UBC Reports | Vol. 51 | No. 1 | Jan. 10, 2005

Regulating Assisted Human Reproduction

UBC professor and reproductive health consultant Judith Daniluk talks about choices and dilemmas

By Erica Smishek

Biological mothers, surrogate mothers, gestational mothers, egg donors, sperm donors, in vitro fertilization -- a lot has changed since the days our parents said they found us in the cabbage patch.

No one knows this better than Judith Daniluk, a professor in UBC’s dept. of education and counseling psychology, and special education, who also serves as a reproductive health consultant at Vancouver’s Genesis Fertility Centre and is the author of The Infertility Survival Guide: How to Cope with the Challenges while Maintaining your Sanity, Dignity and Relationships.

As the Canadian Government moves forward with the Assisted Human Reproduction Act, Daniluk and other specialists in the reproductive technology field are preparing for what impact the legislation will have on them, infertile couples and others they assist.

Daniluk recently sat down with UBC Reports to discuss the new Act, its implications and her continued interest in this ever-changing field.

Q. The Assisted Human Reproduction Act prohibits certain activities and will regulate others with respect to assisted human reproduction and related research. Is it necessary?

A. We needed some general standards of practice. There are still bigger issues. For example, as a society we need to decide what kinds of services we believe should be provided and to what extent is there an obligation to ensure that the children who are produced through third-party reproductive options such as donor egg or donor sperm have the kind of information they need in terms of their social and medical history.

Technology has moved in leaps and bounds compared to what it was even 20 years ago. And questions arise literally daily in this area of health services. The question we need to constantly ask ourselves is “just because we can, does it mean we should?”

Q. You have been working in the reproductive technology field since 1982. How has it evolved?

A. The changes are dramatic. Each time technology affords another opportunity to try something new, it opens up a whole debate in terms of the long-term implications of what we’re doing. For example, with assisted reproductive technologies we’ve pushed the age barrier at which women can have children beyond anything that was ever imagined before. Back in the ’70s, even the early ’80s, if you didn’t have your first child by the time you were 30, people worried. Now it is becoming typical for women of 40, 42, 44, 46 to say, “I’m ready. I want to start having children.”

The questions are numerous. I’ve worked with women who are in their mid- or late-40s married to younger men who have never had kids but really want them. The women have grown adult daughters. Is it okay for them to ask their daughters to give them an egg so that they can have a child with their new partner?

Is it okay for a woman who was born without a uterus to have her mother be the gestational carrier for her child? Is that okay? And what are the implications of that?

It’s amazing what we’re able to do now. And because we’re pushing the envelope, even from a psychosocial standpoint, how do we make those determinations as to what the implications are going to be for the child down the road? Because that has to be taken into consideration. And to not do so is irresponsible as a society. But it requires the value judgments.

Q. Prior to the Act, I understand that most clinics used best practices from a medical standpoint as a guideline.

A. Even when you have your best practice guidelines, there are those heart-wrenching kinds of situations where you have to take the culture and the context into consideration when making those choices….

What do you about the young man who is 14, 15, 16 going through cancer treatments and as a consequence his parents want him to bank sperm. OK, fine. But who owns that sperm? What if he dies? And who has access to it? Or what about the couple who go through in vitro fertilization and have seven or eight frozen embryos. One of the couple dies. The other wants to use the embryos. Say it’s the woman who is trying to create a child even though the biological parent will have died before the child is born. Is that okay? And who decides? These are some of the issues the act is trying to address.

Q. What fascinates you so much about reproductive health?

A. Some of the most fascinating issues are about the reconfiguration of family. Some of that is social, because we have so many more diverse family forms such as blended families and single parent families through divorce. But now there are more single women pursuing motherhood on their own using anonymous donor insemination. Women now have the choice. They don’t have to wait for Mr. Right, or if they’ve waited and Mr. Right hasn’t come along and their biological clock is ticking, they can become mothers on their own. There are also many more lesbian couples creating their families through anonymous donor insemination.

We are blurring gestational and genetic lines, and we’re pushing age limits beyond anything we could have imagined even 20 years ago.

Q. After more than two decades, what keeps the whole area of reproductive health interesting for you both as a researcher and a clinician?

A. The field of reproductive health and medicine is hopeful because we’re talking about creating life, we’re talking about reconstructing family, we’re talking about people having choices and being able to pursue options and if treatment fails, there is some peace for them in knowing they did everything they could and it just wasn’t meant to be. My book deals a lot with coping with the stress of infertility and dealing with the grief of being unable to produce a child. I’ve had people shed tears in my office, I have shed tears with them over some of these situations. And yet, there is a light at the end of the tunnel and it is often a hopeful light.

Whether that is the creation of a family or whether it is moving on to a childfree life having done what they can or whether it is moving on to adoption or other parenting options, it is still moving forward and assisting people in that movement and that part is really exciting.

For more information on the Assisted Human Reproduction Act, visit http://laws.justice.gc.ca/en/A-13.4/2294.html.

For more information on the Genesis Fertility Centre, visit www.genesis-fertility.com.