Blog Archives

Choosing Sex, Compensating Donors and Egg Banks: The NHMRC is calling for our thoughts on IVF

ID-10076744

Australia is reviewing its policy on IVF sex selection, compensating egg donors and egg banks. They have asked for submissions with our thoughts on this. My submission is below. The Working Committee has developed a range of case studies that illustrate the issues that arise. You can read more about each of these case studies here:
http://consultations.nhmrc.gov.au/files/consultations/drafts/artdraftethicalguidelines150722.pdf

You can also make your own submission here:

http://consultations.nhmrc.gov.au/public_consultations/assisted-reproductive-tech

Also, I invite you to read this illuminating article by Tereza  Hendl on the topic of sex selection in The Conversation:

https://theconversation.com/choosing-childrens-sex-is-an-exercise-in-sexism-45836

Appendix 3a Sex selection for non-medical purposes

I am heavily in favour of the existing laws remaining as they currently are. This is largely due to the inherently forceful application of gender norms upon children whose sex has been chosen. I wholeheartedly agree with the 2007 guidelines which state that admission to life should not be conditional upon being a particular sex. I address the case studies in the following ways:

Family Balancing: none of the four scenarios in this case study present a strong enough argument for sex selection, in my opinion. Rather, all four of the scenarios demonstrate an assumption that gender is tied to sex, and expectation that an child of a particular sex will display particular gender characteristics. This is a problem because it reinforces gender norms.

Replacement of a Child: While this case carries much more sympathy that the scenarios in the Family Balancing case, they essentially come back to the same problem – that there is an assumption that a child of one sex with ascribe to a particular gender, and will be somehow similar to the previous child who was or was not of that gender. I cannot support sex selection in this case.

Travelling Overseas for Sex Selection: In these scenarios we are presented with good evidence for why IVF in Australia should be more readily available and cost effective, but not good evidence for why sex selection should be allowed. While some patients will continue to travel overseas for treatment, in order to gain sex selection, it is my opinion that Australian clinics should counsel patients as to WHY they wanted sex selection, and continue to offer them safe and regulated treatment NOT including sex selection. This would mean that more parents might be encouraged to stay in Australia for their treatment, and have the opportunity to address any assumptions they have about gender and their future child.

Respecting Parental Autonomy: These scenarios present exactly the problems I have been outlining in the previous three case studies. Parents should be counselled to realise that their happiness does not depend on their child fulfilling certain gender expectations, and to try and do so is potentially detrimental to the child’s own mental health.

Other potential Uses: The is an obvious flaw here in that sex selection will not determine whether the child will or will not inherit the condition that the parents do not desire. However, there is a more significant problem, in that parents and society more generally are not able to value individuals who are seen as ‘disabled’ in some way. We must work against this assumption, just as we are with gender norms, to realise that those who have been diagnosed with some form of ‘disorder’ are not limited, or lacking potential. Rather, these people possess incredibly valuable personal qualities that can make them hugely significant contributors to our communities.

Appendix 3b Compensation of Australian women for the reproductive effort and risks associated with donating their eggs

It seems that the important distinction to be made is how much egg donors are compensated and what constitutes the difference between compensation and inducement. I would suggest that it is currently common practice for donor-recipients to compensate their egg donors all the costs referred to as ‘reasonable out-of-pocket’ expenses, including medical, counselling, loss of earnings, travel, accommodation, insurance and legal advice. It may be useful then, to have some kind of regulation around these costs, to make the line between ‘reasonable’ and ‘unreasonable’ costs clearer for all parties. So long as the egg-donor was only reimbursed, and not able to actually make a profit from donating, I see no reason why these regulations should not be brought into place. This would increase options for donor-recipients greatly, as more women might be willing to donate, particularly to not-previously-known donor recipients. However, I suspect that the numbers of voluntary donors might still remain low, since this system would not essentially be any different from the current system based on altruism, just more regulated.

Appendix 3c 3c Establishment of an Australian donor egg bank

An egg bank would have the benefit of regulating how children may continue to access their donors, and information about them throughout their lives. Donors would also be able to continue to access information about any children that were born as a result of their donation. However, donors should not be able to contact children unless parents and children have specifically requested this.

I am in support of the establishment of an Australian donor egg bank, under certain conditions. Eggs which have been frozen, but unused, by women who undertook their own IVF cycles, should be available for donation, but not for any compensation. This should only be the case once that woman has completed her own family, to reduce the risk of her regretting the decision to donate. Since the woman’s costs involved in the procedure have already been covered by herself, she should not incur any further costs in choosing to donate the eggs that she no longer wants to use. This would essentially mean that she would not be compensated more than other egg donors, who would be provided with nothing beyond ‘reasonable out-of-pocket’ expenses.

