Thailand: a surrogate mother refuses to allow the child to leave with a homosexual couple

The world’s media attention is currently focused on a legal battle underway in Thailand between homosexual partners and a surrogate mother.

On finding out that the intended parents were homosexuals, Mrs. Kusolsang, the surrogate mother, changed her mind and did not sign the relevant passport documentation for the child she had already handed over to the couple. Since then, Gordan Lake, the American biological father, and Manuel Valero, his Spanish husband, have been unable to leave Thailand with Carmen, pending the completion of proceedings at the end of March. Gordan Lake stated that he never concealed his homosexuality from New Life, the surrogacy agency, which has subsidiaries in numerous countries.

This is a complicated case. Thai law does not recognise same sex marriages. Furthermore, a law passed in February, just after Carmen’s birth, bans commercial surrogacy. In fact, Thailand had become a popular destination for foreign couples keen to employ surrogacy services, particularly because of the few existing regulations and competitive tariffs. However, numerous scandals have emerged (see Surrogacy and child trafficking: an account from the mother of "baby Gammy"), leading to the ban on this practice for foreigners.

UK scientists gain licence to edit genes in human embryos

Scientists in London have been granted permission to edit the genomes of human embryos for research, UK fertility regulatorsannounced. The 1 February approval by the UK Human Fertilisation and Embryology Authority (HFEA) represents the world's first endorsement of such research by a national regulatory authority.

"It’s an important first. The HFEA has been a very thoughtful, deliberative body that has provided rational oversight of sensitive research areas, and this establishes a strong precedent for allowing this type of research to go forward," says George Daley, a stem-cell biologist at Boston Children's Hospital in Massachusetts.

The HFEA has approved an application by developmental biologist Kathy Niakan, at the Francis Crick Institute in London, to use the genome-editing technique CRISPR–Cas9 in healthy human embryos. Niakan’s team is interested in early development, and it plans to alter genes that are active in the first few days after fertilization. The researchers will stop the experiments after seven days, after which the embryos will be destroyed.

The genetic modifications could help researchers to develop treatments for infertility, but will not themselves form the basis of a therapy.

Robin Lovell-Badge, a developmental biologist at the Crick institute, says that the HFEA’s decision will embolden other researchers who hope to edit the genomes of human embryos. He has heard from other UK scientists who are interested in pursuing embryo-editing research, he says, and expects that more applications will follow. In other countries, he says, the decision “will give scientists confidence to either apply to their national regulatory bodies, if they have them, or just to go ahead anyway”.

Development genes

Niakan’s team has already been granted a licence by the HFEA to conduct research using healthy human embryos that are donated by patients who had undergonein vitro fertilization (IVF) at fertility clinics. But in September last year, the team announced that it had applied to conduct genome editing on these embryos — five months after researchers in China reported that they had used CRISPR–Cas9 to edit the genomes of non-viable human embryos, which sparked a debate about how or whether to draw the line on gene editing in human embryos.

At a press briefing last month, Niakan said that her team could begin experiments within “months” of the HFEA approving the application. Its first experiment will involve blocking the activity of a ‘master regulator’ gene called OCT4, also known as POU5F1, which is active in cells that go on to form the fetus. (Other cells in the embryo go on to form the placenta.) Her team plans to end its test-tube experiments within a week of fertilization, when the fertilized egg has reached the blastocyst stage of development and contains up to 256 cells.

“I am delighted that the HFEA has approved Dr Niakan’s application,” said Crick director Paul Nurse in a statement. “Dr Niakan’s proposed research is important for understanding how a healthy human embryo develops and will enhance our understanding of IVF success rates, by looking at the very earliest stage of human development.”

A local research ethics board (which is similar to an institutional review board in the United States) will now need to approve the research that Niakan’s team has planned. When approving Niakan's application, the HFEA said that no experiments could begin until such ethics approval was granted.

Woman, 60, fights for right to give birth to her dead daughter's baby using her frozen eggs

Two senior judges have allowed a 60-year-old woman to continue to fight an extraordinary legal battle that may allow her to give birth to her dead daughter’s baby.

