New mother-to-be at age 66. What do you think?

What happens when the beliefs of one group of people affect the freedom and rights of another group of people?

A month ago, I wrote Part 1 and Part 2 of this series on Georgia Senate Bill 169, a proposed legislation which slams into conflict two groups of people. The supporters of this bill view that laboratory embryos should be afforded the same rights and protections as a live-born child. The other group opposes the bill and believes that infertile couples who are trying to have a baby should not have their options overly restricted. So just what is this bill all about?

There are multiple components to this bill. The first part reads:

(a) It shall be unlawful for any person or entity to intentionally or knowingly create or attempt to create an in vitro human embryo by any means other than fertilization of a human egg by a human sperm.
(b) The creation of an in vitro human embryo shall be solely for the purpose of initiating a human pregnancy by means of transfer to the uterus of a human female for the treatment of human infertility. No person or entity shall intentionally or knowingly transfer or attempt to transfer an embryo into a human uterus that is not the product of fertilization of a human egg by a human sperm.

In our program, there’s only one way we know how to create embryos, namely by fertilizing human eggs with human sperm. I don’t know of any other programs that are doing it any differently, such as any using kangaroo eggs or hamster sperm, but if there are, I guess they’d be in trouble if this bill passes. Granted, this clause could also be interpreted to ban cloning. However, that would be redundant as there are already federal provisions in place aimed at banning cloning. This part of the bill doesn’t affect my patients, as we presently don’t do cloning.

The next section addresses financial compensation given for embryos or gametes. It reads:

No person or entity shall give or receive valuable consideration, offer to give or receive valuable consideration, or advertise for the giving or receiving of valuable consideration for the provision of gametes or in vitro human embryos. This Code section shall not apply to regulate or prohibit the procurement of gametes for the treatment of infertility being experienced by the patient from whom the gametes are being derived.

In a free society, people enter into agreements based on mutual benefit. Infertile couples sometimes need help from other people in the form of donor sperm or donor eggs in order to fulfill their dreams of parenthood. As a way of thanking the donors, financial compensation is routinely offered. To do away with this option would be disastrous if we look to the UK as an example. Over there, paying for donors is forbidden. This all but eliminates anyone from wanting to participate, leading to a loss of options for most couples, unless they are willing to resort to drastic risky behavior. For some of them, there is the option of coming to the US. In the past two years, I’ve had the chance to help four couples from countries in which paid egg donation is banned. After they got pregnant, they vented their anger at the unfair restrictions in their home countries which compelled them to come to the US. Well, if this happens in the US, I’m not sure where patients would go for their treatment, maybe Mexico?

The next section reads:

The in vitro human embryo shall be given an identification by the facility for use within the medical facility. Records shall be maintained that identify the donors associated with the in vitro human embryo, and the confidentiality of such records shall be maintained as required by law.

This is just plain meddlesome and seeks to slap a regulation onto something that is already routinely done out of common sense. We already document and label meticulously, so again, this would not affect us much.

Going on, the next paragraph reads:

19-7-64. (a) A living in vitro human embryo is a biological human being who is not the property of any person or entity. The fertility physician and the medical facility that employs the physician owe a high duty of care to the living in vitro human embryo. Any contractual provision identifying the living in vitro embryo as the property of any party shall be null and void. The in vitro human embryo shall not be intentionally destroyed for any purpose by any person or entity or through the actions of such person or entity. (b) An in vitro human embryo that fails to show any sign of life over a 36 hour period outside a state of cryopreservation shall be considered no longer living.

Here’s where it starts to get a little annoying. This vague statement suggests that the writers of this bill are not familiar with what actually happens in an embryology lab. When we put the sperm and egg together from a husband and wife couple, we have to assign somebody the power to determine what is done with that embryo — whether it is transferred back into the wife, transferred into someone else or frozen for the future. Whether or not it is labeled as the “property” of anyone, we have to give someone the legal authority to make the call of what happens to the embryo. This is like passing a law stating that a child can not be labeled as the property of his parents. That’s fine and dandy, but then is it OK for someone to grab a baby out of a stroller at the mall and take the baby home because it wasn’t the “property” of the parents? Very silly. Whether or not you label it a property, there HAS to be some legal designation, enforced by contract, to confer rights to certain people regarding the embryos, because you know what? The embryos can’t make decisions on their own.

