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Turning to technology when nature isn't enough for pregnancy

by Marion CallahanBucks County Courier Times / The Herald
April 9th, 2016

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Danette Peeples felt broken.

For more than two years, she looked at women who were pregnant and thought: "Why can't this happen to me?"

Though she had one child, the Hatboro resident wanted a sibling for her young son. After two years of trying, she began to lose hope — until a friend told her about the changes that have occurred in reproductive technology.

Science, she thought, could be her answer.

"I knew my journey might be different, but the outcome would be the same — my dream child could happen," said Peeples, who turned to Abington Reproductive Medicine for help.

About one in every eight U.S. women of reproductive age and their partners have difficulty getting pregnant, according to the American Society for Reproductive Medicine. And more American couples today are getting medical help to have babies, according to the group, which represents the majority of fertility specialists in the country.

Between 2002 and 2013, treatment using assisted reproductive technologies jumped 25 percent, from 106,000 in 2002 to 146,000 in 2013, said Owen Davis, society president. The number of treatments, which cost thousands of dollars apiece, is expected to continue increasing, though statistics for 2014 and 2015 aren't available yet, he said.

Davis attributes the hike to women delaying childbirth, an increase in employers providing insurance coverage for such procedures and advances in egg-freezing technologies, which have enabled frozen embryos to survive transfers to the womb at much higher rates than in prior years.

Doctors say a growing number of younger women are interested in freezing their eggs for later implantation now that the success rate has improved. In 2013, nearly 5,000 women had their eggs frozen, up from 500 women in 2009, according to the Society for Assisted Reproductive Technology, a national organization of professionals who specialize in reproductive technologies.

"Women are deferring childbearing, but as they think about having children at an older age, it's more difficult to conceive," Davis said. "So we are commonly treating women in their mid to late 30s."

Beyond egg freezing, most patients seeking reproductive technology procedures do so to identify genetic diseases, but some are turning to the technology to choose the gender of their child, fertility specialists say.

While they'd like to have a girl, Peeples, who is now 36, said the first priority for herself and husband Derrick is to have a healthy baby. Their first child, who is now 3, was conceived naturally. During her journey to get pregnant again, she learned about technologies that have expanded the opportunities for women who have trouble getting pregnant.

In a process called in vitro fertilization, eggs are extracted and sperm is gathered and the two are combined in the lab. A number of healthy embryos are then implanted in the uterus with the hope that at least one develops.

Another process, pre-implantation genetic screening, analyzes embryos that are a few days old to determine whether there are chromosomal abnormalities before they're implanted. The procedure, which can screen for hundreds of genetic disorders, is growing in popularity, according to Dr. Stephen Somkuti, of Abington Reproductive Medicine.

In both procedures, embryos that aren't implanted are discarded.

"You can exclude the abnormal ones from the transfer, stack the deck in the patient's favor for optimizing a healthy outcome," Somkuti said. "Obviously, advantages are not only increasing the chance of a success, but diminishing the chances of miscarriages, because most miscarriages are due to chromosomal abnormalities during the first trimester."

Though embryo-screening procedures are most often used to detect disease, the gender also can be identified at this stage, said assistant professor Dr. Sara Morelli, who directs the Rutgers University Medical School Division of Reproductive Endocrinology and Infertility in North Jersey.

"It is a service that we offer," she said. "The vast majority of couples are coming for chromosome screening to better their chances of a successful pregnancy and not necessarily to select the gender. Once they have the information, some will choose the gender, but most will ask us to put in the healthiest looking embryo."

Sex detection is banned in many countries, but U.S. law doesn't restrict the practice, so clinics that offer the option can draw patients from other countries.

While Somkuti said most of his patients seek assistance to have a healthy baby, he recently saw two couples — one from Europe and one from Asia — who came to the Abington practice for gender selection.

"People come in for family balancing reasons; they may have three girls and want a boy," said Somkuti. "But it's not as common as you would think. We are not being flooded by people who want gender selection, but the technology is clearly available."

Not everyone views reproductive technology as a positive.

The Catholic Church wants couples to have children the "natural" way, said John Brehany, director of institutional relations for the Philadelphia-based National Catholic Bioethics Center.

In-vitro fertilization and other forms of reproductive technology "by their very nature, create quality-screening incentives," he said. "When (using technology to assist nature) happens, children are viewed as products and subjected to quality control and not as gifts, not as human beings with dignity and rights.

"The result certainly will be the loss of people who are viewed as defective and not valued, and the church would view this as a form of abortion," Brehany added. "You are bringing a life into being and discarding it if you don't want it."

The Catholic Church isn't the only religion to oppose artificial means of conception, but it has been among the most vocal about that opposition.

Others have different concerns.

New York University bioethicist Arthur Caplan said embryo screening for gender selection was once discouraged, but that has changed.