Egg sharing, where women are compensated costs for IVF in exchange for donating some of their eggs should not be allowed. Women who need IVF to conceive should have completed their own families before being able to donate to the egg bank, particularly if they have not been able to conceive easily themselves. This will reduce the likelihood of women who are currently undergoing IVF, donating their eggs, and later feeling that they ‘lost’ the ‘good’ eggs to a donor-recipient. This is a separate issue to women who wish to donate to an egg bank prior to choosing to start their own families. This should be allowed, so long as they have received significant counselling about the impact of potentially donating eggs, if natural conception does not come so easily for them later. In this case, women should be compensated, just as they would be if it were an altruistic donation to a known donor-recipient.

IVF Clinic Success Rates

image

The Australian Boradcasting Corporation recently did an interview with doctors and industry professionals on the efficacy of different IVF clinics in Australia. You can hear the segment here:

http://mpegmedia.abc.net.au/rn/podcast/2015/05/hrt_20150511_1730.mp3

I really appreciate how much thought and effort the interviewees make to demonstrate how complex the issues are here. I may be biased, but it seems to me that they are working hard to convince the interviewer that the situation is not so black and white as it appears. In addition to the interviewees comments, I wanted to add a few more concerns.

At least at the beginning of the interview, the interviewer seems to make out that IVF clinics are hiding some raw data number that indicates clinic success rates. On the contrary, just about all clinics self publish their own success rates, as advertising. It is true that there is no way for the public to access the collected and collated data on all clinics, but they can certainly get information on individual clinics and compare those that they are considering using.

One of the biggest factors overlooked by the interviewer, at least at the beginning of the interview, is that the procedures and processes of the clinic are only one (relatively small) factor which will affect a couple’s ability to conceive. Far more significant are the couple’s overall health status, age, existing hormonal problems, etc. Each of these factors usually outweighs the influence of variations between labs and clinics.

The other thing the stats don’t take into account is that there are two very different types of clinics in Australia, publicly and privately funded. The public, Medicare funded clinics typically perform worse than the private, expensive clinics. Part of the reason for this is the demographic of the patients at each clinic. People at Medicare clinics, often have lower socio-economic status than those at expensive clinics, and correspondingly also have lower overall health rates. Further more, even those that do start at the expensive clinics, and find themselves having to go for multiple cycles, will run out of money and end up at the Medicare clinics. By default, these are often the harder cases to get babies from, since they are the cases that have had to go through more cycles, because the problem is not so easily fixed. Medicare clinics also have the same disadvantages of all public health systems, being under resourced to deal with a huge volume of patients, and lacking sustained individualised attention for patients who are treated by whoever is on duty, rather than any one doctor they have chosen to develop a relationship with. This is a problem in something like fertility, where treatment is often long term, and having a doctor who can readily recall the patient’s history is an advantage.

Further more, there are potential problems in ranking clinics, and developing competition in their published success rates. There are accusations that American clinics have raised their pregnancy rates by doing much more risky treatments, like transferring embryos to women who are overstimulated (which risks a potentially fatal condition involving built up fluid in the abdominal cavity) and transferring more than one embryo at a time, which brings all the complications of twins and higher miscarriage rates. In these clinics, increased pregnancy rates come along with increased rates of complications, endangering both the woman’s current health and her potential to continue trying to conceive. Publishing pregnancy rates also means very little, since pregnancy rates mean nothing if they are not followed by live, healthy baby birth rates. Finally, doctors and clinics who are more concerned about their published success rates are more likely to turn away couples who they think will be ‘too hard’ to treat, preferring not to risk lowering their published stats, and advertised reputation.

The long and the short of the situation is that it is not as simple as it may seem, and requires detailed and thoughtful attention, like so many of the issues in this area.

Beautiful healthy bodies

This beautiful woman demonstrates exactly why we do what we do! Because health and fitness is about body joy, not body shame!

http://new.damn.com/chubby-girl-steps-stage-next-blew-everyone-away/

“The Scientific Power of Meditation”

Brilliantly put… Don’t think meditation will cure cancer, but use it to boost your brain fitness in the same way you work out your body to boost your physical fitness.

The Scientific Power of Meditation: http://youtu.be/Aw71zanwMnY

Fertility Yoga Sequence

ID-100281585When we practice yoga for fertility, we are cultivating both the physical space and strength in our bodies to begin new life, as well as the energetic and spiritual space to create a family, new relationships and home for ourselves and our loved ones. Think of it as furnishing your own body and mind, just as you would furnish a house, to turn it from an safe but empty space, into a warm and comfortable haven. Inside this haven you are free to create in so many senses: create a new project, create a new baby, create a deeper empathy with yourself and others. Try the following simple sequence at home, holding each pose for at least 15 breaths. The sequence is for both men and women, and will benefit both. It will calm the nervous system and allow you to drop further into you rest and digest, or parasympathetic nervous state, moving away from fight or flight, or sympathetic nervous system. For this reason it is best done when stressed, or before bed. Once your body has done these poses, it will further understand that it is safe to relax, to rest, and from that place be free and open to create your dreams. If you would like to join me for a fertility class, please get in contact at info@flyingdragonyogis.com.au. Happy practice!

