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Taking In Vitro Fight to D.C.

Andrea Bianchi tried everything to get pregnant. She learned Tibetan chants and did yoga. She lay with her feet up for hours after sex. She even drank rainwater, gathered under the full moon in a blue glass bottle.

Then tests showed her ovarian tubes were entangled and would not let eggs through. In 2001, a year after Costa Rica became the first Latin American country to ban in vitro fertilization, she flew to Colombia for the treatment, which allowed her to conceive.

In addition to the painful surgeries, blood tests, ultrasounds and hormone injections, Bianchi had to quit her job and ended up spending thousands of dollars on travel.

Next week, Bianchi, 43, will travel to Washington, D.C., to represent 10 infertile couples before the Inter-American Commission on Human Rights in a case challenging Costa Rica’s in vitro ban.

It will be the first reproductive health technology case to come before the commission, which is part of the Organization of American States.

“This is like preparing yourself to go back to a stressful and horrible place, like the scene of an accident or a tragedy, in order to be a witness, so people can finally understand that there’s an injustice being committed in Costa Rica,” Bianchi told The Tico Times.

At Tuesday’s hearing, the couples’ lawyer, Gerardo Trejos, will argue the ban violates the right to have a family. Vanessa Videche, legal director at the Foreign Ministry, will testify that the treatment violates a higher right – the embryo’s right to life.

The commission, whose seven members are elected by the OAS General Assembly, will then decide whether to bring the case before the Inter-American Court of Human Rights, based in San José.

In Costa Rica, where about 75 percent of the population is Catholic, the treatment has set off a fiery debate.

“Christian ethics teaches that all children have the right to be conceived in a natural way – through the conjugal act,” San José Archbishop Hugo Barrantes said. “Any manipulation is morally unacceptable.”

In 2000, the Constitutional Chamber of the Supreme Court (Sala IV) found that in vitro fertilization is unconstitutional because most embryos never take hold in the woman’s uterus. The “loss” of these embryos violates their rights to life and human dignity, the court ruled.

“In vitro fertilization causes massive death,” said Alejandro Leal, a genetics professor at the University of Costa Rica (UCR) and president of the Association for the Defense of Life. “There are other ways to deal with infertility … such as adoption.”

Leal will join the state’s delegation in Washington, although he declined to say whether he would testify.

In theory, a typical center will achieve pregnancy at least 35 percent of the time through in vitro fertilization, said Dr. Delia Ribas, who pioneered the treatment in Costa Rica with her husband, Gerardo Escalante, before it was banned.

But even eggs fertilized naturally in the fallopian tube often fail to produce pregnancies, she said.

“Nature does commit errors,” she said. “I am in no agreement with the notion that we purposely provoke death. Quite the contrary, our goal is to try to bring about the continuance of life.”

In a surprise ruling this month, a lower court reinterpreted the Sala IV decision to allow in vitro fertilization using just one egg, instead of the usual two to 12. The court ordered the Social Security System, the Caja, which runs Costa Rica’s socialized health care system, to offer the treatment for free.

The Caja is appealing the decision, which has not yet taken effect. But even if the ruling is upheld, it will change little, Ribas said.

When just one egg is used, the treatment has a 10 percent success rate, so low that it may dissuade even the Caja’s patients, she said. “To go under anesthesia and have your vagina poked, shots for 10 days and only be able to use one egg? Doesn’t sound logical, does it?”

About 15 percent of couples of childbearing age are infertile, Ribas said, and 15 percent of infertile couples respond only to in vitro fertilization.

Ribas and Escalante, the only doctors who have performed the treatment in Costa Rica, delivered 15 test tube babies from 1995 to 2000. Now they prep patients to undergo the treatment in other countries.

Women take hormone shots for 10 to 12 days to stimulate follicle production, then fly with their husbands to clinics abroad, where their eggs are removed, fertilized in a glass lab dish with sperm from the husband and reinserted in the woman’s uterus.

Once back in Costa Rica, they take a pregnancy test.

Bianchi, a patient of Ribas, got pregnant with twins after her second in vitro treatment in Colombia. When the twins were two months old, Bianchi and her husband presented them to the statue of La Virgen de Los Angeles, Costa Rica’s patron saint, at the Basilica in Cartago, east of San José.

Her husband crawled into the church on his knees, with one child in each arm. The church’s position frustrates Bianchi, who is Catholic and sees her children as a gift from the Virgin.

“I presented them to the Virgin at the alter to say, ‘Thank you. Here they are.

They’re yours. We will take care of them for you,’” she said.

Some of the other plaintiffs weren’t so lucky. Ana Cristina Castillo, 43, who has endometriosis, tried artificial insemination unsuccessfully for eight years. The Sala IV ruling fell on her 37th birthday, just as she was preparing to undergo in vitro fertilization.

The expense and stress dissuaded her from seeking treatment abroad. The ordeal put a strain on her marriage, she said, and in 2002 she divorced her husband of 15 years.

Miguel Yamuni, 42, and Ileana Henchoz, 48, also among the original plaintiffs, will never have kids together, either. After unsuccessfully trying in vitro fertilization in Spain and Colombia in 2000, the couple gave up.

Henchoz has a daughter, Marianne, 22, from her first marriage.

Most of the 10 original couples are past childbearing age. They are asking the commission for damages, and they say they want Costa Rica’s ban overturned so that younger infertile couples can avoid the stress and expense of strange doctors, cold hotels and air travel.



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