The woman, who would be at least 61 by the time the child is conceived, has been given the right to appeal against a High Court decision that there was not enough evidence to suggest that the daughter would have wanted her mother to give birth to the baby.

If she and her 59-year-old husband are granted permission to use the frozen eggs, which are stored in a London clinic, it is believed that it will be the first time in the world that a grandmother would give birth to her dead child’s baby.

The couple’s daughter, who cannot be named for legal reasons and was referred to as ‘AM’ in court proceedings, died aged 28 in 2011 but had frozen her eggs five years previously when she was diagnosed with bowel cancer.

Her parents, referred to as Mr and Mrs M, say their daughter wanted her mother to carry a child in the event that she did not survive. However, the Human Fertilisation and Embryology Authority (HFEA) refused to release the eggs because she had not provided full written permission.

In their judgment Lord Justice Treacy and Lord Justice Floyd both admitted they had been ‘doubtful’ that the mother would have any prospect of winning the case but said they were swayed following ‘clear and persuasive’ arguments from the family’s barrister.

In previous hearings, it was claimed that AM had told her mother on her death bed: ‘I want you to carry my babies. I want you and dad to bring them up. They will be safe with you. I could not have had better parents.’

Mrs M said her daughter had ‘wanted her genes to be carried forward after her death’ and had regarded the eggs as ‘living entities in limbo waiting to be born’.

The matter came to court because of the HFEA’s insistence on needing written permission from the daughter.

In a High Court hearing last year Mr Justice Ouseley was told that AM, who was single at the time of her death, would have been ‘devastated’ if she had known the eggs would never be used but he supported the HFEA’s decision, adding that it was not in breach of the family’s human rights.

The judge said: ‘I must dismiss this claim, though I do so conscious of the additional distress which this will bring to the claimants, whose aim has been to honour their daughter’s dying wish for something of her to live on after her untimely death.’

The court heard that the family’s plan had been to take AM’s eggs to a treatment centre in New York so that they could be fertilised using sperm from a donor and implanted into Mrs M at a cost of £60,000.

An HFEA spokesman said: ‘We understand why Mr and Mrs M would wish to carry out what they see as their daughter’s wish.

‘However, we considered their application on three separate occasions, concluding each time that the consent given did not satisfy the requirements of the law. Our decisions were then reviewed by a High Court judge, who supported our view.

‘We will read today’s decision to grant appeal carefully. Out of respect for Mrs M and her family, and for the ongoing legal process, it would be inappropriate for us to comment further at this time.’

DOES THE PARENTAL PROJECT LEGITIMIZE HAVING A CHILD?

Introduced amidst successive bioethical laws, the “parental project” was originally meant to specify the conditions in which a man-woman couple is granted access to medically assisted procreation. Over the course of years, this concept was assimilated to the desire of having a child, which alone legitimized the embryo’s dignity. Gènéthique goes over the facts along with Professor Benoît Bayle.

The parental project has become a key notion, supportive of the reproduction edifice: “From abortion to [artificial] reproduction techniques, the binding element is the all-powerful ‘parental project’. Faced with the absence of a parental project or, possibly, one that turns out to be disappointing or defective, a woman aborts. Driven by a parental project that nature seems reluctant to fulfil, people will turn to technique for the completion of the child of their dreams” [1]. It is also in the name of a parental project that a couple chooses to have recourse to contraception, or decides to stop taking it. The parental project remains an undeniable guiding principle concerning the way conception is managed.  Very popular, considered as the paradigm of the so-called “wanted” child, it rules over our minds because it is the result of a form of societal agreement, thus enabling people to justify not only the practice of abortion, as suggested by the sociologist Luc Boltanski [2], but also, more widely, the instrumentalization of the conceived human being from its first embryonic stage to later prenatal stages.

