opinions as to why an agreement in advance not to be a donor did not prevent the sperm donor from asserting parental rights.

The case, J. McD v. PL and BM, involved a Lesbian couple who chose a friend as a sperm donor.  He signed an agreement stating that the female couple were the parents and he would have a role akin to that of a "favourite uncle."  When he sought a greater relationship, a lower court ruled against him.  But the Supreme Court of Ireland held that he could assert his legal rights. 

The reasoning used by the various justices was sweeping and could be applied to any situation of donor insemination, not just those involving nontraditional family structures.  Chief Justice Murray, for example, seemed to compare the sperm donor, McD., to a biological mother who gives her child up for adoption. Murray indicated that the sperm donor’s consent to relinquish parental rights before the child is born is suspect. Murray said that a sperm donor, "when faced after birth with the reality of a child… may, quite forseeably, experience strong natural feelings of parental empathy and identity which may overcome previous perceptions…arrived at in the more abstract situation before the child was even conceived….  [A] change of heart may be, as it was in this case, an event which raises issues as to whether in the interests of the child access or guardianship ought to be granted to the father."

In the United States, as in Ireland, the biological parents of a child cannot create a private contract which denies either parent's rights or responsibilities.  To get around the legal precedent that private agreements are non-binding, most American states have adopted sperm donor statutes, generally addressed to married couples, which hold that the consenting husband of the woman who is inseminated is the legal father.  There are several loopholes in the American jurisprudence, however.  A handful of states do not have statutes at all.  Some of the statutes only say the husband is the father and the donor is not, but others just say that the husband is the father without specifically cutting off the donor's parental rights.  Some terminate the donor’s parental rights only when a married woman is inseminated, not a single woman.  So, litigation in which a sperm donor asserts his rights is still a possibility in some states.  In the absence of specific statutory guidance that is directly on point, an American court, like the Irish one, would probably turn to the "best interest of the child" standard. 

And changing cultural norms might convince an American court that children have a right to learn the identity of their biological fathers, the sperm donors.  In the Irish decision, Justice Fennelly pointed out, "Scientific advances have made us aware that our unique genetic make-up derives from two independent but equally unique sources of genetic material. That is the aspect of the welfare of the child which arises."

So, ironically, even at the same time that reproductive technology is making it unnecessary for parents to have a biological connection to their child, genetic technology is telling children that biology matters.  And courts may be willing to grant a sperm donor rights, not just for the benefit of the donor, but for the benefit of the child. 

From Rabbits to Humans: Transplanting Wombs

SarahBlennerBy Sarah Blenner, JD, MPH

In 2000, the first human womb transplant was attempted in Saudi Arabia.  The transplant failed when the 26 year old woman developed a blood clot and the transplanted uterus had to be removed.  But now scientists believe that they are close to perfecting a reproductive technology that could solve some women’s infertility: transplanting a womb into a woman who lacks a functioning uterus. 

Infertility affects one in six women.  Some women are unable to get pregnant because they either do not have a uterus or do not have a properly functioning uterus.  At least 15,000 women in Britain alone are infertile because of a condition associated with uterine function.  A woman may lack a uterus because she has had a hysterectomy or may not have a properly functioning uterus because of a medical condition, such as intrauterine adhesions, also known as Asherman’s syndrome.  Currently, if women without a properly functioning uterus wish to have children, they must either adopt or turn to surrogacy.  Despite the availability of these alternatives, some women want to bear their own children and are willing to undergo surgery to achieve pregnancy. 

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Motherhood Divided: What Should Happen When a Clinic Gives a Woman the Wrong Embryo?

Lori Andrews by Lori Andrews

When Carolyn Savage learned she was pregnant through in vitro fertilization, she and her husband Sean rejoiced.  A few weeks later, though, they received devastating news.  The clinic had implanted the wrong embryo in her.  Rather than carrying their own genetic child, Carolyn was carrying the embryo of another couple.

While some women might have chosen to terminate a pregnancy, the Savages’ own moral beliefs precluded that option.  So instead, they selflessly went forward with the pregnancy, agreeing to turn the baby over after birth to the child’s genetic parents.  The one thing Carolyn Savage requested was a moment for her and Sean to be alone with the baby.  She said, “We want a moment to say hello and goodbye.”

In an interview on the Today Show, Carolyn’s absolute emotional pain comes through.  Whatever abstract legal ideas currently exist about the weight given to genetic bonds over gestational bonds, Carolyn had already begun a nine-month relationship with this child.  And, to make matters worse, she will not be able to carry another child.  If she and her husband want to procreate further, they will have to hire a surrogate mother to carry their remaining embryos.

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“Is That Your Grandmother? No, That’s My Mom!”

Marilyn BoskeyGUEST BLOGGER Marilyn Boskey

In 2006, Maria del Carmen Bousada received in vitro fertilization (IVF) from the Pacific Fertility Center in Los Angeles, CA.  At age 66, she was well above the 55-year-old age limit.  Bousada claimed that they did not ask her for any identification, and she simply told them she was 55.  With the birth of her twin sons in December 2006, she became the oldest new mom, according to the Guinness Book of World Records (although that record now belongs to a 70-year-old-woman in India).  Whenever she was criticized for being too old to have children, Bousada would cite her own mother’s 101-year life span.  Unfortunately, soon after the birth of her sons, she was diagnosed with a tumor.  Bousada died this week at the age of 69–her twin boys are only 2.

This is only the latest in a string of news stories that paint IVF in a negative light in recent months.  The birth of octuplets to Nadya Suleman and the recent divorce proceedings between Jon and Kate Gosselin, who used IVF twice to give birth to twins and sextuplets, have caused many to question the regulation of IVF as well as the psychological and physical effects on children. An article in The New York Times provides data that 70% of survey respondents want tougher standards on IVF, and 50% believe that women over the age of 45 are unfit to become mothers.  Although assisted reproduction has allowed many young families the opportunity to have children when they cannot naturally, it has also lead to questions such as the one Maria Bousada’s death creates.  How old is too old to be a new mom?

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Sperm Donors, Products Liability, and the Rights of Children

<Lori Andrews by Lori Andrews

When I first started working in the infertility field 25 years ago, the AIDS crisis had emerged, but doctors still were not screening sperm donors for the virus.  One doctor actually said to me, “I didn’t screen my wife before I had children with her, why should I screen a sperm donor?”

The infertile couples didn’t see it that way.  There might be lots of reasons to have a child with your spouse, but when couples go to infertility clinics, they are specifically trying to have a healthy baby.  Yet, due to lack of screening, children created through sperm donation have been born with AIDS, hepatitis, cytomegalovirus, and a variety of genetic diseases.  No mechanism exists for sperm banks to learn of the children’s problems and stop using the donor for future pregnancies.

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