The next clause appears redundant because it states:

Only medical facilities meeting the standards of the American Society for Reproductive Medicine and the American College of Obstetricians and Gynecologists shall cause the fertilization of an in vitro human embryo. A person who engages in the creation of in vitro human embryos shall be qualified as a medical doctor licensed to practice medicine in this state and shall possess specialized training and skill in artificial reproductive technology in conformity with the standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.

IVF is a medical procedure and as such, can only be done by medical doctors. There is no real need to restate it. Again, this is verbose, but not really changing anything that we already do.

The next section is where it starts to get really intrusive:

In the interest of reducing the risk of complications for both the mother and the transferred in vitro human embryos, including the risk of preterm birth associated with higher-order multiple gestations, a person or entity performing in vitro fertilization shall limit the number of in vitro human embryos created in a single cycle to the number to be transferred in that cycle in accord with Code Section 19-7-67.

In order to grasp the impact of this intrusion, let’s review how IVF works. When a couple make the decision to do IVF,  our goal is to help the couple create some healthy embryos that will grow into healthy babies. We help do this by putting their eggs and sperm together. The procedure take a lot of dedicated work from a team of many people. The main labor is the surgery involved in extracting the eggs. The good thing is that each additional sperm or each additional egg does not add all that much cost to the process.  Therefore, it would be highly wasteful to do IVF with just one egg and one sperm. We can’t know for sure how many of the eggs we get will successfully fertilize. Out of those that do, we can’t know for sure which will continue to survive until the day of transfer. Can you imagine a lawmaker telling you that you can’t put more gasoline in our car than you’re going to use each day?

On the day of an IVF egg retrieval, we surgically remove all the eggs that stimulated for that month. We try our best to fertilize every one of them, because we know that most of them will not end up capable of becoming a healthy baby. By attempting to fertilize all of them, we get the best chance that at least one or some of them will end up being good. In a good scenario, we get enough healthy embryos to transfer as well as some additional ones to freeze for future attempts. For many couples who fail IVF in the first fresh attempt, those frozen embryos are the difference between their ending up with a baby in their home vs. remaining sadly childless.

The rest of the bill piles on further restrictions by telling us how many embryos we can transfer. This issue of embryo number is such a loaded issue that I’m going to save it for the next post.

Nadya S. is NOT in any way, representative of the hundreds of thousands of genuine loving inferile couples in the US, whose only wish is to have a child to love. She is now applying for a trademark on the term “Octomom”. If you ever see her picture and/or name on T-shirts, mugs, ovulation kits or stripper attire, I urge you to boycott the product.

It would be a shame if overreactive legislation were passed to further impede the hopes of infertile couples all because of this one case.

By the way, there is no truth to the rumors that Dr. K has applied for a trademark on the term “OctoDoc”, although he HAS been heard to have jokingly referred to himself as that during a conversation at a recent pharmaceutical company-sponsored event that he attended this past month.

Planning ahead can really pay off.

A teenager diagnosed with leukemia was advised to save his sperm before undergoing his cancer treatment. Now, 22 years later, he and his wife are parents thanks to this forethought. For patients newly diagnosed with cancer, there is an organization which provides information regarding fertility options.

Many patients are referred to me for guidance after finding out they have cancer. Often, after learning about their options, they end up saving their sperm or embryos so that they can have children in the future. While some patients will need these preparations in order to conceive, there have been other patients who make these arrangements, but then end up getting pregnant on their own afterwards.

Can the sperm of a dead man be used to create babies? A recent news story brings up this controversial topic once again. The concept of posthumous sperm utilization is not a new one and there have been many cases of babies being born to deceased men.

I have been involved in such a case myself. I can only share the basics without divulging the details. This was a couple who were in the middle of infertility treatment when suddenly the husband took ill. He went to the doctor and was diagnosed with cancer. The couple halted their treatment, but deliberately took action to freeze many vials of sperm. The husband did not survive his disease, but made it clear that he wishes to give his wife the option of using his sperm. She came back after a time and did just that. Now she is successfully raising happy healthy children conceived from her deceased husband’s sperm.

