Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0018
R. Klitzman
{"title":"Choosing Policies","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0018","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0018","url":null,"abstract":"The United States regulates assisted reproductive technologies far less than do other Western countries, most of which have more nationalized health insurance. US states vary widely in whether they have any laws and, if so, what. Governmental agencies (e.g., Food and Drug Administration, Centers for Disease Control and Prevention) and professional organizations (e.g., American Medical Association, American Society of Reproductive Medicine) have begun addressing several areas but could potentially do more. Improved national and professional policies are needed regarding several areas, including egg and sperm donation, egg donor agencies, numbers of embryos transferred into wombs, gestational surrogacy, oversight of providers, insurance coverage, and data collection. Doctors generally perceive problems in the field but argue that industry self-regulation, rather than government policy, is adequate. Yet many providers fail to follow current guidelines and regulations. Moreover, new technologies continue to develop, including gene editing of embryos through CRISPR and mitochondrial replacement therapy (so-called three-parent babies). More data and research are crucial on current use of procedures and long-term medical and psychological follow-up of patients, egg donors, gestational surrogates, and offspring, to evaluate, for instance, the effectiveness of egg freezing and longitudinal follow-up of children born through these procedures.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"275 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132403437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0013
R. Klitzman
{"title":"“How Much Is a Child Worth?”","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0013","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0013","url":null,"abstract":"Patients face dilemmas of how much to pay for these technologies—how much a child is worth. Countries range widely in their laws and regulations concerning insurance coverage but generally have restraints. Prospective parents commonly draw on present or future savings or income they might otherwise dedicate to graduate school or other long-term goals. Yet uncertainties can persist about how long treatment will take. Medical, financial, and legal stresses mount regarding both the total costs and the eventual extent of insurance coverage. Physicians cannot wholly foresee the kind or amount of necessary treatment, frustrating patients. Critics have also argued that many clinics are too “entrepreneurial” and profit-oriented, raising additional ethical and policy questions.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123457111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0010
R. Klitzman
{"title":"Choosing Children","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0010","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0010","url":null,"abstract":"Prospective parents who fail to get pregnant using these technologies frequently consider adoption of infants or foster children as an alternative but can then encounter various obstacles as well. Many infertility patients investigate adoption as a backup plan, offering hope. But they face quandaries of how long to keep trying in vitro fertilization before pursuing this alternative or accepting childlessness—whether having a biologically unrelated child is better than not having a child at all. Varied financial, administrative, and other logistical obstacles to adoption can prove daunting. Adopting babies from both the United States and abroad has become harder. Due to costs and trade-offs, many individuals consider but finally reject these options.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121198163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0019
R. Klitzman
{"title":"Designing Our Future World","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0019","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0019","url":null,"abstract":"The providers’ and patients’ experiences presented here reveal how powerful technological advances can shape current and future human lives in profound and at times unexpected ways, with critical medical as well as psychological, social, cultural, familial, moral, existential, and financial implications. In the infertility industry, laissez-faire market capitalism, with little regulation, has created a “Wild West.” At the same time, these rapidly advancing technologies remain expensive and not available to everyone, widening disparities between rich and poor and raising key questions about social justice—from access to care to eugenics. As we evolve ever further into these brave new worlds, the individuals here, wrestling with these conundrums today, can benefit us all.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115299760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0012
R. Klitzman
{"title":"“Will They Be Good Enough Parents?”","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0012","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0012","url":null,"abstract":"Physicians often wrestle with whether patients will be “good enough” parents and how much responsibility providers have toward the well-being of the future child—whether to treat all patients and, if not, whom to reject and how to decide. Providers see not only married heterosexual couples but “nontraditional” families, including single-parents-by-choice; lesbian, gay, transgender, or HIV-infected parents; and more “unconventional” types of reproductive arrangements, including gamete donations between sisters and brothers as well as mothers and daughters serving as surrogates for each other. Other couples may seem “highly neurotic” or emotionally unstable. Yet eventual child-raising abilities are tricky to predict. Over time, social attitudes toward certain types of nontraditional families have also been changing. Providers face questions about future blurry and confusing roles in families, children’s welfare, and competing medical, personal, moral, scientific, and social considerations.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131518378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0004
R. Klitzman