There is, indeed, no possible room for the respect of the human embryo’s life in our current society, because it is simply impossible to integrate the notion of respect in the heart of the various practices which contribute towards reproductive health, from modern contraception to artificial reproduction. We are, in this case, dealing with a technical fact, a scientific reality, and not an ideological vision. For example, medically assisted procreation was only able to be developed thanks to experiments carried out on human embryos, without any reproductive finality. Scientists thus had to free themselves from the respect of the human embryo to be able to develop such techniques [3]. On a different note, the use of IUDs and of most oral contraception excludes the possibility of respecting the human embryo, because of their possible or predominant anti-implantation effect. The procreation industry thus forces people to cut free from any ethical imperative relative to the respect of the life of the human embryo, without which it could not carry on developing, or even existing.

The notion of parental project thus supports the procreation edifice by ensuring the promotion of new duties. The ethical necessity of the respect of the life of the unborn child has not become simply optional; it has been reversed and must be abolished in the name of the supposed well-being of the child, which must not live if it was conceived inside an insufficiently elaborate parental project, because its life would hence be a burden: “The ultimate justification brings up the unhappiness of the person who would have been born, had the abortion not interrupted his/her development. It is precisely from that unhappiness that abortion has saved unborn babies” [5]. The parental project thus promotes a new moral that turns our opinion around when faced with the respect of the life of a developing human being. It creates a moral duty that consists in taking out unborn children who don’t conform to a presumably authentic parental project.  On the other hand, the parental project allows the limits to be transgressed, and justifies the instrumentalization of embryos within the boundaries set by procreative parental projects: for example, it is possible, in a double pre-implantation diagnosis, to overproduce human embryos to enable one of them to survive, in order to later use it to treat the disease of a sick brother or sister. Thus, as many as twenty-seven embryos were necessary in order for Ulmut Tahar, “designer baby”, to be born [6]. In that case also, the scientists had but little respect for the life of the embryos; the emphasis was entirely put on the magnified project of helping the sick brother or sister…

The parental project hence requires a verbal confirmation for any new-conceived human being: only a human embryo endowed with an authentic parental project could be granted some dignity; one void of any parental project has none. This reversal of values is quite practical: it is the parents’ desire, their project, which establishes the full humanity of the conceived human being. Only a child wanted within a parental project is human. The dignity of the human being that has been conceived thus finds itself subjected to an extrinsic recognition. But this relational ontology is flawed. Who would be bold enough to assert that the dignity of a human being must entirely depend on the desire that others, exterior people, have for it! The words of others cannot, alone, be constitutive of this dignity. The dignity of a human being exists intrinsically, otherwise it becomes arbitrary and random. The dignity of the human embryo, demonstrable through the indirect way of its violations [7], is no exception to the rule. As such, the parental project is well and truly a delusion used to hide the prenatal instrumentalization of the conceived human being. The greatly problematic nature of this delusion is widely felt, but, as everyone seems to benefit from it, no one can nor dares condemn it.

The unique technique of individual donor selection

Certainly, the choice of the egg donor is the most important step for parents, who need woman's genetic material. Nature is a multi-faceted thing, and the main expert`s task of reproductive medicine clinics is to anticipate it and predict the outcome. Today, there was developed a unique method of 3D modeling appearance of a child, using a three-dimensional model of the donor and the child's father. How does this happen?

To begin with, each donor is fixed in the photo and video with the help of special 3D technology, so you may see a woman from all sides, zooming in and out the image. On the basis of this material, there is created an anthropometric and physiognomic portrait of the woman, and then her basic characteristics are digitized. After receiving the same data about the future father they can be superimposed on each other and predict the possible appearance of a child.

In addition, the other data, such as the IQ of the donor, education, abilities, inclinations and state of health down to small details (like dental health), temperament and character traits are also calculated. There is also explored the history of the family - parents, grandparents, brothers and sisters, questions about existing child donor are also asked.

It is important that the donor base is as widely as possible, then you simply have more options and choices to make.

You can choose the features that are inherent to you or those, which you have dreamed of for a long time and which you would like to see in your child. The choice is yours!