Viparita korani (Legs up the wall, or without the wall, hips supported by pillows/blankets/bolster/block. If without the wall, make sure your legs can balance above the hips easily, so there is very little muscle tension holding you here).

Hip crease opening (With the pillows/blankets/bolster/block under your tailbone, let your shoulders and feet drape to the earth, so that the front of your hips has a chance to open. Focus on making your body as long as possible).

Bridge (With or without pillows/blankets/bolster/block under the soles of your feet lift the hips up to the sky. Squeeze heels towards shoulderblades and shoulderblades towards heels).

Suptabadakonasana (With or without pillows/blankets/bolster/block under the outside edges of your feet, place the soles of your feet together and let your legs fall open in a diamond shape. Breath into your belly).

Squeeze both knees into chest (Roll around drawing circles on the floor with your low back. Massage into the vertebrae of your spine and allow the nerves that run up and down your back to release.)

Happy Baby (Draw both knees out wide and pull them down to either side of your torso. Take your hands around your calves or feet, or use a blanket/towel/strap to wrap around your feet to hold onto. Draw your tailbone and your knees down to the earth. Relax your shoulders).

Savasana (Relax your legs and arms down to the earth to lie still on your back for full relaxation. This is the most important part of your practice – be patient and trust it to work its magic on you. If you don’t find yourself relaxing into it at first, simply ask yourself to keep moving towards peacefulness, away from your distracting thoughts, and slowly, over time, you will find that it gets easier and more joyful to feel completely still, in body and mind).

New Family Yoga at Pure Spin

Looking forward to teaching family yoga at PureSpin, the new place to be in Crows Nest! Come along on Sunday for family fun!

10475433_233294213546328_1923682401935145197_o

Yoga Rebates from Private Health Insurance

Gre??????????????????at news! I have just been upgraded to a Level 1 Registered Yoga Teacher with Yoga Australia, which means that you can claim classes with me on your Private Health Fund!

For details of how to apply with your health fund, see the link below:

http://www.yogaaustralia.org.au/yoga-and-healthfunds

My first Elephant Journal article

I’m excited to announce I have been published by Elephant Journal! Check it out here:

http://www.elephantjournal.com/2013/12/self-awareness-for-goddesses-karen-anne-wong/

goddess-500x387

3 Platitidues That Aren’t As Effective As You Might Think

image

Over time I have definitely handed out my own good share of platitudes. But now that I am at a stage of my life where people offer them to me more frequently than usual, I have developed some strong opinions on their effects. Here’s a few to think about:

1. ‘Don’t worry, it will work out for you’.
When we say this we mean to offer reassurance, and hope. However, the problem is that in saying it we are reaffirming that the possibility of it not ‘working out’ is unthinkable, or unacceptable. The person who hears this knows that we have no idea whether it will ‘work out’, and is struggling hard to be okay with all future possibilities. A more supportive option might be to offer the following: ‘No matter what happens, you will find so much to be joyful and thankful for.’

2. ‘Have you tried [insert modality/supplement/practitioner here]?’
Depending on how long the person has been been dealing with their issue, I can assure you that they have tried it, or something similar. People are exhaustive in their research, and will try everything they can as time goes on. Some of those things will have provided comfort, relief and possibly even effective treatment for that person. But others will have been a waste of time and money. At some point this person becomes completely exhausted with the cycle of other people telling them they are doing something they shouldn’t, or should be doing something they aren’t. They become fed up with endlessly hearing that just being themselves is not good enough. A more supportive alternative might be: ‘You are doing everything you can. Your instincts are good, and leading you to what you need.’

3. ‘Oh, that is hard.’
When we say this, what we mean is that we have sympathy for the person and what they are going through. Sometimes that person does need sympathy, but much more often that person needs to feel how the process they are going through is just normal and routine for some of us. It is a lot easier to deal with a long, drawn out process when you think of it as simply a way of life – one path which many have trodden before you. Thinking of the process as a battle is emotionally exhausting, and it is easier to fall into the depression of fatigue. A more supportive alternative might be: ‘You are dealing with it really well, and you have a great attitude to figuring it out.’

I hope to be more mindful if these things when I offer platitudes to people in the future. And I hope you will too! 🙂

Namaste

People Who Never Expected To Be Models

Absolutely had to be reposted 🙂

 

%d bloggers like this: