Cheaper by the Dozen

by Sean Philpott-Jones, Director of the Center for Bioethics and Clinical Leadership

As a bioethicist, I appreciate the fact that the American public has become deeply engaged in a number of important health policy debates.

For example, should local, state and national agencies forcibly quarantine travelers coming from countries affected by the Ebola virus? Should public and private companies be required to provide employees with health insurance plans that include oral contraceptives if doing so runs counter to the religious beliefs of the owners? Should terminally ill cancer patient Brittany Maynard have the right to end her own life (which she did this past Saturday)?

One interesting story that slipped under the radar, however, was the recent announcement that two major corporations, tech giant Apple and social networking service Facebook, will now pay for female employees who want to freeze their eggs. These companies will cover the costs of extracting, freezing and storing eggs, even when this is done for non-medical reasons. This is a pretty substantial benefit, as the extracting the eggs can cost $20,000 or more. Storage fees can run an additional $1,000 a year.

This should be up for public discussion and debate. Although many people may disagree with me, I believe that these two companies (and those that follow their example) are making a big mistake. That is not to say that I don’t think that companies like Apple and Facebook shouldn’t provide coverage for fertility-related treatments like egg freezing as part of a comprehensive health insurance plan. They should, but only for medically justified reasons.

The technical name for egg freezing is oocyte cryopreservation, and it is a physically invasive and potentially risky procedure. Women must first take a cocktail of drugs called gonadotropins to hyperstimulate egg production, tricking their ovaries into producing a dozen or more eggs rather than one or two ova that are normally released during the normal monthly fertility cycle. Doctors then insert a long needle through the vaginal wall and into the ovary, sucking out the eggs and preparing them for long term storage.

As you might imagine, this is an extremely uncomfortable procedure. Most women experience bloating and abdominal pain, but more severe side effects are not uncommon. Nearly half of all women will experience a condition known Ovarian Hyper Stimulation Syndrome (OHSS), which may require hospitalization to treat the bleeding and severe fluid buildup that results. Errant needles can cause injury to the bladder, bowel and kidneys. Finally, the ovaries can develop scar tissue at the site of puncture or the drugs used for hyperstimulation can trigger early onset of menopause, resulting in infertility in both cases.

Moreover, while new techniques for freezing and storing eggs have improved to the point where over 90% of all cryopreserved oocytes survive the freeze-thaw process, far fewer of those eggs will lead to a successful birth via in vitro fertilization (IVF). According to the Society for Assisted Reproductive Technology, for instance, the rate of live birth among women aged 30 who used cryopreserved eggs for IVF is less than 25%. That rate drops to less than 10% for women over 40.

These concerns – safety, efficacy, and potential physical risks — are why professional organizations like American College of Obstetricians and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM) only support the use of egg freezing when medically necessary. Egg freezing should be done only as a last resort to protect fertility in women undergoing ovary-destroying cancer treatment, for example, rather than as a way to delay childbearing as a matter of choice.

Unfortunately, the latter is exactly what companies like Apple and Facebook are promoting. Covering the costs of oocyte cryopreservation for non-medical reasons reinforces the idea that professional women must choose between having a fulfilling career and raising a family. Moreover, even if a woman successfully delays childbirth by freezing her eggs, she has only delayed the inevitable. She must still confront a corporate culture that sees mothers as an economic liability.

If companies like Apple and Facebook truly want to support their female employees, they don’t need to pay for egg freezing. What they need to do is provide both female and male employees with the services and benefits necessary for meaningful work-life balance, including paid leave for new biological and adoptive parents, family sick leave, and subsidized daycare and preschool programs. Better yet, they should use their wealth and political connections to lobby our leaders in Washington to make such benefits the law of the land.

Until then, we’re still leaving most working women (and many working men) out in the cold.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on November 6, 2014, and is available on the WAMC website. The contents of this post are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]

Three’s a Crowd

by Theresa Spranger, Bioethics Program Alumna (MSBioethics 2012)

There is a new IVF (In Vitro Fertilization) procedure being developed in the United Kingdom.  The procedure aims to prevent diseases of the Mitochonidria.  These include certain types of Muscular Dystrophy that are genetically passed down from the mother.  This procedure would introduce DNA from a third parent by the transfer of the nucleolus from a donor egg.   99.8% of the genes of the resulting child would be from the biological mother and father.  Approximately 0.2% would come from the donor woman’s egg.  This would result in the child having 3 biological parents.

The whole idea is an interesting one and it’s a noble goal to want to protect these children from Mitochondrial disease.  However, I think it’s a “slippery slope.”  Yes, yes, there it is…the standard conservative argument for everything.  I hate making it as much as you probably hate reading it, but I think it applies in this case.

When you talk about genetically modifying humans (which is what we are talking about here), you open some very scary doors.  If a person’s genetics can be modified to correct a genetic disease at conception, could they be modified to ensure the child will be tall?  Or, to ensure she will have blue eyes?  The potential is “designer children,” or children whose genetic makeup has been specifically chosen.

I can already hear some of you out there: “That will never happen.”  “No one is going to pay that kind of money to pick out their child’s eye color.”  And so on, and so on.

