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Olivia Pratten, a Canadian woman conceived through anonymous sperm donation, once quipped that we keep better records of cows in this country than we do of humans. I looked into it. She was right.
Olivia Pratten is well-known to Canadians with an interest in assisted reproduction. Conceived through anonymous sperm donation in 1981, Pratten fought to know the identity of her anonymous donor. She gave evidence during the consultation period for the Assisted Human Reproduction Act but to no avail. In 2008, Pratten filed a lawsuit in British Columbia, arguing that donor-conceived people, like adoptees, should be able to know their origins. She won, then lost on appeal.
As part of a project sponsored by the Alberta Law Foundation, I was asked to look into whether Pratten's cow allegation was correct. The piece that resulted was published as a short chapter in the book The Right to Know One’s Origins. In it, I compared recordkeeping in the bovine fertility industry with recordkeeping in the human fertility industry.
"A Tale of Two Embryos," below, was written almost a decade ago. I have tried to provide some updates in the footnotes, at least where humans are concerned; I apologize that I have not checked to see what has changed in the veterinary world. (I also apologize that the footnotes are clunky in the text, incomplete due to space considerations, and not clickable.)
The point of this piece is not to suggest that humans are the same as cows. Rather, I hope it underscores the fact that there is no practical or scientific reason why human offspring can’t have access to complete, accurate and verified records about their own origins. The capability is there. What is missing is the will.
A Tale of Two Embryos
“Daisy” was born just north of Calgary, Alberta, in the spring of 2010 from donated sperm and egg. No one need ever wonder about her health history, her complete heritage and all the details surrounding her conception -- they are all carefully documented and available for scrutiny.[1] “Rose” will always be less certain about her background. Rose’s mother has detailed profiles of the sperm and egg donors and some information about their family backgrounds, but none of these data have been verified. Rose’s mother cannot even be completely certain that her child was conceived from the donors she selected.
Why the difference? Daisy is a calf.[2] Rose is a little girl.[3] And for calves in this country, but not little girls, there is legislation and regulation that stipulates how such important information must be collected, verified, stored and disclosed.
Fertility specialists and regulators who balk at the challenge of keeping complete, accurate and accessible records for humans created through assisted reproduction need only look to the cattle industry for a solid template. The underlying motives for good record keeping in the cattle industry are completely different -- commerce as opposed to self-knowledge -- but the practicalities of doing so are largely the same.
The origins of Daisy and Rose
Daisy’s conception took place on April 6, 2009 by artificial insemination. Her biological father is “Red Fine Line Mulberry 26P”, a purebred Red Angus. His sperm was collected and frozen on October 15, 2007 and thawed just before the insemination. Daisy’s biological mother is “Red KBJ Miss Power 0890P”, also a Red Angus.
In cattle, assisted reproduction usually involves fertilising the eggs in vivo, that is, inside the donor animal’s body. For humans, this takes place in vitro, in a glass petri dish. Before the insemination, a veterinarian gave hormonal injections to Miss Power. These injections are not unlike the ones taken by human egg donors. They prompted Miss Power to ripen more than the customary one egg per cycle. Then the cow was artificially inseminated with the bull’s semen. As a result, multiple conceptions took place within Miss Power’s body. After seven days, on April 13, the cow embryos were “flushed” out using a special saline solution, and then recovered from the ejected fluid.
A total of 33 embryos were recovered from Miss Power that day by veterinarian and embryo transfer practitioner, Dr Roger Davis, of Davis-Rairdan ET Ltd, based in Crossfield, Alberta. Twelve of the embryos were top quality, four were of fair quality, and 17 were “degenerate”. All twelve grade 1 embryos were frozen on the day of recovery and placed into individual storage “straws”.
Then, on May 14, the embryo that became Daisy, a.k.a. embryo DT21, was ready to be transferred by Dr Davis into a cow, HO 5291, that would act as surrogate mother, gestating the embryo for approximately nine months. Early the following year, Daisy was born.
