martes, 15 de septiembre de 2015

Fertility treatments for gays, lesbians and unmarried persons. Is it a matter of ethics?

Fertility treatments for gays, lesbians and unmarried persons. Is it a matter of ethics?

In occasions we have to make decisions that will definitely impact the future of the world in many ways. Some people argued that being gay comes with genetics. There is a great article about this topic I would like to refer to ( In this study Kenrick Vezina makes a pretty good work at understanding the claims of some geneticists regarding genetics homosexuality. Michael Bailey, a geneticists from Northwestern University and Kevin Mitchell from Trinity College in Dublin claimed homosexuality has a very strong genetic component linked to the Y chromosome.

For what I understood in their work there is a difference between sexual preference and sexual orientation, being the later related to the Y chromosome. Preference is whether you are attracted to males or females, however orientation is the one linked to that Y chromosome and it is moderately heritable. There are regions on this chromosome that influence the development of sexual orientation in men. They say there is no universal path to homosexuality across all people and heterosexuality is not a single default state. For such, there should be a set of other genes that work together and influence the sexual orientation. The conclusion of this work: homosexuality is not a choice, the same as heterosexuality it is not either. It should not be labeled as a disorder. I encourage you to have a look at that article and make your own conclusions.

Where are those people who labeled homosexuality as a disease? And what is the reason they do not like it?

I have a great story. I have these great friends. They are both from well-educated backgrounds, both professionals and successful. They had been together in a stable relationship for over 10 years, even stronger and more solid than many heterosexual couples I have met. One day they made a decision, to have a baby and raise him/her with all the love they could possible give and the security of a stable home. They went for in vitro fertility treatment with an egg donor, and off course needed a gestational carrier. The treatment went well, and they had their first beautiful baby. She was gorgeous and bright. They could not be happier. I got used to check my Facebook every other day just to see the lovely photos they were sharing with all their love ones. I could not be more proud of them. She is today a very warm, lovely and smart baby girl, today almost three years old. They had another baby two years later.

In my practice, I have seen heterosexual couples that have lots of problems undergoing fertility treatments with third persons, as in the case of egg donation, sperm donation, embryo donation, surrogacy or gestational carriers. 1 in 5 couples using third persons will develop problems dealing with frustrations, anger, fear and doubt. In the case of my gay friends, I never saw any doubt. The procedure made them stronger and their relationship evolved and became more solid, full of love and joy.

Fertility specialists usually have doubts whether to treat or not same sex couples, much more than to treat unmarried ones (as to men and women). Most of them are motivated by ethics, religion or family background. For me it is hard to understand that today, there are still a number of specialists in reproductive medicine who do not approve to treat gay, lesbians or unmarried people.

I strongly agree with the American Society of Reproductive Medicine that an over-arching ethical question is whether it is acceptable to help unmarried individuals or couples to reproduce, regardless of their sexual orientation. Several investigations have concluded that children born and raised from these couples do not show difference from children born and raised from heterosexual couples. Also it is interesting to see that in 2011, 46% of all US births were to unmarried women. This also shows that a large percentage of professional women have decided to undergo the path of parenting without the need of a male partner, in this case they use donors chosen from sperm banks. This figure it is likely to be increasing in the next years.

Discrimination laws in several countries have been changing. Today it is a whole different story. We can even see sanctions applied to fertility doctors or any members of the fertility team who denies treatment to these patients. Although it is not a comfortable idea for these patients to have a medical team agree to treat them because they are forced, and not because they want to do it. It changes things. The doctor-patient relationship will be difficult in those cases.

Currently in the United States there is an estimated 6 to 14 million children being raised by at least one gay or lesbian parent, usually as a result of a heterosexual relation. The proportion of children born to unmarried mothers hit a record 47.5% (number of 346,595) in the UK last year. The figure has risen from 25% in 1988 and just 11% in 1979. The following data shows the number of household with children in the US:

Data taken from Lifelong adoptions website (www.lifelongadoptions.com)

Also, demographic data show significant diversity among same-sex couples with children. The percentage by regions varies as in the South 26%, New England 24% and the Pacific States 21%. In 2000 census about 65,000 children lived with same sex parents. In 2012 110,000 live with gay parents, over a 100% increase.

According to the American Society for Reproductive Medicine (ASRM), there is a ethical debate that includes three important factors:

1. The reproductive interest of unmarried and gay and lesbian persons.
2. The protection of the welfare of offspring.
3. Whether professional autonomy, combined with prevailing law, provides a limit on the duty not to discriminate on the basis of marital status or sexual orientation.

For this reason, given the importance to individuals of having children, there is no sound basis for denying to single persons and gays and lesbians the same rights to reproduce that other individuals enjoy.

This has been a very important step for countries to allow these patients to receive the same treatments as the other patients have. Having say that, there is not justification for discrimination. Gay couples, lesbian and unmarried persons have the same right to receive treatments and to use surrogacy as a way for them to make parenthood happen. If children born from these patients do not show differences in their upbringing in comparison with children born from heterosexual couples, what is the issue then?. After all, what does “normal upbringing means”?

The American Psychological Association concluded there is no scientific evidence that parenting effectiveness is related to parental sexual orientation. Lesbian and gay parents are as likely as heterosexual parents to provide supportive and healthy environments for their children.

Over the last years there has been a lot of controversy. Ethics committee’s reunions, multiple groups, religious groups, societies, governments, all reviewing this subject very carefully. Most of them concluded: the same rights for everyone, without discrimination.

However, still lot of controversy and discussion in some places where it is really hard to accept this equality and the refusal to change the society model that has been implemented for those people. It gets even harder in religious countries where those practices can be labeled as unbearable and aberrations.Some countries still penalising and punishing homosexuality.

It is important for me to have your opinion.

Should we all have the same rights irrespectively from sexual orientation or decision to become a single parent?

You can also have a look at this very interesting article from the American Society of Reproductive Medicine (ASRM) in the link attached.

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