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Infertility and the “Yuk Factor”


a blog by David Kreiner, M.D., F.A.C.O.G., March 17, 2010

Those of us who work in the infertility field are often presented with situations that make us ponder whether we should assist in endeavors that make us feel a bit, well, uncomfortable. I suppose it’s common to have these experiences in our field as family building is a cornerstone of our society. But manipulating a family affects not just the people directly involved, but all of us.

There are the straightforward illegal and unethical cases: The married woman who presents with a proposal to conceive with a man other than her husband (without the husband’s consent) or the married man “donating” his sperm to a “friend” other than his wife (without his wife’s knowledge). These are the easy ones that don’t even make me pause.

I come across more difficult questions, however, that require much more intense contemplation and research. On a daily basis, the way most of us professionals try to deal with ethical and legal dilemmas is to resort to an evaluation of the “yuk factor.” It’s an internal cliff notes version of societal morality and law that many of us professionals rely on to make daily decisions when we can’t read the whole book on an issue. Sure, there's a potential downside of going down the slippery “yuk” slope, but when was the last time the approach "if you’d be ashamed to see it on the front page of the New York Times, then don't do it" led you down the wrong path?

Yet, I still have difficulty understanding what’s ethically and/or legally right in some situations. The go-ahead is clear to me if an unmarried man and woman present as a couple, each using their own gametes, and both sign consent acknowledging their rights and responsibilities to the future child. Less obvious is the case of the unmarried lesbian couple who present with only one partner participating biologically. They live as a couple, but the law doesn’t necessarily recognize the partner who isn’t participating biologically as having parental rights. Should they be signing as a couple for use of donor sperm to create a baby and, if so, what --if any-- are the ramifications? Is this situation different if the unmarried-yet-cohabiting partner who is not participating is a male? Does the unmarried lesbian partner have the right to adopt the baby? Does this change if the partner is a transsexual?

It would seem to me that if the couple decides that they will have a baby together, despite the fact that only one is contributing biologically, that there should be parity recognized legally based on the emotional and financial contributions the other partner makes, especially if she were willing to adopt the child and legally take on parental rights. For me the “yuk” factor becomes the legal system if that unmarried partner who is unable to contribute biologically is unable to retain parental rights in a split.

So now I'm off to the clinic to see what murky issues the day will present.

Every day is different.

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