About five years ago, a fortysomething woman hoping to get pregnant with a new partner sought Toronto lawyer Sherry Levitan’s counsel about an unconventional family “collaboration.”
Her own eggs having effectively expired, she intended to use fresher, younger eggs — donated by her adult daughter.
The eggs would be fertilized with the new partner’s sperm and the resulting embryos injected into the woman’s uterus, resulting, she hoped, in the birth of a baby — her genetic grandchild. The new child’s half-sister — the egg donor — would be its biological mother.
Levitan doesn’t know whether the family ultimately went through with their elaborate procreative plans. “I was never informed otherwise,” said Levitan, an expert in third-party reproductive law.
But it’s just one example of “intrafamilial collaborative reproductive arrangements” — the sharing of eggs, sperm or wombs among first-degree relatives — occurring in fertility clinics in the U.S. and Canada.
If we feel there is some coercion, or the medical risks are too high, definitely we’ll back away
The unorthodox, medically assisted conceptions allow intended parents to preserve a genetic link, a “kinship tie,” that would otherwise be lost using an unrelated egg or sperm donor, experts say.
However, such collaborations are also presenting prickly ethical dilemmas, according to a new and updated position statement from one of the world’s leading bodies of fertility specialists, including impressions of “apparent though not actual” incest, undue coercion, confused family dynamics and the “possible confused parentage” for the resulting child.
Some combinations should be rejected outright because they’re consanguineous — involving people descended from the same ancestor — or “simulate incestuous unions,” warns the guidance document produced by the American Society for Reproductive Medicine’s ethics committee.
For example, a sister should be prohibited from providing eggs to be fertilized by a brother’s sperm, a brother’s sperm shouldn’t be used fertilize a sister’s egg and a father shouldn’t donate sperm to replace that of his daughter’s infertile husband.
Other arrangements can also create the impression of incest, including a brother who donates sperm to his sister to use with an anonymous egg donor, or a father donating sperm to his divorced daughter to use with a donated egg.
“It’s not actual incest, at least as we understand incest in common parlance today,” said Judith Daar, chair of the ethics committee and professor of law at Whittier Law School in Costa Mesa, Calif.
“It’s just that if you were to look at the genetic relationship that the child bears to two people, it would suggest some kind of sexual relationship,” Daar said, even though IVF is a medically-assisted process that doesn’t involve sex.
The ethics committee said it’s important not only to consider the impact on individual children and their families, “larger societal concerns are raised by these arrangements as well, because they may create new genetic relationships never before possible.”
“The importance of the goal to preserve genetic linkages may be questioned when the reproductive arrangements become so extraordinary and complex.”
The committee lists 18 such configurations, and the resulting genetic and social relationships for the child.
For example, in the case of son-to-father sperm donation, a son donates sperm to his father, usually for a second marriage. A child is born. The “father” is the genetic grandfather, the child’s half-brother the genetic father.
In a mother-to-daughter donation, a mother donates eggs to her infertile daughter. The child’s “grandmother” is the genetic mother. The child’s “mother” is her genetic half-sister.
The number of requests for, and procedures performed is unknown, because fertility clinics are not collecting or reporting the data.
Little is also known about the impact on the resulting children.
Choosing family members ensures some portion of the infertile person’s genes will be passed to the child, the ASRM committee writes, including in cases involving lesbian, gay, bisexual or transgender individuals.
The importance of the goal to preserve genetic linkages may be questioned when the reproductive arrangements become so extraordinary and complex
In addition to preserving a “genetic closeness,” it’s also considerably cheaper. It costs US$10,000 to $12,000 to order six frozen eggs from American egg banks. In Canada, where it’s illegal to pay someone a fee for donating eggs, donors can still be reimbursed for their expenses, sometimes upwards of $5,000.
A daughter providing eggs to her mother, by contrast, isn’t likely to request payment. And a paper published in February in the journal BMC Medical Ethics predicts that, as more people seek IVF and other assisted-reproduction services, and as the costs of egg donation especially remains high, “such patients will no doubt increasingly continue to seek cheaper, unconventional approaches.”
While the majority of Levitan’s clients needing donor gametes look to the wider commercial market, about 20 per cent “have a family member that’s ready, willing and able” to participate.
Her recent cases include a father who donated sperm used to artificially inseminate his son’s wife. The son “simply had no sperm, as in zero sperm,” Levitan said. “The father volunteered, and the daughter-in-law was very accepting.”
In an ongoing case, “we can’t use the woman’s eggs, but she has a brother, and the husband has a sister,” Levitan explained. “So, they’re using eggs from the sister, and sperm from the brother, so that both intended parents will have a biological connection to the child, but neither one of them is using their own gametes.”
According to the ethics committee, sperm, egg or womb sharing arrangements are generally ethically acceptable, provided everyone has consented freely and fully, and except where “such arrangements are consanguineous or simulate incestuous unions.” While laws banning sexual relations and marriage between certain individuals wouldn’t ban egg or sperm donation involving the same people, “the risks of consanguinity are the same.”
Daar’s committee recommends parents tell their children about the nature of their conception as soon as the child is fully able to understand it.
Vanessa Gruben, an associate professor of law at the University of Ottawa, said critical conversations need to happen before people enter into any one of these arrangements, including, “is this actually going to be in the best interests of the child? How will we explain this to the child?”
Dr. Jeffrey Roberts, president of the Canadian Fertility and Andrology Society, is sympathetic to the concerns. “In medicine the unborn child doesn’t always take priority, unfortunately,” said Roberts, medical director for the Pacific Centre for Reproductive Medicine in Burnaby, B.C.
“It’s important not to pass judgement,” he said, “or convey our own beliefs.” He believes such complex requests are rare. Still, one of the most disturbing requests he’s encountered occurred after informing a woman her chance of conceiving using her own eggs and IVF was “essentially zero.”
“The woman had one daughter, and she’s in the room, she’s 12 at that time, and the woman asked me, ‘Could we use her eggs?’”
“I just asked her to really think about what she just asked me,” Roberts said. (In Canada it is illegal to use gametes from minors under 18.)
“That’s just someone in a panic and not thinking,” Roberts said. “The drive to have a child is obviously quite strong, and they’re grasping at straws. They’re just thinking, ‘Where can I get that egg?’”
“It’s virtually always going to come down to the rights of the donor, the individual that’s doing this for the commissioning couple,” he said. “If we feel there is some coercion, or the medical risks are too high, definitely we’ll back away.”