your great life

The adoption scheme that is flourishing in Harrow

I love spreading news of a family-building scheme that works. Put children who need loving, capable parents together with adults who have love and a nurturing home to share together. It sounds simple, but we know it isn't. As with many other social services in Britain, there is a postcode lottery, meaning that parentless or homeless children in some locales have a better chance of being adopted than a child elsewhere. Statutory guidelines differ, the view of adoption as the best option can vary among local authorities and social workers can dismiss prospective parents who don't "match" waiting children, failing to refer them to neighbouring authorities where they may find a better match.

The Times has gone so far as to call the overall scheme in this country "Britain's adoption crisis;" a result of only 2% of children in care being adopted last year in places such as Croydon, the worst performing council of all in Greater London. "Across England, the rate of adoption has been static for the past four years, with 13% of children in care being adopted annually." That begs the question of what is happening to the other 87% of children who don't have a real home. People who want families have been long put off by how difficult it can be to wade through the challenging bureaucratic tangle of the adoption services. They can face rigourous scrutiny, perhaps warranted, but also negativity, overly strict rules on ethnic "matching," long delays and an overall lack of support.

I was surprised and delighted to hear that my own local council, Harrow, is doing far better than most. According to Rosemary Bennett in The Times, the council that had one of the worst records of adoption in the country is approaching "best" now. The longer a child is in the care of social services, the harder it is to find them a permanent home, the more detrimental to the child's emotional wellbeing and the greater the financial cost to the community. Harrow's record of moving only 2 - 3% of children from care to an aoptive family, as recently as 2005, indicated ineptitude, but credit is due to someone at the local authority for realiing that they needed outside help to turn it around. They brought in 2 social workers and an administrator who were employed by Coram, a children's charity, and instituted controversial, but ultimately successful, systems.

This is what is working here in Harrow:

• The Coram staff work full-time in the local authority, find and assess prospective families, resulting in a pool of approximately 60 adoptive families under consideration at any one time;
• Adoption is considered from the outset, every time a child is taken into care, regardless of the age, race, religion, disability or number of siblings involved;
• The adoption plan is considered simultaneously with other plans which investigate how to support the child within their birth family, so that no time is wasted;
• the decision on whether or not a child should be adopted is taken within 4 months of arriving into care, exceeding the national guideline of 6 months; and
• 100% of those children are actually placed within a year.

Last year 20% of children placed in care in Harrow were either adopted or placed under a special guardianship order. Peter Tolley, service manager in charge of children's placements, said in The Times; "[W]hen these children read their records in the future, we want them to be able to see that every option was considered, that there was robust discussion, and that a lot of time and energy went into making the decision we believe is right for them." This message makes me feel personally very optimistic. Not only will more children be taken into families and private homes, but also that they will have a better understanding of why and how that transition took place, perhaps aiding their sense of belonging. Every child matters, but the longer they are a part of a government "system" and not part of a family, the less they may feel they matter. Their security and sense of personal self-worth are at stake andit is up to us to safeguard them.

Hopefully, Harrow Council will improve even further on their record, with the help of the Coram Harrow Partnership. In the meantime, if you are hoping to adopt, it pays to investigate the record of your local authority. and possibly, to move.

 

 

 

Embryo Freezing as a Lifestyle Choice

This morning on the Lorraine show (ITV), the presenter interviewed a woman, Gillian, by satellite from New York regarding the couple's choice to freeze their embryos at age 30 for a pregnancy later in life. The twist was that this couple is young, healthy and fertile. Gillian spoke about not being ready to become a mother and thinking that she and her husband would perhaps be ready to use the frozen embryos at around age 40.  She wants to be more settled, with a higher level of income/assets. Is there ever a perfect time to become a parent?

Some of the questions brought up by Lorraine Kelly and Dr Hilary Jones were:

• Is a child born to wealthier, "more settled" parents likely to be aware of, or any happier because of their parents' financial status?
• Is there ever a perfect time to become a parent?
• How Gillian would feel if, upon readiness, she finds herself unable to conceive, even with the frozen embryos used?
• How Gillian and her husband would feel if their frozen embryo resulted in a handicapped or special-needs child, because the safety/stability of long-term frozen embryos is unknown?
• What Gillian and her husband would do if they never felt ready to become parents and had frozen embryos in storage?

This was an unsatisfying interview for me, with questions hanging in the air and few definitive answers. I'm sure that Gillian and her husband thought about what they are doing very seriously, but the choice itself seemed an extravagant and frivilous one to me. They are healthy, fertile people of childbearing age, spending a lot of money and using a facility meant to help infertile people have a chance at becoming parents, for the sake of lifestyle convenience. Yes, the medical science is there to achieve the delayed pregnancy. No, they aren't taking anything away from anyone else. But, it doesn't sit well with me, in the same way as using a surrogate so you don't gain weight or get stretch marks wouldn't sit well. Perhaps it's because there are so many couples who would bear that child at any age if they could, regardless of convenience, and can't. Perhaps it's because it's down to money, which this couple clearly has to spare and so many who need it, don't.