Chinese scientists have grown artificial sperm

In China, scientists have grown sperm in the laboratory. Male germ cells were created in the artificial conditions by means of which mice were subsequently inseminated. The experiment was successful and there was brought ultimately healthy offspring.

Spermatids were managed to grow from the stem cell by research team, led by Xiao-Yang Zhao. They hoisted 191 fertilized egg to female rodents. As a result 9 completely healthy mice have appeared, that are also able to acquire offspring in their reproductive age.

This method, according to scientists, will help to deal with male infertility. Although this application, only mice were currently subjected to this experiment. Their biology of development, as we know, has fundamental differences with the human. Nevertheless, the scientists hope that the new testing method on humans is a matter of time.

MRI helps predict preterm birth

MRI of the cervix is more accurate than ultrasound at predicting if some women will have a preterm birth, according to a new study from Italy appearing in the online edition of Radiology.

Early dilation of the cervix, a neck of tissue connecting the uterus with the vagina, during pregnancy can lead to premature delivery. Women in their second trimester of pregnancy with a cervix measuring 15 millimeters or less, as seen on ultrasound, are considered to be at higher risk of preterm birth. However, ultrasound has limitations as a predictor of preterm birth, as it does not provide important information on changes in cervical tissue in the antepartum phase just before childbirth.

"A better understanding of the process of antepartum cervical remodeling, loosely divided in two distinct phases called softening and ripening, is critical to improve the diagnosis of cervical malfunction and anticipate the occurrence of birth," said the study's lead author, Gabriele Masselli, M.D., from the Radiology Department at Sapienza University in Rome.

To learn more, Dr. Masselli and colleagues used an MRI technique called diffusion-weighted imaging (DWI) to examine pregnant women who had been referred for suspected fetal or placental abnormality. DWI reveals differences in the mobility of water molecules in tissue and the results can be used to create apparent diffusion coefficient (ADC) maps that provide a measure of local cell density. DWI has been increasingly used for abdominal and pelvic diseases, but has not been tested for the evaluation of the uterine cervix in pregnant patients.

Each of the 30 pregnant women in the study had a sonographically short cervix and a positive fetal fibronectin test between 23 and 28 weeks of gestation. Fetal fibronectin is a glue-like protein that helps hold the fetal sac to the uterine lining, and the presence of it before week 35 of gestation may indicate a higher risk of preterm birth.

Of the 30 women, eight, or 27 percent, delivered within a week of the MRI examination. The other 22 delivered an average of 55 days later. The researchers compared differences in ADC values at MRI between two areas of the cervix: the inner, subglandular zone and the outer, stromal area. While stromal ADC and sonographic cervical length showed no difference between both groups, the subglandular ADC was higher in patients with impending delivery, suggesting an increased mobility of water molecules in that area consistent with cervical ripening.

"Our results indicate that a high ADC value recorded at the level of the subglandular area of the cervix is associated with the imminent delivery of asymptomatic patients with a short cervix," Dr. Masselli said. "In detail, the subglandular ADC was inversely correlated to the time interval between MRI and delivery and therefore emerged as a powerful imaging biomarker in evaluating patients with impending delivery."

The research team is planning larger, multicenter trials to confirm the role of subglandular ADC analysis in predicting preterm birth, Dr. Masselli said.

Vietnam: DNA testing reveals twins from different fathers

A stark difference in appearances of twins born to a couple in Vietnam led them to take the children for DNA testing, which confirmed the twins had different fathers. The unidentified twins were taken to a lab in Hanoi after the father's suspicions grew leading him to confirm whether or not he was the children's biological father.

"Our Centre for Genetic Analysis and Technology lab has tested and found a pair of bi-paternal twins," said Le Dinh Luong, president of the Genetic Association of Vietnam. "This is rare not only for Vietnam, but for the world." The DNA testing revealed that the man was the biological father of only one of the twins while his wife was found to be the biological mother of both of the children.

