Developments and Issues 1, 1990

CURRENT DEVELOPMENTS AND ISSUES: A SUMMARY

CYNTHIA dE WIT Linneavagen 5, S-141 41 Huddinge, Sweden and GENA COREA Institute on Women and Technology, P.O. Box 338, North Amherst, MA 01059, USA.

BIRTH REGULATION Laws against “fetal abuse” which attempt to control pregnant women may Mother to be tried as “drug-pusher” be unconstitutional because they violate a following birth of her cocaine-exposed woman’s rights to due process and infant privacy, Martha A. Field, Professor of A Florida (U.S.) woman who gave Law at Harvard Law School, said at the birth to a cocaine-exposed baby in annual meeting of the American Society November 1988 has been jailed awaiting of Law and Medicine. trial on felony drug charges. “Forced cesarean sections are the most The mother, Toni Hudson, 29, gave common manifestation of movement birth to a son who tested positive for toward greater control of pregnant cocaine exposure on a urine drug screen. women,” Ob. Gyn News reported. “ . . . The case was reported to the state child Another potential area of enforced control abuse registry and after investigation, the of the mother concerns women who do infant was placed in foster care. not follow all of their physicians’ orders Hudson was arrested in December and during pregnancy.” charged with child abuse and possession In the widely publicized Pamela Rae and delivery of a controlled substance to a Stewart case a California woman was minor. She is being held in the county jail. prosecuted in 1987 for behavior that In an interview with reporter Sarah allegedly led to her son being born with Ahmann, Jeff Deen, the Seminole County brain damage and eventually dying. She Assistant State Attorney who is was accused of using drugs during prosecuting the case, said that the mother pregnancy, having sex with her husband is charged with “possession” of cocaine contrary to doctor’s orders, and “in her system.” disobeying her doctor’s instruction that “Delivery,” defined in the law as the she come to the hospital immediately if transfer of drug from one person to bleeding began. another, is being applied to mean the After this case, state legislators began placental transfer of the drug from mother to consider enacting explicit laws to to fetus, he said. control the woman during pregnancy, “It’s a drug-pusher statute . . . [that Field said. has] never been applied in this way . . . While this legal development has not [but] I think it fits,” Deen told the fully come to pass, Field said, “such laws reporter. have sufficient popularity–and the prosecutions, child removals, and even SARAH AHMANN. March 1, 1989. Mother to be tried for exposing fetus to detentions of pregnant women are becoming sufficiently frequent—that it is cocaine. Ob. GynNews. 24(5): 1. not too early to prepare a defense against Laws against so-called “fetal abuse” may them.” prove unconstitutional 53 54 CYNTHIA DE WIT AND GENE COREA

Laws proscribing “fetal abuse” may hysteroscopic sterilization will probably prove unconstitutional. 1989. Ob. Gyn become available within the next two News. 24(2). years, according to Franklin D. Loffer of the Phoenix Surgicenter. Teenage women paid a dollar a day not to The Ovabloc plugs are currently being become pregnant marketed in Europe and are undergoing Three Denver, Colorado (US) health scrutiny by the U.S. Food and Drug and hospital clinics have participated in Administration. The data look favorable, the Dollar-a-Day program that pays teens Loffer said at the annual meeting of the $7 each week they do not become American Association of Gynecologic pregnant. In addition, the women must Laparoscopists. attend one-hour group sessions one day a The plugs have a preformed tip which week. is inserted into the tube. Then liquid The program was conceived by Jeffry silicon is injected inside and a dumbbell- Dolgan, Ph.D., Chief of Psychology at shaped plug is formed at the other end. Denver’s Children’s Hospital. Dr. Philip G. Brooks of the University “I thought if I could isolate a high-risk of Southern California School of group –low economic, low education, low Medicine in Los Angeles cautioned that occupational achievement, and low the hysteroscopic sterilizations take longer aspiration–and document [the program’sl to perform than those done by effectiveness, other areas could pick up laparoscopy, that they seem to have a the Dollar-a-Day project,” Dolgan told higher rate of complications, albeit minor Ob. Gyn News. ones, and that the pregnancy rate is no The program began in an Hispanic better than for laparoscopic procedures – section of Denver. about 6 per 1,000. It was necessary to overcome some cultural barriers to work effectively with Ob. Gyn News. February 1, 1989. this first set of women. “These kids really Injectable silicon plugs for sterilization want these babies,” Dolgan said. may be available soon. 24(3):9. The program is an attempt to delay a second pregnancy until these young IN VITRO FERTILIZATION mothers are older. Estranged U.S. couple battle over seven “This year a million teenage girls will human eggs fertilized in IVF program become pregnant,” Ob. Gyn News An estranged couple’s battle over the reported. “In 1983 it was estimated that control of eggs fertilized in an IVF each teenage pregnancy costs taxpayers program went to trial in State Circuit $13,000-$ 18,000 a year for food stamps, Court in Maryville, Tennessee August 7, welfare, and Medicaid. In contrast, the 1989. At issue is whether Mary Sue Dollar-a-Day program costs about $600 a Davis, 28, can seek implantation of the year per girl, including administration and embryos, fertilized by her husband’s the dollar payouts.” sperm, to try to become pregnant. Mrs. The program has been compared with Davis is a former service representative the subsidy that farmers receive not to for a Knoxville boat dealer. grow crops. Her husband, Junior Lewis Davis, a DIANA COPSEY. 1988. Teens paid a refrigeration technician, says he has a dollar a day not to become pregnant. Ob. right to control his own reproduction. He Gyn News. 24(8). is suing for veto power over the use of the embryos. Davis, 30, says that for now he “Ovabloc” plugs for blocking fallopian has no desire to become a father. tubes and sterilizing women may soon be Meanwhile, the IVF physician available involved, Dr. I. Ray King, is Injectable silicon plugs for recommending that the frozen embryos Current Developments 55 remain in his control. Later they would be Clifford, her husband’s attorney, said: donated anonymously to an infertile “Our point is that nothing that Mrs. Davis couple, he states. has been through gives her the right to Charles Clifford, Davis’ lawyer, said: compel Mr. Davis to be a father, to “The position of Junior Lewis Davis is deprive him of his rights. To tell Mr. that no disposition of the pre-embryo Davis that he doesn’t matter in this at a should be made until he and Mary Davis time when we are trying to make fathers agree that their rights in this very unique equal partners to and responsible in the material are joint and equal.” reproductive process is somehow not “Judge W. Dale Young must decide if right.” the embryos deserve consideration as a When the custody, rather than potential child and therefore choose who property, approach is taken to the issue, would better serve the interests of a child, commented Arthur Caplan, director of the or if the embryos should be considered Center for Biomedical Ethics at the property and settled as in a regular University of Minnesota, “. . . the question property dispute,” The New York Times is what greater right does Mrs. Davis have reported. than Mr. Davis, since this kind of embryo John A. Robertson, a law professor at can theoretically be implanted in any the University of Texas and a member of woman’s uterus? We have some problems the American Fertility Society’s ethics here.” committee on the new reproductive In an editorial on the case, The New technologies, testified at the trial that the York Times commented: “Mrs. Davis has case should be decided in favor of the one said she neither wishes to force anything who would be hurt worst by losing: the on her husband nor take anything–child husband. Mary Sue Davis, he said, can try support included-from him . . . Mr. Davis another IVF program if she loses, which says he is being ‘raped of my reproduction would be less of a burden on her than rights,’ and that the fate of the eggs ‘is a unwanted parenthood would be on Junior joint decision.’ And it is understandable Lewis Davis. that he might have strong feelings of The eggs, Mrs. Davis said shortly after fatherhood even in the absence of the divorce suit was filed in February, financial and legal obligations. However, were the result of years of surgery, tests there would be no joint decision involved and injections. They were her best chance if Mrs. Davis were pregnant and wanted of having a child, she added. to abort: the decision would be hers alone. She had five tubal pregnancies after “A law professor from the University the marriage in 1979, she said, resulting in of Texas suggests that Mrs. Davis find the rupture of one fallopian tube and the herself another [sperm] donor. But in view tying of the other. Then she entered the of her medical history, and the emotional IVF program run by Dr. King of and physiological pain she has already Knoxville at the Fertility Center of East encountered during the in vitro procedure, Tennessee. Originally there were nine his good idea seems careless, even eggs. Two were implanted, callous.” unsuccessfully, before the marriage On September 21, 1989, Judge Young disintegrated. awarded temporary custody of the Mrs. Davis underwent six unsuccessful embryos to Mary Sue Davis, stating that IVF attempts. the evidence led him to conclude that the “That ought to tell you how much I embryos were “human beings existing as want to have a child,” she said. “People embryos.” say I could start all over again, but this “The court finds that human life begins takes a lot out of you, and my time is at the moment of conception,” he wrote. running out” (New York Times, April 22, The judge declared that the embryos 1989). were children, not property. 56 CYNTHIA DE WIT AND GENE COREA

