11. Quoted in Yeung and Jones, “Pregnancy Dreams.”
12. The Ethics Committee of the American Society for Reproductive Medicine, “Financial Compensation of Oocyte Donors,” Fertility and Sterility 88, no. 1 (August 2007): 305.
13. US Department of Health and Human Services Centers for Disease Control and Prevention, 2013 Assisted Reproductive Technology National Summary Report (Atlanta: CDC, 2015).
14. Defendants’ Motion to Dismiss Plaintiff’s First Amended Class Action Complaint, Kamakahi v. Am. Soc’y for Reprod. Med., 305 F.R.D. 164 (N.D. Cal. 2015) (No. 11–cv–01781–JCS), 2011.
15. Quoted in Lewin, “Sperm Banks Accused.”
16. Tamar Lewin, “Egg Donors Challenge Pay Rates, Saying They Shortchange Women,” New York Times, October 16, 2015, https://www.nytimes.com/2015/10/17/us/egg-donors-challenge-pay-rates-saying-they-shortchange-women.html.
17. Lindsay Kamakahi, Justine Levy, Chelsea Kimmel, and Kristin Wells.
18. Class Action Complaint, Kamakahi v. Am. Soc’y for Reprod. Med., 305 F.R.D. 164 (N.D. Cal. 2015) (No. 11–cv–01781–JCS), 2011.
19. The settlement also provides for payment to plaintiffs’ lawyers in the amount of $1.5 million, and compensation to each of the four named plaintiffs in the amount of $5,000. See Jacob Gershman, “Fertility Industry Group Settles Lawsuit Over Egg Donor Price Caps,” Wall Street Journal, February 3, 2016, https://blogs.wsj.com/law/2016/02/03/fertility-industry-group-settles-lawsuit-over-egg-donor-price-caps/; Melissa LaFreniere, “Egg Donors Get Price Cap Removed in Class Action Lawsuit Settlement,” Top Class Actions, February 2, 2016, https://topclassactions.com/lawsuit-settlements/lawsuit-news/327105-egg-donors-get-price-cap-removed-in-class-action-lawsuit-settlement/. The current ASRM guidelines can be found at http://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/ethics-committee-opinions/financial_compensation_of_oocyte_donors-pdfmembers.pdf.
20. Quoted in Lewin, “Egg Donors Challenge.”
21. R. H. Reindollar, M. M. Regan, P. J. Neumann, et al., “A Randomized Clinical Trial to Evaluate Optimal Treatment for Unexplained Infertility: The Fast Track and Standard Treatment (FASTT) Trial,” Fertility and Sterility 94, no. 3 (August 2010): 888–99.
22. American Cancer Society, “What Are the Risk Factors for Ovarian Cancer?,” accessed December 17, 2017, https://www.cancer.org/cancer/ovarian-cancer/causes-risks-prevention/risk-factors.html; F. Tomao, G. Lo Russo, G. P. Spinelli, et al., “Fertility Drugs, Reproductive Strategies and Ovarian Cancer Risk,” Journal of Ovarian Research, no. 7 (2014): 51.
23. Quoted in Michael Ollove, “Lightly Regulated In Vitro Fertilization Yields Thousands of Babies Annually,” Washington Post, April 13, 2015, https://www.washingtonpost.com/national/health-science/lightly-regulated-in-vitro-fertilization-yields-thousands-of-babies-annually/2015/04/13/f1f3fa36-d8a2-11e4-8103-fa84725dbf9d_story.html?utm_term=.026bd065d982. Debra Mathews of the Johns Hopkins Berman Institute of Bioethics agrees that “assisted reproduction has grown up as a medical services business, not under the auspices of medical research.”
24. For a discussion of early attempts to cure infertility, see Spar, Baby Business, 17–24.
25. Paul Ramsey, Fabricated Man: The Ethics of Genetic Control (New Haven, CT: Yale University Press, 1970), 138.
26. Quoted in Ollove, “Lightly Regulated.”
27. “Obama Overturns Bush Policy on Stem Cell,” CNN News, March 9, 2009, http://www.cnn.com/2009/POLITICS/03/09/obama.stem.cells/; H. Wolinsky, “The Pendulum Swung. President Barack Obama Removes Restrictions on Stem-Cell Research, but Are Expectations Now Too High?” EMBO Reports 10, no. 5 (May 2009): 436–39.
