Gamete Donation Research Articles

Awareness and acceptability of assisted reproductive technology among non-medical tertiary students in a low-resource setting

BackgroundAssisted Reproductive Techniques (ART) have significantly advanced infertility treatment worldwide. However their availability and use in sub-Saharan Africa, remains limited although infertility is highly prevalent, with significant psycho-social challenges including stigma. This study assessed the awareness, attitudes, and perceptions of ART among non-medical tertiary students in Ghana.MethodA cross-sectional study was conducted among non-medical students in tertiary institutions in Ghana. Pre-tested questionnaires were administered to both post-graduate and undergraduate students after obtaining informed consent. Ethical approval was obtained from the Review Board at Community Health Department of the University of Ghana Medical School. The data collected was analyzed using SPSS (version-27) and the results presented using frequency tables, graphs, and charts. significance was P-value below 0.05 was considered statistically significant.ResultsOverall, 196 participants from the two largest universities and other tertiary institutions in Ghana took part in this study. Majority (63.5%) of respondents demonstrated awareness on ART services, but 60.3% showed poor knowledge of the types of ART. Males generally exhibited lower knowledge of ART services compared to females, and knowledge of ART services showed an inverse relationship with age. In-vitro fertilization (IVF) was the most widely recognized and recommended ART technique, known by 65.1% of respondents who were aware of the types of ART. Most participants expressed reluctance to accept or recommend gamete donation due to religious reasons, fear of complications, and a preference for conventional means of procreation.ConclusionThe majority of tertiary students in Ghana are aware of ART for infertility treatment however, many are hesitant toward donor-gamete treatment protocols. Fear of complications and related costs pose major barriers to considering ART among the respondents. Participants unanimously suggested government subsidies and the inclusion of ART under the national health insurance coverage package.

Construction of new genomes of columnar apple trees in the Russian research institute of fruit crop breeding

Relevance. The article presents data on the creation of new genotypes of columnar apple trees based on interval crossings of the 2x × 4x type using traditional breeding methods and elements of accelerated assessment of hybrid forms using cytoembryological and molecular genetic methods.Results. Cytological assessment of seedlings obtained from the studied interval crossings of six columnar apple varieties and the selected columnar form 29-35-123 with tetraploid forms 30-47-88 and 25-37-45, which are donors of diploid gametes, showed that seedlings with a triple set of chromosomes prevail and their share is 83.0%. The share of diploids accounts for 17.0%. A comparative assessment of the ploidy of offspring showed that the difference between the yield of triploid seedlings in the offspring of families where different donors of diploid gametes (25-37-45 and 30-47-88) were taken as paternal forms is insignificant. From the tetraploid 30-47-88, 81.7% of triploid offspring were obtained, from 25-37-45 — 91.3%.The data of molecular genetic analysis confirm that in combinations where both parents have the scab immunity gene, the yield of immune seedlings is high (70,7%) and corresponds to the splitting on this basis in a ratio of 3:1. n families where only one of the parents carries the Rvi6 gene in its genotype (Garland × 25-37-45, 29-35-123 × 25-37-45, Moscow necklace × 30-47-88 and Constellation × 25-37-45) immune seedlings were less common (52%). A unique combination of columnarity, the Rvi6 gene and a triple set of chromosomes in one genotype is characteristic of 23.1% of seedlings.

Diagnosing a genetic disease in a donor-conceived child: case report and discussion of the ethical, legal, and practical issues.

We describe the unexpected challenges pediatricians may experience when children conceived with assisted reproduction are diagnosed with a rare genetic condition. A local case series triggered a dialogue between many stakeholders with varied expertise. Indeed, diagnosing a genetic disease in a child conceived by embryo, egg, or sperm donation is becoming more common now that genetic testing and in vitro fertilization (IVF) are readily accessible. However, how and whether to share that information with other stakeholders in the gamete donation process has not been fully explored, and the clinical responsibilities of the treating clinician remain ill-defined. This work centers on a patient with a confirmed diagnosis of X-linked nephrogenic diabetes insipidus. Ultimately, we found the same AVPR2 mutation in two children from two families conceived by egg donation. It led to multigenerational cascade diagnoses in the family of the shared, anonymous egg donor. First, we review current genetic testing practices in gamete donation and third-party reproduction. Then, we provide an overview of relevant genomic, ethical, legal, and psychosocial considerations for sharing relevant genomic information. Finally, and to maximize the best interests of genetic relatives, we discuss how a pediatrician can play a role in the early disclosure of relevant clinical information to all stakeholders in the gamete donation process, starting with the fertility clinic. While these clinical cases are cast in a Canadian context, we submit that its important lessons generally apply to medical systems of nearly all developed countries, broadly defined.

