‘APPARENT THOUGH NOT ACTUAL INCEST’
Ethics of family sharing eggs, sperm, wombs
About five years ago, a 40-something 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 partner’s sperm and the resulting embryos injected into the woman’s uterus, resulting, she hoped, in a baby — her genetic grandchild. The half-sister — the egg donor — would be its biological mother.
Levitan, an expert in thirdparty reproductive law, cites it as 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.
The unorthodox, medically assisted conceptions allow intended parents to preserve a “kinship tie” that would be lost using an unrelated egg or sperm donor, experts say.
However, such collaborations are 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 child.
Some combinations should be rejected outright because they’re consanguineous — involving people descended from the same ancestor — or “simulate incestuous unions,” warns the 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 to 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 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 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 number of requests 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.
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 for donating eggs, donors can still be reimbursed for expenses, sometimes upwards of $5,000. A daughter providing eggs to her mother, by contrast, isn’t likely to request payment.
Levitan’s recent cases include a father who donated sperm used to artificially inseminate his son’s wife. The son “simply had no sperm,” she said. “The father volunteered, and the daughter-inlaw was very accepting.”
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.”
Vanessa Gruben, an associate professor of law at the University of Ottawa, said critical conversations need to happen before people enter 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, said 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.)
“If we feel there is some coercion, or the medical risks are too high, definitely we’ll back away.”