Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Tuesday, August 02, 2016

Due Diligence in Genetic Parentage

"The couples initially agreed to a shared custody agreement, but ended up in a custody dispute. The genetic parents won."
"The DNA testing came back, and nobody was related to the child. They ran [the test] again. It wasn't a DNA mistake; it was clearly a laboratory mix-up. We don't know if it was an embryo mix-up or a sperm mix-up."
"In other words, most people never check to make sure that the baby they deliver is the baby that they expect."
"Before sperm is used for an IUI [intrauterine insemination], before embryos are transferred for an IVF, they should be looking at the samples and making sure it's their name on the label. Don't just let a nurse read it out to you -- look at it."
Sherry Levitan, fertility lawyer, Toronto

"[Laboratories ... follow a] rigid process of validating patient identity at every interaction with the patient and every time gametes [sperm, eggs or embryos] are manipulated or moved."
Mark Evans, Canadian Fertility and Andrology Society

"I assure you that this is of primary importance to everybody."
"There isn't a clinic that doesn't want to make sure that the embryos go into the right people. It would be the highest priority for everybody."
"There are all sorts of checks, and double-checks and labelling and two people signing off on things."
Dr. Heather Shapiro, president, Canadian Fertility and Andrology Society
AP Photo/Richard Drew, File
AP Photo/Richard Drew, File   In this Oct. 11, 2013, file photo, Embryologist Rick Slifkin demonstrates fertilization techniques on a nonviable embryo at Reproductive Medicine Associates of New York, in New York. 
There are exceptions, of course. As when several years back it was revealed that an Ottawa-based acclaimed fertility specialist who was also a past president of Planned Parenthood Canada was discovered to have used his own sperm on several occasions when inseminating his patients. He became an alter-celebrity, banned for a two-month period from practising by the College of Physicians and Surgeons when he admitted to artificially inseminating three women over a two- decade period with the 'wrong' semen.

Errors in matching correct sperm and eggs with the right receiver are quite uncommon; it is also exceedingly rare when there are newborn mix-ups in hospitals as well, but they do occur and when it is eventually revealed that such an event occurred long afterward, lives are turned upside down. The issue of "misdirected" embryos was one recently addressed yet again by researchers producing the results of a study. The study undertaken for the American Society of Reproduction Medicine points to a moral obligation of fertility clinics to disclose such errors.

It can, in fact, be a serious issue for reasons other than incorrect parentage; in effect 'cheating' families of direct genetic descent. An additional issue to be grappled with is that with a variant in unknown genetic parentage comes unknown family medical histories through genetic inheritance. For obvious reasons, most people would want to know if they are susceptible to having inherited various types of chronic conditions or diseases that can have a decidedly deleterious impact on the quality of life, on their life-span.
Many babies in maternity ward at hospital
A lot of embryos in a lot of petri dishes in a lot of freezers . . . mistakes sometimes happen. Photograph: Alamy

Errors are inclusive of inseminating a woman with the incorrect sperm, or combining that sperm with the wrong eggs, or yet again combining the wrong sperm with the wrong eggs; even transferring the incorrect embryos to the wrong uterus; implanting, in other words, genetic material into totally erroneous receivers with couples winding up with some one else's biological offspring. The article by the Society was published in the journal Fertility and Sterility recently.

A number of IVF confusion reports have come out of the United States where newborns through artificial insemination born to white women have been babies of colour; clear enough indications that someone in this exacting field has been sloppy. One mother was heard to say how much she loves her baby though she knows it has no genetic link to her or her husband. It is the issue of what occurs when that lack of link is revealed that complicates peoples' lives intolerably, with challenges to parenthood.

A woman of Italian heritage in New York gave birth to twin boys, one white, his brother black, in 1999. The embryo transfer at a Manhattan fertility clinic she had undergone was linked to a black couple also undergoing IVF at that clinic that very same day. It was eventually understood that the pipette used in the procedures had not been adequately cleansed between transfers. The white woman became pregnant, the black woman did not. The legal proceedings added headache to heartache.

Ms. Levitan spoke of a Toronto area couple who had an embryo created with the use of a donor egg along with the male partner's sperm; a surrogate carried the embryo. To obtain a Declaration of Parentage, DNA testing was routinely undertaken which came back negative. Obviously enough, the incorrect sperm had been used, not the woman's husband's. The parents, fearful of losing the child, regardless chose not to sue for negligence.

In the United Kingdom, a government watchdog was set up, the Human Fertilization and Embryology Authority, to report on adverse incidents occurring in fertility clinics. Between 2010 and 2012, over 1,600 incidents had been tracked. Most such errors were classified as not being very serious in nature to more serious categories, where incidents such as incorrect labelling and pipettes accidently dropped, or dishes with embryos being contaminated with "cellular debris that may have contained sperm" were found.

The conclusion of those who investigate such mishaps is that patients themselves must become more involved in the process of verification. People tend to not want to be confrontational, or questioning, to be assertive to the point where it might seem they are questioning the professionalism of the health personnel to whom they have entrusted this important function for their future on their behalf. The public has always regarded doctors as being beyond question, let alone reproach.

Researchers are telling them; grit your teeth and do it anyway.

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