Building Our Families: Navigating Barriers in 2SLGBTQ+ Family Building Through Doula Supports

Queer and transgender individuals often encounter barriers when attempting to build their families, Beginning by identifying barriers that 2SLGBTQ+ people face in their fertility and reproductive journeys -- including limited access to information, inadequate diversity in donor gametes, and minority stress -- this article looks to the role of doulas in mitigating challenges by providing critical and tailored support, educational resources, and support and advocacy in navigating medical systems. Using a reproductive justice and intersectional framework, the article highlights the need for inclusive care practices that address the historical and ongoing exclusion of marginalized 2SLGBTQ+ communities. It underscores the importance of improved training for healthcare providers and systemic changes to ensure equitable family-building experiences for 2SLGBTQ+ individuals. By integrating community supports and peer advocacy, the article proposes strategies to enhance both the physical and mental health outcomes of 2SLGBTQ+ intended parents and their families. It calls for a comprehensive approach that combines professional training, systemic reform, and community-based initiatives to create a more inclusive and supportive environment for family-building among 2SLGBTQ+ individuals.

Predictors of gamete donation: a cross sectional survey study.

In 2015, assisted reproductive technology (ART) accounted for 1.7% of all U.S. births, donor eggs accounted for over 17,000 started cycles in 2015, and donor sperm accounting for 6.2% of all cycles started in 2014. With increasing utilization of donor gametes as a method of assisting patients with infertility, the number of babies born each year utilizing gamete donation will also continue to increase. This study aimed to elucidate factors impacting decision to donate, amongst a representative national population. A survey was distributed via the internet utilizing SurveyMonkey Enterprise with HIPAA compliance. Univariate regressions and frequencies were conducted between each demographic and personal characteristic and the willingness to donate. Log Binomial and linear regression was used categorical and continuous variables, and Risk ratios were calculated. In this large survey study, 64% of men and 50% of women reported they would be willing to donate gametes, with the majority desiring monetary compensation. Men with a high Consumer Financial Protection Bureau score were less likely to report that they would consider donating sperm compared to a medium high CFPB score. No other financial indicators were associated with considering donating sperm. There were no associations between CFPB score and egg donation outcomes. Black or African American women were less likely to consider donating their eggs compared to other groups, and more likely to desire > $5000 in compensation. In this large survey study, a small minority of participants reported they would be willing to donate to an unknown infertility patient for reproductive purposes. High and very high CFPB scores were associated with willingness to donate games, but not with desire for monetary compensation or amount.

Extension de l’Utilisation de Gamètes en IntraConjugal (EUGIC) : quel usage des spermatozoïdes d’une femme trans ?

ObjectiveThe French Law relating to Bioethics allows access to medically assisted reproduction for lesbian couples and single women and has expanded the possibilities for self-preservation of gametes. The question now arises of new uses of gametes of the couple, within couples of two cis women, one cis woman and one transgender woman, or two transgender individuals. The acronym EUGIC (Extension of the Use of Gametes in IntraCouple) allows these new situations to be grouped together, particularly if gametes have already been previously cryopreserved, thus avoiding the need for gamete donation. MethodsAnalysis of the different situations of sperm use from a trans woman using gametes available within the couple rather than gamete donation. ResultsThe inconsistency in the use of sperm from a trans woman, the situations already encountered by professionals, the prospects for filiation for a trans woman as well as the issues related to the interest of the unborn child are discussed. ConclusionFrench law does not fully address the use of a trans woman's spermatozoa to meet the new EUGIC requirements and leads to complex situations for healthcare professionals.

Dépistage de variant du gène CFTR chez les candidats au don de gamètes en France : quand ? Comment ? Pourquoi ?

