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Thursday, January 12, 2012

Helping trans-men and trans-women have children


The subject of helping trans-men and women have children with the help of assisted reproductive treatments has received a lot of attention lately.  Strictly FYI, here’s a short review of materials and professional meetings addressing those issues. 

2010

Timothy F. Murphy (2010). The Ethics of Helping Transgender Men and Women Have Children. Perspectives in Biology and Medicine 53 (1):46-60.

In this article, I defend access to ARTs by transgender men and women, even if – as some think – transgenderism is a mental disorder.  There is nothing about transgenderism that disables anyone’s ability to understand the nature and consequences of parenthood, and there is insufficient evidence to show that children of transgender men and women are harmed in any way that would justify prohibition of this kind of parenthood.   

2011

The World Professional Association for Transgender Health issues the 7th version of its standards of care.  This document advises clinicians to ensure that people undergoing hormonal or surgical body modifications for purposes of gender expression be aware of the effects of those treatments on fertility.  Some may suppress gametes temporarily, while other interventions will leave people permanently unable to produce gametes.  The document also advises that clinicians take steps to make sure that men and women are aware of possible means of preserving their ability to have genetically related children later on, through various established and experimental means of gamete and tissue preservation. 

2011

At its annual meeting, the American Society of Reproductive Medicine held a session on transgender men and women. 

Male to Female Transgender Surgery: Techniques, Results, and Postoperative Sexuality
Joint Session presented by the Society of Reproductive Surgeons and the Sexuality Special Interest Group. 

Stanton C. Honig, M.D (Chair), University of Connecticut School of Medicine.  Jared C. Robins, M.D, The Warren Alpert Medical School of Brown University.  Christine McGinn, M.D., Papillon Center.

2011

The professional meeting ‘Controversies in Obstetrics, Gynecology, and Infertility’ held a pre-conference session on transgenderism in general and ARTs as well at its November meeting in Paris.  This is the program: 

WHAT DID WE LEARN FROM TREATING THE TRANSSEXUALS? 

Dealing with transsexuals presents a great surgical, endocrinological and medico-legal challenge. The ability to reproduce following such surgery presents another level of complexity and requires a multidisciplinary approach to formulate the optimal solution. What kinds of skills are required to embark into such complex treatments?  

Part I.  Surgical, medical and medico legal considerations

·         Planning for transsexual surgery: which approach should be offered? - S. Pinho, Brazil
·         Which hormonal treatment should be formulated following surgery? - R. Andrade, Brazil
·         Transsexual who is opting to conceive: what are the medico-legal aspects?  Á. Petracco, Brazil

Part II   Clinical experience

·         Psychological aspects: follow up 150 patients female to male - J.M. Ayoubi, France;
L. Karpel, France
·         Androgens and ovary:  what can we learn? - J-N. Hugues, France
·         Donor insemination in the transsexual; - P. Jouannet, France


2012

The European Society for Health Reproduction and Embryology will hold a one-day program on transgender issues at its professional meeting in Istanbul, July 1.  See: 

‘Non-standard requests?’ – Ethical and legal aspects of medically assisted reproduction in singles, lesbian and gay couples, and transsexuals

Course co-ordinators:  Guido M.W.R. de Wert (The Netherlands) and Wybo J. Dondorp (The Netherlands)

·         Assisted reproduction in single women: problematic or not at all? - Berna Arda (Turkey)
·         Lesbian couples sharing biological motherhood: IVF for reproductively healthy women? Wybo Dondorp (Netherlands)
·         Two men and a baby: ethical and legal issues in surrogacy and egg donation for gay male couplesJuliet Tizzard (United Kingdom)
·         Clinically assisted reproduction and fertility preservation with transgender men and womenTimothy Murphy (USA)
·         Welfare of the child: scrutinizing evaluation criteriaGuido Pennings (Belgium)
·         Non-discrimination, human rights and institutional autonomy in the provision of assisted conception services Emily Jackson (United Kingdom)
·         Gifts with moral strings attached: Should gamete donors have a right to exclude non-standard couples/persons as recipients? ­– Christoph Rehmann-Sutter (Germany)
·         Conclusions Guido de Wert (The Netherlands)

2012

The Cambridge Quarterly of Healthcare Ethics will publish a case of a transgender couple who seek clinical help in having a child.  The clinicians involved seek the advice of an ethics committee.  The case will be accompanied by commentaries by Timothy F. Murphy, Lance Wahlert and Autumn Fiester, and Sarah Hunger. 

Saturday, January 7, 2012

Wi-fi computer connections: A threat to sperm?




Researchers in Argentina took sperm samples and exposed half the sample to a wi-fi connection for about 4 hours. The other half was kept out of the wireless range, but otherwise treated in the same way. 

The exposed sperm “showed a significant decrease in progressive sperm motility and an increase in sperm DNA fragmentation.”  The researchers “speculate that keeping a laptop connected wirelessly to the internet on the lap near the testes may result in decreased male fertility.”  Of course, they say further study is needed to prove this possibility.  

If you're using a wireless connection to the Internet to read this and you're a male trying to have a child, you may want to shift to a cable connection just in case.

The complete article -- C. Avendaño, A.  Mata, C.A. Sanchez Sarmiento, G.F. Doncel.  Use of laptop computers connected to internet through Wi-Fi decreases human sperm motility and increases sperm DNA fragmentation. Fertility and Sterility 2012 (97):  39-45.e2.  – is at:  http://www.fertstert.org/article/S0015-0282%2811%2902678-1/abstract

Thursday, January 5, 2012

Some candidates for president think a personhood pledge is a good idea. It's not.


A batch of candidates running for the Republican party’s nomination for President of the United States have signed the Personhood Pledge.  The sponsor of that pledge -- ‘Personhood USA” -- describes itself as “a movement working to respect the God-given right to life by recognizing all human beings as persons who are “created in the image of God” from the beginning of their biological development, without exceptions." (See:  www.personhoodusa.com.)  The effort is, therefore, inherently rooted in religious beliefs.

But the group’s standard of personhood is not obviously religious.  It says that “Personhood is the cultural and legal recognition of the equal and unalienable rights of human beings.”

This may be the effect of being a person, but it is not what personhood is.  Personhood has to be – and can only be – the possession of certain traits and capacities.  It is in the name of respecting and protecting those traits and capacities that we confer moral and legal protection on persons.   

The “Personhood Republican Presidential Candidate Pledge” asserts that: I believe that in order to properly protect the right to life of the vulnerable among us, every human being at every stage of development must be recognized as a person possessing the right to life in federal and state laws without exception and without compromise.”  The moment of conception is the threshold at which personhood is reached.

This approach may make sense according to some theologians, but it is neither good moral philosophy nor law.  Conception is a process, and it fails probably more often than it succeeds in producing a child.  Zygotes and  embryos do not have either the property of persons.  This is to say that all zygotes, embryos, and fetuses are human organisms, but not all human organisms are persons.  We can lose our personhood.  We do it – for example – when we become brain dead.  Most people do not think of brain-dead people as brain-disabled people, and I mean really brain-disabled.  We think of the loss of certain properties as the loss of the life of a person.  And if we can think that way at the end of life, we can think that way at the beginning of life.  Persons emerge over time, and both morality and the law confer rights and duties on human beings according to their traits and capacities, not just because they were once conceived.  The idea that conception is both necessary and sufficient to bring persons into existence is a moral and legal mistake. But that’s apparently not enough to keep it from being used as political football. 

Freezing eggs? Don't delay.


Freezing female ova has always been more complicated than freezing male sperm, but recent developments in freezing techniques have increased the odds of achieving a pregnancy and a live birth.  But freezing is only one problem in the process.  Retrieval of useable ova depends on several factors, and a woman’s age is decisive here.  At age 35, women’s ability to produce viable eggs falls off sharply.  Not only that, but success rates in establishing pregnancies in women through in vitro fertilization falls off sharply with increasing age as well.  Many women do not, however, have good estimates of their future fertility, and they often delay taking steps to freeze their eggs until they have very poor prospects for achieving a successful pregnancy.  The average age for women to take steps to freeze ova in the hopes of having a child later on is 38.  That’s ‘old’ by the standards of successful pregnancies.

In light of this outcome, two analysts – Heidi Mertes and Guido Pennings -- at the Bioethics Institute at the University of Ghent have argued on behalf of a campaign to get the message about ova freezing to women early.  By the time a woman is in her early 30s (if not before), they think she should know the basic fertility arithmetic:  younger is better when it comes to freezing eggs and that age 35 puts the prospect of a pregnancy in doubt even with the assistance of fertility clinicians.  Women who wait will be “more often wrong than right” that they will be able to have a baby, frozen ova or not.  

As freezing techniques improve, it is likely that more and more women will turn to clinicians for help in storing their ova in the hopes of having a child.  This prospect will reinvigorate the debate about whether it is ethical to freeze eggs for ‘social reasons,’ namely for non-medical reasons.  Most commentators seem sympathetic to the idea that women facing therapies that will destroy their ova should have the option of freezing some to preserve their option of having a genetically related child later on.  Women who delay having children because they are pursuing a demanding job, higher education, or because they can’t seem to find the right partner do not always seem as sympathetic.  Nevertheless, the demand for freezing ova is only likely to increase, but that demand should be informed by the realities of human physiology, and it is reasonable to take steps to ensure that women know what lies ahead of them, since their prospects of having children are much different than for men. 

See Heidi Mertes, Guido Pennings.  Social egg freezing:  for better, not worse.  Reproductive Biomedicine Online 2011 (23):  824-829.