Journalist Ronald Smothers reported: “I made a suggestion to my daughter “In effect, he treated the case like a typical Giovanna that she bear my child,” said the custody dispute in which the overriding mother, who has been identified only as concern is in the best interest of the child. Manuela. That is what Mrs. Davis had argued, Dr. Antinori revealed the birth in saying that the case involved custody November 1988, expecting to be issues and questions related to a woman’s congratulated for his precedent-setting right to choose whether to bring a work, Susan Jimison reported in Weekly pregnancy to term.” World News. Instead, through days of Judge Young declared: “From front page headlines and television fertilization, the cells of a human embryo specials, the doctor was called upon to are differentiated, unique and specialized defend his actions while the family tried to the highest degree of distinction . . . to explain that they had done nothing [Thus] human life begins at conception.” wrong. Jana B. Singer, specialist in family law The family said that the mother of at the University of Maryland Law School three, Manuela, had fallen in love with in Baltimore, said that “the logic of the Marco, a man 13 years younger than she. court’s decision does have some The couple wanted a child of their own disturbing implications for abortion rights but doctors warned Manuela that she and for reproductive rights.” would be unable to have another child. By deciding that life begins at “To save her relationship with Marco – conception, the judge “went way beyond who very much wanted his own child – what was necessary to decide the case,” Manuela asked her unmarried daughter Singer said. Giovanna, 19, to carry her baby for her,” In an interview with the Associated Jimison reported. “Giovanna consented Press, Judge Young said: “The full focus and Manuela’s egg, fertilized by Marco’s of the court in the case of children is on sperm, was placed in the womb of the what’s in their best interests, not what teenager.” mom wants, nor what dad wants, and not The baby boy was born in November what the grandparents want.” 1988. RONALD SMOTHERS. April 22, 1989. Embryos in a divorce case: joint property SUSAN JIMISON. December 6, 1988. or offspring? The New York Times; Girl gives birth to her own brother. August 8, 1989. New divorce issue: Weekly World News: 15. embryos’ status; The New York Times, August 11, 1989. Pre-born children or British women pressured to “donate” blastocysts? Ronald Smothers. September eggs to IVF clinics, patients’ 22, 1989. Tennessee judge awards custody organisations charge of 7 frozen embryos to woman. The New Women seeking sterilization are being York Times. pressured by doctors in private hospitals to surrender their eggs to IVF programs, Italian physician goes into hiding after Jeremy Laurance reports in the The arranging IVF birth in which a teenager Sunday Times of London. Because of a gave birth to her brother severe shortage of donors, the women are A 19-year-old woman gave birth to her being offered free sterilizations when they brother, through IVF, to help her mother surrender eggs. The operation normally save her second marriage to a younger costs more than 600 pounds. The waiting man. Dr. Severino Antinori, who practices list for sterilizations on the National at Rome’s Nuovo Regina Elena Hospital, Health Service (NHS) is two to four years went into hiding after provoking a public in some areas, the Family Planning controversy by arranging the surrogate Association said, so the offer of a free IVF pregnancy. private operation was “very persuasive.” Current Developments 57

Patients’ organizations say the free spray every four hours, and visit the hospital operation amounts to a bribe. It could lead twice for ultrasound scans, Laurance to exploitation, they assert. reported. Ten eggs were obtained from her The case of a woman who was told by by inserting a tube through the vagina under a private Lister hospital said she could light general anesthesia. have a sterilization only if she agreed to Specialists told The Sunday Times that surrender her eggs has lead to a call for an the egg shortage is getting worse because investigation of hospital practice. couples can now have all their eggs “The woman was offered the operation fertilised and the embryos frozen for their in a private hospital in return for her eggs own future use. So they are reluctant to after a dispute between the gynaecologists donate the eggs to others. and the health authority where she lived Commenting on the egg donation issue had halted NHS sterilisations,” Laurence in The Independent, William Thompson, reports. “The woman’s general practitioner professor of obstetrics and gynecology at has complained to her MP and this week Queens University, Belfast, Northern her case is to be taken before the licensing Ireland, said: “What happens to these authority that monitors the test-tube baby eggs? Those taken will be sold to clinics.” someone else. It is then the business of the The Lister hospital in west London has sale of a commodity. What will patients 120 couples waiting for egg donations, be charged? Someone will make a huge Laurance noted. profit out of this.” Sam Abdallah, consultant JEREMY LAURANCE. May 14, 1989. gynaecologist at the hospital, told The ‘Blackmail’ at fertility clinics. The Sunday Sunday Times: “If a woman wants to Times; CELIA HALL. May 5, 1989. donate eggs and that is her prime motive, Inducement offer to women for eggs but she also wants a sterilisation, we will ‘unethical’. The Independent. do it free of charge. We are not offering free sterilisations in return for eggs.” Most women undergoing sterilization But, Laurance pointed out, when a unwilling to surrender eggs to IVF clinics, Sunday Times reporter called the hospital U.S. physician finds to inquire about sterilization, a secretary Women undergoing laparoscopic in the fertility clinic, without being asked, sterilizations are apparently not a good said: “If ladies are willing to donate their group to approach for egg donation, even eggs, it’s free.” She said the cost would when they are compensated, Dr. Michael otherwise be 670 pounds. Feinman reported at the annual meeting of The Bupa hospital in Manchester also the American Association of Gynecologic offers free sterilizations to women who Laparoscopists in Dallas, Texas. surrender their eggs. Said fertility clinic “It seems there is no easy way to get director Adrian Lieberman: “If a woman donors,” Feinman, of Albert Einstein wishes altruistically to give up her eggs, College of Medicine, New York, said. we would be grateful.” Ob. Gyn News reported: “The shortage Because of the hazards involved, egg of donated oocytes has recently become donation is not comparable to sperm more acute because of the increasing donation. The women are injected with number of centers that use them.” hormones before the eggs are captured In late 1987, Feinman and associates under general anesthesia. Some women began approaching women undergoing suffer side-effects, Laurance points out. tubal ligation and asking them to donate Elaine Crook, 34, a hysterectomized eggs. woman who volunteered to donate eggs “Because the women have to undergo after hearing of the Lister hospital’s some risk by taking Pergonal to stimulate desperation for donors, had to have daily their follicles, a decision was made to hormone injections for 14 days, sniff a nasal offer them $500,” Ob. Gyn News stated. 58 CYNTHIA DE WIT AND GENE COREA