The difference in the case of Nikolas Colton Evans is that he never explicitly expressed his permission to do this. In fact, he never even went to the trouble of saving sperm ahead of time. So this is not just a case of using posthumous sperm, it’s a case of harvesting posthumous sperm.

Instead of arguing the merits of doing it, one might present the counterargument of why NOT do it, as long as the mother wishes to. Well there is the question of the rights of the deceased. Do dead men have the right to not have their sperm taken and used? What about the rights of the future children? Do future children have the right not to be conceived if their biological father is already deceased?

By comparison, this woman and this woman make Nadya look like Mother of the Year. I haven’t decided yet what is the solution for preventing grossly irresponsible women from becoming mothers. Any ideas, besides withholding welfare handouts to women until they can prove they are practicing safe contraception? So sad.

This bizarre story illustrates how time and time again, turkey basters and alcohol don’t mix.

In the previous post, we introduced the setting, describing what’s going on in Georgia. A trio of politicians are pushing for the adoption of new laws governing what people can do with regards to in-vitro fertilization. Today, we’ll begin dissecting the actual meat of this proposed legislation to see if it really is the best way to prevent cases like the octuplets from ever happening again.

I tried to be open-minded. I really did. But, right away, looking at the very name made me fight with every ounce of energy to avoid rolling my eyes. This act is cited as the “Ethical Treatment of Human Embryos Act”. Ethical treatment of a microscopic cell? I do understand that physical size is not the sole criterion of how significant something is, but it does lead to some amusing perspective to imagine cruelty being done against something that can’t even be seen. A human embryo is smaller than the specks of particles that you stir up when you blow on a dusty old countertop. In fact, you can’t even see an embryo with the naked eye. I can visualize images of torture against human beings in North Korea. I can even imagine people being cruel to a kitten. And of course, there is a tiny part of my humanity that mourns for the life of the little ants, right after I blast them with Raid. But my limited imagination falls short when I try to conjure up images of evil scientists in the lab inflicting pain and suffering on macroscopically invisible entities.

OK OK. So size isn’t everything. One can argue that an embryo can become a golden-haired blue-eyed little girl some day. That’s certainly true. But it’s still a huge fallacy to compare the humanity of an embryo with the humanity of a baby. A sperm CAN become a person someday, if it meets the right egg, but most of them don’t. An egg CAN become a person someday, if it meets the right sperm, but most of them don’t. An embryo (union of sperm and egg) CAN become a person someday, if it is normal and encounters the right environment, but most of them don’t. As somebody who works with this day in and day out, I do not think of an embryo as having constitutional rights. And I take issue with the people who scream, “Eggs, sperm and embryos can’t defend their own dignity, so we have to do it for them.”

OK OK. I know. These people are not screaming for the rights of eggs and sperm (gametes) — only for the embryos that form after the two combine. So if you present these esteemed politicians with a culture dish with an egg in it, I understand they’ll just yawn and say “oh that’s just a fleck of biological dust”. If you then show them a droplet of sperm, they’ll likewise agree “move on, move on, nothing to see here”. However……..(drumroll)…..the moment that the droplet of sperm is added to the dish with the egg in it, these politicians begin having heart palpitations and start drooling and dancing around the dish, ranting about preserving the dignity of the contents of that dish.

OK OK. So maybe I should be a little more serious. Again, I work with this day in and day out. I fully agree with the sanctity of family and of human life. People rely on my labor to help them have little babies. This thrills me without end and gives meaning to my existence. I respect that out of the bodies of the husbands and wives we can take tiny tiny biological cells and put things in motion so that maybe, possibly, one of these combinations MIGHT end up causing a baby to start growing inside the womb (or so we hope), which is why, I immediately become protective when someone starts to impede our mission, and for what? For the purpose of preserving the dignity of an embryo.

The utter ludicrousness of this might be more evident when you consider that were this bill to become law, it would be illegal and punishable, for you to put an embryo dish on the counter at room temperature and allow it to sit long enough to become nonviable. But, (now this is just mind-boggling), if the embryo were transferred into a woman’s uterus and it happened to implant (most of them won’t by the way) and if this implanted embryo were to grow and grow to become a moving fetus with heartbeat and everything. OK, THEN, in the state of Georgia, it would be completely legal to terminate it. How can you argue to give rights of embryos that supercede the rights even of successfully implanted fetuses? Whether we agree with it or not, we live in a country where first trimester terminations are not illegal.

