German mom expecting quadruplets at 65

Excerpted from “German Mom Expecting Quads at 65 Is 'Irresponsible': Bioethicist,” NBC News. April 14, 2015 — Berlin school teacher Annegret Raunigk is proudly prolific and, at age 65, not done making babies — pregnant with quadruplets that would enlarge her family from 13 to 17 children. Raunigk said she became pregnant again because her 9-year-old daughter asked for a younger sibling. (Her first 12 children — by five men — are ages 22 to 44). She told German tabloid Bild that donated eggs were fertilized and implanted at a clinic in Ukraine. Multiple attempts were required to get the eggs to fertilize. She did not say whose sperm was used or if the egg donor was paid.

What she is doing is unethical. She doesn't think so. But she left her country to receive an infertility treatment that's illegal in Germany due to her age. And she sought that help on the sole grounds that her youngest daughter wants a sibling. Of course, given that logic, future requests by any of her newest kids apparently guarantee no end to her pregnancies.

The number of reasons why this very-late-in-life pregnancy is morally wrong nearly equates to the number of children Raunigk has conceived. But let's stick to the main issues. First, she likely will not live long enough to raise her current children, much less any new kids. It is not fair to children, as adoption agencies know when they limit adoption to those under 55, to intentionally create a family where mom and dad will enter a nursing home as the kids enter junior high.

Making four kids in a 65-year-old body also is irresponsible. The quadruplets are likely to be premature and, if they survive, may pay a steep price for this decision in terms of their health. Her older body makes the pregnancy extremely high risk all the way around. There will be a C-section, which is dangerous for her. And there certainly will be no breast-feeding by mom.

And what clinic would agree to accept as a patient a woman with 13 children — simply because her daughter wants a sibling? What clinic would not insist on a surrogate mom? What clinic would not demand she stay nearby during the pregnancy? What clinic would even let her try to deliver four fetuses?

The answer: One looking to gain fame and clients by engaging in a publicity stunt with nascent lives. Then again, this theoretically could have happened as well in the U.S. where there are no restrictions about who can use technology to have a baby — grandparents, mentally ill, very old single parents, even child molesters. Despite the headlines babbling about "miracles" and "gifts," and despite Annegret Raunigk's insistence that she should be free to reproduce however and whenever she wants, what's needed is a far more thoughtful, moral stance to govern reproductive technology.

Commentary

CMDA Member John Pierce, MD: “The case of Annegret Raunigk is another clear example of doing what is ‘…wise in your own eyes’ (Proverbs 3:7a, NIV 2011). In the world, there are arguments for age limits on IVF including the multiple health risks for the older mother and her infant, as well as arguments against age limits purporting reproductive freedom, equality for women (as older men can father a child) and social factors ‘to help fulfill lifelong dreams.’ Moral arguments might ask questions such as, ‘Is it right to have a child when the average life expectancy (about 80 years old for women in the developed world) means the child would be without a mother before driving a car?’ or ‘On what grounds do you deny the patient her rights?’

“Clear thinking using the principles of autonomy, beneficence, non-maleficence and justice has been supplanted with situational ethics incorporating intense emotions and cultural relativism. Why would we not have these struggles when there is no standard and a crumbling foundation? The law is silent on age in reproductive rights and most medical organizations provide weak recommendations,ⁱ leaving the decision up to individual clinics,ⁱⁱ or refute the need for practitioners to use their conscience.ⁱⁱⁱ

“Solomon sincerely asked the Lord, ‘So give your servant a discerning heart to govern your people and to distinguish between right and wrong...’ (1 Kings 3:9, NIV 2011). While we may argue vehemently, the loudest voice will be undeniable examples of healthy relationships, thriving marriages, happy families and renewed minds.”

ⁱEthics Committee of the ASRM. Oocyte or Embryo Donation to Women of Advanced Age: A Committee Opinion. Fertil Steril, 2013;100:337-40.
ⁱⁱ Fisseha S and NA Clark. Assisted Reproduction for Postmenopausal Women, AMA Journal of Ethics, Jan 2014, Vol 16, No 1:5-9.
ⁱⁱⁱCommittee on Ethics. ACOG Committee Opinion: The Limits of Conscientious Refusal in Reproductive Medicine. Obstet Gynecol, 2007 (reaffirmed 2013);110:1203-8.

Resources

CMDA’s Assisted Reproductive Technology Ethics Statement
Standards4Life – Infertility and Reproductive Technology

Women hold egg freezing parties

Excerpted from “For women in tech, egg freezing parties are new post-work event,” SFGate. November 10, 2014 — In Silicon Valley, where many tech employees put in long hours, Dr. Aimee Eyvazzadeh wants women to think about freezing their eggs — after work, and over drinks. The fertility expert is hosting three informational events this week, called egg freezing parties, at restaurants in the Bay Area. Over wine and appetizers, a small group of women will learn more about the egg freezing process and there will be experts to help with any questions.

Eyvazzadeh, who calls herself “The Egg Whisperer,” is jumping on growing interest in preserving eggs in Silicon Valley, as some tech companies have decided to make the procedure a standard health benefit for a young workforce that is faced with the decision on whether to delay parenthood.

More tech companies are offering perks for parenthood in order to keep employees happy. Facebook already covers up to $20,000 for several procedures, including egg freezing, and also offers other benefits for parents, including giving $4,000 in “baby cash” for each child born. Meanwhile, Apple plans to include egg freezing and storage as part of items covered by its health insurance policy next year.

