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LGBT: Assisted Reproductive Technology (ART) as Part of Human Evolution

LGBT

A moving piece in JAMA boosts our pride in the profession

It does not happen too often that reading an article in JAMA touches one’s heart and, at the same time, increases one’s pride in the profession. But that is exactly what happens to, likely, most professional readers of “On the Origin of Our Family,” a short Piece of My Mind article in the May 15 issue of JAMA by Jason M. Nagata, MD, MSc, from the Division of Adolescent and Young Adult Medicine in the Department of Pediatrics at the University of California, San Francisco [JAMA 2018;319(19):1983-4].

In the article, Nagata describes how he struggled internally with his sexuality for more than a decade before coming out of the closet to his conservative Asian parents. He agonized about not being able to “naturally” procreate as a gay man. After finally coming out, he felt like a “suddenly freed caged bird,” fell in love and married Ryan. Both loved children and were striving to have a family, while Nagata, consciously chose to become a pediatrician, “so he could promote health for all children.”

At the end of an adolescent health rotation to Ecuador, he traveled for a weekend retreat to the Galápagos Islands, the location for many of Darwin’s most important observations, wondering how he and his husband fit into Darwin’s survival of the fittest theory, and fearing that they, like his parents had prophesized, were not meant to procreate. It was at that moment that he decided “to beat natural selection,” and become parents after all.

Upon his return to San Francisco, he and his husband learned from another gay couple that they could have children with their sperm fertilizing donated eggs, and a gestational carrier serving as surrogate recipient for the so created embryos. In a conference, later the same year, where “families of all shapes and sizes gathered to share experiences with IVF and surrogacies,” Nagata met a woman who offered to be their surrogate, and off they were to the races.

Seeing the many options, the egg donor selection process led Nagata to conclude that selection had “moved beyond natural selection,” as proposed by Darwin. He and his husband were pursuing natural selection through their sperm but “unnatural” selection by making choices between egg donors with so many different characteristics. Survival of the fittest is also characterized by survival of those able to adapt best, and here they were adapting to a new world.

Nagata concluded his piece by noting that “modern science and medicine had given him and his husband the opportunity to start a family that is genetically related to both of them.” They were at the time of the writing still undecided whether to follow Nagata’s parents’ idea of choosing a son as their first-born, though were leaning “to leave this to chance.” Like many straight couples, this gay couple is now on the way toward establishing their own family tree and, thereby, becoming an integral part of human evolution. The field of ART can be proud to be part of this evolution!

This is a part of the June 2018 CHR VOICE.

Norbert Gleicher, MD

Norbert Gleicher, MD, FACOG, FACS

Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.

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