13 September 2022
Individual fertility is precious and fragile. It can be lost or impaired for a variety of reasons, making it important to maximise and protect it for future family building purposes. Recognition and protection of individual genetic legacy is also becoming increasingly important from a medical standpoint, personal identity perspective, for personal privacy and security reasons and for the benefit of future generations as scientific, medical and genomic technology continues to rapidly advance.
Can medical conditions impact my fertility?
Yes, there are a variety of medical conditions which can impair or prevent a pregnancy, including:
- Turners Syndrome (e.g. which can cause the failure of ovaries to develop).
- MRKH Syndrome (causing the vagina and uterus to be underdeveloped or absent).
- Azoospermia (e.g. where no sperm is produced).
- Polycystic Ovarian Syndrome (PCOS) (producing irregular or failure of periods).
- Endometriosis (e.g. tissue similar to the lining of the womb grows elsewhere, including the ovaries and fallopian tubes).
- Uterine Fibroids and Polyps (producing benign non-cancerous growths in the uterus).
- Endocrine system disorders (e.g. thyroid and adrenal disorders, diabetes).
- STDs (e.g. pelvic inflammatory disease which can lead to scar tissue and abscesses developing in the reproductive tract causing permanent damage to the reproductive organs).
- Cancer (whereby active disease and chemotherapy can result in loss of reproductive organs and viable eggs and sperm).
For these and other reasons, it is important to proactively consider individual fertility and genetic legacy and take steps to protect it where possible to maximise the chances of conceiving a much-wanted child and/or achieve a child with whom you have a genetic connection.
What if I am not ready for children?
We are increasingly seeing trends in later-life parenthood, with people delaying having children for a variety of reasons, including:
- Career building.
- Financial reasons (e.g. trying to get on the property ladder).
- Not yet met the right partner.
- Not emotionally ready to have a child.
Fertility preservation can help to mitigate the constraints of the biological clock and age-related fertility decline (particularly for women) and other risks associated with the passage of time, although it is worth bearing in mind that it does not provide an absolute guarantee of achieving a biological child/ren in future.
Is it worth taking steps to protect my fertility against unexpected injury, illness or death?
Yes, it is important to take steps to protect individual fertility not just for yourself but for the benefit of your partner/spouse and family too because it can be lost unexpectedly with devastating consequences for a variety of reasons, including:
- Road traffic or high-risk sporting accident.
- Obstetric and gynaecological incident (e.g. birth injury and/or hysterectomy).
- Incorrect, missed or late cancer diagnosis (e.g. resulting in infertility following surgery and chemotherapy).
- Surgical negligence resulting in impaired or lost fertility.
- Serious infections (e.g. meningitis, sepsis).
In the same way that people take steps to protect other aspects of their life, including life and critical illness insurance or building and contents insurance, it is advisable to protect individual and genetic legacy too.
Will my fertility be affected if I transition gender?
Yes, a decision to transition gender can result in infertility due to hormone medication regimes and surgery. This makes it important to take proactive steps to preserve and protect individual fertility before undertaking gender reassignment hormone or surgery treatment. This will help to maximise chances of achieving a biological child in future.
What fertility preservation options are there?
There are a variety of different ways to preserve individual fertility, including:
- Egg freezing.
- Ovarian tissue freezing (still experimental and there is only limited data available in its efficacy).
- Sperm freezing.
- Testicular tissue freezing (still experimental).
- Embryo freezing.
Whilst these options do not guarantee the birth of a biological child, they can help improve the chances of one. There are also a range of different fertility testing and treatment options available to help maximise the prospect of a successful pregnancy and birth of a healthy child including genetic testing, IUI, IVF and ICSI.
Why is my genetic legacy important from a personal identity perspective?
There is growing awareness that individual genetic legacy can be important from a personal identity perspective because it can through DNA testing and from a wider family perspective:
- Inform understanding about personal ancestry and oneself.
- Help construct family trees and networks.
- Trace genetic parents, siblings, relatives, donors, straight surrogates, birth parents prior to adoption.
- Answer suspicions about family relationships and biological parentage.
- Uncover fertility fraud.
- Uncover fertility mix-ups at clinics.
- Highlight disease risk and potential to transmit this to genetic offspring.
Investigating and awareness of genetic legacy can raise complex issues medically, emotionally, legally and practically that need to be navigated carefully. This can trigger preventative medical procedures (e.g. removal of ovaries, hysterectomy or mastectomy) following genetic testing, complex legal disputes about parentage, birth certificates, contact and upbringing of a child, child maintenance and inheritance, negligence as well as evolving issues about the use of personal genetic information.
Why is my genetic legacy important from a personal privacy and security perspective?
Issues about the privacy and security of personal genetic data extend far beyond personalised and preventative healthcare and human reproductive options too. Careful attention needs to be given to the implications and risks of big business controlling individual genomic data given rapid developments in human genome sequencing, growth in popularity of direct-to-consumer genetic tests and digital and artificial intelligence.
Most people undertake a direct-to-consumer DNA test in the hope of finding genetic relatives, learning about their ancestry and obtaining insights about their health. However, these direct-to-consumer genetic tests raise legal and wider issues and risks that many users are unaware of and do not fully understand, including questions about personal genomic data security in the face of genetic-data attacks, commercial value and benefit derived from personal gene data and the protection of civil and human rights. Concerns continue to be raised about the accuracy of their results, particularly from a healthcare and reproductive perspective, and the fact that they spell the end of donor anonymity. Many unanswered questions also remain about the implications and risks of sharing genetic information in combination with increasing public activity disclosing personal data on social media platforms and the ongoing digital, artificial intelligence and genomic revolutions. As a result, greater awareness and proactive management of personal genetic legacy and information is important.
Specialist fertility and family law
This evolving landscape is likely to continue to intensify fertility, genomic and family trends, including:
- More delayed and later-life parenthood.
- Increased demand for egg, sperm and embryo freezing.
- More demand for fertility treatment and assisted conception.
- Increasing demand for donor eggs, sperm and embryos.
- Greater uptake of modern and diverse family forms.
- Greater focus on posthumous conception and genetic legacy.
Undergoing fertility treatment and building modern family forms increasingly requires prospective parents, donors, children and families to navigate a range of complex legal, practical and wider issues. This requires careful consideration and proactive management to ensure the best outcome and minimise the challenging issues that can arise. Specialist fertility and family law advice helps effectively navigate many complex legal and wider issues, including:
- Issues associated with DNA-testing and genomics in family building and later life.
- Legal and practical options for those with rapidly declining age-related fertility (e.g. fertility preservation and maximisation, management of existing personal relationships and implications of using donor gametes).
- Difficulties with storage and use of frozen eggs, sperm and embryos in fertility treatment in the UK (e.g. lack of consent and expiry of storage terms).
- Problems associated with import of frozen gametes and embryos into the UK for use in fertility treatment and surrogacy (e.g. due to anonymous and commercially obtained gametes and embryos which engage UK public policy restrictions).
- Issues with the export of frozen gametes and embryos abroad for use in fertility treatment and surrogacy (e.g. lack of consent and storage term difficulties).
- Unexpected death of a loved-one and issues associated with posthumous storage and use of eggs, sperm and embryos in fertility treatment (e.g. due to an accident, illness including Covid-19).
- Legal issues and options associated with fertility preservation and maximisation.
- Issues associated with assisted conception using frozen gametes or embryos involving a known donor, co-parent or surrogate (e.g. legal parentage and parental responsibility, financial responsibility and dispute mitigation).
- Issues and problems associated with the care and upbringing of children following a dispute with an ex-partner, parent, donor or surrogate.
- Legal parentage disputes with an ex-partner, donor, co-parent, step-parent, surrogate.
- Legal parentage disputes with a UK fertility clinic (e.g. problems and omissions with HFEA consent forms).
- Acquisition of legal parentage following a domestic or international surrogacy arrangement.
- Acquisition of legal parentage following a known donor arrangement.
- Acquisition of legal parentage following a co-parenting arrangement.
- An application to bring or defend a Declaration of Parentage (e.g. following a direct-to-consumer DNA test or to re-register a birth certificate).
- An application to bring or defend a step-parent adoption order.
- An application for an order to recognise a foreign adoption under English common law.
Need a fertility lawyer or a family lawyer? If you would like to discuss your situation or you require specialist fertility and family law advice and assistance please contact Louisa Ghevaert by email louisa@louisaghevaertassociates.co.uk or by telephone +44 (0)20 7965 8399.