{"title":"Choosing Eggs","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0004","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0004","url":null,"abstract":"Women who fail to get pregnant using their own oocytes (or eggs) can try using another woman’s but then face challenges. Potential parents who decide to use someone else’s eggs must determine whose to use—family members’, friends’, or strangers’. In the United States, one of only three countries that legally permit individuals to buy and sell human eggs, most prospective parents who use other people’s eggs buy them from strangers, fueling a proliferation of egg donor agencies. Women and agencies selling eggs can earn relatively large fees—up to $50,000 for an egg. Yet young women selling their eggs do so primarily for money and may not sufficiently grasp the risks, especially ovarian hyperstimulation syndrome, raising ethical concerns. Many patients also grapple with whether to tell others that an outsider’s egg was used. To avoid needing others’ eggs in the future, young women also face dilemmas of whether to freeze their own eggs. Providers and patients often wrestle with uncertainties and dilemmas.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"100 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124107697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0008
R. Klitzman
{"title":"“Two Kids for the Price of One?”","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0008","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0008","url":null,"abstract":"Providers and patients grapple, too, with how many offspring to produce. A California woman who gave birth to octuplets through in vitro fertilization, whom the media labeled “Octomom,” brought worldwide attention to the problems of multiple births from these technologies. Many patients and providers still seek twins to save time and money, fueling an “epidemic of twins.” Yet even with twins, the risks of complications rise significantly. In over 40% of twin births, the infants encounter medical complications. Commentators have argued that single embryo transfer should become the standard of care, but patients frequently oppose it. If more than one fetus develops, providers and patients also confront dilemmas of whether to abort all but one of the fetuses. Decisions about such fetal reduction can excruciate both doctors and patients. Even many pro-choice patients are wary of such partial abortions.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124100138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0006
R. Klitzman
{"title":"Choosing Embryos to Avoid Disease","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0006","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0006","url":null,"abstract":"Preimplantation genetic diagnosis (PGD) lets patients reject embryos with certain genes (e.g., for breast cancer, cystic fibrosis, or Down syndrome). Increasingly, researchers are also using whole-genome and whole-exome sequencing to identify genetic markers associated with other diseases. Doctors and patients can also choose embryos with certain immune system markers or human leukocyte antigens to enable the future child to donate stem cells or other tissues to an existing child with a severe disease and be a so-called savior sibling. This procedure has been used for sickle-cell anemia and beta-thalassemia. In the near future, CRISPR (clustered regularly interspaced short palindromic repeats) also will let doctors insert desired genes into embryos. But providers and patients struggle with when to use PGD, for which conditions, how to decide, how many times to attempt PGD if it fails, whether to select embryos to create savior siblings, whether patients should always be told the results of genetic tests on embryos, whether to test the fetus to confirm the results, and what to do with leftover embryos—whether to freeze, discard, or donate them.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121204926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0005
R. Klitzman
{"title":"Choosing Sperm","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0005","url":null,"abstract":"Many prospective parents need to seek sperm from others but face complex choices as well. Both sperm and egg recipients wrestle with what to seek in a donor—from medical history to physical appearance or other, behavioral traits that are not necessarily fully inherited. Many heterosexual men resist using another man’s sperm, feeling that doing so impinges on their masculinity. Future parents confront dilemmas, too, of whether to disclose the donation to others, including to their eventual offspring. Many heterosexual couples decide to keep the donation secret and never to reveal it to their offspring. Yet psychological studies show that it is better for offspring to be told in an appropriate manner to avoid later feelings of being betrayed and deceived.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127330710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0014
R. Klitzman
{"title":"Emotional Roller Coasters","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0014","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0014","url":null,"abstract":"Patients face stresses from not only infertility procedures themselves but also the psychological and social aspects of these interventions, including uncertainties, failures, costs, and loss of dreams. These physical, social, psychological, financial, and moral strains can exacerbate each another. Patients who quickly succeed in getting a “take-home baby” generally feel pleased with their treatment. But treatment failures can mean loss of purpose, identity, hopes, and dreams, thus embittering, confusing, and disturbing patients. Doctors may be overly optimistic, fueling eventual patient disappointments. Couples can disagree over how much effort, money, and time to spend in trying to have a healthy child—how to weigh medical odds against financial and psychological costs. External supports range from negative to positive and from weak to strong. Well-meaning outsiders may offer suggestions that patients feel are unhelpful. These reproductive journeys can strain marriages, friendships, and jobs. Communication about these issues can help but be difficult.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126187524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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