Where do you sit on this issue? Please leave a comment below.

 

Chana Medical Conference will speak to Jewish concerns re fertility issues

Chana, a Jewish organisation concerned with fertility, is hosting its 1st Annual International Medical Conference in North London on Monday the 31st of January, 2011: "Facing the Fertility Challenge Together." Both medical experts and rabbis will present topics, being especially sensitive to Halachic (Jewish legal) implications. The workshops include Matters of Relationship Intimacy, Advances in Fertility Treatment, PCOS - Something to Fear?, Latest Developments in the Treatment of Recurrent Miscarriage and Endocronological Aspects of Fertility for the Jewish Woman.

I will be attending the Conference with a double-pronged interest:

1. reporting what I learn here and in other media; and
2. furthering my understanding of the unique perspective of Jewish law and culture toward fertility treatment, so that I can better serve the Jewish community as a fertility coach. 

If you have any questions you would like me to bring with me to the Conference, feel free to email them to me at [email protected].  I will do what I can to have them answered by one of the experts there on the day.

If you would like to attend the Conference, contact Chana at 020 8203 8455 or email [email protected]  Registration for the conference and all workshops is essential.

 

Steering IVF patients toward adoption from the start

How would you feel, if on your very first visit to the doctor regarding IVF, you were given an information pack about adoption?

Last week, there was a news report that Tim Loughton, the UK government minister for children and families, announced an initiative to prime childless couples for adoption, rather than fertility treatment. Loughton is concerned that there are too many children in care and too few being placed with families. Only 70 babies were adopted in the UK last year. He has a point. Is it too obvious to state that it is preferable to give a child a stable, loving family environment than to have them grow up in orphanages or foster care? He has good intentions, and the need is present, however, I wonder whether you have thoughts about the method he intends to employ?

Loughton apparently wants to get to childless couples before they begin the medical process to attempt assisted conception. His reasoning is that "they are clearly committed to bringing up children." He may be right, but I think he's missing a step here. At that point, on their very first appointment, they are committed to having and bringing up their own children. I fear that his proposed leafletting might be damaging, both emotionally to the infertile couple and in having the counter-productive impact of sending potential parents running. 

First,  a couple that has just begun to wonder why it's taking so long to conceive is hardly going to think of themselves as childless...yet. They may just be coming around to the realization that they need medical help to have a child, and think that once it's sorted, they will go along their merry way and have the family they want.

Second, it's jumping the gun a bit to approach a couple about adoption, when they are just exploring how medical treatment can help them to have their own child. Children aren't commodities. It's not like going to the shops to place an order for a sold-out product, and being offered a returned item instead.  I believe that with the vast majority of patients, the highest priority will be placed on having their own biological child at that point in the process. They will only be seeking guidance and approval on how to go about it. Some will find this type of information premature and disregard it; others may take comfort that it provides them with a Plan B, while still others may find it hurtful, intrusive or insulting.

Third, for many infertile people, the idea of being like "everyone else" and having a child who joins them as a couple and has recognizable, family traits is the ultimate choice.  We are romantic beings, wanting to recognize in our babies a mother's eyes, a father's smile, a grandparent's colouring or  a sibling's mannerism. With the advent of sperm and egg donation making the experience of pregnancy available to those who would otherwise have missed out, adoption is still seen by many as a last choice. There is not necessarily an immediate leap of consciousness from "why haven't I gotten pregnant this year?" to "let's adopt."

Mr. Loughton, finding out that you are infertile can be very difficult. If medical science can overcome infertility and give a couple what they want most, why shouldn't they go down that route? Additionally,a couple may need to go through a grieving process for the child they will not be able to bring into the world. They will not be receptive to your information packs until they have dealt with their grief. Sensitivity, time and coaching or counselling may be required to achieve acceptance of their situation and mental clarity about what IVF would entail in comparison to adoption. At present, adoption is not all that simple in the UK.

 I suspect that the difficult adoption process is the reason why only 3,200 children a year are adopted. Some people won't even bother trying because they have heard how notoriously difficult, intrusive and judgmental the process can be. The upper age limit for potential adoptive parents ranges between the ages of 35 and 40. Ironic then, that it is being proposed as the preferable option to IVF when many of those seeking treatment will be women in precisely that age range, cutting their chances rather close. Because people are getting married older, and women's fertility goes into rapid decline from age 35, it is often not until this age that they will seek IVF as an option to help them conceive.

It should be pointed out that besides the current, upper-age limit on adoption, the NHS cuts off funded IVF treatment at age 40. We might conclude from this that the government position has been that women aged 40 and older should not become parents, but apparently that's more about cost-effectiveness of treatment for women who have few healthy eggs remaining because of their age.  I wonder if cost plays a part in Loughton's new scheme, as diverting younger couples toward adoption would help both the NHS and Social Services reduce the stress on their budgets.

Adoption is a wonderful thing to do for an unwanted or parentless child and can create families where there would have been none. Thankfully, Tim Loughton wants to address the difficulty of adopting as well as shepherding would-be parents in that direction. He is quoted in The Sunday Times as saying that "the major consideration is [whether there is] a stable, loving environment to bring up a child [now] in care. There shouldn't be a hard and fast age limit or BMI (weight) index. We have older foster carers and we should consider older families to adopt."  He proposes that the upper age limit be lifted.