During a three month period, 194 than a quarter of the women who took part women underwent laparoscopic in the survey said they changed their sterilization. Of these, 153 were ineligible attitudes toward their partners as a result as egg donors because of age, pregnancy of the IVF program and in the main those and other reasons. Of the remaining 41, changes were negative.” only five were willing to donate their eggs. “During the discussion that followed,” PETER TERRY. May 24, 1989. the newspaper reported, “Dr. John J. Nightmare of high-tech rape haunts IVF Stangel of New York Medical College, programs. The Australian. Valhalla, said that despite the high percentage of reluctant individuals, Congress releases survey revealing low sterilization patients are a good group to success rates of U.S. IVF clinics approach for egg donation because many The overall IVF success rate for U.S. have demonstrated previously that they clinics in 1987 and 1988, when defined as are fertile.” the number of live births per stimulation cycle, was 10%. The rate for IVF was 9% Ob. Gyn News. February 1, 1989. and for GIFT 14%. Between 1987 and Finds few sterilization patients willing to 1988 the “take-home baby rate” for IVF make oocyte donation. 24(3):5. remained at 9%. The rate for GIFT rose from 11 to 16%. The total number of Nightmare of high-tech rape one example women enrolled in IVF clinics rose from of the stress women experience in IVF 10,598 in 1987 to 13,597 the following program, Australian report reveals year. The mother of an IVF baby has told These findings of a national survey of researchers her biggest fear before IVF clinics were released at a implantation of the fertilized eggs was Congressional House subcommittee that doctors would make a mistake and hearing on IVF. use sperm that did not come from her husband, Peter Terry reported in The “The need for strict guidelines Australian. concerning the practices, ethics, and The nightmare was described in a advertising of infertility clinics; a standard report prepared for the West Australian definition of clinics’ ‘success’ rates; and Health Department. Written by Sandra stepped-up efforts by the Federal Trade Webb of the department’s epidemiology Commission to investigate centers or branch, the report is based on a detailed individual physicians suspected of survey of 26 IVF mothers. misrepresenting their success rates” were It found that 92% of IVF couples proposed at the Congressional hearing, found the treatment stressful. Almost half Miriam E. Tucker reports in Ob. Gyn described the stress as extreme. News. “More than 80% of the women The congressman holding the hearings, described their biggest worry as the long- Rep. Ron Wyden (Democrat-Oregon), term effects of the drugs they had to take,” chairman of the House subcommittee on Terry reported. “But more than a third regulation, business opportunities and complained of their anxiety over the energy, plans to submit legislation that number of embryos the drugs made them will require all IVF and GIFT laboratories produce and the experiments that might to be subject to the same government have been taking place on the discarded regulation as are other medical labs. embryos. Wyden released the results of an IVF “The treatment itself disrupted their clinic survey compiled from responses to daily lives; its chances for success were questionnaires sent to 260 U.S. infertility low; its high cost caused couples clinics–all those believed to be doing IVF considerable financial worries . . . More or GIFT. Current Developments 59

Thirty-two clinics did not respond. per attempted egg recovery rather than Twenty-seven were no longer performing mentioning live births because “it takes a the procedures. Thirty-six were few years to get a good track record” of duplicates. One hundred forty six producing babies, Dr. J. Benjamin provided complete data for 1987 and Younger of Birmingham, Alabama, 1988. president of the American Fertility Physicians and government members Society, told the subcommittee. at the subcommittee hearing differed over Ellis showed the subcommittee several how to define success rates. Physicians examples of misleading advertising by preferred “deliveries per egg retrieval IVF clinics in which various attempt.” Government members wanted manipulations of numbers were used to “live birth per stimulation cycle.” The exaggerate success rates. This, he said, 1987 overall IVF success rate goes up two has created a situation in which “the points – from 9% to 11 % – if the doctor/patient relationship is fast physicians’ definition of success is used. becoming a vendor/consumer relationship Dr. Martin M. Quigley of Cleveland, with the ethic ‘let the buyer beware.’” president of the Society of Assisted Ellis suggested that Congress direct the Reproductive Technology (SART), told Federal Trade Commission to examine the subcommittee that egg recoveries, whether advertising of success rates at rather than stimulation cycles should be various infertility clinics is misleading, used by measuring success rates, since 20- and if so, to issue regulations for 25% of stimulation cycles are terminated standardizing the reporting of results. before egg recovery is made and are not The Federal Trade Commission, which as costly. is charged with truth-in-advertising Dr. Richard P. Marrs, director of the enforcement, “has been absolutely Institute for Reproductive Research at the sleepwalking on this issue,” Rep. Wyden Hospital of the Good Samaritan, said. disagreed. He pointed out that each Defining the main problem as the lack stimulation cycle costs $2,000, a of regulation of IVF, Wyden said: “At significant amount. present, there is virtually no professional Gary B. Ellis, Ph.D., director of a U.S. or government oversight of this booming Office of Technology assessment study on industry. Any practitioner can hold infertility issues, commented: himself out as a fertility specialist.” “Stimulation cycles, not egg retrievals, are According to Younger, because of the important for patients. You have to start at malpractice crisis, many former ob/gyns the bottom of the staircase, not the are now calling themselves “gynecologist middle.” and fertility specialists” with little or no The data on success rates were derived additional training in infertility treatment. by counting as live births the percentage At the hearing, Wyden promised that of continuing pregnancies at the time of he would try to promote funds for the survey that were expected to result in infertility and IVF research. He expected delivery. to find bipartisan Congressional support Of the 70 clinics with live births, the for the funding, he said. lowest success rate (live births per egg MIRIAM E. TUCKER. 1989. Congress recovery) was 1.5% and the highest, eyes possibility of regulating infertility 25.3%. Three clinics reported rates greater clinics; releases results of success rate than 20%, and 16 rates greater than 15%. survey. Ob. Gyn News.24(8):l. Nine clinics had rates lower than 5 %, and 20 rates lower than 8 %. The remaining 39 If IVF fails, try ZIFT, German researchers clinics ranged between 8% and 15%. suggest Many newer clinics have been telling Zygote intrafallopian transfer (ZIFT) is patients their rates of clinical pregnancy an alternative for women in whom

