International and social consequences of advances in ART Gedis Grudzinskas UK .

International and social consequences of advances in ART

Gedis Grudzinskas UK

www.grudzinskas.co.uk

International and social consequences of advances in ART

1) Society and advances in ART

2) International consequences of ART

3) Society and advances in ART

Society and advances in ART

How has the modern woman responded to the liberties afforded

by choice in our progressive societies?

Society and advances in ART

How has the modern woman responded to the liberties afforded by choice in our progressive societies?

Women are engaged fully in the workplace, are a more potent force in commerce and

government

What if women ruled the world ? With Spain's government now female-dominated, the proposition no longer seems hypothetical. Six writers imagine what life would be like Independent ,London, 19 April 2008

What if women ruled the world ? With Spain's government now female-dominated, the proposition no longer seems hypothetical. Six writers imagine what life would be like Independent ,London, 19 April 2008

Oral contraception Fertility preservation Hormone replacement therapy

What if women ruled the world ? With Spain's government now female-dominated, the proposition no longer seems hypothetical. Six writers imagine what life would be like Independent ,London, 19 April 2008

“Say hello to egg-freezing…….. ”

“Egg freezing would quickly become a reality”

Society and advances in ART

“Say hello to egg-freezing…….. ”

“Egg freezing would quickly become a reality”

Leading ethicist asks : Should we be advising all women in their mid 20’s to consider cryopreservation of their ovarian tissue? ISFP Brussels , 2009

Sterility as a social problem

How has the modern woman responded to the liberties afforded by choice in our progressive societies?

They have done so by becoming engaged fully in the workplace, become a more potent force in commerce and government but also

delayed age at marriage, pregnancy and motherhood.

Sterility as a social problem

The cause of infertility in increasing numbers of women is aggravated by age related effects , so the issues

surrounding infertility and its treatment are becoming more social and less medical.

Society and advances in ARTThe cause of infertility in increasing numbers of women is

aggravated by age related effects , so the issues surrounding infertility and its treatment are becoming more social and less

medical.

Older mothersFewer children

Fertility preservation for social reasonsMore use of donor oocytesMore use of host surrogacy

Decreasing national pension fundsOlder grandparents

Society and advances in ART

The first wave of interest was in oocyte vitrification for social reasons. More recently, the improvement in cryobiology

technology of ovarian tissue and its successful autologous transplantation, has inspired a leading ethicist to ask whether we should be advising all women in their mid 20’s to consider cryopreservation of their ovarian tissue for their own further

use. To some this may become attractive, as the process which does not require expensive hormone injections but does involve

the use of anaesthesia and endoscopic surgery.

Follicles and Age: 1

ANTRAL FOLLICLE COUNT

Society and advances in ART

.

But ART/IVF is not always successful when infertility declares itself in women their mid to late thirties,

there has been an increased demand for treatments based on oocyte donation, donor insemination and

host surrogacy. What was once a private medical matter for an individual couple influenced by their

financial circumstances, now involves other healthy women for reasons of personal financial gain

Society and advances in ARTThus, as the cause of infertility in increasing numbers of women is aggravated by age related effects, the issues surrounding infertility

and its treatment are becoming more social and less medical.

Older mothersFewer children

Fertility preservation for social reasonsMore use of donor oocytesMore use of host surrogacy

Decreasing national pension fundsOlder grandparents

Society and advances in ARTWhereas the demand for these services is

greatest in the wealthier countries and sections of societies, the sources of donor

gametes and host surrogates are to be found largely in the poorer societies, where women

driven by their financial circumstances are recruited. But, not all women and societies have felt comfortable with this direction of

change.

International consequences of ART

In societies where such activities are unacceptable or illegal, cross-border care(CBC) occurs.

Facilitated by cheaper international travel, better communication with colleagues abroad & acceptance that where we once travelled for vacations, we now travel for

medical care.

European ARTWomen

Men & Women

Sperm

Embryos

Blastomere/DNA

Global ART

Women

Men & Women

Sperm

Embryos

Blastomere/DNA

International consequences of ART

The current superior efficacy of ART developed to alleviate the suffering caused by disease of infertility is now exploited by those who wish or may wish to delay decisions regarding

parenthood. This matter which once only seemed to involve the individual couple now has wider implications as we recognise that the

consequences will be profound in industrialised nations in the future and are so already in poorer societies.

