figurine with a void shape of a child and family of parents with a child. Surrogacy concept.

Regulating International Commercial Surrogacy

By Hannah Rahim

In January 2024, Pope Francis called for a universal ban on surrogacy as a threat to global peace and human dignity, claiming that the practice is a “grave violation” of the mother and child’s dignity and based on the “exploitation of situations of the mother’s material needs.” Surrogacy raises complex ethical and legal issues, particularly in cases of international surrogacy, where people seek surrogacy services from another country. There is currently no regulation of international surrogacy. Creating such regulation is important to allow appropriate access to surrogacy services while mitigating its harmful consequences.

Read More

rendering of luminous DNA with gene being removed with forceps.

Designer Babies? The Ethical and Regulatory Implications of Polygenic Embryo Screening

By Hannah Rahim

New technologies are increasing the accessibility of polygenic embryo screening, which can assess the likelihood of an embryo developing polygenic diseases (e.g., diabetes, schizophrenia) or provide insight into certain polygenic traits (e.g., height, intelligence). This procedure has many complex clinical, social, and ethical implications, but is currently unregulated in the U.S.

Read More

cell with pipette and needle.

Are Embryos Children? The Alabama Supreme Court Says Yes

By Joelle Boxer

This month, the Alabama Supreme Court held that the term “children” in a state statute includes embryos, or “extrauterine children.”

As fertility treatments like in vitro fertilization (IVF) involve the creation of multiple embryos, not all of which are implanted, the implications of this ruling could be far-reaching. Four million births each year in the U.S. are via IVF, an important pathway to parenthood for couples with infertility, LGBTQ couples, and single parents.

This article will examine the Alabama Supreme Court’s decision in LePage v. Mobile Infirmary Clinic and its consequences for Americans building their families through fertility services.

Read More

Birmingham, Alabama - February 8, 2020: University of Alabama at Birmingham UAB Hospital title and logo on brick facade.

The Beginning of a Bad TRIP – Alabama’s Embryonic Personhood Decision and Targeted Restrictions on IVF Provision

By Katherine L. Kraschel

Last week, the Alabama Supreme Court called frozen embryos created via in vitro fertilization (IVF) “extrauterine children” and referred to the cryotanks where they are stored as  “cryogenic nurser(ies).” The Court sided with couples who claim the accidental destruction of frozen embryos created through IVF and cryopreserved ought to be treated equally to the death of a child. 

The case, LePage v. Center for Reproductive Medicine, involves plaintiffs seeking punitive damages from an Alabama fertility clinic for the “wrongful death” of their embryos that were destroyed when a patient in the hospital where they were stored removed them from the cryotank. While the lower Alabama Courts concluded that the cryopreserved embryos were not a person or child under the state’s law, the Alabama Supreme Court disagreed and held that the state’s Wrongful Death of a Minor Act “applies to all unborn children, regardless of their location,” and that the  plaintiff’s wrongful death claims could proceed. 

Thoughtful scholars have argued that existing state laws do not sufficiently redress mistakes and accidents that occur in the process of fertility care, pregnancy, and birth. However, the ends do not justify the means in this case; likening frozen embryos to children is not a legally sound mechanism to hold fertility clinics accountable for negligently storing embryos. It illustrates how sympathetic stories can be used to further the agendas of those who seek to equate embryos and fetuses  to “people” under the law and undercut the critical role modern fertility care plays in (re)defining the bonds that create families, and particularly, many LGBTQ+ and single parent families. 

Specifically, lawmaking in fertility care stands to fuel the movement to create fetal personhood rights and a federal abortion ban. It may also signify an inflection point in regulating assisted reproduction reminiscent of pre-Dobbs targeted restrictions on abortion provider (TRAP) laws that sought to limit abortion provision by imposing restrictions. TRAP laws’ new sibling – targeted restrictions on IVF Provision – or TRIP laws, as I call them, stand to rob patients of their ability to build their families by compelling physicians to provide less effective, more expensive care. TRIP laws will erect barriers and exacerbate long standing racial disparities in accessing fertility care, and they will disproportionately impact members of the LGBTQ+ community who wish to build families through fertility treatments.  The Alabama decision is severe, but it should serve as a warning to state legislators with a new responsibility to safeguard reproductive health care without the floor of Roe’s protections – proceed with extreme care and regard for “unintended” consequences of regulating fertility care.  Read More

Close up of surgery team operating.

Access to Uterus Transplantation and the Workplace

By Natasha Hammond-Browning

Uterus transplantation first hit the headlines in 2014, with the birth of the first baby born following a uterus transplant. This first birth in Sweden has led to trials worldwide. Most recently, in August 2023, the United Kingdom saw its first uterus transplant. In the United States, the University of Alabama (UAB) Medicine uterus transplant program is the first program to offer uterus transplantation outside of a clinical trial, and the first birth in that program was in May 2023.

