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3 Potential Clinical Implications of IVG
Pages 31-50

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From page 31...
... • The desire to build families in varied ways, including through genetically related offspring, is strong for many people. IVG could be a game changer for women and men dealing with infertility, women of advanced maternal age, and same-sex couples, allowing them to have genetically related children they could not otherwise.
From page 32...
... (Serour) This chapter covers a panel discussion that anchored the workshop in the potential real-life impacts of IVG on stakeholders and society, moderated by Susan Crockin, a senior scholar at the O'Neil Institute for National and Global Health Law at Georgetown Law and private practice lawyer in ART law.
From page 33...
... It might remove or reduce age limitation barriers, she continued, noting that this could be "as exciting as birth control" for allowing people to control their family building. She also raised concerns about the potential consequences of doing so: "if we are breaking age barriers just because we can, should we?
From page 34...
... However, some within the LGBTQ community hold the belief that the goal ought to be to radicalize ideas of family formation, Kraschel con­tinued, noting that queer access to ART has torn down patriarchal notions about family building and parentage, in part, by normalizing third-party reproduction. Over time, this has catalyzed a shift away from genetic essentialism.
From page 35...
... Although this development could be beneficial to LGBTQ families for legal and psychosocial reasons, Crockin shared her concern that the advent of IVG could undermine the work performed to expand legal definitions of family and reify genetic essentialism. Kraschel reframed the conversation around replacing the current donor market with in vitro–derived gametes.
From page 36...
... Impact of Gamete Donation Paula Amato of Oregon Health and Science University asked ­ raverman to discuss the impact of using nonidentified versus directed B donation4 on donor-conceived children and their families. Despite no comparison studies, follow-up studies have been done for both groups, Braverman said.
From page 37...
... . The Appropriations Committee in the Connecticut Legislature recently considered a bill that would mandate that Medicaid include fertility care inclusive of queer parents and single parents, Kraschel said, ultimately allowing many more intended parents to be covered.
From page 38...
... Mathews asked panelists to reflect on the interplay between the kinds of families people want to build and the policy structures that facilitate family building. These two elements are inextricable, Braverman responded, noting that although people may differ in how they would like to create their families, all individuals want agency to make these choices free from legal or social concerns.
From page 39...
... They also highlighted how its application might differ between countries according to political, cultural, and religious contexts if it were ever practiced. This session was moderated by Hugh Taylor, a practicing reproductive endocrinologist and professor at Yale University, who opened by noting the breakneck pace at which the field is moving, concluding that "it's not a matter of if this will be available for clinical practice but just a matter of when." Clinical Considerations Paula Amato provided a "clinician on the ground perspective [for]
From page 40...
... Men with infertility issues, including azoospermia,7 may also use IVG. IVG would also allow same-sex couples to have a child that is genetically related to both parents (see the section on IVG and the LGBTQ Community)
From page 41...
... The resulting baby would be their genetic grandchild. Amato emphasized that these paths to parenting are "theoretic possibilities." Potential Impacts of IVG on Clinical Practice Beyond extending who could potentially conceive a genetically related child, IVG would likely change how reproductive medicine is practiced.
From page 42...
... If ever available clinically, Dr. Amato would expect that IVG would significantly reduce demand for third-party egg and sperm donors; those of advanced maternal age, same-sex couples, and single individuals rely on these donors.
From page 43...
... For example, reprotoxicity of drugs on fertility and embryonic development could be assayed more easily with a greatly expanded ­supply of oocytes and embryos. IVG could also have implications for regenerative medicine, including therapeutic cloning to generate ESCs, an area that would also be controversial.10 Looking Toward Potential Clinical Use: Ethical Issues and Regulatory Oversight Amato foreshadowed workshop discussions concerning ethical issues, regulatory barriers, and a potential time line for clinical use.
From page 44...
... from using any of its budget to consider any application for a clinical trial "in which a human embryo is intentionally created or modified to include a heritable genetic modification"; whether FDA considers IVG to do so is up for discussion, Amato said. Potential Time Line Several forecasters, including Metaculus, predict that the field is about 10 years away from a baby conceived via IVG, and Amato agreed this time line seemed reasonable.
From page 45...
... Finally, employing IVG for eugenic applications would likely be condemned in most if not all societies, Serour said. Global Scientific and Ethical Concerns Serour shared his scientific and ethical concerns through a global perspective.
From page 46...
... IVG may increase existing disparities in access to reproductive health care between high-income and low-income countries; the latter tend to have weaker health care systems and smaller health care budgets, he said. In addition to equity and access, Serour reemphasized that IVG will need to be applied with respect for different cultural contexts, noting that "what can be applied in one society cannot be applied in another." Panel Discussion Cost Considerations for IVG Ogbogu offered comments, concerns, and a question about the potential cost, pricing, and access to IVG.
From page 47...
... It is only available to those using ART, who may have few, if any, embryos to choose among. Using IVG to generate embryos could increase the potential feasibility and marketability of embryo screening, he said, transforming the potential patient population to everyone.
From page 48...
... In his clinic in Egypt, patients are provided with evidence-based information about the risks involved in pregnancy at advanced maternal ages, but the choice is left to them. Amato agreed that U.S.
From page 49...
... Many were concerned that practices such as trait selection or even pressure for the use of heritable genome editing could increase if IVG were ever clinically practiced. Potential Mass Production of Embryos Several participants disagreed about the likelihood that large n ­ umbers of human embryos would be produced from in vitro–derived gametes if ever available clinically.
From page 50...
... Participants discussed the underlying potential for eugenics inherent in embryo screening technologies and the potential implications for disability by routinely using them. Several participants acknowledged that including voices from a broad range of communities in these conversations is crucial.


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