“They are bringing a lot of these women who are graduating from college with very high level coding degrees and they really want them to work … during their younger years, knowing full well that once they get a family, the pressure on them are very different,” said Tim Bajarin, president of advisory services firm Creative Strategies. “What this does is it gives these women another level of choice.”

Alec Levenson, a senior research scientist and labor economist at USC’s Marshall School of Business, called the egg freezing parties “innovative.” “It’s another example of what marketers have always known,” Levenson said. “If you can get people to refer something by word of mouth to friends and family, it’s a much more effective marketing method than trying to do something through general advertising.”

Commentary

Medical Director for the National Embryo Donation Center Jeffrey Keenan, MD: “While egg freezing is medically indicated in limited situations, such as prior to chemotherapy or pelvic radiation in women who desire to maintain their fertility, marketing this service to women in their 20s who are in good health is inappropriate, in my opinion. I disagree with Dr. Eyvazzadeh, that this is just ‘raising awareness.’ I believe throwing ‘egg freezing parties’ is done to raise doubt, not awareness, in a group of people who are typically unsure of exactly what their life will look like in 10 or 20 years. Once doubt has been raised, and especially if your employer pays for it, it’s an easy jump to freeze eggs ‘just in case.’

“That translates into $15,000 for this physician’s practice and some good public relations. Profit and PR are often good things. But the problem with that approach is the great majority of women will never need or use those frozen eggs for a variety of reasons.

“There is a better approach. For younger women who have anxiety about their chances of eventually having a child, we offer a ‘fertility checkup’ to determine her relative fertility compared with her peer group. Then, we discuss her relational status, when she thinks she would like to conceive and how many children she’d like to have before even mentioning an expensive, invasive and (usually) unnecessary procedure like freezing eggs.

“As for the Silicon Valley companies that are offering this as part of employees’ health plans, I think the analyst in the article said it best—they are doing it because ‘once they have a family, the pressures on them are very different.’ In other words, the companies are doing this out of self-interest, although it is cleverly disguised as ‘increasing diversity in the workforce.’”

Resources

Assisted Reproductive Technology Ethics Statement
Dr. Jeff Keenan’s Interview about Egg Freezing Options
National Embryo Donation Center

Woman gives birth from a transplanted womb

Excerpted from “World first: baby born after womb transplantation,” Medical News Today. October 6, 2014 — In September, a 36-year-old Swedish woman became the first ever to give birth from a transplanted womb. A new paper published in The Lancet provides a "proof of concept" report on the case. The woman received her womb from a 61-year-old family friend. As the recipient had intact ovaries, she was able to produce eggs, which were then fertilized using IVF prior to the transplant.

"Absolute uterine factor infertility" is the only type of female infertility still considered to be untreatable. Adoption and surrogacy have so far been the only options for women with absolute uterine factor infertility to acquire motherhood. However, the news of the first baby to be born from a woman who received a womb transplant brings hope to women with forms of absolute uterine factor infertility.

The researchers who performed the transplant - from the University of Gothenburg, Sweden - have been investigating the viability of womb transplantation for over 10 years. In 2013, the researchers initiated transplants in nine women with absolute uterine factor infertility who had received wombs from live donors. The Swedish woman who recently gave birth was one of these women. Although two of the women in the trial had to have hysterectomies during the initial months - because of severe infections and thrombosis - the team reported success in the other seven women.

According to Prof. Brännström, who led the team of researchers, "Our success is based on more than 10 years of intensive animal research and surgical training by our team and opens up the possibility of treating many young females worldwide that suffer from uterine infertility. What is more, we have demonstrated the feasibility of live-donor uterus transplantation, even from a postmenopausal donor."

Commentary

CMDA National Director of Campus & Community Ministries J. Scott Ries, MD: “At first glance, it seems like a heartwarming tale of the newest medical ‘miracle’ and a triumph of life. But one doesn’t need to squeeze hard to deliver a very sour and sobering insight of what lies ahead. Though it is at its surface a sweet story of an otherwise impossible birth, deeply thinking and conscientious physicians must pause and ask, ‘At what cost?’

“Three things should deeply concern us in the pushing of these ethical boundaries:

1. How many developing babies will we immolate on the altar of innovation? This patient on three separate occasions nearly rejected her uterine transplant. How many babies will be sacrificed in future trials of uterine transplantation?
2. At what age do we stop? If it works for a 36-year-old woman, why not a 56-year-old woman? Or perhaps a 76-year-old woman? Where does the ‘right’ to bear a child end?
3. Why limit a uterine transplantation to only women? In this day of gay and transgender rights, why not allow a male partner to receive a uterine transplantation? If the barrier is simply vascular anastomosis and hormone infusion, why not permit gestation within the abdomen of a man?

“The story is both a wonder and a worry. That a uterus dormant for years can suddenly spring to life with mere influx of blood and hormone is wondrous testimony to its divine design.

“Yet if we abandon moral standards given by that same Designer, on what basis shall we then make these decisions? We have so quickly progressed from challenging the boundaries of moral standards to repudiating their existence altogether. As followers of the Way, we must infuse in our culture the distinction between what could be and what should be.”

Resources

CMDA Resources on Reproductive Technology
CMDA Ethics Statement – Assisted Reproductive Technology