28. Megan Kearl, “Dickey-Wicker Amendment, 1996,” The Embryo Project Encyclopedia, https://embryo.asu.edu/pages/dickey-wicker-amendment-1996.
29. E. R. Myers, D. C. McCrory, A. A. Mills, et al., “Effectiveness of Assisted Reproductive Technology (ART),” Evidence Report/Technology Assessment, no. 167 (May 2008):1–195.
30. See chapter 14, notes 17–19.
Chapter 12
1. Marketdata Enterprises, “U.S. Fertility Clinics & Infertility Services: An Industry Analysis,” October 2013, https://www.marketdataenterprises.com/wp-content/uploads/2014/01/Infertility%20Services%20Mkt%202013%20TOC.pdf.
2. See Rene Letourneau, “Global Infertility Drugs, Devices Market to Approach $4.8B in 2017,” Healthcare Finance, October 3, 2012; Cat Zakrzewski, “VCs See Opportunity in Growing Fertility Market,” Wall Street Journal, February 7, 2017, https://www.wsj.com/articles/vcs-see-opportunity-in-growing-fertility-market-1486470601.
3. According to the ASRM. See http://www.reproductivefacts.org/faqs/frequently-asked-questions-about-infertility/q06-is-in-vitro-fertilization-expensive/.
4. According to FertilityIQ. See https://www.fertilityiq.com/cost.
5. Ibid.
6. Ibid.
7. P. Katz, J. Showstack, J. Smith, et al., “Costs of Infertility Treatment: Results from an 18-Month Prospective Cohort Study,” Fertility and Sterility 95, no. 3 (March 1, 2011): 915–21.
8. See chapter 11, note 1.
9. Katz et al., “Costs of Infertility Treatment.”
10. Fertility lenders such as CapexMD offer loans through participating fertility clinics.
11. See FertilityIQ, “Paying for IVF with a Loan or Credit Card,” accessed December 11, 2017, https://www.fertilityiq.com/cost/paying-for-ivf-with-a-loan-or-credit-card.
12. Attain IVF, “Multi-Cycle Programs Overview,” accessed December 11, 2017, http://attainivf.attainfertility.com/attain-ivf-flex-plan-overview. Attain IVF offers its Muti-Cycle Programs exclusively through clinics and physicians within the nationwide network of IntegraMed Fertility.
13. ARC Fertility, “The ARC Success Program,” accessed December 11, 2017, https://www.arcfertility.com/arc-treatment-packages/the-arc-success-program/. ARC Fertility operates through a nationwide network of doctors and clinics, offering referrals, treatment packages—such as the ARC Success Program and ARC Cycle Plus Programs—and financing options, through ARC Fertility Financing.
14. See FertilityIQ, “IVF Refund and Package Programs,” accessed December 11, 2017, https://www.fertilityiq.com/cost/ivf-refund-and-package-programs.
15. Ibid.
16. Dean Kirby, “Couples to Get ‘Money Back Guarantee’ on IVF treatment,” Manchester Evening News (UK), July 31, 2014, http://www.manchestereveningnews.co.uk/news/greater-manchester-news/money-back-failed-ivf-fertility-7545779.
17. See Access Fertility homepage, www.accessfertility.co.uk.
18. Ginia Bellafonte, “Baby-Making by Lottery,” New York Times, April 27, 2017, https://www.nytimes.com/2017/04/27/nyregion/zhang-fertility-center-lottery.html.
19. Frontline interview with Sauer.
20. Quoted in “The Fertility Race: The Fertility Industry—Business Is Prospering,” American RadioWorks, American Public Media, accessed December 11, 2017, http://americanradioworks.publicradio.org/features/fertility_race/part3/section1.shtml.
21. Quoted in Spar, Baby Business, 46.
22. Ibid, 50.
23. See Fred Decker, “The Salaries of Fertility Doctors,” Houston Chronicle, accessed December 11, 2017, http://work.chron.com/salaries-fertility-doctors-3463.html.