60 CYNTHIA DE WIT AND GENE COREA previous IVF attempts have failed, antagonists will simplify IVF treatment according to Dr. Miklos Hamori and and increase the success rate, he believes. associates of the In Vitro Fertilization Trounson predicted an increase in Clinic in Wurzburg, Federal Republic of pregnancies arising from cryopreserved Germany. embryos and, when the problems with egg The clinic performed ZIFT in 42 freezing are solved, with unfertilised women in whom artificial insemination frozen eggs. He also predicted an and at least one IVF attempt had failed. increased interest in surrogacy for women For the ZIFT technique, IVF is without functioning uteri along with the performed and fertilized eggs in the introduction in IVF of the diagnosis of pronuclear stage are transferred to chromosomal and genetic errors to reduce fallopian tubes by laparoscopy. ZIFT embryonic wastage and the occurrence of allows tubal transport of the embryos to miscarriage and birth defects. the uterus. Recent advances in microinsemination In Hamori’s sample, 12 of the 42 techniques will likely increase the women became pregnant, two with twins. probability of assisting infertile men, There were two spontaneous abortions at Trounson said, adding: “Unfortunately, 9 and 11 weeks gestation. these techniques involve the female The advantage of ZIFT is the partner in IVF even though she may have opportunity to screen and eliminate no particular infertility problem herself. abnormally fertilized eggs. Hamori and This situation must involve a substantial associates maintain (Fer-til.Steril. 50:519- commitment between the partners and the 21. 1988). need for each to recognise this commitment.” Zygote Intrafallopian Transfer Professor Roger Pepperell of the ‘alternative’ when IVF methods fail. ob/gyn department at the University of 1989. Ob. Gyn News. 24(8). Melbourne told the conference that the use of clomiphene citrate, GnRH and When IVF success rate rises, GIFT may bromocriptine, alone or in combination, be phased out, specialist says virtually guarantee that a woman can be The IVF success rate is expected to made to ovulate, providing there are match or exceed that of GIFT in the near follicles remaining within the ovaries. future through improved laboratory and All forms of ovulation stimulation, culture techniques and this, according to with the exception of that believed with Dr. Alan Trounson, will signal the bromocriptine, have the potential to cause phasing out of GIFT. ovarian over stimulation which, as well as With IVF, embryos are created in the causing multiple pregnancies, can lead to laboratory. None are created in GIFT as large ovarian cysts, haemoconcentration, the egg and sperm are inserted directly ascites and even death, he said. He into the fallopian tube. stressed the importance of monitoring. Trounson, director of the Centre for Early Human Development at Monash TREVOR ROBBINS. March 24, 1984. University, was speaking at the annual IVF trend increasing; Therapy to stimulate Biological Sciences Symposium organised ovulation. Australian Dr Weekly:40. by the Family Planning Federation of Australia in Bellarat, Victoria. New report reveals low IVF success rate The administration of gonadotrophin in Australia releasing hormone (GnRH) by minipumps IVF in Australia and New Zealand has for ovulation induction can be a a success rate of only 8.3%, lower than satisfactory way of treating anovulation the popularly held figure of 15% which is due to deficient gonadotrophin secretion, arrived at by counting clinical pregnancies he said. The use of GnRH agonists and rather than live births after IVF. The 8.3 Current Developments 61 figure is calculated as the success rate of infants with major urinary tract one hundred treatment cycles commenced. malformations was greater than “It slightly over-estimates the success expected.” rate throughout the nation because not all The report also noted the higher in vitro fertilisation units reported the incidence of ectopic pregnancy, number of cancellations before the stage spontaneous abortion, preterm delivery, of oocyte retrieval “egg collection,” low birth rate and perinatal death among Margaret Rice writes in Medical IVF and GIFT pregnancies than among Observer. infants naturally conceived. The report on IVF statistics was jointly There were 920 pregnancies, 819 published by the National Perinatal clinical pregnancies, and 753 births in the Statistics Unit at the University of Sydney 1987 IVF cohort. There were 548 GIFT and the Fertility Society of Australia. pregnancies, 516 clinical pregnancies and The GIFT success rate is 16.2. 445 births. When only those treatment cycles reaching the stage of egg retrieval are MARGARET RICE. March 17, 1989. considered, the success rate for IVF rises IVF birthrate down, or is it? Medical to 9.5 per 100 treatment cycles and to 17.4 Observer: 26-27. for GIFT. Dr. Paul Lancaster, director of the National Perinatal Statistics Unit, Infertility drugs may lead to early believes this is a more practical measure menopause, editor of book on women’s of the program’s success than experience of reproductive medicine consideration of the treatment cycles states commenced. “More and more women are finding “The new measurement system that infertility drugs lead to early acknowledges that it often takes each menopause, some women ceasing woman more than one treatment cycle to menstruation as early as 30,” Dr. Renate achieve a successful IVF or GIFT Klein, editor of Infertility: Women Speak pregnancy, and that the number of cycles Out About Their Experiences of of treatment offered to each woman will Reproductive Medicine (Pandora Press, vary from unit to unit,” Rice points out. 1989), said in an interview with the The report entitled “IVF and GIFT Geelong Advertiser’s Slavka Brdar. No Pregnancies, Australia and New Zealand. one has done a study on it yet, but it 1987” examined the most recent data from makes sense when you consider that all 18 IVF patients in Australia and two in women are supposed to produce one egg a New Zealand. It includes information month and fertility drugs make them about births up to September 1988. ovulate up to 49 times in one month. Success rates varied markedly at “Few people realise that Clomid, the centers across the country, the report most popular fertility drug, causes showed. The pregnancy rate per 100 enlarged and ruptured ovaries, ovarian cycles reaching the stage of oocyte cysts and other serious side-effects,” she retrieval varied between 2 and 15 in added. individual centers. The rates after GIFT “New procedures and techniques are ranged from 12.6 to 30.3 per 100 cycles in being discovered all the time with no various centers. thought to the possible effect it may have The report notes: “The incidence of on the women or children involved in five major congenital malformations was 2.2% or ten years time. The advances in IVF after IVF and 3.1% after GIFT. Among inevitably lead to embryo experimentation the IVF births, there was an excess of which is a big research interest but infants with spina bifida and with requires a constant flow of eggs.” transposition of the great arteries. Among Dr. Klein said of her book: “I hope a the GIFT births, the served number of lot of people read this book and realize 62 CYNTHIA DE WIT AND GENE COREA that it is not just about a few hysterical urgently before it is too late. The rampant women who are upset about not being sex determination tests, indeed a form of able to have a baby. Doctors have tried to NRT, are only an indication of what is to make it look like the failures are only a come. Reproductive engineering is also few unfortunate cases when the truth is aimed at women. It is, therefore crucial to the reverse – very few women go through oppose such destructive technology. IVF unscathed and fewer still produce Hence the decision to debate it.” healthy babies.” Twelve IVF births are said to have In the Klein book, Kirsten Kozolanka taken place in India. “As Shah rightly relates how her infertility treatment started pointed out,” Saroj Iyer wrote in The with one Clomid pill. Times of India, “what has been kept a closely guarded secret is the number of “... I knew other women who had failures behind the 12 successful IVF started with this small dose of Clomid, but births claimed. How many times does a swiftly progressed onto a steeper drug woman undergo IVF for one successful regiment. They took Pergonal to ripen pregnancy and live baby? What is the more than one egg, a shot of a hormone to ratio of the total number of women who release the egg on schedule, Premarin to start the IVF programme to actual live control the quality of their cervical mucus, births?” Progesterone suppositories to keep the In another article in The Times of India level of that hormone high. They were critical of IVF, Malini Karkal points to the monitored constantly through blood tests many low birth weight babies born in and endless ultrasounds. Sometimes they India who have a poor chance of growing were also artificially inseminated by a into physically and mentally healthy frozen sample of their partner’s sperm just adults and to the poor health of many to coax things along ... They too had Indian women. started with five small tablets.” Dr. Indira Hinduja, an IVF practitioner SLAVKA BRDAR. July 26, 1989. who delivered India’s first IVF baby in Reproductive medicine: exploding myths 1986, is well aware of the poor health of of a “failed technology.” Geelong Indian women and of the problems they Advertiser (Australia). face, Karkal wrote. She quotes Dr. Hinduja as saying: “In our country Bombay groups concerned with the tuberculosis is a major cause of infertility misuse and abuse of women for scientific by causing irreparable blockage of the development meet to discuss reproductive fallopian tubes.” and genetic engineering Karkal comments: “Tuberculosis and Various organizations in Bombay, all other infections are incapacitating a large concerned with the misuse and abuse of section of our population. A doctor women for scientific development, met suggesting a diversion of huge March 12, 1989 as part of the investments in treating infertility is not International Women’s Day celebrations only being cruel to the public but is also to discuss the implications of reproductive doing injustice to his professional and genetic engineering, particularly in learning.” India. Meanwhile, Dr. Hinduja has moved on Chayanika Shah of the Forum Against to GIFT, described by writer Uma Prabhu Oppression of Women, which is in Bombay Weekly Magazine as “a more organising the workshop, explained why sophisticated, sure-fire technique of reproductive and genetic engineering were embryo transfer.” She quotes an “elated” favored for discussion over other burning Dr. Hinduja saying: “I ventured into issues: “The NRT [new reproductive trying the GIFT method because I found technology] is as vital an issue as any that the success rate in in vitro was very other today and we need to take it up low. My first GIFT patient is due in Current Developments 63