Tim, I couldn't agree with you more. But, please don't shoot yourself in the foot by pouncing too early on infertile couples who dream of having their own child. I propose that:

• the restrictions on adoption in the UK be revised first, so that more people can adopt;
• Then, a public awareness campaign can reach out to those who previously thought adoption was out-of-reach for them.;
• Only then would I target couples seeking IVF, in the sense of offering them alternatives to explore;
• Perhaps a simple, non-judgemental leaflet and questionnaire sent after an initial medical consultation could encourage those who would consider adopting instead of going through IVF;
• Couples who are willing to explore the idea of adoption could be offered coaching to help them weigh the pros and cons of IVF v. adoption as they apploy to them specifically, find common ground with each other on their values and priorities and make a positive choice for one or the other.

 

For known donor insemination, thorough discussion, legal advice and a contract are key to protect all parties, especially the children

There was a news item recently about a sperm donor who is involved in litigation over access to the two children conceived through artificial insemination using his sperm.  He had placed an advertisement in the Gay Times newspaper, stating that he was a gay male in a happy relationship, looking for a similar female couple who want to have kids. The children are now 7 and 9 years old. 

In this situation, there was apparently an agreement for some degree of co-parenting. Unfortunately, relations subsequently broke down and the women tried to rescind the agreement, forcing the father to get a court order in June this year. He won the right to see his children for almost half a year. The women are appealing the shared residency order.

We all know that any relationship can break down and that the fallout can be extremely difficult for father, mother and children. The complications usually arise from the emotional rift between the parents who, in all likelihood, once loved each other and intended to live together as a family. While lacking the personal hurt and emotional desertion, there are a whole host of other complications that can potentially arise from the breakdown of a donor/recipient relationship.

In some ways, it may seem that the very nature of donor/recipient relationships are  clear-cut in a way that a love relationship cannot be. You would think that all parties would have had ample time to discuss their desires and expectations and agree important aspects of the relationship before the children are born. However, no contract can really take into account the potential changes that people  will go through as they age, as their relationships evolve and as the children grow up.  While at least the donor/recipient don't have to deal with the particular ill will of a love relationship that has soured, they still have to work through unrealized expectations of each other as parents to their shared children.

If you are contemplating being a sperm donor to a known recipient, i.e. giving your sperm to a female acquaintance so she can conceive, or receiving donated sperm from a known male donor, through a private agreement, it's advisable to have your own legal advisor. 

• If the donation is completely altruistic and free of any intention to share parenting rights and responsibilities, there should be a written agreement that reflects this.  Regardless, under current legislation, upon turning 18 years old, the child will have the right to seek the identity of their biological father.
• If the donor wants to be involved in his biological child's upbringing, this intention should be stated from the very beginning and an agreement as to the extent of his involvement put in writing, signed by both parties and witnessed.
• Discuss access to the child, which could include co-parenting, visitation rights, holidays together or merely the agreement that one day, after a specified age, the child could reach out to meet his/her biological father. Contingencies should be discussed, such as whether the mother can move residence to a location out of the donor father's reach for visitation.
• Try to anticipate the fundamental issues involved in bringing up any child, such as what religion they will be raised in, who will have a say in medical decisions for their health and welfare, who is entitled to make decisions regarding their education, who can apply for a passport on their behalf and who will be named as their guardian if the custodial parent is incapacitated or deceased.
• Discuss financial responsibility for the child, including maintenance and education, including whether there are any contingencies, and until what age the responsibility is in force.
• Talk about emotive issues like gift-giving, especially if there is a disparity in the financial means of the donor father and the recipient mother/parents. Are gifts welcome at all? Do they have to be approved by the custodial parent? Should financial gifts be made directly or through a Trust?
• Agree who will be regarded as siblings, half-siblings and grandparents.
• A woman who is in need of donor sperm to conceive may make concessions during an agreement with a known donor out of desperation. For example, she may regret those concessions once she is a mother and raising a child without the benefit of child support from the donor father, or she may regret agreeing to visitation because of a different views regarding the best interests of the child. Either way, a change of mind is bound to upset someone and may be best mediated by a third party.

There are so many more areas to cover that this only scratches the surface. Even if everything above is covered by a written agreement before the child is born, one cannot anticipate what the child himself will think of the way in which he was conceived.  It's unlikely that he will wish it had never happened, as that would mean his own non-existence, however, he could wish it away, preferring to love and honour his biological mother and her partner, if any, to the exclusion of the biological donor father. What if the child identifies strongly with the donor parent and wants more access to him than any of the parties originally anticipated? The worst imaginable situation, would be for the child to become a pawn, moved back and forth by parents whose amicable relationship has ceased.