24. Frontline interview with Sauer.
25. Fertility Authority, “IVF Success Rates May Be Misleading,” accessed December 11, 2017, https://www.fertilityauthority.com/articles/ivf-success-rates-may-be-misleading; V. A. Kushnir, A. Vidali, D. H. Barad, and N. Gleicher, “The Status of Public Reporting of Clinical Outcomes in Assisted Reproductive Technology,” Fertility and Sterility 100, no. 3 (September 2013): 736–41.
26. CDC, 2013 Assisted Reproductive Technology, 5.
27. “IVF Success Rates May be Misleading.”
28. Press Association, “Fertility Treatments ‘Threaten Our Humanity,’ Warns Robert Winston,” The Guardian, May 5, 2014, https://www.theguardian.com/science/2014/may/05/fertility-treatments-threaten-humanity-winston. Lord Wi
nston was formerly president of the British Association for the Advancement of Science.
29. F. Bissonette, S. J. Phillips, J. Gunby, et al., “Working to Eliminate Multiple Pregnancies: A Success Story in Québec,” Reproductive BioMedicine Online 23, no. 4 (October 2011): 500–4.
30. This view is supported by a paper that came out of a March of Dimes–supported research project that involved a comprehensive review of medical, policy, and ethics literature and a workshop with leading clinicians, professional association leaders, patient advocates, and insurance industry representatives. See Johnston et al., “Preterm Births.”
31. Survey by Mercer Health and Benefits LLC, “Employer Experience with, and Attitudes Toward, Coverage of Infertility Treatment,” May 31, 2006, http://familybuilding.resolve.org/site/DocServer/Mercer_-_Resolve_Final_report.pdf?docID=4361.
32. See Johnston et al., “Preterm Births,” 37.
33. E. G. Hughes and D. Dejean “Cross-border Fertility Services in North America: A Survey of Canadian and American Providers,” Fertility and Sterility 94, no. 1 (June 2010): e16–19.
34. See Maria Finoshina, “Fertility Tourists Eye Russia,” RT News, December 13, 2010, https://www.rt.com/news/fertility-tourists-eye-russia/; Tom Parfitt, “Why Infertility Treatment Is Booming in Ukraine,” The Guardian, May 22, 2009, https://www.theguardian.com/world/2009/may/22/infertility-treatment-ukraine; www.fertilityclinicsabroad.com; www.fertility.treatmentabroad.com.
35. Business Wire, “Russia In Vitro Fertilization—Opportunity Analysis and Industry Forecast, 2014–2022—Research and Markets,” August 24, 2017, http://www.businesswire.com/news/home/20170824005481/en/Russia-Vitro-Fertilization—-Opportunity-Analysis-Industry.
36. At the Fertility Institutes, a group of clinics in Los Angeles, New York, and Mexico, nearly 90 percent of their patients come for family balancing. Sumathi Reddy, “Fertility Clinics Let You Select Your Baby’s Sex,” Wall Street Journal, Aug 17, 2015, https://www.wsj.com/articles/fertility-clinics-let-you-select-your-babys-sex-1439833091.
37. For further background on Enid’s story, see Persky, “Reproductive Technology,” 1–2.
Chapter 13
1. Analysis of 15,033 embryos biopsied showed 47.3 percent to be normal (euploid), 39 percent to be abnormal (aneuploid), and 13.7 percent to be mosaic, with nearly 5 percent of the mosaics showing low levels of mosaicism and therefore treated as normal, and just under 9 percent showing high levels of abnormality (Reddy, “Fertility Clinics”). A further analysis of data from Reprogenetics and Genesis Genetics through March 2016 regarding 33,236 embryos showed a range of mosaic embryos from 11 percent to 22 percent depending on age group, and a range of aneuploidy embryos from 16 percent to 42 percent.
2. Munné, “Appraisal of PGS Outcome-Data” presentation.
3. Ibid.
4. Santiago Munné, “Aneuploidy in Embryos: Variability Between Centers, Between Patients, and Between Cycles of the Same Patients,” presentation at CoGen First World Congress on Controversies in Preconception, Preimplantation, and Prenatal Genetic Diagnosis: How Will Genetics Drive the Future?,” September 25–27, 2015, http://www.ivf-worldwide.com/cogen/oep/pgd-pgs/aneuploidy-in-embryos-variability-between-centers,-between-patients-and-between-cycles-of-the-same-patients.html.