December. So far her pregnancy is normal. of IVF – and its greatest success stories – All the same, I’m keeping my fingers to as wide an audience as possible.” crossed.” The public relations firm invited the Prabhu writes: “Although not much parents of the 168 test tube babies, the research has been done, Hinduja feels that babies themselves and the press to a the chances of abnormalities in a baby “birthday” party at the Tavern on the thus conceived are absolutely the same as Green in New York City’s Central Park. in an ordinary pregnancy.” No studies The party was planned as a buffet to give were cited in support of Dr. Hinduja’s parents and journalists a maximum “feeling.” opportunity to interact. “We wanted the national press to have SAROJ IYER. March 5, 1989. Whose an opportunity to see what IVF was about life is it anyway? The Times of India; in real terms and to provide them with a MALINI KARKAL. February 26, 1989. hundred human interest stories, and we Values or technology?; UMA PRABHU. wanted the specialist medical press to see June 22, 1987. Fertile concept: a new what new advances had been made in technique of embryo transfer for sterile IVF,” senior account executive Mensch couples. Bombay Weekly Magazine. told PR Week. The party was timed for mid-morning Public relations firm explains how it sells on a Wednesday, PR Week reported, “not IVF to the public for its client, the so early that out-of-town guests couldn’t company IVF Australia make it but early enough for the press to The public relations (PR) firm get maximum play from the story, in mid- Creamer Dickson Basford organized a week so the story could run on over the “birthday party” for the 168 test-tube next few days ...” babies conceived by IVF in Australia as All staff present at the party were part of a public relations strategy for trained in dealing with the media, promoting the business of its client. according to the trade journal. According to an article in the trade journal “The media were notified a month PR Week, Creamer Dickson Basford before,” PR Week stated, “reminded once began working on IVF in Australia in more a week ahead and then contacted autumn 1987. again. With each release, the excitement There were two main communication of the event was stressed. TV reporters challenges, senior account executive were told what great photos it would Nancy Mensch stated: making people produce, radio people were told that the realize that IVF is no longer experimental sound would be fantastic.” and presenting IVF in Australia as one of The account team at Creamer Dickson the leaders in IVF. Basford used facsimile transmission to PR Week reported: “The success story ensure that information was distributed of IVF was thus presented (and is still efficiently. being presented) to both childless couples “The results speak for themselves,” PR themselves and to their doctors – a major Week stated. “Eight TV news teams source of referrals – many of whom knew turned up, and two radio teams. There little about IVF, apart from its test tube were 36 publications represented, ranging tag, which makes it sound much more from New York Post and Life Magazine to clinical, less personal experience than is Bride’s Magazine and Family Circle. really the case.” Pick-ups included a front page of USA The occasion of the 10th anniversary Today, the front of the Metro section of of the first IVF birth in England, the the New York Times, Newsweek, Life, and second birthday of IVF Australia and the most of the major TV stations.” start of spring provided an opportunity Evidence of similar public relations “for an event that could present the reality strategies can be seen frequently in the 64 CYNTHIA DE WIT AND GENE COREA major media. For example: – The of the photograph with Howard holding Washington Post ran a Mother’s Day Elizabeth, 3, the first U.S. test-tube baby. story headlined “test-tube babies reunite at In a relatively low-budget public home base” along with a photograph of a relations tactic, the Fertility Center of crowd of mothers holding their test-tube New York, the company headed by Noel babies and standing behind IVF P. Keane that rents contract mothers to physicians Dr. Maria Bustillo and Dr. customers, sent out a card to its mailing Joseph Schulman. The story began: “Like list with a photograph of small children at the other proud parents at the gathering, a birthday party – cake in the foreground Greg and Kathy Roseberry were showing and balloons in the back. The card read: off their baby. ‘He looks just like a real “We’re Celebrating 300 Birthdays! Our baby,’ some people say. Or, ‘He looks so 300th surrogate baby was born in August, normal,’ said the father of 4-month-old 1989.” Greg, Jr. ‘They think he was in a lab for New Zealand Times has reported on nine months or something.’ The the publicity campaign of IVF Roseberrys were among the 12 couples practitioners at Auckland’s National who gathered yesterday at the first annual Women’s Hospital: “Of the 15 test-tube reunion hosted by the Genetics and IVF babies born in New Zealand, only two Institute in Fairfax (Virginia, USA) to have been photographed publically with celebrate their children, all of whom are their parents. The others have met a glare ‘test-tube’ babies made possible by the of media hype nestled in the arms of the clinic’s work.” doctor who helped conceive them, “He’s ‘Daddy’ of them all!” ran the Auckland’s Freddie Graham,” Linda Sun-Herald headline over the photograph Clark wrote. Parents liked keeping the of IVF practitioner Ian Craft surrounded children anonymous “and as for Graham, by a host of men holding their test-tube publicising the programme’s successes babies. The story read in part: every child has proved a powerful way to lobby. In in the picture above can thank the man in December 1983, when the first two the centre for the gift of life itself. And pregnancies were announced, grabbing “Every mother there can thank the man public interest was vital if the in vitro for her happiness. The children and their fertilization programme was to get off the mothers were among 40 test-tube babies ground.” who joined Professor Ian Craft last week At that time, IVF was a research at a celebration party at the Cromwell project only. But, Clark reported, ‘in a Hospital in London. Professor Craft slickly produced public relations plug,” headed the medical teams whose the three leaders of the IVF program techniques brought the children into the announced to the media that two world. He made sure, too, that he was in women had become pregnant and that charge at every birth and on hand to IVF was now a going concern. The congratulate each joyful mother. Last hospital board had little choice but to week Ian Craft surveyed his great ‘family’ follow along, committing itself to with pride while their parents swapped paying for the IVF. stories of heartbreaking years of “Six months later, New Zealand’s first infertility.” test-tube baby girl was featured in A U.S. magazine displayed a full-page newspapers up and down the country, photograph of parents holding aloft their nursed by Graham and described as his babies, all conceived in vitro at the ‘pride and joy,’” Clark wrote. “... Since Eastern Virginia Medical School. The then there have been more babies and parents, with their babies, had returned to more photo sessions. And not once have the clinic in Norfolk, Virginia for a party. Graham and his colleagues missed the IVF practitioners Drs. Howard and chance to crusade on behalf of their Georgeanna Jones stand in the foreground clinic.” Current Developments 65

But, as it developed, the clinic could their experiments would lower the not meet the demand for its service which possibility of IVF babies being born with Graham and his colleagues in a sense Down’s syndrome or other abnormalities created. and lessen the incidence of abortions. The “The bottom line is that the Hospital tests could be used to identify sex-linked Board regards infertility as a low priority diseases. and is not willing to put more money into Legislation regulating IVF provides it,” Graham explained to Clark. that experiments on human embryos must Auckland Hospital Board chairman be approved by the Standing Review and Frank Rutter said his board does not Advisory Committee on Infertility chaired regard infertility as a top priority. When by Professor Louis Waller. On January all their hospitals were experiencing 19, 1989, the committee gave that shortages in money and staff, life-saving approval. and life-preserving services had to take Six months earlier, the committee had priority, he said. If there is money to be approved the testing of 20-hour-old spent on infertility, he added, he would (presyngamy) human embryos for like to see more of it directed towards chromosome defects. The latest decision prevention. approved the testing of four-cell embryos, about two days old, that have taken longer PR Week. April 4–10, 1988. than normal to fertilise and that scientists Something to celebrate; RUTH GLEDHILL. believe may carry genetic defects. February 3, 1985. He’s ‘Daddy’ of them The director of Monash’s Centre for all! Sun-Herald; JOEL GARREAU. May 10, Early Human Development, Dr. Alan 1987. Test-tube babies reunite at home Trounson, said that if, during the course of base. The Washington Post; LINDA the experiments, the technique were found CLARK. March 9, 1986. IVF unit caught in to detect chromosomal defects in publicity web. New Zealand Times. embryos, it would be introduced into the IVF clinic “as soon as possible,” pending EMBRYO RESEARCH advice from the Waller Committee. Controversy erupts in Australia over The centre would then be the first in embryo testing in IVF program the world to offer embryo biopsy for The IVF watchdog committee of the routine clinical use, Calvin Miller government of Australia’s state of reported in The Herald (January 16, Victoria gave Monash University 1989). scientists permission to test human IVF To biopsy an embryo, scientists embryos for possible birth defects before remove one cell from a four-celled implantation in women. This set off a embryo without destroying it. They public controversy leading to a decision inspect the cell under a microscope for by the Victoria Minister of Health to genetic damage. If it is normal, they impose a moratorium on the experiments. implant the remaining three-celled Only months before the approval, state embryo into the woman. Tests on animals officials had issued public assurances that have reportedly shown that the three no experiments would be conducted on remaining cells have a good chance of human embryos beyond the stage of survival. syngamy, when the genetic material from Scientists would reportedly biopsy the the sperm and egg fuse together about 20 embryos only of those couples at risk of to 22 hours after fertilisation begins. producing an abnormal embryo. Syngamy occurs right before the first cell The experiments initially would detect divides to form two cells. abnormal chromosomes and other Under the approved research plan, abnormal cell characteristics. Later embryos found to have genetic defects experiments would detect abnormalities at would be destroyed. The scientists believe the molecular level – in the genes. 66 CYNTHIA DE WIT AND GENE COREA