There are several sources of support, information and guidance for donor-conceived children and their families:

• The Human Fertilisation and Embryology Authority is a UK government reglatory body.  http://www.hfea.gov.uk/23.html 
• Donor Conception Network is a self-help network of over 1,300 families created with the help of donated eggs, sperm or embryos; couples and individuals seeking to found a family this way; and adults conceived using a donor.  http://www.donor-conception-network.org/ 
• Altrui provides a professional service to find altruistic egg donors for people who need donated eggs or sperm to help them start a family, and may provide an alternative for you to using a known donor. http://www.altrui.co.uk
• There is a service that helps people find their "perfect parenting partners" which has a good section on their website listing frequently asked questions and answers for people to consider. http://co-parentmatch.com

 

 

 

Planetary link to fertility? A British astrologer thinks so

Last week at the Fertility Show, I walked past the stand for Fertilityastrology.com without stopping. Honestly, I didn't think it was worth my time to stop and inquire what it was about, when I had a few dozen other practitioners on my list to see during the day.  I may have sold Nicola Smuts short.  According the The Sunday Times, Smuts has just agreed to let Shady Grove Fertility, a chain of U.S. fertility clinics, test her claims that women are most fertile when the alignment of certain planets are similar to when they were born.

It's not for nothing that we refer to the circle of life and the miracle of life. The fact is, that with all the advances in medical science, we still don't understand everything about fertility and conception. A hefty percentage of cases of infertility and miscarriage are unexplained. There are plenty of instances of conception after years of both, which are also unexplained. I have come to believe, over time, that we can develop subconscious blockages to conception; born from pain, fear, trauma, stress and anger, among other negative sources. I have seen the positive impact on women who de-stress, resolve deep emotional issues and take on an attitude of openness to possibility. I have spoken to women who swear that they were helped to conceive by acupuncture, yoga, reflexology and massage, all of which are regularly refuted in medical trials. However, when conception follows, I do believe that these changes contributed to a woman's success; not that they are a substitute for medical treatment or wholly responsible. Thankfully, neither does Smuts. In The Sunday Times article, she admits that her clients' success could also be "down to coincidence, a placebo effect or the power of suggestion."

So, why did I initially react with skepticism to Smuts' astrological service? I don't have great belief in astrology under any circumstances. If I read the weekly astrological predictions in the back of a magazine, I treat it the same as I do the fortune in a Chinese cookie: I ignore what I don't like and circle what I do. I think of it as a bit of fun, but I don't take it seriously. I suppose that I am afraid that women who have spent years and fortunes to have a baby and come up empty-handed, may be desperate enough to put their hopes in the hands of someone who may be spinning them a story.  I have nothing on which to base my belief or disbelief, so don't go by me.

It's true that our menstrual cycles tend to follow a 28-day pattern, like a lunar month. I just don't see the connection between where the planets were on the day I was born and my ability to conceive. I was born a month premature. Perhaps if I supplied Nicola Smuts with my birth details, she could help me understand if there was a connection between that and why I failed to conceive for several years, and why I conceived my two children when I did. Regardless, there are women who were labelled infertile who credit Smuts with predicting the conception of their babies.  If it's good enough for them, who am I to knock it? I would like some more proof, before I can suspend my disbelief, so I am looking forward to reading the results of the Shady Grove test when it is made public.

How many siblings do I have? For Donor 150's children, it's 14 and counting

I've become very interested in the issue of regulations surrounding the use of donor sperm and eggs, so it was with great interest that I read an article in the Sunday Times this weekend, written by Kate Spicer.  It recounts the story of Donor 150 from the California Cryobank and the children born with the use of his donated sperm. A film about six of Donor 150's biological children, Donor Unknown, is premiering this week at the Sheffield documentary festival.  The true story is told of how six half-siblings met each other and their biological father; Jeffrey Harrison.

The children of Donor 150 became aware of each other through the Donor Sibling Registry; a website that helps donor-conceived children find any half-siblings they might have, and potentially, their father.  Wendy Kramer, founder of the Donor Sibling Registry, has been able to match 7,800 of them since 2000.  She predicts that she will be even busier as time goes on, as more donor-conceived children become young adults and want more information about their origins.

The lovely story here is that, so far, six of the 14 children known to have been fathered by Harrison now have the information they sought. They have met and developed relationships with their half-siblings; noticing similarities in their physical appearance, mannerisms and personalities. They now know where at least some of their characteristics come from. I am guessing that the association has added another level of identity to their emotional toolkit; better understanding of who they are because of where they came from.

According to Spicer, Jeffrey Harrison is a likeable beach bum and animal lover, cheerful, happy-go-lucky and spiritual. He does, however, come from intellectual stock, with some accomplished close relatives, so perhaps "his children" can trace their own intellectual and creative talents to them. While this is not their father in any sense of the word other than the use of his cells to create them, their tolerance of his offbeat ways and recognition that he is a kind and gentle person give them something on which to form a relationship of sorts.  For his part, Harrison sounds quite bemused to have a half-dozen young people who are biologically connected to him, look like him and want to know him. He says "I love the kids."