5. S. I. Nagaoka, T. J. Hassold, and P. A. Hunt, “Human Aneuploidy: Mechanisms and New Insights into an Age-Old Problem,” Nature Reviews Genetics 13, no. 7 (June 18, 2012): 493–504; E. Fragouli, S. Alfarawati, N. N. Goodall, et al., “The Cytogenetics of Polar Bodies: Insights into Female Meiosis and the Diagnosis of Aneuploidy,” Molecular Human Reproduction 17, no. 5 (May 2011): 286–95.
6. A. H. Handyside, M. Montag, M. C. Magli, et al., “Multiple Meiotic Errors Caused by Predivision of Chromatids in Women of Advanced Maternal Age Undergoing In Vitro Fertilisation,” European Journal of Human Genetics 20, no. 7 (July 2012): 742–47; A. S. Gabriel, et al., “Array Comparative Genomic Hybridisation on First Polar Bodies Suggests That Non-disjunction Is Not the Predominant Mechanism Leading to Aneuploidy in Humans,” Journal of Medical Genetics 48, no. 7 (July 2011): 433–37; R. R. Angell, “Predivision in Human Oocytes at Meiosis I: A Mechanism for Trisomy Formation in Man,” Human Genetics 86, no. 4 (February 1991):383–87; J. M. Fisher, J. F. Harvey, N. E. Morton, and P. A. Jacobs, “Trisomy 18: Studies of the Parent and Cell Division of Origin and the Effect of Aberrant Recombination on Nondisjunction,” American Journal of Human Genetics 56, no. 3 (March 1995): 669–75; M. Bugge, A. Collins, M. Petersen, et al., “Non-Disjunction of Chromosome 18,” Human Molecular Genetics 7, no. 4 (April 1, 1998): 661–69; A. Kuliev and Y. Verlinsky, “Meiotic and Mitotic Nondisjunction: Lessons from Preimplantation Genetic Diagnosis,” Human Reproduction Update 10, no. 5 (September-October 2004): 401–7.
7. Nagaoka et al., “Human Aneuploidy.” Errors can also occur during subsequent stages of mitosis, when a single cell divides into two identical daughter cells.
8. P. A. Hunt and T. J. Hassold, “Human Female Meiosis: What Makes a Good Egg Go Bad?,” Trends in Genetics 24, no. 2 (February 2008): 86–93.
9. R. M. Winston and K. Hardy, “Are We Ignoring Potential Dangers of In Vitro Fertilization and Related Treatments?” Nature Cell Biology 4, supplement (October 2002): S14–18 and Nature Medicine 8, supplement (October 2002): S14–18.
10. Ibid.
11. E. B. Baart, E. Martini, M. J. Eijkemans, et al., “Milder Ovarian Stimulation for In-vitro Fertilization Reduces Aneuploidy in the Human Preimplantation Embryo: A Randomized Controlled Trial,” Human Reproduction 22, no. 4 (April 2007): 980–88.
12. C. Rubio, A. Mercader, P. Alamá, et al., “Prospective Cohort Study in High Responder Oocyte Donors Using Two Hormonal Stimulation Protocols: Impact on Embryo Aneuploidy and Development,” Human Reproduction 25, no. 9 (September 2010): 2290–97.
13. F. Ubaldi, L. Rienzi, E. Baroni, S. Ferrero, et al., “Hopes and Facts About Mild Ovarian Stimulation,” Reproductive BioMedicine Online 14, no. 6 (June 2007): 675–81.
14. G. N. Allahbadia, “Stimulation and Aneuploidy: Why Are Milder Stimulation Protocols Better?,” IVF Lite 3, no. 2 (October 14, 2016): 41–5.
15. Keiichi Kato, “Natural-Cycle IVF: 10-Year Experience,” presentation at 2016 ART World Congress, October 13, 2016.
16. V. V. Grabar and A. V. Stefanovich, “Aneuploidies in Oocytes Used in IVF Programs,” Georgian Medical News, no. 237 (December 2014): 7–12.
17. Cited in Nicholas Kristof, “Contaminating Our Bodies with Everyday Products,” New York Times, November 28, 2015, https://www.nytimes.com/2015/11/29/opinion/sunday/contaminating-our-bodies-with-everyday-products.html.
