A report from Meryl B. Rosenberg, LPG and colleagues

We had a number of relevant sessions that peaked the interest of those attending, and sparked much discussion.  Here is a bit of a recap and highlights:

Legal professional group and the society of Reproductive biologists and technologists interactive session – laboratory and clinical errors: Real Life pitfalls and how to avoid them.  Discussion between Susan Crockin, JD and C. Brent Barrett, Ph.D. of Boston IVF

Bottom line recommendation - Deal with them when they happen!

• Critical to have in place procedures to prevent lab error and if there is an error, get in front of it and disclose immediately.
• When there are real-life mix ups in the lab, which have occurred in the past, and one finds themselves carrying another’s baby, the questions that must be addressed are –
  • What happens legally speaking both during a pregnancy and after birth?
  • Who is the legal parent?
  • Who will get custody of the baby?
  • Who will make pregnancy decisions?
• With real life cases, some have a “happy” ending and some do not. 
  • Have had decision made by “carrier” to abort a baby not genetically hers where had transfer of embryo not hers
  • Have had case where decision has been made to leave the baby with the “gestational” parents
  • Have had case where child placed with biological parents after birth, treating gestational “mother” as a gestational surrogate
• Duty of confidentiality between doctor and ALL the patients.
• Dr. Barrett provided a matrix for how to code and report errors, and emphasized how major errors there are but that having systems in place, multiple checklists, and training people properly helps.
• “To err is human” so train people well; firing and hiring new people not the answer because it will discourage others from confessing to errors and will always be starting anew.

Cultural sensitivity across borders with Susan Crockin, Susan Gordon-Pinnell, RN, BSN of Boston IVF and David B. Smotrich MD of La Jolla IVF

The topic discussed was the hot topic of cross-border reproduction, which is increasingly being done.  The panelists noted necessity of cultural sensitivities to the patients involved, recognizing language and other barriers.  Though some involved understand pre-birth and post-birth orders regarding parental rights are important, seemed from the discussion like most parties and professionals are unaware of complexities or their part if any to play in it. Legal clearance letters are routinely used to proceed, but seems they are no different in content from non-international clearance letter despite presence of the more complex issues of immigration, citizenship and parentage.

Highlighted the following:

• In 2010 HFEA called “Reproductive Tourism” the most pressing and challenging new development in ART.
• Critical to make sure can get home wherever that may be with your baby.
• Be careful of the insurance challenges for both any gestational carrier involved and your child.
• Many countries have legal restrictions – all Intended Parents must understand these and seek legal advice about any applicable restrictions and legal steps to recognize parental rights PRIOR to conception, and to make sure understand if and how can get home with their baby.  Must have legal advice from counsel in home country.
• Informed legal advice also critical for the gestational carrier or egg donor.

Fertility Preservation Special Interest Group Interactive Session- Why Ask Why: Should the Reason for Oocyte Cryopreservation Matter? With Karine Chung, M.D. (Chair), Infertility USC Fertility, Nicole L. Noyes, M.D., New York University Langone Medical Center, and Dr. Samantha Pfeifer

The removal of the “experimental” label for oocyte (egg) freezing led to a heated debate regarding freezing eggs for social reasons (if provided accurate information and appropriate counseling, the decision should rest with the woman) versus for medical reasons.  Dr. Pfeifer’s position was it is still too risky to sanction freezing eggs as a way for women to delay childbearing, feeling that it is an undo medical procedure if the eggs are not used, there is a risk of exploitation, the cost/benefit ratio is unfavorable, and still do not know how long can be cryopreserved.  The “other side” did not buy this reasoning, with Dr. Noyes saying that every woman should be able to decide to preserve her own eggs for future use just as a man can choose to freeze sperm.  Compelling arguments were heard on both sides.  It is an interesting question posed by Dr. Pfeifer – what will be done with the unused eggs?  A colleague posed a different critical question: “What are we going to do with all of these excess embryos; Excess embryos may decrease if women have better options to use their own eggs (or not)…and isn’t it easier to dispose of eggs than to dispose of embryos?”

The takeaway:  As most now know, IVF centers are already offering egg freezing to women for social reasons.  This is no longer just a theoretical debate but a reality.

It is therefore critical that every woman choosing to freeze her eggs, regardless of her reasoning, must have full informed consent, understanding all costs, risks, chances at a future pregnancy (or not), and what to do with her eggs if she chooses not to use them in the future. 

Mental Health Professional Group Symposium - Transparency in Surrogate Arrangements: The Good, The Bad, The Forgettable with Elaine R. Gordon, Ph.D. (Chair), Santa Monica/University of California Los Angeles Hospital, Patricia A. Mendell, M.S.W., Private Practice, New York, Richard J. Paulson, M.D., University of Southern California, and Andrew W. Vorzimer, J.D., Vorzimer and Masserman, P.C

Though I was not able to be there for this timely discussion, the panelists discussed both good ways for surrogacy arrangements to go, which are in fact most of them, and also some of the “bad” ways to proceed with a so-called surrogacy case.  Clearly defined the lines of what is and what is not actually a surrogacy arrangement, highlighting some of the “illegal” processes that have occurred in the past (and how to stay clear of any arrangement proceeding under the guise of surrogacy but that is not in fact surrogacy at all).

Roundtables:

Incorporating SART Model Consents Into Daily Practice, Nidhi Desai, J.D.

     Ballard, Desai & Miller

The group discussed using the SART model consent forms, how to use them for ART procedures, and if they in fact should be used at all.

Treating Patients/Minimizing Conflict: Legal Aspects of Treating Same Sex

Couples, Reagan N. Rasnic, J.D., Skellenger Bender Family Law Practice Group

The group at this roundtable discussed issues specific to LGBT ART patients, focusing on the need for clinic staff and professionals to be aware of their state’s laws regarding relationship recognition and parentage.  Some time was spent discussing cross-jurisdictional cases – e.g., donor(s) or gestational carrier in different state(s) or country from intended parents – and the issues which arise when the involved jurisdictions have different laws regarding parentage and relationship recognition.  There was also discussion of the issues presented by unmarried couples who are not in a legally recognized relationship who may want to co-parent, or who are in a legally recognized relationship but who do not want to co-parent.  The importance of referring LGBT patients to competent counsel was recognized.  We all know that at the end of the day the goal it to ensure that all legal parental rights are established in accordance with the applicable state’s laws!

Following the Legal Professional Group business meeting, the First ever cocktail and town hall reception was hosted by the Legal Professional Group and sponsored by Good Start Genetics, Inc., with an expert panel discussion of the topic of: Responsible Genetic Carrier Testing – a robust discussion about current guidelines, standards, technologies and potential legal issues.