OK OK. I am aware it is very likely that the same people who want to make it illegal to treat embryos “unethically” are also in favor of banning abortion, which raises the obvious question of what’s going on here with this bill. Is it to improve the quality of life for people as a whole? Or is it an indirect way to advance a political agenda? You be the judge. Now many of you may be curious as to my view on abortion. I do have a view. There is a 99%+ chance that no matter what I say about it, somebody from either side of the debate will egregiously misinterpret what I say, and twist it around, so I’ll choose my words judiciously in asserting that I am emphatically OPPOSED to abortion, specifically to the concept of aborting a known healthy fetus that is very likely to be born normal, just for the sole purpose of not having it be born. However, there is a difference between being opposed to something and necessarily thinking that it absolutely must be made illegal. The question is will making abortions illegal stop them from happening, or even lessen their occurrence? What is the tradeoff in harm, if any? I am opposed to murder, rape and abortion (as defined earlier in this paragraph). And I agree that murder and rape should be fully punishable, because if we were to make murder and rape no longer criminal, life would suffer greatly as a whole. The laws against murder and rape don’t prevent them 100%. Every day, these horrible crimes occur. BUT, to make it legal is not only silly, but also would result in things being much much worse. This concept is not as clear-cut when it comes to the matter of making abortion illegal. Criminalizing abortion might make the number of abortions go down somewhat, but cases of deaths or reproductive injury to young women would very likely go up from horrid back-alley procedures. This is more than just a theoretical argument. My beliefs about human behavior along with historical observations convince me of this. So before I get too off topic, I would assert that if I were a politician, I would vigorously enact changes that could lead to fewer abortions. But for me, those changes would be targeted at changing the mindsets of people regarding how much risk they are willing to take when subjecting themselves to the chance of an unwanted pregnancy. In other words, I greatly favor doing what we can to prevent abortions, which I feel could best be done at the level of preventing unwanted pregnancies in the first place. Now as to what policy changes I think would lead to fewer unwanted pregnancies? That’s a whole other lengthy post, maybe for another day.

So after taking this entire post to address the very title of this proposed bill, I’m guessing this is going to take more than two posts to address. Stay tuned as we dissect this further.

The fears of many infertile couples regarding kneejerk government reaction to the octuplets case have now been validated. On February 18, the Georgia senate referred a bill calling for certain restrictions. Here is the official wording. Many thanks to the readers who called this news to my attention.

Before we dissect this, I want to take a moment to remind everyone of one fundamental, indisputable fact of life. PEOPLE MAKE DECISIONS AND TAKE ACTIONS THAT SERVE TO MAKE THEIR OWN LIVES HAPPIER. It sounds ridiculously obvious, but I take the time to mention it because recognition of this universal truth is critical in helping us evaluate the realities of this bill. In an ideal society, the rules are set up so that when people are driven by their own happiness, it also results in the happiness of others. Win/win. Case in point. We may wishfully like to think that the mission of a restaurant owner is to provide the best food and best service for their customers at the cheapest prices. Let’s call this these the IDEAL GOALS. But in reality, from the personal viewpoint of the restaurant owner, his mission is to do maximize his own happiness, plain and simple. Depending on his personal values, that happiness might entail making more money or enhancing the reputation of his establishment (and himself) and/or minimizing the labor, time sacrifice or stress that he has to put into running the place. Usually it’s some balance of all of these. Let’s call these the TRUE GOALS. The beauty of a fairly governed society is that the attainment of the TRUE GOALS are highly dependent on the achievement of the IDEAL GOALS, meaning that in a society where people are free to make their own decisions, the owner can best achieve his goals, by providing a product that is as yummy, pleasant and modestly priced as possible. This will entice patrons to very willingly flock to his restaurant and hand him money. They do this not out of a favor to the owner, but they do it because it is worth it to them to come and enjoy sitting in a romantic environment and consuming prime rib medium-rare, amazing creamed corn, crème brulee and a bottle of fine Merlot.

