Tuesday, January 25, 2011

When the Surrogate or Donor is Family

An anonymous comment alerted me to this article (thank you) about intrafamilial medically assisted reproduction (IMAR). It discusses a position paper published 20 January 2011 by the European Society of Human Reproduction and Embryology (ESHRE). The context framing this is when unrelated spouses use a close relative of one of the spouses to assist in reproduction, but the issues are also relevant to those involved in consanguineous spousal relationships (such as, say, first cousins or a mother and son or a sister and brother) who want to have children.

The group advises to evaluate each request for IMAR individually, based on four ethical principles in health care: the respect for autonomy, beneficence and non-maleficence and justice.

That sounds reasonable.

The Task Force explains that the right for individual autonomy is elementary: any individual should have the principle of choice with whom to reproduce. It is understandable that couples wish to preserve some sort of genetic identity with the child, and hence may wish to choose a donor in the family.

I personally know a lesbian couple who had used sperm from a brother of one of the women. It is fairly common for same-sex couples or heterosexual couples experiencing infertility to involve a close relative in some way, whether as a surrogate mother, sperm donor, egg donor, or embryo donor.

In some countries IMAR is illegal and the relevant laws against incest and consanguinity apply to protect the offspring from genetic risks and to avoid possible social disruptions and conflicts.

Ridiculous. How about using genetic testing to avoid risks?

According to the principle of justice, doctors should treat similar cases in the same way. So if sister-to-sister oocyte donation is accepted so should brother-to-brother sperm donation.

This is fair.

The paper gives special attention to (rare) cases of consanguineous IMAR, involving the mixing of gametes of persons that are genetically closely related. "The Task Force considers consanguineous IMAR between up to third degree relatives as acceptable in principle, subject to additional counseling and risk-reduction," says Professor Guido de Wert, coordinator of the ESHRE Task Force. "Here, genetic counseling is appropriate to assess the increased risk of conceiving a child affected by a serious recessive disease."

With genetic counseling, there shouldn’t be any restriction on degree.

First-degree intergenerational IMAR needs special scrutiny, also in view of the increased risk of undermining autonomous choice. First- and second degree consanguineous IMAR is at odds with the spirit of anti-consanguinity and anti-incest legislation in most countries and should not be offered.

The laws should be changed.

In any general population the risk of having a child with a handicap or a major disease is 3%. In third degree consanguinity [such as between cousins], the risk is estimated to be around 5-6%. If the applicant and the intended collaborator carry the same disease, there is a 25% risk of conceiving a child affected with that particular condition.

I encourage anyone, even if they don’t believe they are closely related, to get tested before making children, and that would include testing any donated sperm or egg. Isn’t it good to know the risks ahead of time so that an informed decision can be made? Close relatives can and have had healthy babies together, but it is good to know the possibilities? You don’t have to get tested as a pair. You can get individual tests.
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