We have to wonder about the other children potentially born from Harrison's sperm, the number of which is as yet unknown.  Harrison donated sperm up to four times a week on and off for a period of eight years.  Because his profile was particularly attractive, mentioning good looks, a mellow personality and his illustious relatives, but leaving out the mention of his camper van home, Harrison was a popular choice of women requiring donor sperm. 

One of the hotly debated issues at the recent PET debate was how donor-conceived children will feel when they find out the truth of their origin.  There were a few on the panel and in the audience who thought that emotional upset, if not psychological damage, could result from a child finding out that their mother was paid money in exchange for her eggs. Others challenged this assertion, including me, believing that if the child is given the information in a sensitive and age-appropriate way, honouring the use of this form of assisted reproduction with gratitude for helping to create that child and that family, it would not be damaging. The children of Donor 150 bear this second theory out. Spicer interviewed them:

• 20 year old JoEllen Marsh (no relation to me) who is the child of a two-mother, lesbian couple, who said "If you grow up and it's part of your identity, it's cool. I'm proud. It's my story." 
• Roxanne Shaffer, 21, thinks Jeffrey is nice, with "the kindest heart."
• 23 year old Ryann McQuilton considers herself lucky that her parents were always honest with her about being donor-conceived. She believes that "keeping the truth from [children] can be damaging both to the relationship and the child's self-imag."
• Danielle Pagano, 21, was not told that she was donor-conceived by her parents until she was in her teens and has "some issues." It was Danielle who originally contacted JoEllen Marsh, when they were 16 and 15 years old, through the Donor Sibling Registry.

These young people seem to consider themselves fortunate, for the most part, to have met each other and to have met and liked the man who fathered them.

The industry in America is unregulated, so many dozens of children of Donor 150 could unknowingly be half-siblings. One of these, Rachelle, felt paranoid about the possibility of dating one of her half-siblings so chose only those of different ethnic origins. This was one of the issues brought up at the recent PET debate in London, as a reason to limit the number of children who could be born of a particular donor's gametes (sperm or eggs).  The HFEA is currently examining its UK regulations which govern donor gametes, including the issue of payment v. compensation. Currently, the law in the UK only allows for up to £250 compensation for expenses while there is a free market in the US, encouraging men like Jeffrey Harrison to sell his sperm frequently and over many years.

If UK law continues to limit compensation for donor gametes, the quantity will undoubtedly remain sparse. More people desperately wishing to create families will  feel it necessary to travel to a less regulated marketplace, such as the US, where they can choose from a menu of personal characteristics to find the donor of their choice. However, they will also run the risk of their child being half-sibling to dozens, if not hundreds, of other donor-conceived people.

If the law changes to allow a higher rate of compensation (see my blog post on the PET debate) or payment beyond compensation, more donor gametes will undoubtedly become available here in the UK. The higher cost of the gametes themselves would be offset by the money saved on international travel.  The other, equally if not more important, factor would be that the UK law limiting the number of times any donor may donate gametes is unlikely to change.  This effectively reduces the risk of half-siblings unknowingly engaging in incestuous relationships with each other. Since UK law now entitles children conceived with donated sperm in the UK after April 1, 2005, to know the donor's identity once they reach 18, the children would not be disadvantaged by being conceived here.

If this interests you, you may want to attend The Progress Educational Trust (PET) conference 'PASSPORT TO PARENTHOOD: THE EVIDENCE AND ETHICS BEHIND CROSS-BORDER REPRODUCTIVE CARE', taking place later this month, on Wednesday 24 November 2010 at London's Institute of Child Health, and there are still places available - see http://www.progress.org.uk/conference2010

I'd really like some comments on this topic. Have you seen Donor Unknown? If you have a perspective on any aspect of donor gametes, please let me know what you think.

A chance to listen, learn and speak at PET's Debate - Paying Egg Donors: A Child At Any Price?

There are times when I feel very fortunate to live within easy commuting distance of central London and last night was one of those.  Instead of the usual household chores and evening TV shows, I popped into London to attend a debate organized by the Progress Educational Trust (PET) at the Royal Society of Medicine: "Paying Egg Donors: A Child At Any Price." It was well worth the effort, to be privy to the information and opinion of several eminent speakers on the panel, as well as those audience members from the fields of medicine, counselling, government, related charities and scientific research.

One thing about which there is no debate is the extreme shortage of egg donors in the UK. The Human Fertilisation and Embryology Authority (HFEA), which currently regulates the providers of fertility treatment such as IVF using donor eggs, will be considering various models of compensation in January, 2011, as a possible means of boosting supplies of donor eggs. as well as reversing the increasingly popular choice among British residents to travel abroad for fertility treatment.  At the last HFEA Open meeting on the 8th of September, 2010, which I attended, its chair, Prof. Lisa Jardine, made no bones about the fact that she is concerned that fertility treatment providers in foreign countries may not be subject to the same stringent oversight as in the UK, therefore creating a risk to patients. Others' objections to "fertility tourism" may be equally concerned about the loss of revenue to UK fertility clinics, exploitation of egg recipients' desperation for a baby, and the trading of human, genetic tissue (gametes) as a moral issue.