Rose’s conception also took place in April 2009 - but in a petri dish in Toronto. Her biological father is Xytex donor AFL 9821 and her egg donor is donor DEB823004. The date when the semen was collected is clear from the batch number on the vial. The eggs were harvested in early April by Rose’s mother’s fertility doctor.
Notes in Rose’s mother’s medical file show that 10 eggs were retrieved from DEB823004 and that all of them were fertilised later the same day. For each day thereafter for five days, there is a report noting the quality of each embryo and whether and why it was discarded. By the fifth day following the day of fertilisation, there were 7 embryos remaining: three of them were grade 1. Two of these were transferred into Rose’s mother’s uterus that day, and the other top-grade embryo was frozen. Within weeks, it was clear that only one in utero embryo had survived. Rose was born in January, 2010.
Differences in documenting assisted reproduction in cattle and humans
In comparing the assisted creation of Daisy and Rose, important differences in record keeping come to light. In cows but not humans:
1. The progenitors’ history is carefully documented and the accuracy of that documentation is subject to Canadian federal law;
2. Information about health and family history is available through a registry;
3. The genetic identity of the offspring is confirmed through DNA analysis;
4. Misrepresenting the identity of offspring is a serious offense;
5. The records follow the progeny
Let us examine each of these differences in turn.
The progenitors’ history is carefully documented and the accuracy of that documentation is subject to Canadian federal law
The documentation for Daisy says that her biological father is Fine Line Mulberry, and her biological mother, Miss Power. The official Canadian Angus online Herd Book shows the history of both her biological mother and her biological father, back multiple generations on each side.[4]
For Fine Line Mulberry himself, a single click reveals his registration number, colour, sex, birth date, identification by ear tatoo, that he’s free of a number of genetic defects and who his parents were.
Another click shows his immediate family tree, with links to each member. His sire, for instance, was Red Compass Mulberry 449M. Fifteen previous progeny of Fine Line, all searchable, are also listed, along with an analysis of the growth and performance qualities of those offspring.
There is good reason to trust that the information about Daisy’s family background is accurate. The Animal Pedigree Act,[6] formed in part to “protect persons who raise and purchase animals”, makes it a federal offense to misrepresent an animal’s identity on a registration, subject to a fine of up to $50,000.
The job of policing accuracy in animal lineages falls to Breed Associations, such as, in Daisy’s case, the Canadian Angus Association. Under the Act, these associations are empowered to be the sole keepers of detailed historical pedigrees of their breeds, and to register and identify all animals whose owners claim they belong to the breed.
But whereas in cattle, there is a federal law requiring accurate reporting of family history, no such protection is extended to “persons who raise” a human child born through IVF. Indeed, the Assisted Human Reproduction Act says nothing at all about ensuring accuracy of information about donors. Though children are conceived for completely different reasons than are cows, concerns about the progenitors’ identities are just as valid -- if not more so.
Like Daisy, Rose’s conception is documented. Her paperwork states that her biological father was Xytex donor AFL9821 and her biological mother DEB823004. According to information contained in the donor profile, AFL9821 is a Caucasian male with dark brown eyes and thick, dark brown hair. His parents are reportedly both still alive and in good health, as are his two female siblings; three of his grandparents are deceased, two of “old age” and one from emphysema. AFL9821 claims to have three male offspring of his own, a singleton plus twins.
Unlike Daisy’s biological father, Fine Line Mulberry, whose precise heritage is documented and openly available for scrutiny, little about Rose’s donors is really certain. Indeed, the Xytex website carries the disclaimer that “the medical and social history was provided by the donor and cannot be verified for accuracy.” He says he’s of German, Irish and Scottish extraction, but neither Rose’s mother nor the fertility doctor can know for sure. (AFL9821 may not even be certain himself.)
Rose’s sperm donor lists various conditions in the elder family members, including asthma, cataracts, diabetes, heart disease, stroke and skin cancer. Records indicate that no one in the family has suffered any mental illness, but as with the other information, this has not been confirmed. It isn’t possible to verify these claims because no information about the identities of the donor’s progenitors is provided at all. The same discrepancy exists between the egg donors: Miss Power’s background is carefully documented, but human egg donor DEB823004 -- of alleged Greek and Canadian ancestry, with a family history of alcoholism, type 2 diabetes and ulcers -- must be taken at her word.
Information about health and family history is available through a registry
In time, Daisy will be registered with the Canadian Angus Association. To complete the registration, her owner must provide Daisy’s birth date, her ear tattoo number and the names of her sperm and egg donors, known as the sire and the dam. Most Canadian Breed Associations require that official documents pertaining to the retrieval, freezing and transfer of embryos be filed with them in order to complete the identification process, though the Canadian Angus Association does not. But even Breed Associations that don’t keep those records on file retain the right under the law to audit the owners of all registered animals, and at that time may demand to see the certificates.
Provided that all conditions are met, the Breed Association will enter Daisy into the Official Herd Book and issue her owner an individual registration certificate. The records of her parentage and ancestry will be kept indefinitely in an online open-access database.
Rose will also be registered -- with the province of Ontario. According to the Vital Statistics Act, all human offspring born in the province must be officially registered. Information about Rose’s weight, sex, date of birth, place of birth and birth attendant must all be recorded. It is also noted whether she was a singleton or a multiple.[10] Information about her mother -- defined as the person from whose body she is born -- is also collected, including the woman’s legal surnames (any she’s ever had), given names, her place of birth, her age at the time of Rose’s birth, her address, the total number of children to whom she has given birth and whether or not they were live births. Details about the “other parent” are also collected. No information is collected specifically about the biological progenitors and no inquiries are made about whether or not they are different people from those already registered. Nowhere in the official record of Rose’s birth will there be information pertaining to or alluding to those progenitors.
Obviously, neither Rose nor her parents would want this information about her identity freely available to the public the way Daisy’s information is. And indeed no information about Rose’s identity is freely available; only people with a demonstrated right to view the information, such as Rose and her parents, can gain access.
In time, the province will issue Rose an official birth certificate. But that legal document will make no mention of her biological progenitors. Indeed, the Vital Statistics Office will remain unaware of them. Only her legal parents will be named. Rose may someday be interested in the information about her genetic background, but at present, she has no legal right to any of it. Her parents may choose to share that information with her -- or not.
The Assisted Human Reproduction Act called for a “health information registry”, which was to have collected and maintained health data about the parties involved in reproductive procedures.[11] Under the Statute, the Agency had an obligation to give people conceived through ART or their descendants the right and practical ability to discover whether they had been conceived using donor gametes and, if so, to learn about the health of his or her progenitors. The registry would also have given donor offspring a way to ensure that a mate was not a genetic relative.[12] To date, there is no official registry of donor-conceived human offspring in Canada.
The genetic identity of the offspring is confirmed through DNA analysis
The cattle industry recognises that, even when a detailed pedigree is maintained, and even when embryos are retrieved and transferred by professionals, sometimes the offspring are not who you think they are. A stray bull could inseminate the donor female during the seven days of embryo development prior to flushing, for instance, or a surrogate cow might produce her own egg that is then accidentally fertilised. For that reason, many Breed Associations require an offspring’s identity to be confirmed through DNA testing after birth.
As soon as Daisy’s owner applies to register Daisy officially as a member of the herd, the Canadian Angus Association will send out a “DNA parentage kit”, so that a sample of hair can be taken from Daisy (and from Miss Power, if that isn’t already on file). The DNA derived from the hair sample must be sent to a specific lab which will confirm -- or dispute -- that Fine Line and Miss Power are in fact Daisy’s genetic progenitors.
All Angus animals created through embryo transfer must be DNA tested. For those calves conceived naturally, the Canadian Angus Association does spot tests on roughly one in every 200 animals born. (According to the Association, about 8 per cent of animals who are spot-tested turn out to be the biological offspring of animals other than those whom the owner believed were the parents.)
Such routine DNA confirmation does not occur in human fertility clinics. Obviously, DNA testing on humans after birth would have enormous ethical and social ramifications. Those effects must be weighed against the possibility of learning the same information later in life. But even before conception, there is no routine or random verification that the sperm in a vial is in fact sperm belonging to the man in the donor profile. Further, there is no DNA confirmation that the sperm intended for use -- even when provided by an intended parent -- is the sperm that is in the end used for fertilisation.
As in veterinary assisted reproduction, errors occasionally occur in human assisted reproduction. How frequently they occur is unknown, since no one audits human fertility clinics in Canada for accuracy. The Assisted Human Reproduction Act does not call for data collection on errors of this kind.
What drives the desire for accuracy in the cattle industry is commerce. Purebred heifers with known pedigrees can fetch $3000 to $5000 in the marketplace, whereas regular young cows are sold for approximately $1000.
The need for accuracy in human offspring is much more complex -- and arguably, even more important. Sometimes, one of the intended parents wants to be genetically related to the offspring; there is no book value for such a relationship. Sometimes parents have painstakingly selected donors for very specific attributes that they feel are important to them, for instance, ethnicity, health history or appearance. Yet, unlike ranchers, intended parents have no means to ensure that they received what they asked for.
Misrepresenting the identity of an offspring is a serious offense
In most provinces, only licensed veterinarians can perform embryo transfer in cattle. Vets, like doctors, are licensed by their provincial professional body and subject to provincial law. In Ontario, for instance, vets must adhere to the Veterinarians Act, which states that failing to make or keep proper records could bring a charge of professional misconduct.[15] Even accidental errors can be considered misconduct, according to the College of Veterinarians of Ontario.[16] One item that must be accurate is the individual’s identity. The College can, at any time, inspect the records.
Similarly, only licensed doctors, with very specific training and certification, can perform embryo transfer in humans in Canada. Doctors are also expected to accurately identify patients. But whereas in veterinary medicine, one of the individuals to be identified by the embryo transfer practitioner is the embryo or animal created, in human medicine, the only individual identified by the fertility doctor is the commissioning parent. Because formal identification of the embryo is not required, there are no specific penalties for getting it wrong.[19] Nonetheless, parents who discover an error can take their case to the College governing physicians in their province which has the power to limit or remove their license to practice medicine.[20] No such case has been reported.[21] They may also go to the Assisted Human Reproduction Agency or to Health Canada.[22] There is no evidence that a parent has ever done so. On at least two occasions, however, a Canadian doctor has settled out of court with parents who have threatened legal action over sperm errors. The settlement included a commitment by the parents not to speak publicly about the error or the settlement.[23]
The rules regarding cattle identity are even more strict in cases where embryos will be exported. Errors in embryo identification can result in the permanent loss of not only the license to export but also the license to practice veterinary medicine.[24] All vets who create embryos for export must be licensed by the Canadian Food Inspection Agency and be certified by the Canadian Embryo Transfer Association (CETA), a non-profit body based in Kemptville, Ontario.
Among other things, CETA helps promote practice standards established through its international counterpart, the International Embryo Transfer Society, based in Champaign, Illinois. Like their parallel bodies in the world of assisted human reproduction -- the Canadian Fertility and Andrology Society and the International Federation of Fertility Societies – neither CETA nor IETS has powers of enforcement.
The records follow the progeny
In Canada, typically an animal’s veterinarian is required by law to keep the records of that animal’s conception, along with other records about its health, for a minimum of five years after the last entry on its chart. Most importantly, the documentation of a cow’s conception -- the “certificate of embryo recovery”, “certificate of freezing”, “certificate of transfer” -- are considered part of the veterinary history of that animal, and as such, are kept in the file of that animal and in the possession of its owner.
In human medicine, records about a conception are kept in the file of the commissioning parent. They are not considered to be documents pertaining to the offspring. Records about the means of conception and the genetic parents are not placed into the child’s pediatric medical file at birth and the person created through that conception has no legal right ever to possess them or even to view them.
Conclusion
Information regarding the progenitors of humans created through assisted human reproduction are an important part of the child’s record of health or identity. In fact, such information is not a part of the child’s record at all. It should be.
The experience of record-keeping in the cattle industry demonstrates that with the right combination of legislation and practice standards, it is possible to create and maintain accurate records, ones which can follow the individual created. There is no practical or scientific reason why human offspring cannot have access to complete, accurate and verified records about their origins.
1. I wish to acknowledge and thank Dr. Jay Cross, Associate Dean Research & Graduate Education, Faculty of Veterinary Medicine and Professor, Department of Comparative Biology and Experimental Medicine, University of Calgary; and Dr. Roger Davis, of Davis-Rairdan ET Ltd. Crossfield Alberta, for their expertise and insight.
2. All the details about this animal’s provenance come from actual records. I have invented the name and guessed at the gender.
3. Rose’s sperm and egg donors are real, and the details come from actual records, but as far as I know no child was conceived from their union. The details about the date of conception and birth were contrived. Details about what records might have existed come from interviews with fertility doctors.
4. http://www.cdnangus.ca/registry/online_herdbook.htm
6. https://laws-lois.justice.gc.ca/eng/acts/A-11.2/
10. No attempt is made to ascertain whether, as in Rose’s case, she shared a womb at any point during the pregnancy. “Missing twins” are a well-documented phenomenon and have health implications: http://www.newscientist.com/article/ mg17223134.600-and-then-there-was-one.html
11. Assisted Human Reproduction Act (Canada, 2004) s. 18(3) Update: this has since been struck from the Act.
12. Assisted Human Reproduction Act (Canada, 2004) s. 18(4) Update: this has since been struck from the Act.
14. In the UK, where they do check, there were apparently eight “serious incidents” in UK clinics in 2009, some of which may have involved sperm or embryo mixups. The Human Fertilisation and Embryology Authority, the UK equivalent of AHRC [update: Canada's regulatory body has since been disbanded], has now agreed to post inspection reports on its website, outlining the incident, its seriousness and the consequences. http://www.bioedge.org/index.php/bioethics/bioethics_article/ uk_watchdog_to_disclose_ivf_errors/ accessed 01 June 2010.
15. Veterinarians Act, Ontario, Part II Practice Standards.
16. Personal communication between Alison Motluk and Martin Fischer, Investigator, College of Veterinarians of Ontario, April 19-26, 2010.
19. The original footnote read, in part: There are no known cases in Canada where a physician has misrepresented the identity of an offspring. In the US, however, in 2009, a US physician was fined $10,000 and ordered to stop performing artificial inseminations by the Connecticut Public Health Department when it was discovered he used his own sperm rather than that of the intended father to impregnate a patient. A separate civil suit filed by the couple was settled out of court. There was no criminal inquiry and the doctor retained his licence. Update: We now know that in multiple instances, offspring born to patients of Ottawa fertility doctor Norman Barwin were created using the wrong sperm, including in some cases, his own.
20. Each College has the legislated responsibility to regulate the medical profession in its province. For example, in Alberta, responsibility is delegated to the Alberta College of Physicians and Surgeons under Section 3(1) Health Professions Act, R.S.A. 2000, c. H-7,
21. Update: In fact, several cases had been reported to the College, relating to Dr Norman Barwin, dating back to the 1980s. In 2014, Barwin did lose his license to practise medicine.
22. Update: this body has been disbanded.
23. Journalist Amber Kanwar investigated the case of an Ottawa fertility doctor who used the wrong sperm to fertilise donor eggs that were then transferred to a surrogate, who carried the child to full term. The commissioning father was supposed to be the genetic father but DNA analysis has confirmed that he is not. Update: some 50 people are now part of a class action suit against this doctor.
24. Ontario veterinarian Brian Hill was charged in 2009 with falsifying the identities of over 6000 exported bovine embryos. http://www.oxfordreview.com/ArticleDisplay.aspx?archive=true&e=1373851 accessed 01 June 2010.
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Related reading:
The Right to Know One's Origins, edited by Juliet Guichon, Ian Mitchell and Michelle Giroux.
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Upcoming conference:
Regulating Creation — Friday, November 23, 2018, Toronto — A conference on the law, policy and ethics surrounding assisted reproduction
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Get in touch: alison.motluk@gmail.com or 416-465-0497
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