Sunday, February 16, 2014

IVF centers flourishing in Iran

by Salman Hameed

A year ago, I had posted about the stunning decline in fertility rates in much of the Muslim world. This will have a profound social impact in the next few decades. But in the article, Iran was singled out as its birth rate has now fallen below the level it requires to replace its current population. With that in context, here is a Foreign Policy article on the growing number of IVF (In Vitro Fertilization) centers in Iran. The article is interesting and yet the tagline unnecessarily brings up the fear factor of neighboring Sunni Muslims. Here is the title: How the supreme leader's revolutionary acceptance of 
cutting-edge fertility treatments 
is changing lives in Iran -- and unsettling the deeply conservative 
Sunni Middle East. Can we talk about Iran as Iran or do we always have to place it in a Sunni vs Shia context?

In any case, the interesting point here is not that IVF is popular and that it is allowed within a religious framework. Numerous Muslim countries have IVF centers and - even if the topic is considered a bit taboo - couples have been using the technique. But it is the permissibility of third-party egg or sperm donation in Iran that is pleasantly surprising. It is only a matter of time when it will be widely accepted, but Iran is certainly leading the Muslim world on this front. One of the reasons for that is a 1999 fatwa from Ayatollah Khamenei that gave green light to third party donations. From the article:
Iran's first in vitro fertilization (IVF) clinic opened up in Yazd, a desert city in central Iran, more than 20 years ago. It immediately found itself inundated with clients. By the mid-2000s, it was so popular that lines stretched out the door. Couples who had traveled from rural areas would camp outside in hopes of getting an appointment. More clinics soon
opened in Tehran and across the country. 
IVF quickly gained acceptance in other parts of the Middle East, but physicians ran into religious restrictions prohibiting more advanced forms of fertility treatment. Standard IVF involves fertilizing an egg with sperm in a laboratory and then returning the embryo into the womb, a process requiring that both the egg and sperm of the respective partners be viable, which is not always the case. The next step in treating infertility requires a third party -- that is, an egg or sperm donor from outside the couple. In Islam, the ethics of such treatment are murky: Patients initially worried they might be committing adultery or that children born of such unions would be illegitimate.  
But childless couples continued to demand a way to conceive. In Iran, medical specialists set about finding a religious solution, seeking the support of sympathetic mujtahids (clerics qualified to read and interpret the Quran). The Shiite tradition of reinterpreting Islamic law was central to the clerics' willingness to go along -- in stark contrast to Sunni jurisprudence's focus on scholarly consensus and literal readings of the Quran, which has meant few fresh legal rulings on modern matters. Although, to Westerners, Iran's Shiite clerics might appear reactionary, they are downright revolutionary when it comes to bioethics. In recent years, they have handed down fatwas allowing everything from stem-cell research to cloning.  
And here is the bit about the 1999 fatwa:
In 1999, Khamenei issued his landmark fatwa making third-party sperm and egg donation permissible. "Both the egg donor and the infertile mother must abide by the religious codes regarding parenting," the ayatollah decreed, setting out the various conditions that made the act permissible before God. Through Khamenei's edict, the Islamic Republic had made clear at the highest level that the state was ready to sanction Iranians' efforts to make babies -- whatever it took. 
But here is a fascinating bit. Even though Khamenei issued the fatwa, Iranian legislators overruled him. This is interesting as Iran is often presented as 1-dimensional country under the sole dictates of the Supreme Ayatollah. Again from the article:
In some ways, fertility treatment may be the rare area where the Iranian regime has moved forward before society is ready. Although legislators approved embryo donation, they overruled Khamenei on sperm donation, banning the procedure in 2003. As a result, the practice was pushed underground, and those clinics that quietly offer the treatment are vulnerable to prosecution. Sara Bamdad, a researcher in Shiraz who conducted a survey on public attitudes about assisted reproduction, found that only 34 percent of respondents approved of egg donation. "Lawmakers should be thinking about the future and what is going to happen to these children when they're older," says Bamdad. "If a society can't accept a child that's born of assisted reproduction, then there'll be so many problems in the future."
And this plays into the issue of family law:
Iran's legal system has yet to catch up with the implications of third-party fertility treatments. Under Iran's Islamic family law, babies born of sperm or egg donation fall into the legal category of adopted children and stepchildren, who are not permitted to inherit property from non-biological parents. Couples thus must find alternative ways to put aside assets to provide for these kids, and the rights and responsibilities of biological parents (the egg or sperm donors, who are meant to remain confidential but whose identities are sometimes disclosed in practice) remain unclear. 
Read the full article here. Also see this article on IVF clinics in Pakistan and a health tourism IVF ad for Turkey

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