Currently, in the UK, egg donors are only compensated for their expenses, which include loss of earnings for days of work missed; a daily maximum of £61.28 or a total of £250.  The questions regarding payment were these:

1. Should compensation merely compensate for lost earnings, or for additional factors such as risk to the donor, drug treatment, sexual abstinence and/or pain and discomfort? If the latter, then how much compensation is reasonable, to leave the donor no worse off than she was before the egg donation, but no better off financially?
2. Is egg sharing morally favourable because the donor is giving her eggs to another woman, or is it merely a financial transaction (trading of human eggs for financial gain) by another name (donors receive a discount on their IVF)?
3. Should egg sharing be limited to altruistic donation in which the donor has no expectation of any financial payment, or other compensation?
4. If there is no legal barrier to a woman giving her eggs to someone else, why shouldn't she be able to sell them?

One panel member, Brenda Almond of the Philosophical Society of England, likened the trading of genetic material, cells, to the slave trade.  She cited libertarianism, as a philosophy holding that the vulnerable should be protected, to support her assertion that human eggs, which could one day become embryos and eventually, a living child, need protection. I assume what she meant is that the children who are born of those eggs are not able to assert free will over how the transaction takes place.  She also posed the question of whether, by performing donor egg IVF, clinicians are violating the "do no harm" rule, as there is inevitably emotinal impact upon the donor, the recipient, the donor's children and the recipient's child.

While I don't doubt that Ms Almond holds sincere views on the subject, these controversial views, were, in my opinion, stated for effect last night. While I don't subscribe to her views, I was very open to hearing everyone, but found her to be the least persuasive of all the speakers. My belief is that the slave trade argument doesn't apply, as :

1. the egg is not "human flesh;"
2. if produced by the donor, but unused to create a pregnancy, it would otherwise go to waste; and
3. there is no human child, if the egg is not fertilized with the intended father's sperm and carried in the intended mother's womb.

Opinions diverged widely during the debate, much of it focusing on what the donor could reasonably expect to receive for giving her eggs to intended parents. In egg sharing a woman, who is already planning to have an egg retrieval for her own IVF, can expect to receive £2 - 3,000 worth of fertility treatment as a benefit.Several people present last night voiced opinions that egg sharing is really egg trading because of the value of the benefit received, making it a financial transaction by another name.

But, what of the healthy, fertile woman who doesn't need IVF? She may want to give her eggs to a specific woman; a sister, friend or stranger, completely from a place of generosity. There are avenues for making this gift, such as Altrui - an egg donation scheme that matches donors and recipients. One such woman, Laura Witjens, Chair of the National Gamete Donation Trust, and a mother, sat on last night's panel, personally advocating a payment to egg donors of approximately £700.  She believes that amount would be enough to cover the donor's costs, and constitute a gesture of appreciation for the value attached to the donation, without being potentially exploitative....not enough money to change the donor's life, pay off their debt, etc... Interestingly, while Witjens' twins were naturally conceived, she stated that if she had been infertile, she absolutely would have paid for eggs to become a mother.

Some of the people present at the PET debate, both on the panel and in the audience, batted back and forth the idea that knowing their biological mother received payment for the egg that created them would be psychologically damaging. Some people may have difficulty coping with the knowledge that they sprung from a donated egg, regardless of the issue of payment. How is this scenario any different from adoption, where adoptive parents must prepare themselves for educating their child about their origins in a sensitive and understandable way? Raanan Gillon, Chair of the Institute of Medical Ethics, countered that argument in the best way possible; saying "the alternative to having a donor-conceived child be upset about the egg being bought, would be that they don't exist at all." Quite right. How many people would wish they had never existed and their parents never having had children, rather than any payment being made to the donor?

In regard to the argument of almost-inevitable harm, I have to ask: "so what?" The donor should be provided with counselling prior to carrying out the egg retrieval and donation, to ensure that she understands the physical risks and emotional ramifications involved.  Her existing or future children can be raised with the message that Mom did something generous to allow another woman to have a child who would not otherwise have been able to do so. The recipient is surely informed about all of the angles of the process and should be counselled up until she conceives, if not afterward as well. The donor-conceived child is the one who needs the most attention and sensitivity.  Yes, there is a risk, especially in cases of anonymous egg donation, when there will be a loss of genetic connections with biological maternal relatives. This could cause feelings of not belonging, incomplete sense of identity.  However, anonymous donation was not the topic of the evening.

In the case where the donor-conceived child will have the right to seek their biological mother at the age of 18, his parents have the responsibility of preparing their child adequately for what he may discover. Prof. Brian Lieberman, Medical Director of Manchester Fertility Services, called for all of the exchanges taking place in egg donation to be open and transparent. I believe it was he who said that his overriding concern for the donor-conceived child is that they are able to feel proud of who they are and how they are created. That, to me, is the goal in raising any child, conceived naturally, through assisted reproduction techniques or adopted. That message is one of love and belonging.