18. For a detailed discussion of folate, the B vitamins and CoQ10, see Rebecca Fett, It Starts with the Egg (New York: Franklin Fox, 2016), 101–12.
19. I. M. Ebish, C. M. Thomas, W. H. Peters, et al., “The importance of Folate, Zinc and Antioxidants in the Pathogenesis and Prevention of Subfertility,” Human Reproduction Update 12, no. 2 (March–April): 163–74.
20. See, for example, A. J. Gaskins, S. L. Mumford, J. E. Chavarro, et al., “The Impact of Dietary Folate Intake on Reproductive Function in Premenopausal Women: A Prospective Cohort Study,” K. A. O’Connor, ed. PLoS ONE 7, no. 9 (2012): e46276; I. Dudás, M. Rockenbauer, and A. E. Czeizel, “The Effect of Preconceptional Multivitamin Supplementation on the Menstrual Cycle,” Archives of Gynecology and Obstetrics 256, no. 3 (1995): 115.
21. J. C. Boxmeer, R. M. Brounds, J. Lindemans, et al., “Preconception Folic Acid Treatment Affects the Microenvironment of the Maturing Oocyte in Humans,” Fertility and Sterility 89, no. 6 (June 2008):1766–70.
22. A. Turi, S. R. Giannubilo, F. Brugè, et al., “Coenzyme Q10 Content in Follicular Fluid and Its Relationship with Oocyte Fertilization and Embryo Grading,” Archives of Gynecology and Obstetrics 285, no. 4 (April 2012): 1173–76.
23. J. Van Blerkom, “Mitochondrial Function in the Human Oocyte and Embryo and Their Role in Developmental Competence,” Mitochondrion 11, no. 5
(September 2011): 797–813.
24. Y. Bentov, N. Esfandiari, E. Burstein, and R. F. Casper, “The Use of Mitochondrial Nutrients to Improve the Outcome of Infertility Treatment in Older Patients,” Fertility and Sterility 93, no. 1 (January 2010): 272–75; A. Ben-Meir, E. Burstein, A. Borrego-Alvarez, et al., “Coenzyme Q10 Restores Oocyte Mitochondrial Function and Fertility During Reproductive Aging,” Aging Cell 14, no. 5 (October 2015): 887–95.
25. M. Susiarjo, T. J. Hassold, E. Freeman, and P. A. Hunt, “Bisphenol A Exposure In Utero Disrupts Early Oogenesis in the Mouse,” PLoS Genetics 3, no. 1 (January 2007): e5; P. Allard and M. P. Colaiácovo, “Bisphenol A Impairs the Double-Strand Break Repair Machinery in the Germline and Causes Chromosome Abnormalities,” Proceedings of the National Academy of Sciences 107, no. 47 (November 23, 2010): 20405–10; J. Peretz, R. K. Gupta, J. Singh, et al., “Bisphenol A Impairs Follicle Growth, Inhibits Steroidogenesis, and Downregulates Rate-Limiting Enzymes in the Estradiol Biosynthesis Pathway,” Toxicological Sciences 119, no. 1 (January 2011): 209–17.
26. V. Y. Fujimoto, D. Kim, F. S. vom Saal, et al., “Serum Unconjugated Bisphenol A Concentrations in Women May Adversely Influence Oocyte Quality During In Vitro Fertilization,” Fertility and Sterility, 95, no. 5 (April 2011): 1816–19.
27. S. R. Ehrlich, P. L. Williams, S. A. Missmer, et al., “Urinary Bisphenol A Concentrations and Implantation Failure among Women Undergoing In Vitro Fertilization,” Fertility and Sterility 92, no. 3, supplement (September 2009): S136.
28. M. S. Bloom, D. Kim, F. S. Vom Saal, et al., “Bisphenol A Exposure Reduces the Estradiol Response to Gonadotropin Stimulation During In Vitro Fertilization,” Fertility and Sterility 96, no. 3 (September 2011): 672–77.e2; E. Mok-Lin, S. Ehrlich, P. L. Williams, et al., “Urinary Bisphenol A Concentrations and Ovarian Response Among Women Undergoing IVF,” International Journal of Andrology 33, no. 2 (April 2010): 385–93.
Conceivability_What I Learned Exploring the Frontiers of Fertility Page 30