While recent estimates of future uterus transplants are relatively small — for instance, Womb Transplant UK estimates that between 20-30 uterus transplants could be performed annually — the increasing number of uterus transplant recipients should not be ignored. In particular, questions of access and the workplace rights of those undergoing this surgery are important to consider. This post will briefly lay out some of the issues that may arise for potential recipients and their partners in the workplace.

Read More

Scales with the center depicted as an egg being fertilized through ivf.

Surrogacy and Employment Rights in the UK    

By Zaina Mahmoud and Kirsty Horsey

At the end of March 2023, the Law Commission of England and Wales and the Scottish Law Commission published their joint Report, Building Families Through Surrogacy: A New Law, outlining recommendations for a new regulatory regime governing surrogacy in the UK, including a new route to (legal) parenthood for intended parents (IPs), referred to as “the new pathway” (para 1.10). Chapter 15 of the Report provides an overview of the consequential impact of surrogacy on other areas of law — most relevantly here, employment law.

Read More

Large and diverse group of people seen from above gathered together in the shape of two intersecting circles.

An Intersectional Analysis of Proposed Fertility Leave in England and Wales

By Elizabeth Chloe Romanis and Sabrina Germain

For people in England and Wales needing access to fertility treatment, economic barriers can be a huge hurdle. There are the direct costs of the treatment (some, but not all, of which are covered by the National Health Service). But there are also the less visible indirect costs associated with accessing these treatments. These include needing time off work to attend appointments, funding travel to and from fertility clinics, and having access to spaces at work to store and administer medication and take private phone calls. Indirect costs limit access to fertility treatment for structurally disadvantaged individuals in England and Wales. It is for this reason that a Private Member’s Bill currently being debated in the House of Commons, the Fertility Treatment (Employment Rights) Bill, which seeks to introduce fertility leave in the UK, should be welcomed (see earlier posts in this symposium by Dafni Lima and Manna Mostaghim).

Introducing a formal entitlement to “allow employees to take time off from work for appointments for fertility treatment; and for connected purposes” is a step in the right direction. We offer an intersectional reading of the Fertility Treatment (Employment Rights) Bill and consider how the benefits offered are likely to be stratified along class, race, sexuality, and gender lines. The Bill is well-meaning and highlights the critical issue of indirect barriers to fertility treatment in the workplace, but it is inattentive to structural issues affecting marginalized people experiencing infertility.

Read More

Out of office - memo on office desk with glasses, pen, clock, paperclip.

Fertility Leave: Seeking Assisted Reproductive Technology as an Employee in the UK

By Manna Mostaghim

Fertility leave — employer-sanctioned time off for fertility treatment appointments — is becoming a feature of modern employment relationships in the UK. Some public and private sector employers in the UK have fertility leave policies within their organizations; however, currently there is no “statutory right to time off for fertility appointments” in UK law. As of March 20th, 2023, a private members’ bill (the Fertility Treatment (Employment Rights) Bill) has had its second reading in the House of Commons to codify the right for employers to be required to “allow employees to take time off from work for appointments for fertility treatment.” But, as it stands, employees in the UK still require the beneficent support of their employers to receive support and fertility leave in their workplaces.

Read More

A Liquid Nitrogen Bank Containing Sperm and Eggs Samples - ivf - in vitro fertilization, egg freezing.

Egg Freezing in Israel: Legal Framework and Women’s Viewpoints

By Yael Hashiloni-Dolev and Nitzan Rimon-Zarfaty

In 2009, Israel was one of the first countries to authorize social egg freezing, before it was declared non-experimental.

Israel is a highly pronatalist familistic society with relatively high marriage rates, low divorce rates, and the highest birth rate among OECD countries. Israeli pronatalism frames the favorable Israeli approach to fertility medicine and preservation. Currently, egg freezing is used for both medical and social reasons, and for transgender men.

Israeli policy views social egg freezing as primarily enabling, based on liberal ideology, “individual autonomy.”

Indeed, on one hand, social egg freezing has been praised as a revolutionary solution for women’s age-related fertility decline, thus providing women with liberating opportunities. On the other hand, it has been criticized for as oriented toward women’s bodies rather than toward taking away social obstacles to their full participation in the labor market and society in general. Giant corporations such as Apple and Facebook have offered funding for social egg freezing to their female employees while provoking ongoing bioethical and public debates regarding their implications, including; medicalization, (dis)empowerment, “appropriate” motherhood, medical risks, and success rates. This post considers these debates with a focus on the Israeli context.

Read More

EU flags in front of European Commission in Brussels.

Surrogacy and the Workplace: Maternity, Paternity, and Parental Leave in the European Union

By Marianna Iliadou

In surrogacy, a woman (surrogate) gestates a child for a (different/same-sex) couple or single person (intended parents [IPs]). This can generate issues in the workplace: for example, IPs may be unable to secure leave after the birth of the surrogate-born child, as maternity leave is traditionally linked to gestation and childbirth. In this blog post, I will examine maternity, paternity, and parental leave within the European Union (EU) and its applicability to surrogacy. While EU maternity leave policy regarding surrogacy has not seen developments since 2014, recent developments concerning paternity leave bring the topic back to the fore.

Read More