"As time has gone by, arguments about doing this for family balancing reasons have emerged," he said. "I argue that doctors shouldn't do it. Gender is not a disease; it's a preference. Once you start doing it for preferences, not medical reasons, you are opening a door to a big slippery slope. Maybe someone doesn't want a child with freckles or one who is short. It slides from there."

Caplan said that mapping of the genome and a greater understanding of genes are opening the door to many more tests and procedures, including gene editing.

"The future is not throwing out defective embryos, but trying to fix them using gene editing," he said. "I'm for it, if you can prevent terrible diseases — as opposed to using it to get rid of freckles."

Many foreign governments oppose embryo screening for gender selection, said Marcy Darnovsky, executive director of the California-based Center for Genetics and Society.

Forty-nine countries ban embryo screening for anything other than medical reasons, said Darnovsky. And sex selection is specifically banned in Canada, Taiwan and Great Britain, among other countries, for example. There is also widespread debate internationally about whether sex selection for family balancing reasons is ethical.

"There are regions of the world where sex selection is so widespread it's leading to widely skewed sex ratios and it's a crisis," said Darnovsky, adding that sex selection is even growing in countries that have banned the practice, such as India and China. "Some countries have laws against it, but they are not well-enforced."

Darnovsky said data in the U.S. show no dominant preference for males or females. But eventually — with the emergence of gene-editing technology — there may be preferences for "a certain height or appearance."

"Gene editing could have quite dire social consequences," she said. "We could all too easily see a situation where wealthy parents, who can afford this, are able to design traits of future children. With this, we introduce new kinds of discrimination and inequality in the world. We have far too much of that already."

The Center for Genetics and Society is a secular group of ethicists, public health specialists and sociologists who also have other objections to screening embryos, Darnovsky said.

"We have concerns of discrimination and broader societal concerns," she said. "Our concerns are not religious at all."

For example, she said, screening procedures, by their very nature, discriminate against abnormal embryos that would develop into people with disabilities.

"There are many people with disabilities living happy and fulfilling lives," she said. "The condition they have is part of who they are and is being targeted by selected technologies."

Major questions about ethics surface as these technologies advance, she said: "It raises the issue of 'where do you draw the line?' "

Patricia Wunsche said the issue for her and husband Robert was healthy babies — not gender.

She was among the first women in the Philadelphia region to try pre-implantation genetic diagnosis to avoid passing on a rare skin disease, pachyonychia congenita, from Robert to their child. The disease causes painful blisters to develop when too much pressure is applied to the skin. Even standing for a few hours can trigger painful sores. Skin cells become fragile and cannot withstand pressure or stretching. Just walking across a room can put enough pressure on the soles of the feet to burst skin cells.

Wunsche, who is now 41, underwent the embryo-screening procedure for the first time in 2003 at Abington Reproductive Medicine.

"We knew we were given an option that people hadn't had before," said Wunsche, who was living in Bristol Township at the time. "Knowing, as a parent, you are supposed to do what's best for your child, well, sometimes that starts before you have them. We just wanted a healthy baby."

Eight of the couple's nine embryos were found to have the skin disease, and the one healthy embryo died, she said.

Wunsche and her husband, who now live in North Carolina, didn't give up. After five in-vitro fertilization procedures using donor sperm, she was able to deliver two healthy baby girls.

"We went through a lot of hard work to make sure we had healthy children," said Wunsche, adding that she and her husband spent more than $50,000 on fertility treatments. "It shaped our lives for a while, and it seemed it was all we ever paid for. The end result was fabulous. I have my family because of what (the Abington practice) did for me."

Somkuti believes the decision to use or not use science to help with a pregnancy is a personal choice.

"It depends on your perspective in life," the physician said. "If you feel science has something to offer, then these technologies will stack in your favor the best that modern medicine can do to eliminate or prevent the transmission of a disease or a condition. I mean, people can argue that family balancing is a superfluous use of this technology and that when it first came onto the scene, the prediction was that fertility clinics were going to be flooded with patients for family balancing. But the reality is that these are very expensive technologies and that the vast majority of couples are interested in having a healthy child and a healthy outcome."

All Danette Peeples — who's six months pregnant with her second child — and her husband want is a healthy baby — boy or a girl.

She tried to get pregnant through in vitro fertilization, but the procedure didn't work for her. Intrauterine insemination, which is more commonly known as artificial insemination, did. It injects sperm directly into the uterus to ensure they reach their destination, as opposed to the usual 1 percent that make it to the uterus after intercourse, Somkuti said.

Their health insurance covered all but about $2,000 of the cost, Danette Peeples said.

Peeples said she's not embarrassed about or ashamed of using science to help her conceive. In fact, she wants people who are in her situation to feel less alone and hopes sharing her story will inspire couples with the same challenge to "keep the faith."

"This is my journey, but their journey could be different," she said. "If there is another woman who feels broken because she can't have a child the traditional way, she shouldn't give up. There are other ways to keep that dream alive."

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