For those who are skeptical of the idea, please allow me to give you an example of who this technique could be marketed to:

Kim Kardashian – a woman with more money than brains, whose maternal instinct didn’t stop her from naming her daughter North West.  Could you honestly tell me that someone like Ms. Kardashian wouldn’t want to create her “perfect” child?  Or, that no company would allow her to do this for the right price?

There is an epidemic in our society right now of “trophy babies.”  Some parents have babies and forget that they are tiny people.  That those children need to be nurtured and taught, and that one day they are going to need to be functional adults.  I think the ability to have “designer children,” would only make this trend worse.  It would allow those with enough money to choose qualities in their child like a little girl picks a doll from the American Girl store.  I don’t think this would be good for the child or society.

What if the “designer baby” trend then really took off?  What would society look like?  Naturally, there would be the haves and the have-nots.  People who could afford it would select for: intelligence, athleticism, beauty, etc., and the gap would widen between socioeconomic classes in our country.

As much as I would love to see a cure for mitochondrial diseases, any time we manipulate a person’s genes we are playing with fire.

[This blog entry was originally posted in a slightly edited form on Ms. Spranger’s blog on September 17, 2013. Its contents are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]

Stripped for Parts

by Theresa Spranger, Bioethics Program Alumna (MSBioethics 2012)

There was an article in the British Daily Mail recently about the possibility that eggs from aborted human females could be used for in vitro fertilization (IVF). The idea is that the ovaries of the aborted female would be harvested, and the eggs cultivated in a lab and then used in IVF treatments where a donor egg is required.  Ultimately, this would lead to the birth of a baby whose biological mother was never born.

I haven’t read any of the study results first hand, so I cannot speak to the scientific accuracy of the article.  Therefore, let’s discuss the issue purely as a hypothetical.

As I see it, there are several ethical issues involved with harvesting eggs from an aborted fetus:

  1.  How do you tell a child (or an adult person for that matter) that their biological mother was never born?  This would be incredibly difficult for a person to process.  Imagine the feeling of knowing that you were given a life to live because your mother died, that you were given a life she never got to experience.
  2. Who owns the genetic information contained in those eggs?  At this point in our society we do not grant the rights of person-hood to the unborn.  So, do we give the right of donation to the woman who had the abortion?  Is the body of the unborn child her property once it leaves her body?  Is it ok to use these eggs with permission from no one?  What kind of genetic testing will be done?  How will this information be used?  There really is no end to the questions and I don’t see how an adequate solution can be developed.  Keep in mind that to give donation rights to the mother alone would be an issue because it isn’t her genes alone she is donating; it is also the genes from the father.

Both 1 and 2 are major ethical hang-ups in my opinion, but what I would really like to talk about in this post is the dichotomy in our society regarding the issue of life.  Consider this scenario:

Jane is 19, in her first year of college, and discovers she is pregnant.  She decides this is not the time for her to have a child and she has an abortion.  Jane was carrying a little girl and at the abortion clinic they ask if she will donate the ovaries from that little girl.  Jane decides to do this; the nurse tells her all about how the eggs she donates will help a couple in need conceive a child.  Jane wants children someday, just not now, and she hates to see anyone who wants a child denied one.  Plus, it means that this whole ordeal wasn’t for nothing; it had a purpose, right?  She feels sort of empty and alone now that everything is done, maybe donating the ovaries will help bring her closure and make that empty feeling go away.

During this time, Tom and Mary are deciding what to do next.  They have tried everything imaginable to conceive and are left with two options: adoption or IVF with a donor embryo.  They consider the pros and cons.  Adoption can take years and there is always the chance that the mother will change her mind.  Can we deal with that they wonder?  They have been at this for 3 years already.  IVF on the other hand…it’s expensive sure, but they can start soon and maybe have a child by next year.

Tom and Mary go to the in vitro clinic and choose to use eggs from Jane’s aborted fetus.  The treatment takes and 9 months later they have a healthy baby girl.  Effectively making Jane, who thought she was too young to be a mother, a 20 year old grandmother.

The fact that we would consider using eggs from an aborted female highlights a real problem in our society: we are confused about life.  We seem to define life as that which is “wanted.”  This is illogical.  How can we justify valuing the eggs (and the life they can potentially produce) more than we value the human girl they came from?  Her little body was simply tossed aside after being stripped for parts.  On one end of the spectrum we are literally tossing life in the trash and on the other we are painstakingly and expensively creating it in a lab.

In our story, Jane wanted to donate the eggs to help a couple in need.  What if she were told about the amazing gift she could give a couple, as well as her unborn child, by choosing adoption?  Would Tom and Mary have been less excited to have this little girl?  Remember, they only decided against adoption because it is an arduous, bureaucratic nightmare, but isn’t there a way to fix that?  And wouldn’t it be well worth our time to help parents waiting for children more quickly find the children who need parents?

A world in which unfertilized eggs are worth more than a growing female fetus is a world confused and conflicted.  We create the very thing we have just destroyed.

I tire of the legal/illegal argument regarding abortion.  Most people, regardless of how they feel about the legality of the procedure, agree that abortion is not ideal and should, at the very least, be rare.  Let’s get creative and have a discussion about how to make abortions rare or even unnecessary.  By changing the conversation and making adoption a decision to be praised and honored in our society we could decrease the overall number of abortions and fix a bit of the confusion in our society about life.

[This blog entry was originally posted in a slightly edited form on Ms. Spranger’s blog on April 7, 2013. Its contents are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]