Now let’s talk about politicians. The THEORETICAL GOAL of a politician is to serve the public, ie make legislative decisions that will enhance the quality of life for the people as a whole. Agreed? However, the TRUE GOAL, in their minds is to get elected, so that they can continue to enjoy the prestige, power and financial perks of their position. There’s nothing wrong with admitting that, because, in an ideally governed country (and I am clearly not so naïve as to think that we live in such), the THEORETICAL GOALS and the TRUE GOALS would go more hand-in-hand, meaning that the more that politicians do to improve the quality of life of the people, the more likely they are to get elected. But in truth, there is a greater disconnect between these two thing in politics than there is with restaurant owners or other free-market based businesses.

Bearing this in mind, let’s ask ourselves what truly motivates politician to introduce new laws? ONE, they are acting with sincerity to improve the quality of life of the people. TWO, they are promoting the illusion of busy-ness to look as if they are actually doing something. THREE, they are maneuvering to give themselves more and more power.

How can we judge which of these things is going on? By dissecting the facts of the situation, we can get clues as to which of these three things is going on.

First of all, let’s ask if this bill was conceived out of careful thought about what legislative changes would make life better for people OR was it just a knee-jerk reaction to a sensational isolated current event. In other words, did the politicians one day, after due diligence of careful homework and thought, conclude, “You know, the taxpayers who elected me really really want more restrictions regarding people’s embryos, above and beyond what the current law provides. By golly, we’re going to give it to them.” OR did they one day say, “This single isolated octuplets incident has really stirred up some emotion. Now, while the iron is hot, is the ideal chance to exploit this anger and outrage to get votes in the future. Hopefully, I can get a bill out of this with my name on it.” So which was it? I clearly know my opinion on it and encourage you to make your own as we consider things further.

The outrage in this case is that it combines two different hot topics - the increasing use of advanced technology to override nature in the arena of human reproduction AND the concept of taxpayers supporting children born to parents who can’t care for them. We can separate these two issues by changing the scenarios and seeing how it changes how we feel.

Imagine if this were a case of octuplets born to Bill and Melinda Gates after fertility treatment, who out of respect for what’s right declare “We would like to thank the doctors and nurses who worked so hard to deliver our babies safely. We know it would be unfair to force anybody else to pay for all that hard work, so we have asked for an itemized bill and have paid every penny ourselves. It’s only right. We have even voluntarily made a generous donation to the hospital. Also, rest assured that we will be working hard to support these babies of ours and not burdening anybody. We will create eight new nanny jobs with full wages and benefits paid out of our own pocket to further help the economy. Thank you for all your letters of congratulation. We have a long road ahead, but will work hard to raise eight children who will be happy, healthy and contribute greatly to society as much as Microsoft has, er with the exception of Vista, of course.”

Now imagine, if this were a case of the theoretical Suleman sisters, five women from the same family who are all single, living off of disability, unemployment, food stamps, welfare and defaulting on their debt. In the past five years, all the sisters, out of their love of having children, decided to keep getting pregnant naturally through various liaisons, and now have given birth to three or four children each, one at a time, without fertility treatment, so that now this lovely family collectively has sixteen fatherless children running around. They clearly intended to have these children deliberately, but they did it without involving doctors, but just persuaded various men with no medical education to inseminate them the old-fashioned way. Now their crowning achievements have given them access to going on the talk show circuit and crying about how difficult it is to be a single mom nowadays.

Each of these two scenarios would create buzz in itself, but the fact that Nadya’s case involves both elements really gives it media sex appeal. And as could be predicted, new legislation has been drafted to address this situation. Bear in mind that there have not been an epidemic of octuplets this past year, nor even quadruplets. Until this case surfaced, reproductive restrictions ranked well below the bottom 5% of today’s concerns.  But all it takes is one case and all of a sudden, there is the sudden NEED for changes to the law. OK. Fine. Let’s assume for a moment that there is such a need. In the next post, let’s look at this bill in detail and see what these proposed changes entail and whether or not they really are the best way to serve their intentions.

To the best of my knowledge, this pregnancy did not involve IVF. There seems to be a lot of news lately involving pregnancies in which the identity of the father is unclear. If any of you are worried how a 13-year old and a 15-year old are going to support a child, rest assured that everything is well-taken care of.

What a coincidence that it happened in a country which is even more of a nanny-state government than the US. Well, than we are so far anyway.