ObjectivesAccording to French recommendations, only the caryotype is carried out as a first line in candidates for gamete donation. The prescription of additional genetic tests for variants responsible for serious monogenic diseases is only recommended in the case of call points. However, cystic fibrosis remains the most common genetic disease with serious consequences in childhood. The purpose is to assess the different screening strategies in the Centres d’Études et de Conservation des Œufs et du Sperme humain (CECOS) regarding abnormalities of the Cystic Fibrosis Transmembrane conductance Regulator gene (CFTR). MethodOur study is based on the analysis of data collected using a questionnaire. Private centres authorised to donate have been excluded from this work. ResultsTwenty-six centres participated out of the 33 interviewees. Two centres carry out systematic screening in all their sperm donation candidates while only one centre practises it in its oocyte donation candidates. For the other 23 centres, research is carried out in case of strong clinical suspicions according to personal or family history and when one of the two members of the recipient couple has a known variant. Regarding the molecular analysis technique used, 56.5% of centres use PCR with commercial kits, whereas the other centers use next-generation sequencing. ConclusionTargeted screening therefore remains widely practiced in France unlike other countries. Moving to expanded systematic screening raises ethical, financial and organisational issues.

The emergence and use of expanded carrier screening in gamete donation: A new form of repro-genetic selection.

With the continued expansion and commercialisation of fertility treatments, the selection and matching of donors have become more sophisticated and technologised. As part of this landscape, new form of genetic screening: 'expanded carrier screening' (ECS) is being offered as a technique to avoid the risk of donors passing on genetic conditions to future offspring. Allowing donors to be tested for hundreds of genetic conditions simultaneously, ECS marks a considerable departure from traditional 'family history' models of screening, which rely on an individual's knowledge of family health. There is growing evidence of a drive towards the use of ECS within the fertility sector, and a growing number of clinics are offering it for a fee, as part of an egg or sperm donation cycle or as an add-on to IVF treatment. In this article, we use methods of critical reflection to synthesise data from two studies to explore how ECS is being used to avoid genetic risk in IVF treatment using donor gametes. We suggest that ECS is a new form of repro-genetic selection-a selective reproductive technology-with specific and important implications for donors, recipients and clinicians and with the potential to reconfigure the scope and application of gamete donation. We examine these implications and conclude that the existing policy blind spot relating to this development in fertility treatment practice needs to be urgently addressed.

Mapping Ethical, Legal, and Social Implications (ELSI) of gamete donation.

This scoping review investigates the Ethical, Legal, and Social Implications (ELSI) of gamete donation, a critical facet of Assisted Reproductive Technologies, by analyzing the evolving research scope, methodological approaches, and the geographical skew in the literature. Despite the increased global uptake of donor gametes, current scholarship predominantly emanates from Western contexts and focuses on majoritized groups. This bias constrains the universality of research findings and limits their applicability across varied legal, cultural, and social contexts, underscoring a need for broader inclusivity. We addressed 867 pivotal articles published between 1999 and 2019. Our analysis reveals a discernible escalation in research volume, with 62% based on empirical research. The intellectual landscape unfolds into four dominant clusters: Regulatory Frameworks, Incentives, and Access; Family Dynamics and Genetic Linkages; Identity and Privacy in Donor Conception; and Cultural and Societal Attitudes towards GD. Each cluster highlights nuanced dimensions of gamete donation, from regulatory intricacies and psychological welfare to identity ethics and cultural perceptions. Our findings advocate for a shift towards more globally representative and methodologically inclusive research. By integrating diverse cultural narratives and expanding geographical breadth, future research can offer holistic understandings of gamete donation, fostering equitable and culturally resonant practices and policies worldwide.

Preconception carrier screening and preimplantation genetic testing in the infertility management.

Genetic testing serves as a valuable element of reproductive care, applicable at various stages of the reproductive journey: (i) before pregnancy, when a couple's genetic reproductive risk can be evaluated; (ii) before embryo implantation, as part of in vitro fertilization (IVF) treatment, to ascertain several inherited or de novo genetic/chromosomal diseases ofthe embryo before transfer; (iii) during the prenatal period, to assess the genetic costitution of the fetus. Preconception carrier screening (CS) is a genetic test typically performed on couples planning a pregnancy. The primary purpose of CS is to identify couples at-risk of conceiving a child affected by a severe genetic disorder with autosomal recessive or X-linked inheritance. Detection of high reproductive risk through CS allows prospective parents to be informed of their predisposition and improve reproductive decision-making. These include undergoing IVF with preimplantation genetic testing (PGT) or donor gametes, prenatal diagnosis, adoption, remaining childless, taking no actions. Both the presence of the affected gene (PGT-M) and chromosomal status (PGT-A) of the embryo can be comprehensively assessed through modern approaches. We provide a review of CS and PGT applications to equip healthcare providers with up-to-date information regarding their opportunities and complexities. The use of CS and PGT is currently considered the most effective intervention for avoiding both an affected pregnancy whilst using autologous gametes in couples with known increased risk, and chromosomal abnormalities. As our understanding in the genetic component in pathological conditions increases, the number of tested disorders will expand, offering a more thorough assessment of one's genetic inheritance. Nevertheless, implementation and development in this field must be accompanied by scientific and ethical considerations to ensure this approach serves the best long-term interests of individuals and society, promoting justice and autonomy and preserving parenthood and the healthcare system. The combination of CS and PGT aligns with principles of personalized medicine by offering reproductive care tailored to the individual's genetic makeup.

Assessment the carrier frequency of monogenic diseases in populations requiring assisted reproductive technology

PurposeThe objective of this study is to assess the carrier frequency and pathogenic variation of monogenetic diseases in a population of 114 subjects in Han Chinese from Hebei province who are undergoing assisted reproductive technology through the utilization of Expanded Carrier Screening (ECS).MethodsThe study utilized a panel consisting of 155 severe monogenic recessive genetic diseases for ECS. Next-generation sequencing technology was employed to identify specific variants associated with ECS in a cohort of 114 subjects from 97 couples, comprising 97 females and 17 male spouses.ResultsA total of 114 individuals received ECS. The carrier rate of pathogenic genes in the enrolled population was 44.74% (51/114). Among the 97 females, the carrier rate of pathogenic genes was higher in those without assisted reproduction indicators than in those with assisted reproduction indicators (59.09% vs. 41.33%). However, the carrier rate of pathogenic genes in males without assisted reproductive technology was slightly lower than that with assisted reproductive technology (40% vs. 41.67%). Among both female and male participants, the carrier rate of pathogenic genes between individuals without indicators of assisted reproduction and those with such indicators was 55.55% vs. 41.38%. In 51 carriers, 72.55% (37/51) carried one genetic variant, 25.49% (13/51) carried two genetic variants, and 1.96% (1/51) carried three genetic variants. A total of 38 pathogenic genes were detected in this study, and GJB2 and MMACHC were most common. The carrier rates of the two genes were both 5.26% (6/114). A total of 55 variations were detected, and c.235delC was most frequently found. The carrier rate was 3.51% (4/114). The incidence of couples carrying the same pathogenic genes was 1.03% (1/97).ConclusionsThe findings elucidate the carrier rate of pathogenic genes among 155 severe monogenic recessive genetic diseases and underscore the significance of ECS as a preventive measure against congenital anomalies. When both partners carry the same genetic mutation for a monogenic disease, preventive strategies can be taken in offspring through preimplantation genetic testing (PGT), prenatal genetic testing, or the utilization of donor gametes. ECS is instrumental in assessing reproductive risk, guiding fertility-related decisions, and reducing the prevalence of monogenic recessive genetic disorders in subsequent generations.

Procreative Obligations and the Directed Duty of Care

ABSTRACTThere is much dispute about what we owe the children we are responsible for creating. Some argue that so long as we provide offspring with lives worth living we do no wrong. Others argue that our procreative obligations are weightier and oblige us to provide (or attempt to provide) our offspring with a reasonable opportunity to thrive, or meet some other standard beyond merely providing a life worth living. Our practices and intuitions on this matter are inconsistent. For example, gamete donors who intentionally participate in the project of creating a child are thought to have few obligations to their offspring, but those who create a child accidentally are thought to have weighty obligations. Furthermore, a justification for why we are obliged to provide offspring with more than a life worth living has been elusive. To resolve this puzzle I argue that an under‐theorized element of morality, the directed duty of care, explains why we owe our offspring more than a life worth living.