Much was made of the US free-market model for egg donation, the range being quoted as anywhere from £8 to £19,000.  While Prof. Gillon did not see payment for eggs, in itself, morally objectionable, the consensus of most panel members and speakers from the audience was that if payment was made it should be a regulated, fixed fee, rather than a market-driven fee like in the US.  Among that group, a lump-sum fee of an amount between the current £250 and Laura Witjen's suggested £700 seemed to be favoured; the amount resting on the difference between inducement and coercion.  For those willing to embrace a fee at all, this amount was sufficient as an inducement to give something of value, the egg, to someone else which requires the donor to experience some physical risk and inconvenience. Anything more, in their opinion, could make a change in the donor's lifestyle, therefore running the risk of coercing that person to do something which they might otherwise believe immoral or otherwise wrong. Dr Sue Avery, Director of the Fertility Centre at the Birmingham Women's Hospital and a panel member, felt that the "lump sum argument is fallible, because any amount will be an incentive to someone to do something they would not otherwise wish to do."

You may be interested to hear my contribution to the debate. I had had no intention, whatsoever, of speaking; however at the end of the evening, I felt it necessary to point out that it was all well and good debating ethics in a vacuum, but it should not be forgotten that real people are involved here.  The British government, associated with the Church of England, promotes family values. The evidence is undeniable that most people want to create families and they are not willing to let a diagnosis of infertility come between them and a baby. The country is proud of the breakthroughs in medical science that have occurred here, and more money has been made available for fertility treatment through the National Health Service (NHS). However, there are still many couples who find themselves shut out, some by the severe shortage of donor eggs available.

I shared with the PET audience that my husband and I never got to the point where I was told I couldn't go any further because of a shortage of donor eggs. We felt let down by the medical system here that moved at a snail's pace in responding to my infertility and then told us I was too old to qualify for IVF under NHS regulations. At 42 years old, with few quality eggs left, using donor eggs would have had to be my next step if we had gone further. (I am one who, like the cliche, miraculously conceived naturally 3 months after my failed IVF cycle.) I have clients who are in the same position now that I was in ten years ago. Faced with the probability that their own sub-standard eggs mean they will never conceive, I believe that most women would be willing to pay something in appreciation for this priceless gift from another woman.

As Laura Witjens pointed out, "patients vote with their feet." If they cannot get access to the assisted reproduction techniques they need to create their families in the UK, they will seek them out elsewhere, even if payment must be made. If the government wants those needing fertility treatment to stay in this country, it has to make concessions to the needs and desires of those concerned. It can't rely upon "in the best of all possible worlds..." but, instead, must make the world we live in as easy to negotiate as possible, in a positive way, aimed at a positive result.

If you have been an egg donor, used donor eggs or just have an opinion about whether payment should be made to an egg donor, and if so, how much, I would like to hear from you.

I expected to be judged, frowned upon for choosing single motherhood

Guest blogger: Emma, 41, single & mum to be. 2 attempts at IVF using donor sperm. Second cycle resulted in a BFP and am now 12 weeks pregnant.  

When I first started thinking of embarking on my path to single motherhood, I thought of every reason ‘not’ to do it rather than the reasons why I should.   I thought about my own relationship with my father which had been supportive & loving, I thought about how my Mother had been adopted & the curiosity I have had with not knowing who my grandparents were & where they came from. I thought about how unfair it would be to bring a child into this world without a father.  I mulled it over & over and in fact decided against it many times, deciding to wait for Mr Right to turn up & hope that we could live a ‘normal’ family life together, whatever that might be! 

As I turned 40, I realised that as there was no sign of Mr Right perhaps I should get on with things myself.  This coincided with several events, a friend of mine was being beaten up by her partner, and another friend’s husband had just left her with 5 month old twins. It made me realise that there was no ‘ideal’ situation. Someone who had ‘had it all’ 3 months ago was now on her own, struggling, furious, hurt and bringing up 2 small children."

I was also talking to a young girl who had been brought up by a man she believed was her father but had found out when he had tragically died that he was not.  I asked her if she thought about her ‘real dad’.  She said no and that she had considered the man who brought her up & loved her to be her ‘real dad’.  It really made me realise that it is the people who love and support you that are your family, not necessarily your genetic partner.  

In making my decision I chatted to friends and family. My Mum didn’t agree, “I wouldn’t do it if it was me”.  I asked her how she would feel now, widowed and with no children.  “Of course, I wouldn’t be without you & your brother.”  I told her that I didn’t want to be childless, and that if I were to have my own child I had to hurry u about it.  At 40 my ovaries were not about to wait for a perfect partner to show up.   I think her reaction was tied up to the fact that she was adopted.  Unfortunately she was never told as a child & it was too late when she had eventually tried to trace her Mother.  She had died some years before and taken the information about my grandfather to the grave. 

I explained that things would be different with my child, that it would never be a secret & that I would always be completely open with my child about their conception. Not only that but I would assist them in finding out about the sperm donor/ genetic father if that was a route they wanted to take.   Mum wasn’t sure but I told her it was something she needed to get her head around as it was going to happen.  I am happy to say my Mum has since been a tower of support and has very involved through out my 2 cycles of IVF.   