The twins born a few hours apart are now two years old and look nothing alike –while one has thick, wavy hair, the other twin has thin, straight hair. A hospital mix-up was ruled out after it was confirmed that the woman is the biological mother of both the twins, reported state-run Tuoi Tre newspaper.

Bi-paternal twins are born when a woman's eggs are fertilised by sperms from two different men during the same ovulation period. When both eggs are fertilised by the same man, normal fraternal twins are born, however when two different men are involved, the phenomenon is known as superfecundation.

Earlier in 2015, a US woman applying for child support from the father of her twin daughters was shocked after it was discovered that the man was the father of only one of the twins. Obstetrician-gynaecologist Jennifer Wu said that a sperm can remain viable for up to five days and ovulating women can produce over one egg, making it possible for a woman to be impregnated twice.

The kids are OK

A study in the journal Fertility and Sterility has found that children born from assisted reproduction are as healthy and well-educated as their naturally conceived peers. Lead researcher Jane Halliday, of the Murdoch Children’s Research Institute in Melbourne, Australia, wrote about her work in The Conversation. She said that: “most IVF offspring have grown into healthy young adults with a quality of life and educational achievement comparable to those of non-IVF conceived peers.”

Questions hover over the long-term safety of IVF because of the great differences in the early environment. Hormonal stimulation, fertilisation outside the body and living in a Petri dish for a couple days are not the way that most people begin life.

IVF children clearly have an increased risk of preterm birth and lower birth weight compared to other children. They are also more susceptible to some birth defects. However, little research has been done on the effect of IVF upon the health of older children. Dr Halliday and her colleagues studied the health of young adults aged 18 to 28, and reached generally positive conclusions. The only caveat was that

“We did find that IVF children had a slightly higher chance of asthma and other respiratory allergies, such as hay fever, which are common conditions in the whole community. But the difference was small with 30% for IVF children and 23% for others.”

There were some limitations to the research. First of all, the good news was self-reported by mothers and children and was not based upon medical examinations. In fact, the information was gathered over the phone. There may have been a degree of selection bias, as a high percentage of couples fail to tell their children that they were conceived through IVF. Mothers were excluded if their child had died (which is the ultimate confirmation of bad health). And only singletons were studied, but much of the ill-health for IVF babies is linked to multiple births.

What the study may show is that if women have singleton IVF babies, it is unlikely that they will be less healthy as young adults. But the question of whether they have a lower life expectancy due to health problems in middle age remains unanswered.

Womb transplants: first 10 British women given go-ahead

The UK’s first womb transplant is set to take place next year as part of a clinical trial in which 10 women will get the chance to carry their own babies.

Following the birth of a baby boy last year after a successful procedure in Sweden, the Health Research Authority has granted ethical approval for 10 transplants. The first British baby born from a transplanted womb could arrive as soon as late 2017 or 2018.

More than 100 women have been identified as potential recipients of transplants for a team of surgeons to be led by Dr Richard Smith.

About one in 5,000 women – or 50,000 of childbearing age in the UK – were born without a womb, while some cancer sufferers have had theirs removed.

Smith said the technique would offer hope to women who could only have children through adoption or surrogacy. The consultant gynaecologist at the Queen Charlotte’s and Chelsea hospital, who has been working on the project for almost 20 years, said he was “really, really pleased” to obtain ethical approval for the transplants.

“For many couples, childlessness is a disaster. Infertility is a difficult thing to treat for these women,” he said.

“Surrogacy is an option but it does not answer the deep desire that women have to carry their own baby. For a woman to carry her own baby – that has to be a wonderful thing.”

To take part in the trial a woman must be aged between 25 and 38, have functioning ovaries and their own eggs, a long-term partner and be a healthy weight. Only a third of the 300 women who approached the Womb Transplant UKteam met the criteria.

Before the trial starts, embryos will be created and frozen using each woman’s eggs and sperm from her partner. They will then undergo a six-hour operation to receive a womb from a donor who is classed as braindead but who has been kept alive.

Smith said using deceased donors reflected the complexities of the operation.

