Fatal Attraction? On the Risk of Incest for Children of IVF
As the month of love rolls in, we are inundated with stories of romance on television, in the news, and even in forwarded e-mails.
Among the stranger stories are those like the December report of British twins who unwittingly married each other. Such stories have been the basis of ancient literature as in the legends of King Arthur, or in the current cultural icon of the soap opera.
While this story is based on a single reference lacking in detail, its introduction in a debate in the British House of Lords was raised to point out the current risk of sibling marriage among children conceived through anonymous donor sperm or donor eggs.
But is there a risk of incest among children of in-vitro fertilization (IVF)?
Regulation of assisted reproductive technology (ART) in the United Kingdom is through the Human Fertilisation and Embryology Authority which was created by legislation in 1990.
In the United States there is no such comparative authority regulating ART. Because of the American legal tradition of limited government and a deferral to the authority of medicine, after nearly thirty years of practice, ART in the United States is governed by very few laws.
The Fertility Clinic Success Rate and Certification Act of 1992 requires reporting of fertility cycles and their success rates to the Centers for Disease Control, but does not require fertility centers to comply.
A few states have enacted embryo protection laws in regard to fertility treatments and parental rights and responsibilities. But so far, there is no regulation on collecting information for donors of gametes.
Internal standards of regulation have been made by the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART).
Practice guidelines for gamete donors suggests that directed (or known) donation is better than anonymous donation, but no standards exist for management of the donor information.
Large sperm donation centers, such as California Cryobank, insist on the anonymity of their donors, and keep no means to track donors once they are finished.
ASRM and SART have recently acknowledged this failure and say they will meet in March to begin discussions for the creation of a registry which would track gamete donors. But as with their other standards, such a registry would have the status of voluntary participation only.
With so little external or internal regulation and increased numbers of children being born from donor gametes, the means for adult children of ART to discover their genetic inheritance is limited.
So has the risk of fatal sibling attraction increased?
Let's do the math: if one person's gametes have resulted in multiple births (from two to several hundred, as in the case of sperm donation) over a limited time period, and in a given geographical zone, the possibilities are unknown, but are definitely NOT zero...
[February 2008 www.tennesseecbc.org, Melanie Unruh, The Tennessee Center for Bioethics & Culture]