My brother, with whom I am very close, was supportive from the start.  He could see where I was coming from and has supported me throughout my IVF process.  He is now thrilled to be a uncle-to-be and signs his emails off as ‘Uncle D’.  

Now when it came to discussing it with my friends, I must admit I  expected someone along the line to put up some resistance, to tell me I was being selfish or to ask me what on earth I thought I was doing.  But no one did.  Everyone told me that I would make a great Mum and they all seemed to understand to my reasoning of why I was doing it, and everyone wished me the very best of luck.  

I had to have counselling as part of my IVF, I expected the counsellor to judge me and thought that I might have to really justify my actions to her.  She was really supportive & again said she understood why I was taking the route I was.   At my first appointment with the midwife, again I expected to be judged, frowned upon, but no, she was, like everyone else had been, incredibly supportive.  

So despite waiting for negative comments, half expecting them from everyone I told, I wasn’t really prepared for my first negative reaction!!   It came from my Aunt.  I had said nothing to her about the IVF, I was just ringing to tell her that I was pregnant. There were no words of congratulations.  “Don’t you think you’re too old? I mean, you’ll be 61 when your child’s 20. It’s going to be very hard work on your own. Have you thought about this?”  

I was more annoyed than upset.  Of course I have thought about it, I have thought about it for years.  Of course I know it will be hard work.  But I know it will be worth it. I will be a Mum. Something I have always wanted.  I’m not too cross at my Aunt, she is not likely to understand.  This is a woman who has had 4 abortions and has no living children of her own. She has obviously never had the desire to be a Mum as I do. She had at least one of those abortions while in a happily married relationship as she didn’t want her lifestyle to change.  I find it very hard to respect her because of her decision and don’t expect her to be able to respect mine.  We are very different.  

So at 12 weeks pregnant I now face the dilemma of whether to tell people how I got pregnant.  I don’t want it to be a big dirty secret and I don’t mind what people say about me but I would hate my child to be bullied about it in later years.   I went to the hairdressers yesterday, as I walked in I could see her eye up my belly.  As I sat down I told her I had some news, that I was pregnant.  “Oh my God, how exciting, I want all the details” she said.  Someone else washed my hair and I sat there thinking, what do I say? Do I tell her the truth? Or do I make up a story? I felt a bit panicked after my Aunt’s response.   As I sat in front of my hairdresser she said “Come on then, all the juicy details.”   So I told her, I told her the truth…because I am not ashamed of what I’ve done. And guess what, she was really understanding, supportive & excited for me!  

It’s made me come to the conclusion it’s not what other people think about you, it’s about how you feel yourself.  No one can make you feel inferior without your consent.

Indian surrogates are very cooperative?

This Tweet appeared in my timeline tonight:

#Surrogate mothers in #India are very co-operative and never cause any legal issues & also they don’t fight for ur kid http://bit.ly/aTSEa7

In the blog, Dr Shilpa Saple talks about how surrogates in the U.S. reserve a right to claim the child they bear. She wants to reassure interested parties that this legal right doesn't exist in India, therefore they won't run the risk of a custody battle. 

Does anyone else think that sounds really suspect? I hope that its the stiff use of English as a second language that makes this sound like the surrogates are like penned innocents with no rights.  Let me state right away, that I am in favor of people being able to travel abroad for the best medical care at the best price.  I don't have any direct experience of Rotunda IVF and have no problem with either them or the country of India as they relate to fertility treatment.  I would commiserate with any couple who found themselves involved with an "uncooperative" surrogate, who Gd forbid, decided to stake a claim to they child she carried for them.

Maybe it's my middle-class, Western political correctness coming out.  I once read a novel about a society in which a separate class of women were used as breeders by the upper class, but not allowed any emotional involvement. They were meant to accept their lot in life; even be proud of doing their duty. It also reminds me of the Stepford Wives. Except in India, the women are real.

Taking on surrogacy is an enormous decision, involving the woman's physical and emotional health. I don't object to the commercial aspect of surrogacy at all; I just want reassurance that it is being done with good will, regardless of how much it paid. I have read stories of poor Indian women traveling from their villages to the cities to become surrogates, so they can bring a substantial payment back to help their own families.  As long as it is completely voluntary, fairly compensated and will actually allow the women to achieve that better life they want, it makes some sense to me. I just don't want them to sign away any rights that they will need if all doesn't go to plan.

In regard to the suggestion that the Indian surrogates are being exploited by well-off Westerners who pay for whatever they want, I think the issue is more about how they are managed and treated by the IVF clinic itself.  One could argue that it is the Indian clinic and surrogates are the ones doing the exploiting, since they see a market demand and are rushing to fill it, helped along by their different economy. The $6,000 the woman might earn goes a long way in India.

What do you think? Is the Tweet at the beginning of this post poorly worded, or suspect? I'm sure that Dr. Saple has the best interests of her patients and clients in mind.  Perhaps it is just the sweeping generalizations she makes in her blog that make me worry; not just about this topic, but also about how American gay couples live in isolation and how they are offered only impaired children to adopt. I can't help but think that she needs a ghostwriter or editor.

Please leave a comment about how you see this situation. Thanks xx