“Donor retrieval is a bigger operation than transplanting the uterus into the recipient,” the surgeon said. “We don’t want to subject a live donor to that operation.”

Organ donor coordinators have suggested that about five wombs annually could be made available.

After 12 months on immunosuppressant drugs and close monitoring, each woman will be implanted with one of her embryos, with the hope of achieving a successful pregnancy.

A baby would be delivered by caesarean section to prevent the donor womb suffering the trauma of labour.

Six months after giving birth, each woman can try for another child, or the womb will be removed. That would minimise the risk of keeping women on immunosuppressant drugs for the rest of their lives.

However, the trial needs to raise £500,000 before any operations can take place.

“I’ve always been an enormous optimist,” Smith said. “The project has run with no money from the start. Somehow or other, somebody has always turned up and given us enough money to keep it going.”

Just over £40,000 has been donated to the Womb Transplant UK project andcontributions can be made here.

A 36-year-old Swedish woman gave birth to a baby boy in September 2014 after receiving a donor womb from a 61-year-old family friend who had given birth to two sons. She and her partner – both competitive athletes – named the baby Vincent, which means “to win” in Latin.

“As soon as I felt this perfect baby boy on my chest, I had tears of happiness and enormous relief,” the mother said. She had been told at the age of 15 that she did not have a womb.

Demographic and Lifestyle Factors Influence Who Receives a Medical Evaluation for Infertility and Who Does Not

Boston researchers conducting a prospective cohort study found that women who already had children, who were older, current smokers, or had a higher BMI were less likely to report having a medical evaluation for infertility than younger, slimmer, non-smoking, childless women.
Using data from the Nurses’ Health Study II, researchers at Harvard’s TH Chan School of Public Health and Brigham and Women’s Hospital identified a number of demographic and lifestyle factors associated with whether or not a particular woman having trouble conceiving receives a medical evaluation for infertility or not.
The Nurses’ Health Study II began in 1989 with 116,430 female registered nurses between the ages of 25 and 42 returning a mailed questionnaire on their health and lifestyles.  Every two years, they answer a follow-up questionnaire, with about 92% of the original group continuing to participate. On each questionnaire from 1989 to 2001, and then again in 2005 and 2009, the were asked “if they had tried to become pregnant for more than one year without success.” Then, they were asked the cause of their infertility. The questionnaire permitted them to choose from several different diagnoses, report multiple diagnoses or that the cause of their infertility was not found, or report that that the cause of their infertility was not investigated.
The subjects of this study were the 7,422 women who reported experiencing infertility after the first questionnaire cycle. Women were eligible to enter this analysis until menopause. About 65% of the women reporting infertility also reported having had a medical evaluation for infertility.
Certain indicators of better access to health care were significantly predictive of whether or not a woman would have had a medical evaluation for her infertility. Women who lived in states with comprehensive insurance coverage, had a high household income, or had a recent physical exam were all more likely to report receiving an infertility evaluation.
In addition, demographic characteristics influenced the likelihood of a woman receiving an infertility evaluation.  Older women and women who had already had children were less likely to have an infertility evaluation, while women whose husbands had a graduate level education were more likely to be evaluated.
Lifestyle choices also played a part. Women who exercised frequently, took multivitamins, and who had never smoked were more likely to have had a medical evaluation for their infertility.

Owen Davis, MD, President of ASRM commented, “This study shows that even within a group whose members have a high degree of medical knowledge and a professional connection to the medical system, there are a host of subtle factors that influence who receives a medical evaluation for infertility and who does not.  No doubt there is a degree of self-selection at work; individuals’ temperaments and personal health philosophies, as well as their economic and family situations, affect their decision to seek fertility care and whether or not they receive it.  Women who practice a healthy lifestyle, in addition to those women who have more comprehensive insurance or better financial resources, may be more likely to pursue an infertility diagnosis. As practitioners, we can try to recognize the potential personal, individual barriers patients face to seeking fertility care and work to create a treatment environment where they see more options beyond the barriers.”