In Costa Rica, viva la in vitro?


SAN JOSE, Costa Rica — Ileana and Miguel Yamuni desperately wanted to start a family, but just couldn’t conceive.

They went to a clinic, and began the lengthy and expensive process of attempting pregnancy with the help of in-vitro fertilization, or IVF. Ileana had begun the hormone therapy to ready her eggs for extraction, after which they would be joined with her husband’s sperm in a lab.

Then the Costa Rican government forced them to halt.

It was 2000, and Costa Rica’s Supreme Court deemed IVF unconstitutional. The Yamunis were shocked.

IVF, recognized as a highly effective treatment for infertility, was the couple’s best chance for pregnancy. Suddenly their country’s Supreme Court was telling them the technique violated “the right to life.”

Even in the devoutly Catholic country, the decision seemed unexpected. Costa Rica is the only Western Hemisphere country where in vitro is banned; other places that forbid it include Libya, Iran and the Vatican.

The Yamunis tried other ways to conceive, but nothing worked. Their biological window closed several years ago.

Illeana, 52, and Miguel, 46, believe some closure might come to them this month. An international court will announce soon whether Costa Rica violated human rights laws by banning in vitro. If the Inter-American Court on Human Rights rules in favor of the plaintiffs — nine couples, including the Yamunis — Costa Rica will be obligated to legalize IVF and the country likely will face fines for the prohibition.

“We’re very positive that we’re going to get the result we’re looking for,” Miguel Yamuni said. “We’re hoping this is a message to the state of Costa Rica and the [Supreme Court] that in regards to human rights they don’t have the last word.”

IVF involves fertilizing a woman’s eggs outside her body. Doctors then select the most viable embryos to be transferred to the woman’s uterus. The rest are often discarded. (The first babies conceived using this procedure were referred to as “test-tube babies;” IVF has since become commonplace.) The Supreme Court wrote in its 2000 decision that “the embryo is a person from the moment of conception,” and banned the technique.

Couples who saw IVF as their only option to have a child pushed back. They filed a lawsuit in 2004 with the Inter-American Commission on Human Rights, an arm of the Organization of American States. In 2010, the commission decided that an IVF ban violated several human rights, including the right to family, right to privacy and women’s reproductive rights. Costa Rica needed to legalize in-vitro fertilization or go to trial.

The Costa Rican congress tried several times to pass an in-vitro fertilization bill, and the human rights commission gave lawmakers multiple deadline extensions. But outside pressure halted the bill’s progress. At one point, a Catholic radio station broadcasted ads comparing in vitro to “homicide.”

In August, the country headed to trial at the Inter-American Court for Human Rights, which happens to be located in the country’s capital city of San Jose. Boris Molina, the lawyer for 12 of the 18 plaintiffs, dubbed it “ironic” for Costa Rica — a country with an international reputation for championing human rights issues — to be sued for banning a practice that’s a realistic option for infertile couples almost everywhere in the world.

Ana Lorena Brenes, representing the state of Costa Rica, made arguments that echoed the Supreme Court. Doctors on both sides of the issue argued about ethics. Plaintiffs explained to the inter-American court’s judges how the prohibition damaged their lives.

One man described how he became paralyzed from the waist down after an accident. He couldn’t have children without IVF. His wife divorced him. She remarried another man and conceived.

Ileana and Miguel tried to circumvent the ban. The Yamunis traveled to Valencia, Spain to receive IVF treatment. They stayed in hotels, asked for special permission to bring medical equipment on plane flights and rushed their stay due to the high cost of living abroad. The treatment, which has a success rate of about 20 percent, failed. They tried one more time in Bogota, Colombia. Same result. Nothing.

Going abroad for IVF became unaffordable. The Yamunis spent more than $30,000 on the treatments before giving in to the reality: They would never have children of their own. The couple fought on through the lawsuit, hoping to change the law for future pairs that needed the treatment.

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The decision could have an impact beyond Costa Rica, one that could affect the rest of Latin America. Alejandra Cardenas, of the New York-based Center for Reproductive Rights, served as a legal adviser for the plaintiffs on the case. She said the court’s ruling could serve as a stepping-stone for overturning conservative policies throughout the region, such as Nicaragua’s ban on abortion even when the mother’s life is at stake.

“It’s not only the IVF ban which [we] are against,” Cardenas said. “But also what’s at stake here is reproductive rights throughout the region in regards to abortion, or emergency birth control.”

Many expected a decision to come at the end of November. On Nov. 30, the lawyer Molina held a news conference at San Jose’s Children’s Museum — a not-so-subtle location. The lawyer had planned to announce the court’s ruling that morning. Instead the judges revealed that a decision had been made, but it would not be released for possibly another three weeks.

“After 12 years of waiting, we know something. There is a verdict,” Molina said. “We’re just not sure if it’s positive or negative.”

Brenes, the state attorney, told media she won’t comment until the decision comes out. Lawmakers have said even if they don’t agree with the court’s verdict, they will obey it. The ruling cannot be appealed.

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When it became apparent that a decision might not be forthcoming last week, several plaintiffs idled with Molina and a swathe of reporters outside the castle-like Children’s Museum. The Yamunis said they were hoping to wake up the next day for the first time in a dozen years without having to worry about the future of IVF in Costa Rica.

Teenagers walked by the group, headed for a high school graduation in the museum. Eventually, the crowd tired of waiting around, accepting the fact that no decision would come that day.

“It’s a delicate subject even for the commission and the international court,” Miguel Yamuni said. “We’re definitely a lot closer than we were 12 years ago. We’re just hanging out. Just waiting for it.”

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