A local clinic offering in-vitro fertilisation (IVF) to infertile women, men and couples is seeking to hire nurses and to recruit sperm donors by local press advertisements, all of which indicates much activity in this field.
Curiously there are no laws in TT to regulate IVF, and its myriad of social and ethical controversies. Should a woman be allowed to carry another woman’s embryo to term?
Should there be limits as to who is seen as a “suitable parent” for receiving IVF? Does the IVF process “play God” in creating new life, and does it reduce a baby to a product to be traded?
TT’s Parliament began to mull such issues in 1999 when the then Health Minister, Dr Hamza Rafeeq, had brought a bill to regulate IVF techniques — The Human Reproductive and Genetic Technologies (No.2) Bill, 1999 — but it had lapsed, never to be resurrected.
Currently, women in TT can seek fertility treatment at the Trinidad IVF Centre at Medical Associates Private Hospital in St Joseph, or go further afield to the Barbados Fertility Clinic.
Sunday Newsday spoke to three religious leaders, two doctors who provide IVF, and one Government Minister to get thier views on this topic.
Health Minister, Dr Fuad Khan, gave Sunday Newsday mixed views on laws to govern IVF.
“I’m thinking of bringing back the 1999 bill, regulating these businesses and procedures to the extent of international, acceptable regulations,” said Khan initially. “It is a lucrative business. You pay a lot of money for it, then take whatever results you get, with no refund. You sell hope; once you sell hope, people buy. These clinics sell hope, but do they deliver?”
He likened the IVF business to dubious herbal cures for infertility and even cancer.
Yet two days later Khan sang a different song, saying IVF legislation was not on the cards, and asked why was there a need for such legislation.
Roman Catholic Abbot John Pereira, head of Mount Saint Benedict Monastery, said, “The Catholic Church does not encourage IVF but considers it to be morally illicit.” He said IVF does not take account of marriage which he said was a sacrament of the church in which a man and woman become one flesh in a relationship exclusive to them. Marriage involves the unfolding of love, leading to the procreation of a new human life, said Pereira.
Saying the sex act was sacred between a man and woman, he said marriage consisted of both a procreative dimension and a unitive dimension, both of which should never be separated from one another.
“Out of that unitive expression of marital bonding, a child may be born,” said the Abbot.
“The child is part of the procreative dimension of sexuality, so bringing forth a child is not just a mechanical process like producing a car,” said Pereira. The sex act is sacred as it may lead to the creation of another human being, made in the likeness of God.
“The bringing forth of a child is not something mechanical. It is sacred. A child is not a ‘thing’ you are producing,” said Pereira. “The unitive dimension of the marriage bed should never be divorced from the procreative. You have to bond with your wife and out of that bonding comes the procreation.” However Pereira emphasised that any child born by IVF must not be discriminated against but was a child of God. He also claimed that the IVF procedure has little publicised the ill-effects on women’s health.
Sunday Newsday got an Islamic perspective from Maulana Sadiq Nasir of the educational group, the Ahlus Sunnah Wal Jama’ah Institute. He has studied Islam, and has degrees in law, education and philosophy.
“Islam wants us to preserve the sanctity of marriage and does not want genealogical relations to be blurred,” said Nasir. “So generally if two people are married and have a problem carrying a child, generally Islam would allow IVF for them, if married.” Nasir also said the couple should still both be alive, as he lamented the notion of sperm and ovum being frozen and be used to create a new life after the donors/parents had died. He said Islam’s requirement that IVF be restricted to living, married man-woman couples, would answer Sunday Newsday’s other queries about whether IVF could be used by same-sex couples.
He said that generally, Islam would not approve of the involvement of any surrogate mother in IVF. Condemning any payment for surrogacy, he hit, “You are ‘renting’ a womb, being paid to do it. In Islam parts of the human body are considered sacred and should not be sold.” He said TT has laws against the buying and selling of human organs.
“Islam would not approve of this — renting a womb for payment.”
Maha Sabha leader, Sat Maharaj, said he knew Hindu couples who had used IVF to overcome infertility problems, adding, “We don’t have a position on that”.
