Legal issues in IVF

Abstract
It is desirable when considering legal issues related to IVF not to restrict attention solely to the
impact of laws in existence at the time the IVF technology appeared. Laws then in existence were
not designed with IVF in mind. New laws are needed, particularly to deal with legal problems that will
arise from 'existing' laws in relation to two unprecedented features of IVF. These are the new
technology whereby fertilized human eggs may be frozen, stored and later used for childbearing,
and the fact that a 'host' mother may bear an IVF embryo. This chapter has discussed legal issues in
IVF by examining in succession: a number of matters of basic social concern that require attention
and raise questions that should be answered before new laws are made the need for laws on IVF to
rest on clear principles acceptable to the community the application to IVF of 'existing' laws in six
countries (France, the United States, Canada, England, Israel and Australia) and the kinds of
problem that are thereby raised new laws that have already been created in Australia specifically to
regulate IVF, and new laws that are in the course of preparation in the United Kingdom.
Abstract
All areas of medical practice are shaped by ethical and legal mandates. When a physician provides
infertility services, however, ethical and legal concerns reach an even greater prominence. The
infertility specialist is in the awesome role of facilitating the creation of new life. A task of that level of
importance brings with it responsibilities of an equal magnitude. Clinicians performing in-vitro
fertilization and artificial insemination should be especially sensitive to the ethical and legal concerns
raised by the selection of patients and donors, the informed consent process, and record-keeping.
As reproductive technologies such as these develop, the clinician not only has a duty to monitor their
safety and efficacy, but also to provide extensive information to the participants and to society at
large to make possible informed decisions about how best to enhance the benefits and avoid the
risks of these new technologies.

PMID:

3617272

There are three elements to consider with in vitro fertilization. First, the paramount concern needs to
be the well-being and best interests of the child, even though he or she may be an embryo at the
time. Second, some people think a child will solve their marital problems. Although couples seeking
in vitro fertilization should not be subjected to more scrutiny than couples conceiving in the traditional
way, the stresses and uncertainties of in vitro fertilization can further strain a marriage. Clinic staff
members should be sensitive to this issue as a way of helping to avoid complications later. Third,
how we resolve the status and fate of the frozen embryo and who has disposition over it surely will
reflect how we consider abortion rights. For example, if the standards of Roe vs Wade were applied,
 one could argue that the woman should have total disposition over the frozen embryo. On the other
hand, if the father receives a say in the matter, what impact would this have? Given the nature of our
society and the tenuous state of marriage, the problem of disposing frozen embryos is a critical one
that has no satisfactory solution. Finally, there is the stress factor. Although this is not an issue of
direct ethical concern, it is related to the necessity of the couple receiving accurate information. If the
couple receives an incorrect impression of a clinic's success rates, they may be exposed
unnecessarily to further stress and frustration.(ABSTRACT TRUNCATED AT 250 WORDS).

PMID:

2221910
Legislative changes in recent years have streamlined access to IVF for all women and couples who seek to undergo
assisted reproductive treatment, and removed discriminatory barriers to access on the basis of sexuality, relationship
status or fertility.

Single women, heterosexual or married couples and same-sex couples now all enjoy equal rights to receive IVF
treatment, however complexities still exist surrounding the use of IVF in gay and lesbian co-parenting arrangements,
surrogacy agreements or for people whose relationships may not meet the definition of 'de facto'.

Our team has many years experience in this often complex area of family law and we can assist you in relation to all
IVF legal issues, including:

 The necessary legal steps you need to take prior to or following IVF treatment
 Who is considered to be a parent under the Family Law Act and other relevant state legislation
 Parental rights eg non-biological parent, lesbian and gay male couples, sperm donors
 Surrogacy and sperm donor agreements
 Co-parenting arrangements
 Obtaining parenting orders
 For lesbian couples where one partner gives birth to a child as a result of an artificial conception procedure,
the couple will (in most circumstances) legally be considered the child’s parents.

 The same may not apply to gay male couples as, in an effort to protect sperm donors from financial and
other responsibilities, the law has only recognised donors as "parents" in limited circumstances. This applies
despite any intentions to the contrary by the parties involved and despite the fact that one of the partners is
biologically the child's father.

 Couples in this situation may need to take steps to legally formalise their parental status, either by obtaining
parenting orders form the Family Court or by adopting the child.

 Although the status of lesbian parents is protected by law, it is also prudent for lesbian couples to obtain
parenting orders to protect both partners’ roles as parents – particularly the partner who is not the child’s
biological mother. This ensures (largely for the benefit of third parties) that both parents are legally
recognised as having the right to make important decisions about their children, such as schooling, health,
religion, as well as other decisions like overseas trave

Basic Law of In Vitro Fertilization

In Vitro Fertilization or IVF as it is commonly called, is a much sought after procedure by infertile
couples. Normally fertilization occurs within the fallopian tube which joins the uterus (womb) to the
ovary. In an IVF procedure, the fertilization between a sperm and an egg occurs in a laboratory after
eggs and sperm have been collected from the desiring couple. The process involves removing a ripe
egg from a woman’s body and combining that egg with sperm in a Petri dish, by a process called
Laparoscopy or “aspiration.” If fertilization occurs, the embryo is implanted in the uterus to continue
growth. Children that have been conceived this way are often called “test tube babies.”
The world’s first test tube baby was born in 1978. The first live birth of a child conceived in vitro
occurred in 1979 in Great Britain after 20 years of research by a British team. Johnson v. Calvert, 5
Cal. 4th 84, 105 (Cal. 1993). The first IVF birth in the United States took place in December, 1981.
Since 1978, more than 169 clinics specializing in IVF have been established in the United States
alone. IVF is expensive and can be unsuccessful. In a few cases, laboratory mix-ups (misidentified
gametes, transfer of wrong embryos) have occurred.
This relatively new procedure has caused a raft of questions as to rights of the various parties and
remedies available to them if wrongful acts occur related to the procedure. This article shall outline
the basic law that applies and remedies often available should things “go wrong.”

The Legal Framework:

In general, the law does not recognize IVF plaintiffs’ procreative interest. Therefore, IVF plaintiffs
cannot recover for procreative injury, no matter how serious the injury is. There are no existing legal
theories in tort law that includes the losses attached with this new technology. Similarly, there is no
uniform law governing legal theories for aggrieved IVF patients, apart from some state laws for their
protection. However, there have been instances where courts have gone beyond the general law and
have allowed a claim.
The courts have often attempted to apply traditional theories of contract and tort law to this new
technology. Indeed, many inventive legal counsel have advanced theories of recovery based on
intentional infliction of emotional distress or even loss of property rights. The record of success is
mixed. The most common claim is breach of contract or professional negligence on the part of the
provider.
Breach of Contract
Breach of contract claims differ from “emotional distress” and “property loss.” Breach of contract is
not a personal injury caused by wrongful actions of another, as torts are. It is breach of an assumed
contractual duty. See our article on Contracts. Medical errors are normally considered as tort and not
as breach of contract unless a doctor warrants the result of his care as in Itskov v. N.Y. Fertility Inst.,
Inc., 782 N.Y.S.2d 584, 587 (N.Y. Civ. Ct. 2004), where the doctor breached the surrogate parenting
contract.
Failure of Claims for Injury Due to Emotional Distress
In Harnicher v. University of Utah Medical Center 962 P.2d 67, 68 (Utah 1998) an infertile couple,
David and Stephanie had chosen a donor who resembled David. The clinic switched donors. The
couple had three children who did not resemble David. The Harnichers were distressed at the clinic’s
negligence. It was difficult for them to determine the basis on which to file suit. They had not been
physically injured. They had no financial losses beyond those they had bargained for. In the absence
of a better alternative, they claimed emotional distress and failed in court. Common law rule forbid
recovery for negligently inflicted emotional distress without accompanying physical
injury. Harnicher at 69-70. Many other IVF plaintiffs made the same claim and lost for the same or
similar reasons. Similar was the plight of Cora Creed when her embryos were implanted in another
woman in Creed v. United Hosp., 600 N.Y.S.2d 151 (N.Y. App. Div. 2d Dep’t 1993), and also of a
Jane Doe when hers were put in a preservative solution possibly infected with Mad Cow disease
in Doe v. Irvine Sci. Sales Co., 7 F. Supp. 2d 737 (E.D. Va. 1998). There was no physical injury to
which emotional distress could be attached.
Loss of Property Claims Can Succeed
IVF plaintiffs have also alleged loss of property. In Frisina v. Women & Infants Hosp. of R.I., 2002
R.I. Super. LEXIS 73 (R.I. Super. Ct. 2002), three women whose embryos were accidentally lost or
destroyed joined as plaintiffs and alleged injury as they were deprived of their property-their
embryos. The court permitted the suit to go forward. The Court even allowed emotional distress
claims to attach to the loss of “irreplaceable” property considering the unique qualities of IVF. The
court in Frisina’s case found that the plaintiffs were seeking to recover for the physical loss of their
pre-embryos rather than for the loss of the possibility of achieving pregnancy as claimed by the
defendant. The court found merit in the argument raised by plaintiffs that recovery for damages for
emotional distress based on the “loss of irreplaceable property,” the loss of their pre-embryos was
permissible under the Rhode Island Supreme Court’s holding. Therefore defendant’s motion for
summary judgment on the issue of damages for emotional harm due to the loss of irreplaceable
property was denied.
Pure pecuniary loss, such as medical expenses and lost wages, is another category of injury. It is
similar property-loss claims. Courts have permitted recovery for it in certain IVF cases. In Paretta v.
Medical Offices for Human Reproduction, 760 N.Y.S.2d 639 (Sup. Ct. 2003) the doctor knew that
the egg donor had the recessive gene for cystic fibrosis, and skipped a routine test to check if the
husband was also a carrier. When the child was born with the disease, the Parettas successfully sued
for the cost of caring for their baby. The theory of pecuniary loss failed in another case for a couple
who did not have a child in the first place.
Physical Harm to Patient
The law does protect IVF plaintiffs against physical injury. If IVF plaintiffs can establish even a
minor form of physical injury associated with their doctors’ negligence, they can seek relief.
However, the mere act of surgery is not considered sufficient for physical injury. Two plaintiffs
brought an action arguing that the IVF procedure itself constituted physical injury. They argued that
extracting eggs and implanting embryos were both painful surgeries and that this constitutes
compensable physical injuries. The Court denied their claims on the ground that the plaintiffs
consented to the “injury” of surgery. Creed v. United Hosp., 600 N.Y.S.2d 151 (N.Y. App. Div. 2d
Dep’t 1993). However, if the doctor had made an error in the surgery that caused other physical
injury, the action would have survived.
Putting Round Pegs in Square Holes:
As anyone who is familiar with the law of the internet or intellectual property can advise, the law is
often slow in catching up with new developments in technology or society and the initial stage of
legal reaction to something new is to seek to expand existing legal theories to cover new issues. Here,
we have a classic example of the law playing catch-up and the ultimate solution will be enactment of
legislation at the state level granting certain rights to individuals and imposing specific duties on
providers. State law should be examined by the person interested in determining potential relief and
in those states in which the law is moribund, the above common law is the sole source of relief.
Conclusion:
Not only is the process expensive and often unsuccessful, but the medications required to be taken
can have significant effect on the emotions. Few couples go through the process without some
turmoil and when injury or apparent neglect occurs, the reaction can be extremely emotional. It is
important before seeking relief to carefully analyze the available remedies practically available in
your jurisdiction, calmly consider what is appropriate and obtain good legal and financial advice. As
the law evolves, many of the problems described above will be resolved, but American litigation is
always a difficult and expensive process and should be carefully evaluated before action is taken.
That said, relief may be available for those harmed and the inquiry is almost always worthwhile.
IVF and Legal problems
Sep 16, 2014

There are numerous areas in which we can critically appraise IVF. One very important set of concerns over
IVF has to do with legal issues, court cases, and related matters. The truth is, this whole area can become a
legal minefield – and that is just what has happened. A number of famous legal cases can be mentioned here.
Let me focus on just two of them, as an indication of the sorts of legal nightmares which can arise because of
IVF and assisted reproductive technologies (ART).
The first case has to do with an American couple and an Australian fertility clinic. In 1981 Elsa and Mario
Rios from California made use of an IVF clinic in Melbourne. Three embryos were created with the help of an
anonymous sperm donor. An implanted embryo did not work, and the other two were put in cryopreservation.
However, the wealthy couple died in a plane crash in 1983 in South America, without leaving behind a will.
Ethicist J. Kerby Anderson notes just some of the many vexing issues which arose here, and how even the
wisdom of Solomon may not have sufficed in such a case:

Two kinds of questions surfaced. First, did these frozen embryos have a right to inheritance, and do they have
a right to life? Mr. and Mrs. Rios were multimillionaires. Were those embryos potential millionaires? Did they
have a right to inherit the Rioses fortune? Second, did those frozen embryos even have a right to life? Are IVF
clinics obliged to protect embryos produced there? Should the Australian clinic implant those embryos in a
surrogate mother who would carry them to term?
Other questions surfaced as well. For example, who would be the legal father and mother? Here are Mr. Rios,
Mrs. Rios, an anonymous sperm donor, a surrogate mother, and possibly an adoptive father and mother. The
child that would be born could have as many as six “potential parents.”
But those are not the only questions and considerations that can be raised. Philosophy professor Donald
DeMarco offers even more:

The legal uncertainties of the situation provide excellent grist for a fiction writer’s imagination. Could a
woman become an heir by serving as the gestational mother of the two children? Once having secured the title,
could she then exercise her prerogative and abort the children without forfeiting her claim on the estate? Or
could she hold the children hostage in the womb, to assure getting what she wanted? Would a woman be
entitled to a sizable share of the fortune if complications during the pregnancy left her infertile? Should there
be two gestational mothers? If so, on what grounds should they be selected?
Talk about a legal headache and a moral quagmire. And that indeed was the case. Lengthy medical and legal
proceedings were undertaken, with things not exactly becoming crystal clear in the process. DeMarco
continues:

A “scholarly” committee studied the matter and recommended that the embryos be destroyed. State officials
accepted the recommendation. Lawmakers in the State of Victoria, however, rejected it and passed an
amendment calling for an attempt to have the embryos implanted in a surrogate mother and then placed for
adoption. Scientists held little hope for the orphans’ survival.
Nonetheless, Laura Horwitch, the lawyer representing the Rios estate, was not taking any chances. She
declared that the orphaned embryos could not be heirs under California law since Mario Rios was not their
natural father. This judgment, however, is at odds with other instances involving AID and IVF where the
consenting husband of a wife whose egg is fertilised is always presumed to be the father of the newly formed
embryos.
If the orphaned embryos were victims of legal discrimination, they would have no one to defend them since no
legal guardian was appointed to act in their behalf. As things turned out, these legal questions became a moot
point. The attempt to implant the embryos failed.
Wow, I get a headache just trying to follow all this! What a mess. My second case is not much better I am
afraid. This one involves a couple from Tennessee, Junior and Mary Sue Davis. Beginning in 1985, they went
through IVF procedures on six different occasions, costing $35,000, resulting in the creation of seven embryos
which were left in storage. However, the couple then divorced in 1989, with the ex-husband wanting them
destroyed, and the ex-wife wanting them implanted. The courts were kept busy with this one as well.
Again, plenty of questions arise in such a case. Are the embryos property? And if so, who do they belong to? Is
this a custody dispute, or something else? There were differing court decisions surrounding this case. At first, a
court sided with Mary Sue, claiming she had a right to the embryos. But in 1990 an appeals court decided that
both parties should have an equal say in the fate of the embryos.
But things did not end there. In 1992 the Supreme Court of Tennessee decided in favor of Junior Davis. But by
this time however Mary Sue had remarried, and decided to donate the embryos instead of having them
implanted in her. Of interest, in the last court case, the embryos were declared to be preembryos, not embryos,
and were thus treated as neither persons nor property.
Sadly such cases are not unique, but are representative of many such legal fights. I have already spoken about
these elsewhere, including “wrongful birth” cases. Let me mention just two more of these, both from Australia.
The first involves a Queensland couple who got more than they bargained for, and took their IVF clinic to
court. Here is how one write up covers the story:

A couple in Queensland who used IVF to conceive, are suing the fertility clinic that they paid to help them.
And not because they didn’t get a chance to ever hold a baby in their arms. Because they got more than they
expected. The Weekend Australian has reported that the 35-year-old couple is suing after a woman gave birth
to triplets instead of the twins she thought she was having. The couple are seeking $510,400 in damages, to
help cover the costs of bringing up a third child that they weren’t expecting. The couple alleges that when they
signed a consent form, they indicated that they wanted a maximum of two children. But during the embryo
transfer, a doctor planted three embryos – not two.
Also consider this case about a NSW couple suing their IVF doctor, seeking massive compensation. The story
goes like this:

Debbie and Lawrence Waller love their 11-year-old son, Keeden, but they believe he should never have been
born. Just days after Mrs Waller gave birth in August 2000 following IVF treatment, Keeden suffered a
massive stroke that caused severe brain damage and meant he was never able to walk, talk or go to the toilet.
The stroke was the result of a rare blood clotting condition known as antithrombin deficiency which Keeden
inherited from his father. Tragically, the Wallers did not know there was a 50 per cent chance that Keeden
would have the defective gene. They are now suing the IVF specialist who oversaw Keeden’s conception –
Christopher James – in the NSW Supreme Court for what is known as ”wrongful birth” and seeking
compensation in the order of $10 million for the lifelong care of their handicapped son.
However, 15 months later a judge ruled against the couple and their case. But as mentioned, increasingly we
are finding such legal tussles involving the new reproductive technologies. Lawyers are having a field day with
all this, and may be the only ones actually gaining from this. The biggest losers are of course the children
themselves, treated as mere pawns by selfish adults who squabble and fight over their “products”.

15 Laws On IVF
Treatments From
Around the World
IVF or in vitro fertilization is used by many
couples that experience fertility issues. It is an
assisted reproductive technology used to extract
eggs, retrieve sperm, and then manually
combine them in a laboratory dish. Once
fertilized, the embryo is implanted into the uterus
to grow a baby. Some women have pregnancy
success following IVF treatments. In some
places, this process is well known and seems
very common place. However, there is more to it
than meets the eye.
Almost every part of IVF is regulated by
legislation. It has to be. A doctor is literally
holding the ability to create life in their own hand.
These laws protect doctors, parents, donors,
surrogates, and children. They can also dictate
who has access, what options are available, and
the processes that are allowed to be used. What
may be considered legal in one country is
completely banned in another. It is important to
know your rights and understand the laws that
exist so you can choose a facility that will provide
you with the best chance for success.
Legal and ethical issues can be very
complicated. They range from your
understanding belief on when life begins and
religious views surrounding conception. What
happens to eggs that have been fertilized, but
are not implanted? There are also very grey lines
related to testing and medical advancement.
Where do we draw the line and what should be
considered OK? Most countries have taken a
stab at answering these questions and have
implemented legislation.
The anonymity of the donor has been a fairly
common practice in IVF. However, some
countries are stepping up their game when it
comes to tracking information for later use. This
includes both identifying and non-identifying
information being preserved. Rules around how
it is kept, how and when it can be released, and
even who can request it. Portugal has a public
national database of donors. In Hong Kong,
sperm donation is allowed both anonymous and
non-anonymous. However, egg donation must
be non-anonymous.
In the UK, offspring are allowed to request non-
identifying information at the age of 16 and
identifying information at the age of 18. In Spain,
non-identifying information will only be
released if the offspring is sick with a serious
illness. In the US it is the patients that get to
specify their wishes. Those are followed as often
as possible. The degree of anonymity varies
greatly by country!
Surrogacy is a complex topic in IVF. It is
important to understand the different definitions
used and which apply to your scenario.
Surrogacy can refer to the woman that carries a
baby for another couple. Or it is the reference to
treatments used to obtain a fertilized embryo.
There are so many conflicts of interest when
defining roles in the IVF process. Even the ability
to be paid is heavily governed (sometimes
forbidden)!
In Australia, the birth mother must be listed on
the birth certificate. They also only allow "not for
profit" surrogacy. In Brazil, the surrogate host
must be related to the couple. Countries of
predominantly Muslim faith do not allow
surrogacy at all. In Thailand, the birth mother is
the legal mother and the couple must adopt the
child after birth. New Zealand requires all cases
be reviewed by an ethics committee. In the US
there are generally no limitations, though some
states do not allow payment.
There are several methods that can be used in
the fertilization process to select the gender of
the baby. The reasons provided for choosing to
do this are preventing sex-linked inherited
genetic disorders, family balancing, or for social
reasons. The most commonly accepted one
being to prevent sex-linked inherited genetic
disorders. Regardless, the motivations of the
couple is extensively reviewed ahead of time.
The two most common ways it is done is through
sperm sorting for insemination (75% accurate for
boys and 85% accurate for girls) and IVF with
PGD to transfer only embryos of the desired sex
(99% accurate).
There are currently 9 countries that allow sex
selection. Those countries are: Belgium,
Czech Republic, Greece, Hong Kong, Israel,
Libya, Russia, Saudi Arabia, and the United
States. Many laws still govern this process.
Some methods have a higher success rate.
Those tend to be more expensive and only
available in more affluent countries.
In many countries, embryos are allowed to
develop for several days prior to implantation. At
that time the selection process is done choosing
the healthiest embryos for use. During the
maturation process, some stimulation may be
required to ensure successful fertilization and
readiness of the embryos. In many countries it is
allowed with either regulation or guidelines in
place to ensure it is done ethically. Those
guidelines are typically things like allowing it for
research only, limiting it to certain facilities, or
under certain medical circumstances.
The only two countries that notably do not
allow it is Denmark and Senegal. In other
countries, the early embryos must be used
for implantation. Egg maturation processes are
just starting to gain some traction as it is a newer
technology. Over time we will likely see countries
change their stance as more is known about it.
For many it is still considered fairly experimental
in nature.
The maximum time embryos are able to be
frozen and then used is highly regulated. The
intent of freezing is to make more embryos
available for future use by preserving everything
they can. This process is no longer viewed as
experimental and is commonly practiced now
as it is considered safe. Freezing eggs has
actually simplified the process for IVF. Most
countries allow the freezing of fertilized eggs.
Where the legislation tends to come into play is
around the time frame allowed.
Many countries limit it to 5-years. An extension
may be available for cancer patients. Some
countries will store up to 10 years with age
restrictions for when the transfer can take place.
Then there are places like Japan that will store
for the duration of a marriage as long as the
female partner is of reproductive age. Consent
by both partners is typically required for both
freezing and disposal of unused material.
The maximum time embryos are able to be
frozen and then used is highly regulated. The
intent of freezing is to make more embryos
available for future use by preserving everything
they can. This process is no longer viewed as
experimental and is commonly practiced now
as it is considered safe. Freezing eggs has
actually simplified the process for IVF. Most
countries allow the freezing of fertilized eggs.
Where the legislation tends to come into play is
around the time frame allowed.
Many countries limit it to 5-years. An extension
may be available for cancer patients. Some
countries will store up to 10 years with age
restrictions for when the transfer can take place.
Then there are places like Japan that will store
for the duration of a marriage as long as the
female partner is of reproductive age. Consent
by both partners is typically required for both
freezing and disposal of unused material.
There are two common scenarios where sperm
is used for IVF prior to the donor's death. The
first would be someone that donates prior to
medical treatment for a condition like cancer. If
he then dies, he has provided consent as to his
wishes following his death. In most countries,
decisions regarding the use of sperm
following death is made by a court of law or
by the treating physician based on consent
forms that have already been signed. This
would be the typical way a widow could move
forward with IVF following her husband's death.
The other scenario would involve retrieving
sperm following brain death when the patient is
unable to consent or make his wishes known.
This is highly controversial and most countries
prohibit this use. In the United States, some
states allow sperm use after the donor's death.
Israel only allows it with court order. Then there
are countries that require donations to be
discarded following a patient's death.
The very first IVF birth was a result of one
embryo being implanted. As the practice has
been researched and advanced, the success
rate was known to go up by implanting more
than one embryo. The cost of the process
rose. As did the risk of having multiple births.
Many countries viewed this as reason to
implement legislation to reduce the number
of embryos allowed for transfer in each
session. Many factors go into the number
allowed to transfer like the age of the mother, the
reason for infertility, and the number of
pregnancies she has had.
In most cases the maximum number is 2 with a
few countries allowing up to 3 given certain
conditions are met. In the future, as IVF further
advances and success rates continue to
improve, the assumption is that more countries
will implement legislation to limit the number of
embryos to one or two maximum.
Sperm and egg donation are standard clinical
practices when it comes to infertility treatment.
However, there are many different variations in
the application and collection of donations of this
process. Legislation in this area is influenced by
religious, ethical, and cultural traditions in each
country. While sperm donation and banking has
been around a long time, egg donation and
storage is a fairly new idea. There is a lot of
legislation being put in place regarding how and
when these donations can be used. In some
countries, donated sperm is not allowed in
IVF at all.
For other countries, there is regulation related to
the anonymity and screening of such donations.
Egg donation is more widely accepted. However,
in places like the UK, there is high regulation.
They require donors to be screened and consent
to be given to having their identity shared in the
future. In China, it is only allowed with written
permission where more eggs are retrieved than
used.
In spite of infertility being recognized by the
World Health Organization as a major health
issue, insurance coverage available to IVF
patients is varied. The majority of countries offer
some sort of public or private coverage, typically
partial coverage. However, there does not seem
to be any standard eligibility criteria that is
applied. Where eligibility requirements exist the
most common are the age of the mother
(typically under 40 or up to 44), the number of
cycles of IVF offered, and the type of insurance
they carry (public versus private).
In Israel, coverage is provided only for the
first two live births and a medical issue must
be documented to qualify for IVF. Both the
US and the UK have variable coverage
options. Most of the treatment is not covered. In
Portugal, it is free for up to 3 cycles of IVF. Then
there are countries like China that offer no
support at all.
As if you needed more pressure to get married! It
is possible you could be asked to show your
marriage certificate when being considered.
There is legislation out there to help determine
who is allowed to participate in IVF treatments.
The standard seems to be to specify you must
be in a "stable relationship". However, there is
no real definition around stable relationship to
ensure uniformity. There are some countries
(mostly Islamic and South East Asian) that
define a stable relationship as being married.
Others are more loose in their definition and
allow other relationship statuses to be
considered stable.
There are 26 countries that allow single
patients to participate. Then there are 14
countries that permit same sex couples
access to treatment. Countries that currently do
not consider marital status before offering IVF
treatment are the United States, Finland, Ireland,
Argentina, New Zealand, South Africa,
Dominican Republic, and Mexico.
Micromanipulation techniques refer to how the
egg is fertilized and have been designed to
increase the chance of success for IVF.
Microinsemination attempts to improve the
fertilization process where there is impaired
sperm function using a variety of techniques
including surgery for retrieval. This practice
seems to be generally accepted across the
board clinically. Assisted hatching techniques
are typically offered to patients with frozen or
thawed embryos, or those that have had multiple
failed attempts.
This practice is also widely accepted with few
exceptions. Cytoplasmic transfer was
developed to treat older women that were
thought to have less viable eggs. Therefore,
they borrowed part of a younger egg to mix
with the older egg prior to fertilization. This
version is only currently acceptable in 5
countries (Argentina, Greece, India, Kazakhstan,
and the United Kingdom). The US prohibits
cytoplasmic transfer and cloning requiring FDA
approval. To date, no approval has ever been
granted.
Legislation regarding the welfare of the child has
started springing up in a small number of
countries. The thought behind this legislation is
to ensure the child is being brought into a stable,
good home. These countries choose to protect
the child as these are elective, assisted
pregnancies. For example, the UK uses this as
part of their formal assessment during the first
consultation. Questions related to the parents
past convictions related to harming a child,
contact with social services for care of current
children, history of drug and alcohol abuse,
history of violence, and medical history related to
mental health.
They have the most robust legislation in this
area. Other countries known for having child
welfare regulations in place for IVF are Australia,
China, Finland, Hong Kong, Italy, New Zealand,
Norway, Slovenia, and Sweden. The United
States is in the majority here offering no
formal legislation. It is only briefly
mentioned, but not addressed as a major
concern.
Pre-implementation genetic diagnosis (PGD)
refers to the process of screening embryos for
the possibility of genetic disorders. Ultimately,
any embryos found to have genetic
abnormalities are removed and discarded prior
to the transfer process. This type of technology
requires the couple to make moral decisions
related to the difference between a pregnancy
termination and the discard of non-transferred
embryos.
PGD is reportedly allowed in majority of the
countries that offer IVF. The only two countries
that strictly prohibit the process are
the Philippines and Switzerland. Where it is
allowed, it is restricted to a small number of
hereditary disorders. In the United States it is
considered experimental. The legislation
covers things like when it is performed, how, and
who performs it. There are regional
organizations popping up to cover these types of
regulations. The demand for this procedure is
expected to continue to increase. It is generally
considered safe and has a low frequency of
errors.
Scientific experimentation on human
embryos creates a controversial, ethical conflict
between eliminating human suffering and
advancing medicine versus playing God and
showing respect for the value of life. There is
also the debate over the ethical legitimacy of
stem cell research. Stem cell research uses
cells with the ability to create more cells of
the same type. Based on the complexities of
these arguments, most countries prohibit any
sort of experimentation in the IVF process.
Fairly recently, Argentina made some changes to
their laws allowing limited experimentation on
non-viable embryos. There are very strict
protocols in place to govern that
experimentation. China is currently the only
country that has allowed human cloning with
restrictions. Otherwise, most countries prohibit
these activities while they hash out the pros and
cons and establish an ethical line they feel good
supporting. In spite of these laws, significant
progress has been made on stem cell research.