“They would be world firsts that extended, she pointed out. would revolutionize reproduction “They have their foot in the door and technology as applied in infertility they will push and push to continue clinics,” Calvin Miller wrote (January 17, experimentation,” she said. 1989). The Right to Life Association The law in Victoria stipulates that IVF announced it was considering a court can only be used for infertile women. action to stop the experiments. “Monash is Trounson said the law was a handicap undertaking a selective breeding program because only infertile women could and it’s an affront to human dignity,” benefit from embryo biopsy. The Acting President Mary Pretty said (Miller, procedure, he said, could decrease the January 20, 1989). number of terminations in fertile women Nick Tonti-Filippini, the director of at risk of bearing a child with hereditary bioethics at St. Vincent’s Hospital in defects. Melbourne, said January 17 that without Senior researcher Dr. Leanda Wilton government intervention, embryo biopsy pointed out that embryo biopsy would could eventually lead to social detect only those genetic defects being engineering – the destruction of embryos looked for so scientists would not know because of their sex, eye, or hair color. whether the embryo was normal in other “This is the major issue in IVF – the respects. developing of the genetic control of “The Monash proposal is a remarkable human embryos,” he said. “We have been development in embryo diagnosis,” saying all the way along that this is what Professor Waller said. “It’s part of helping IVF is about.” infertile couples establish families.” The proposed experiments, he said, The embryo experiments, he added, would have grave implications for could help prevent the discarding of disabled people. embryos which doctors believe are “Disabled people in the future might unsuitable for implantation but actually be regarded as those who escaped are normal (Miller, January 1, 1989). screening and a selective destruction But community and ethics groups process,” he said. reacted angrily to news of the National Party Senator Julian experiments. IVF critics asserted that McGauran called on Waller to resign: genetic analysis of embryos gives “Professor Waller’s committee’s decision scientists too much control over inherited to approve genetic testing on two day old traits. As the technology develops, parents human embryos is not only in flagrant will be tempted to select embryos for disregard of the legislation but is also an superior characteristics, they state. example of his utter desire to hand over Dr. Robyn Rowland, senior lecturer in unlimited powers to the scientists. Under women’s studies at Deakin University and Professor Waller’s leadership the IVF a leading IVF critic, told the Geelong scientists have been allowed to stretch Advertiser that the embryo testing plan their activities to the outer limits of the was “only the tip of the iceberg” and law and even beyond the law” (The forecast moves to genetic engineering and Express, January 24). manipulation. As a feminist, she said, she In an editorial January 20, The was concerned that the research and Australian called on the Victorian scientific study was controlled by men government to overrule the Waller with little interest in the wishes of women. Committee and disallow the embryo The research, she said, would eventually biopsies. It stated: “. . . It is but a tiny step fall into the hands of commercial interests. from ‘discarding’ an embryo because of a Scientists were originally allowed to defect to discarding it because it has the experiment on embryos up to 20 hours wrong sex, or in due course the wrong old, but the period was now being hair colour, or some other allegedly Current Developments 67 undesirable physical characteristic. Will could rebound on themselves. If the we eventually reach a situation where resulting public debate became female embryos are routinely destroyed sufficiently emotive, for the sake of one because parents prefer sons to daughters, battle they could lose the war.” or vice versa? ... Is parenthood to be Trounson defended the embryo biopsy understood in the future as a quest for a procedure, saying it had nothing to do physically perfect child? What about the with genetic selection. status of handicapped people? Are they to “It’s just a means of returning some be seen merely as unfortunate mistakes discarded embryos back to the patients,” which somehow survived an as yet he said. “These are embryos which are imperfect screening process?” normally thrown away or discarded so Responding to the editorial, reader you would think ethically ... it would be Mark Radnor of Aldgate, South Australia very much in the community’s interest to wrote: “We all seem to spend so much of do studies like this.” (Doudle, January 18, our time in trying to better the lot of the 1989). human race yet so many people of your “Along with researchers in England, conviction feel that genetic improvement scientists at the Clayton centre (Monash is somehow a sacred cow, not to be Medical Centre) have played a leading touched. Genetic improvement of the role in pioneering the technique, which human race is the biological equivalent of could reap big financial returns for local Columbus’ voyage –while you hold that IVF researchers,” Michael Pirrie reported the earth is flat and we will sail off the in The Age (January 17, 1989). “If the edge of the world.” biopsy tests prove accurate and do not In another letter that same January 30, harm healthy human embryos, the Dr. Simon McCaffrey, an obstetrician- technology could be marketed worldwide gynecologist at Liverpool Hospital in for use by infertile as well as high-risk Sydney, wrote The Australian: “The fertile couples with a family history of public acknowledgement by doctors genetic disorders. Women who have involved in the recent delivery of [IVF] conceived naturally could have their early quadruplets and quintuplets in Perth that embryos flushed from their bodies, both couples had been offered selective examined in the laboratory through biopsy termination of several of their infants in and later returned to the womb if the utero to enhance the chances of survival embryo is healthy, according to local IVF of those remaining exemplifies the totally experts.” utilitarian approach which reproductive The Victoria Premier, Mr. Cain, said scientists are applying to their trade. January 21, 1989 that Victoria would not “Coupled with this was a proposal by allow genetic engineering, cloning or any Monash University scientists to split early “Brave New World stuff,” but would human embryos. Chromosomal faults consider the experiments on the two-day could be identified ... old embryos. The Government had “The above examples only reinforce previously said it would not permit the view that the National Health and experimentation on embryos older than 22 Medical Research Council’s self- hours (Mullaly, January 21, 1989). regulative recommendations that research Cain said the embryo biopsies were and experimentation should be not experimentation for research. It could administered by ‘advisory’ bodies be argued, he said, that tests to ensure that consisting mainly of medical and embryos were normal and fit to be scientific experts to be completely implanted were similar to tests to check fatuous.” for abnormalities during pregnancy. The Herald editorialized January 18: Premier Cain appears to have changed “Scientists who move too far ahead of the his position on embryo experimentation. public risk a negative backlash which In May 1988, he had written to Roman 68 CYNTHIA DE WIT AND GENE COREA

Catholic Archbishop of Melbourne Sir and intent of the amendments (January Frank Little assuring him that there would 24). be no experimentation on human embryos In the spring of 1989, Caroline Hogg, beyond the stage of syngamy (about 20 to the new health minister replacing White, 22 hours after fertilisation begins). imposed a moratorium on the embryo In his letter, the Premier said the biopsy experiments, calling for a review standing committee did not have the of the human-embryo research legislation. power to approve human embryo research Two members of Waller’s committee beyond syngamy. resigned in protest at the moratorium. “In this understanding of the position, Monash University IVF researchers Mr. Cain was confirming views stated decided to boycott the parliamentary publicly by the Health Minister, Mr. committee responsible for approving White, and this was stated by the Premier human embryo research. Professor Carl in the letter,” Michael Pirrie reported in Wood explained that although the The Sun. (January 20) scientists had no quarrel with the In 1988, Health Minister White said committee, they felt it was the only way publically that approval would not be they could express their frustration with given for experiments on human embryos the government’s moratorium on their older than 20 hours as he did not believe embryo experiments. that the community would tolerate such Trounson said a key staff member research. involved in the project was applying for Robyn Dixon and Michael Pirrie work overseas to continue the research. The Age: reported in “Members of Mr. He told The Age’s Philip McIntosh that White’s staff now say, however, that he with the loss in personnel and funding, the was referring to embryos specifically embryo screening technique might never created for research, and that be developed in Melbourne. experimentation could be done on embryos at a more advanced stage of He added: “The longer the delay the greater the number of normal embryos development if they were ‘spare’ or leftover embryos in an IVF clinic.” will be lost, as all embryos associated But some MPs involved in the 1987 with delayed fertilisation are discarded in IVF clinics throughout the world” (April parliamentary debate (which produced legislative amendments allowing research 12, 1989). on embryos up to but not beyond 22 hours Asked by the state for his opinion on after fertilisation begins) told reporters the legality of the proposed embryo Dixon and Pirrie that they believed the experiments, Solicitor-general Hartog time restrictions applied to all embryos Berkeley, QC, supported the Waller used in research. committee’s decision. He argued that “The Opposition spokeswoman on experiments could be performed on industry, technology and resources, Mrs. embryos older than 22 hours if the Marie Tehan, said no distinction was embryos were “spare.” Despite this drawn in the parliamentary debate pronouncement, the controversy over the between spare and experimental embryos, experiments continued unabated. and it was generally believed that the 22- The solicitor-general’s advice hour cut-off applied to all embryos that “prompted criticism that there would be a might be used in research,” Dixon and strong temptation to harvest larger Pirrie reported. numbers of eggs than normally required Tehan added that she believed that the from women patients on IVF programs by community and other parliamentarians using potentially harmful fertility drugs to involved in the debate would be provide banks of spare embryos for concerned if the Government used a research scientists,” Pirrie reported (April, technical legal point to override the spirit 5, 1989). Current Developments 69

Referring to the resignations of the two on IVF embryos ‘serious mistake.’ The Waller Committee members, both known Herald; CALVIN MILLER. January 20, supporters of embryo research, ethicist 1989. IVF committee split on embryo Tonti Filippini commented in The Age experiments decision. The Herald; (May 9, 1989): “Their resignations and January 18, 1989. Protest at move to test the level of angry comment that followed embryos. The West Australian; CLAIRE indicates that the researchers regard this HEANEY. January 19, 1989. Feminist’s issue as extremely important, though they ‘designer babies’ warning. Geelong have maintained that they merely want to Advertiser; IAN MUNRO. January 21, test a group of embryos that would 1989. Embryo tests: new row flares. The otherwise be discarded to save those that Sun; January 20, 1989. Victoria’s genetic are normal. But the number of embryos engineering problem. (Editorial). The that might be ‘saved’ by this means is Australian; MARK RADNOR and SIMON extremely small.” MCCAFFREY. January 30, 1989. IVF “From the reported figures, 3% of eroding human values. (Letters to editor). embryos are late fertilisers and hence The Australian; January 24, 1989. IVF suspect. Approximately 10% of these are boss should resign, says MP. The expected to be genetically normal and (LaTrobe Valley) Express; January 18, hence transferable. The live birth rate per 1989. Ethics and IVF. (Editorial). The transferred embryo is approximately Herald; ROBYN DIXON and MICHAEL 3.5%. Thus, in conclusion, approximately PIRRIE. January 24, 1989. Older embryos one embryo in 10,000 might be ‘saved’ by may still be tested. The Age; DEBORAH this process, not allowing for any damage STONE. January 20, 1989. Embryo testing that might occur.” ruling touches off IVF row. The “The fuss being made by the Australian; MICHAEL PIRRIE. March 23, resignations and the reported boycott of 1989. IVF committee member quits over the committee by the scientists would not tests ban. The Age; PHILIP MCINTOSH. seem to be warranted unless there was March 31, 1989. Another embryo scientist much more at stake than the chance of quits over research row. The Age; April 5, saving less than one embryo in 10,000. 1989. The embryo enigma. The Age; The teams ordinarily accept a loss rate MICHAEL PIRRIE. April 1, 1989. IVF greater than 97%. One can only conclude committee backs Hogg on moratorium that the embryo biopsy experiments have decision. The Age; PHILIP MCINTOSH. far more significance than the scientists’ April 12, 1989. IVF move an ‘act of public explanation would lead us to desperation.’ The Age; NICHOLAS TONTI- believe.” FILIPPINI. May 8, 1989. More at stake CALVIN MILLER. January 16, 1989. than one embryo in 10,000. The Age. IVF doctors seek tests on embryos. The Herald; MICHAEL PIRRIE. January 17, Embryo screening experiments proceed in 1989. Committee approves testing of Britain embryos for defects. The Age; ROSEMARY Researchers at London’s MULLALY. January 21, 1989. Cain orders Hammersmith Hospital will soon be IVF legal check on embryo test. The trying out an experimental technique to Australian. SANDRA OLSEN. January 19, screen two-day-old embryos for a faulty 1989. Designer babies in pipeline–expert. gene before implanting them in women’s Daily [Sydney] Telegraph; CHRISTOPHER wombs. Eggs will be removed from the DOUDLE. January 18, 1989. Embryo plans woman, fertilized with sperm in the IVF labelled ‘baby engineering.’ The procedure, and the resulting embryo will [Adelaide] Advertiser; SID MAHER. be screened. January 18, 1989. Warning on checks for Professor Robert Winston, head of embryo defects. The Courier-Mail; fertility studies at Hammersmith, said the CALVIN MILLER. January 17, 1989. Tests new genetic amplification tests in which a 70 CYNTHIA DE WIT AND GENE COREA cell is removed and checked for defects make public disclosures on the numbers had already been carried out on about 400 of frozen embryos. embryos in the laboratory, but none had yet been implanted in the woman after CALVIN MILLER. January 23, 1989. being screened. The report on these IVF ‘out of control’ as European embryo experiments in Australian Dr. Weekly did stockpiles grow, The Herald. not state how the 400 embryos had been People in the future will want from IVF obtained. clinics, not just children, but healthy children, IVF clinic scientific director Embryo checks for IVF. March 31, says in reporting on genetic testing of 1989. Australian Dr. Weekly. embryos Preimplantation evaluation of embryos Scientists reporting tales of secret in IVF may soon be possible, Gary D. experiments on excess embryos from IVF Hodgen, Ph.D., said at a program on fetal programs disorders organized by Columbia IVF practitioners are stockpiling more University College of Physicians and than 200,000 frozen human embryos in Surgeons and Sloane Hospital for Women clinics across Europe. in New York. “Numbers are heading for the millions Within as little as four to six years, it because of the absence of controls over may be possible to test embryos with IVF clinics, and scientists are reporting diseases caused by a single gene defect. tales of secret experiments on excess This would be useful not only for infertile embryos,” Calvin Miller reports in The couples, but also for fertile couples at high Herald (Australia). risk of producing babies with genetic Deputy director of legal affairs of the disease, said Hodgen, professor and Council of Europe Dr. Fritz Hondlus told scientific director at Jones Institute for Miller the embryo stockpiles were a Reproductive Medicine, Eastern Virginia matter of “great urgency” and Medical School, Norfolk, Virginia. “What characterized IVF practice as out of people will want from us in the decades control in the European clinics. ahead are not just children, but healthy Rumors were circulating among children,” Hodgen said. scientists that embryos had been One of the biggest obstacles to the use specifically created for research, Hondlus of preimplantation evaluation, he said, said. He added: “Because there are no was the financial one. He pointed out that controls, our worry is that no one knows most insurance policies do not cover IVF. exactly what is going on. The figure of The price of three IVF cycles is about 200,000 embryos is credible, but we have $15,000 and this does not include any no absolute proof. Numbers already could genetic testing. be greater.” If insurance companies decided or The 23-member Council of Europe were forced to offer coverage for IVF, wants to introduce uniform legislation for preimplan-tation genetic screening may all reproduction technology and become financially feasible, Hodgen said. surrogacy, Hondlus said. He added: “It may be difficult to see A Melbourne IVF doctor who told that preimplantation genetic diagnosis is Miller he wished to remain unnamed, said financially feasible. But 10 years ago, you 5000 to 10,000 human embryos could be would have had difficulty saying that in- stored among the 18 IVF clinics around vitro fertilization would be practical.” Australia. In its report on Hodgen’s speech, Ob. John Fleming, director of the Southern Gyn News listed other obstacles to the use Cross Bioethics Institute in Adelaide, of preimplantation evaluation: the DNA Australia, called on the state and federal from the embryo would have to be governments to require all IVF clinics to obtained without compromising survival Current Developments 71 of the embryo; the DNA would have to be Khatamee of New York University School amplified so it can be tested; the entire of Medicine. The estimated overall cost process of biopsy, DNA amplification, for a single incident of pelvic genetic testing and transfer of normal inflammatory disease and later treatment embryos would have to be done within the for infertility was $36,325, Dr. Khatamee “window” of implantation. reported {International Journal of Fertility, 33:246-251, 1988). Ob. Gyn News. March 1, 1989. Pre- The Centers for Disease Control, implantation screen of embryo may be Atlanta, has warned that infections caused possible. 24(5):3. by Chlamydia trachomatis are the most prevalent and damaging STD, affecting an REPRODUCTION INDUSTRY estimated 3 to 4 million U.S. citizens. If young people used condoms, Khatamee U.S. medical products company gives states, almost half of all infertility could “get-pregnant-or-else”guarantee to be eliminated, resulting in huge savings of customers money and emotion. Fertil-A-Chron Inc., of Deer Park, “In one study of 105 patients tested for New York has decided to guarantee the presence of Chlamydia antibody, conception through use of its 31.5% had some degree of antibody computerized fertility indicator within six reaction,” Ob. Gyn News reported. “In months or refund purchasers their money. another in a New York City abortion The announcement was made in a clinic, 70% of sexually active women company press release adorned, in its left tested positive for colonization of the corner, with a stork in the form of a cervical canal by Ureaplasma urealyticum computerized print-out and the logo: and Mycoplasma hominis.” “Fertil-A-Chron: Meet the computer that Khatamee attributed the increased need can get you pregnant.” for infertility treatment to five major The company began marketing its factors: sexually transmitted disease and Bioself 110 Fertility Indicator in late pelvic inflammatory disease; 1988. The product is a computerized, endometriosis; contraception technology – hand-held device based on the basal body oligo-ovulation from oral contraception, temperature (BBT) principle of ovulation and infection and infertility from use of detection. It gives the customer a daily IUDs; adoption shortages and an increase indication whether she is in a fertile or in the child-bearing population. infertile part of her monthly cycle. It costs $145 plus $10 for shipping and handling. Infertility due to STD costs ‘$64 billion’ a year. 1989. Ob. Gyn News Fertil-A-Chron press release. July 20, 24(1):36. 1989. “Get-pregnant-or-else” guarantee announced by Fertil-A-Chron Inc. SURROGACY AND TRAFFIC IN WOMEN PREVENTABLE INFERTILITY Bride trade scandal exposed in China Infertility due to sexually transmitted “Miss X,” a PhD candidate at diseases said to cost $64 billion a year Shanghai University with influential To date, infertility has been only connections, was kidnapped from her treated, not prevented, even though the university dormitory and sold as a bride to estimated total annual cost of infertility a farmer three times her age for $800. due to sexually transmitted diseases “Miss X was the victim of one of the (STDs) is approximately $64 billion, but increasingly brazen bands of bridesellers the yearly price for prevention of STDs is who kidnap young girls,” Louise Branson $335,000, according to Dr. Masood A. reported in The Australian. “Confined until 72 CYNTHIA DE WIT AND GENE COREA now to the countryside, they are becoming determination tests and strictly regulating bold enough to venture into the cities.” their use for detection of genetic There were no telephones in the village abnormalities. and little transport to enable the woman to The central government has followed escape. Friends and colleagues in the lead, circulating a draft of central Shanghai attempted to locate her. Police legislation against the tests, which are notified federal security agencies in conducted in almost every part of India, Beijing who turned up nothing. and setting up State Vigilance Nine weeks after her capture, she was Committees. The implementation of the tracked down through an anonymous law was hampered by delay in its letter to her college adviser. enforcement. “For every Miss X from the city, “The Forum, however, drew attention hundreds of thousands of illiterate country to the lack of any representation from girls are tricked or abducted by bride persons involved in the campaign in the sellers every year and never heard from committees,” Indian Express reported. again by their families,” Branson wrote. “The Forum’s criticism centered around “Some gangs specialise in supplying the fact that none of the committee young brides to invalids. Even if they did members had taken a clear stand on the find their way back home, they would be issue, a crucial fact given the strong rejected as ‘soiled.’” medical lobby supporting the tests.” The report of a government committee LOUISE BRANSON. Growing bride to draft Central legislation banning sex trade scandal exposed. The Australian. detection tests leading to female feticide April 24, 1989. must be cleared by the Union cabinet before it can be introduced in Parliament. Physician who conducted sex detection In the meantime, the Goa Government tests appointed to committee to monitor already introduced a bill in the State misuse of the tests; resigns following Assembly in April while neighboring women’s protests Gujarat (which witnessed a plethora of A physician in Bombay, India who clinics offering prenatal diagnostic tests conducted prenatal sex determination tests after the passage of a law banning sex to detect female fetuses that were detection in Maharashtra) is also drafting ultimately aborted and who was appointed a law. to a State Vigilance Committee to monitor In the report for a Central legislation, misuse of the tests, resigned from the the law provision meting out punishment committee following protests from for a woman undergoing such a test has women’s organizations. been retained. Some committee members The physician, Dr. Hema Purandare, believe that such a punishment – a small who had a clinic in Bandra, Medical fine – was a “token” one and would act as Genetics and Research Laboratory, said a deterrent. The Forum Against Sex she “used to” perform the tests Determination and Sex Pre-Selection (amniocentesis and chorion villi biopsy) maintains that the woman is more often but refused to answer further questions. acting under family pressure to undergo Her appointment was condemned by the test. the Forum Against Sex Determination and “Apart from Governments of Gujarat Sex Pre-Selection Techniques, comprised and Goa, those of Madhya Pradesh, of female activists, concerned citizens, Kerala, Arunachal Pradesh, Himachal and physicians. The Forum spear-headed Pradesh, Manipur, Mizoram, Meghalaya, a three-year campaign against the tests and Tripura have expressed willingness to and their misuse for sex determination. have a Central legislation,” Geeta Seshu Following that campaign, the state reported in Indian Express. “The Govern- government passed a law banning sex ments of Karnatak, Orissa, Tamil Nadu Current Developments 73 and Uttar Pradesh have responded by to halt funding. stating that the matter is under their CATHY O’LEARY. February 1, 1989. consideration while Andhra Pradesh, Fund cuts force child unit shut. The West Assam, Bihar, Haryana, Jammu and Australian. P. 8. Kashmir, Punjab, Nagaland, West Bengal, Rajasthan and Sikkim, have yet to reply to PRENATAL DIAGNOSIS the committee’s draft legislation.” Gene amplification allows prenatal Indian Express. January 29, 1989. Sex diagnosis of cystic fibrosis detection tests doc quits panel; GEETA First trimester prenatal diagnosis for SESHU. June 19, 1989. Draft of Central cystic fibrosis is possible using gene law on sex tests ready. Indian Express. amplification, according to Dr. Carolyn Williams and associates of St. Mary’s PREVENTABLE INFANT Hospital Medical School in London. DEATHS “Villus tissue was obtained at nine weeks’ gestation from a woman who had Fund cuts force units dealing with the given birth to a previous child with cystic health of Aboriginal children to shut down fibrosis,” Ob. Gyn News reported. “The A Perth [Australia] research unit that DNA was amplified using the polymerase has commanded worldwide attention for chain reaction technique, and a probe was its work in child health is closing because used to determine whether a DNA of lack of funds. Much of the recent work polymorphism found in most patients with of the gastroenterology and nutrition unit cystic fibrosis was present, the of the Princess Margaret Child’s Medical investigators say in a letter to the editor Research Foundation has involved the (Lancet II:102-103, 1988). The fetus was health of young Aborigines. This has found to be heterozygous for the included the rate of infection, birth abnormality, so highly unlikely to be weight, and growth. affected.” The director of the unit, Professor Michael Gracey, has won acclaim for his Prenatal diagnosis of cystic fibrosis by work on diarrhoeal disease and DNA amplification. 1989. Ob. Gyn News. malnutrition in children. 24(1):11. “The real tragedy is that 18 years of skills and expertise is likely to be lost and Indications expanding for use of new fetal this work into Aboriginal health will assessment test, U.S. physician reports stop,” Gracey told reporter Cathy Indications for the use of percutaneous O’Leary. “It is disastrous because this is umbilical blood sampling (PUBS) are the only work of its kind in Australia and expanding, Dr. Jeffrey C. King said at an the health of Aborigines is clearly the ob. gyn conference presented by worst of any single group of people in Georgetown University School of Australia. There are still many things we Medicine, Washington, D.C. Worries have yet to learn and at the moment the about the procedure’s safety have proven health of young Aboriginal mothers is a unfounded, he said. disgrace and low-birth weight in their Ob. Gyn News reports that in PUB a babies is double the rate of the rest of the specimen of fetal blood is taken from the community.” umbilical cord under ultrasound guidance Aboriginal leader Ken Colbung said and used to assess the fetus for suspected the unit’s research was playing a large genetic, hematologic, and other problems. role in improving the health of Aboriginal The test, first described in 1982, is usually children. done late in pregnancy. Gracey said the foundation’s board of “Before PUBS is undertaken,” Ob. management had told him of the decision Gyn News states, “a neuro-muscular

74 CYNTHIA DE WIT AND GENE COREA blockade, usually d-tubocurarine or A review of the procedure in 1,600 pancuronimum bromide, may be women in 10 centers worldwide showed administered to the fetus intramuscularly that the risk of fetal loss is 1.5% per or intravenously to paralyze the fetus who patient tested or 1.9% for each procedure. could otherwise move, perhaps hitting the needle and lacerating the cord. As a rule, Ob. Gyn News. February 1, 1989. the fetus stops moving within 25 seconds Percutaneous umbilical blood samples. of the I-V.” 24(3): 1.