He did not think there was as yet any pressing need in TT to legislate on IVF, but would welcome a debate on the social/ethical issues. “Start a debate and let’s see where it goes,” urged Maharaj.
“I’m all for modernity. Retain your traditions but also live in a modern world.” He said a religion should influence any such changes taking place. Asked about surrogacy, he said it is occurring all over the world, being rampant in India where western couples pay impoverished women a few US thousand dollars to carry their baby to term. “I’m not sure how you could control it by the State using legislation to get involved in this personal matter.” He said an impetus to legislate on IVF might come if something goes radically wrong carrying out in the procedure, but added, “I don’t see a problem as yet”.
If there was ever a call to legislate, he’d prefer for this society to beforehand have an open discussion on the matter, including the participation of social and religious organisations. “At this point in time, I see no urgency for legislation,” concluded Maharaj.
The IVF sector in TT adheres to the ever-evolving guidelines used by two professional societies in the embryology sector in the USA and Europe, yet two foreign doctors working in TT varied slightly in their views on what regulations should obtain in TT.
Trinidad IVF head, Dr Catherine Minto-Bain (of the UK), agreed with the notion of all medicine being regulated by law, while embryologist Dr Cristine Hickman (of Brazil) said she’d prefer TT’s IVF sector to be run by professional guidelines, not State laws which she said abroad fail to keep up with changes in this evolving field and were likely to be too rigid for an area which actually needs some flexibility and doctor discretion.
For example it is impractical for the law to specify age 38 as a cut-off age when in fact a woman of this age might find her body acting like that of a woman age 42 years, and so require some legal flexibility not rigid laws on IVF.
Embryologist, Dr Cristina Hickman, said the world has a variety of regulations for IVF, ranging from the UK and Australia which have laws to the USA which has guidelines as updated annually by the American
Society of Reproductive Medicine (ASRM). Guidelines for Europe come from the European Society for Human Reproduction.
The America group allows the transfer of more embryos into the womb than the European group so as to increase the chances of getting pregnant, but the downside is that this increases the risk of multiple births. Dr Hickman said she is a member of the European society while centre head, Dr Catherine Minito-Bain is a member of the USA society. “Once a year we attend conferences to keep up to date,” said Hickman.
She welcomed an educated regulation of TT’s healthcare, in accordance with guidelines set down by the societies, which will be known by IVF doctors. Hickman hailed the US system of flexible IVF guidelines that could be reviewed as things go along, rather than being ruled by The Law which is stricter and more severe but lacks the agility of regulations.
Dr Minto-Bain said all medicine should be regulated, including by self-regulation. Asked if doctors predominate the debate on IVF ethics due to their specialist knowledge of the technology, she said the science is very basic and the debate should be held in ways people can understand. Asked if laws or regulations should regulate IVF, she said all medicine should be regulated, whether by self-regulation or not. “Our clinic is very well regulated,” she assured, referring to the role of the Ethics Committee. “Quality, regulations and ethics are your cornerstones.”
While her clinic mostly offers imported, anonymous sperm, she said she is mulling the issue of whether to offer the option of letting local donors be made known to the recipient woman/couple.
At present, a local sperm donor stays anonymous, unless of course he was sourced by the recipient herself.
She said that fifty percent of TT sperm donors have said they’d be happy for the child(ren) created to know their donors/fathers identity. This is a much higher ratio than globally, she added.
Does the centre have limits on the status of a woman who can be artificially impregnated, such as a ban on single women or lesbians?
Minto-Bain said there is no ban on single women, unmarried couples or lesbians, but that you should be in a stable relationship, seek the welfare of the child, and be able to provide a long term stable environment for him/her.
What protection should be given to the embryo?
She replied that her clinic usually implants just a single embryo in women patients, so as to avoid multiple pregnancies. “81 percent of our pregnancies are single babies.”
While others clinics outside of TT might implant several embryos so as to increase the chance of attachment to the uterine wall, that practice could lead to a multiple pregnancy which could often progress unhappily as a women with several embryos in her is likely to lose one or more through miscarriages.