International consequences of ART

Increasing payments to women for “donor” oocytes & surrogacy

International consequences of ART

Increasing payments to women for “donor” oocytes & surrogacy

Supply of oocytes exceeds the demand by recipients in USA

Increasing willingness by women to sell their oocytes (USA egg exportation)

International consequences of ART

2008 : ESHRE : Task Force

2010 : ASRM : see Fertility & Sterility for workshop report

2010 : Society of Cross Border Reproductive Care (SCBRC)

International consequences of ART

2008 : ESHRE : Task Force

2010 : ASRM : see Fertility & Sterility for workshop report

2010 : Society of Cross Border Reproductive Care (SCBRC)

Terminology, Data, Charter/Code of Practice

Society and advances in ARTThus, as the cause of infertility in increasing numbers of women is aggravated by age related effects, the issues surrounding infertility

and its treatment are becoming more social and less medical.

Older mothersFewer children

Fertility preservation for social reasonsMore use of donor oocytesMore use of host surrogacy

Decreasing national pension fundsOlder grandparents

Society and advances in ART

Fewer Children=Declining population growth

Society and advances in ART

Fewer Children=Declining population growth

Diminishing pension funds in UK

Society and advances in ART

Assessing long-run economic benefitsattributed to an IVF-conceived

singleton based on projected lifetimenet tax contributions in the UK†

M. Connolly1,4, F. Gallo2, S. Hoorens2, and W. Ledger31Health Economics, Global Market Access Solutions, St Prex 1162, Switzerland 2RAND Europe, Westbrook Centre,

Cambridge CB4 1YG,UK 3Academic Unit of reproductive and Developmental Medicine, University of Sheffield, Sheffield S10 2SF, UK

Copyright restrictions may apply.

Connolly, M. et al. Hum. Reprod. 2009 24:626-632; doi:10.1093/humrep/den435

Mean age-stratified income from the Survey of Personal Income data (HM Revenue and Customs) and projected aged-stratified lifetime income adjusted according to work productivity

increases over lifetime of the individual

Copyright restrictions may apply.

Connolly, M. et al. Hum. Reprod. 2009 24:626-632; doi:10.1093/humrep/den435

Projected present value for naturally and IVF-conceived child based on the age of the mother as 35

Society and advances in ART

Fewer Children=Declining population growth

Diminishing pension funds

Solution?????

Society and advances in ART

Fewer Children=Declining population growth

Diminishing pension funds

Temporary solution in UK ? More NHS funding for ART

Society and advances in ART

Fewer Children=Declining population growth

Diminishing pension funds

Solutions elsewhere ?????

Society and advances in ART

Solution is not more women in government or elsewhere behaving like men !!!!!!

Changing behaviour of men after 7 years of age is not possible

Change attitudes in society ? How

Society and advances in ARTThus, as the cause of infertility in increasing numbers of women is aggravated by age related effects, the issues surrounding infertility

and its treatment are becoming more social and less medical.

Older mothersFewer children

Fertility preservation for social reasonsMore use of donor oocytesMore use of host surrogacy

Decreasing national pension fundsOlder grandparents

Society and advances in ARTThus, as the cause of infertility in increasing numbers of women is aggravated by age related effects, the issues surrounding infertility

and its treatment are becoming more social and less medical.

Older mothersFewer children

Fertility preservation for social reasonsMore use of donor oocytesMore use of host surrogacy

Decreasing national pension funds

Older grandparents

Society and advances in ARTThus, as the cause of infertility in increasing numbers of women is aggravated by age related effects, the issues surrounding infertility

and its treatment are becoming more social and less medical.

Older mothersFewer children

Fertility preservation for social reasonsMore use of donor oocytesMore use of host surrogacy

Decreasing national pension funds

Older grandparentsNo grandparents

International and social consequences of advances in ART

Gedis Grudzinskas UK

www.grudzinskas.co.uk

Sterility as a social problem

ART themes is crime novelsMurder of donor sperm conceived children by spurned

wifeFrozen embryos stolen to be used in hosts to give birth

to suicide bombersMega-prams of the ART era are a health hazard

Sterility as a social problem

Decrease in population growthDecrease in the number of children

Decrease in pension paymentsIncreasing payments to women for “donor oocytes” & surrogacy

Increasing willingness by women to sell their oocytes(USA egg exportation)