Predicting the pregnancy outcome: Uncovering the link between β-hCG, patient factors and live birth in IVF

ObjectiveThe objectives of the study were to correlate live birth rate with the initial level of β-hCG in all patients undergoing embryo transfer and develop a predictive model of live birth based on patients’ and assisted reproductive technology (ART) characteristics. Study designSingle-center retrospective cohort study, including a total of 7587 positive first serum β-hCG from women who performed fresh and frozen embryo transfer.Twenty-one variables related to patient characteristics and treatment modalities were analyzed by step-wise univariate analysis followed by multivariate analysis. The study included women between 18 and 45 years with a positive (>20 IU/L) serum β-hCG between January 2011 and December 2020 while it excluded cycles from donation of gametes, PGT and >3 embryos transferred simultaneously. Main results and the role of chance: Among the positive serum β-hCG measurements 5085 (67.0 %) resulted in live births. β-hCG was higher in the live birth group (691 IU/L) compared to the failed pregnancies group (304 IU/L) (p500 IU/mL provided a positive predictive value for live birth of 85.3 % (95 %CI 84.0–86.4).Failed pregnancies were more common among older maternal and paternal age. Previous abortions were more common in the failed pregnancies group (25.0 %) compared to the live birth group (19.4 %). The most common indication to treatment was male infertility, accounting for a larger portion in the live birth group (41.7 %). At multivariate analysis, the factors independently associated with live birth were: first serum β-hCG (OR 1.35, 95 %CI 1.32–1.37), maternal age (OR 0.93, 95 %CI 0.91–0.95), previous abortions (OR 0.77, 95 % CI 0.68–0.88). The number of embryos transferred showed a positive correlation below a maternal age of 39 (<35 years old OR 1.60, CI 95 % 1.32–1.94; <39 years old OR 1.27 CI 95 % 1.09–1.47). The prediction model incorporating these four variables resulted in a sensitivity and specificity with an area under the ROC curve of 0.798. Conclusion: The study confirms the importance of the first value of β-hCG and proposes a predictive model that takes into account maternal age, number of embryos transferred, and obstetric history, thereby aiding in couples’ counseling and ultimately improve patients’ care.

Clinical effectiveness and safety of time-lapse imaging systems for embryo incubation and selection in in-vitro fertilisation treatment (TILT): a multicentre, three-parallel-group, double-blind, randomised controlled trial

Time-lapse imaging systems for embryo incubation and selection might improve outcomes of in-vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) treatment due to undisturbed embryo culture conditions, improved embryo selection, or both. However, the benefit remains uncertain. We aimed to evaluate the effectiveness of time-lapse imaging systems providing undisturbed culture and embryo selection, and time-lapse imaging systems providing only undisturbed culture, and compared each with standard care without time-lapse imaging. We conducted a multicentre, three-parallel-group, double-blind, randomised controlled trial in participants undergoing IVF or ICSI at seven IVF centres in the UK and Hong Kong. Embryologists randomly assigned participants using a web-based system, stratified by clinic in a 1:1:1 ratio to the time-lapse imaging system for undisturbed culture and embryo selection (time-lapse imaging group), time-lapse imaging system for undisturbed culture alone (undisturbed culture group), and standard care without time-lapse imaging (control group). Women were required to be aged 18-42 years and men (ie, their partners) 18 years or older. Couples had to be receiving their first, second, or third IVF or ICSI treatment and could not participate if using donor gametes. Participants and trial staff were masked to group assignment, embryologists were not. The primary outcome was live birth. We performed analyses using the intention-to-treat principle and reported the main analysis in participants with primary outcome data available (full analysis set). The trial is registered on the International Trials Registry (ISRCTN17792989) and is now closed. 1575 participants were randomly assigned to treatment groups (525 participants per group) between June 21, 2018, and Sept 30, 2022. The live birth rates were 33·7% (175/520) in the time-lapse imaging group, 36·6% (189/516) in the undisturbed culture group, and 33·0% (172/522) in the standard care group. The adjusted odds ratio was 1·04 (97·5% CI 0·73 to 1·47) for time-lapse imaging arm versus control and 1·20 (0·85 to 1·70) for undisturbed culture versus control. The risk reduction for the absolute difference was 0·7 percentage points (97·5% CI -5·85 to 7·25) between the time-lapse imaging and standard care groups and 3·6 percentage points (-3·02 to 10·22) between the undisturbed culture and standard care groups. 79 serious adverse events unrelated to the trial were reported (n=28 in time-lapse imaging, n=27 in undisturbed culture, and n=24 in standard care). In women undergoing IVF or ICSI treatment, the use of time-lapse imaging systems for embryo culture and selection does not significantly increase the odds of live birth compared with standard care without time-lapse imaging. Barts Charity, Pharmasure Pharmaceuticals, Hong Kong OG Trust Fund, Hong Kong Health and Medical Research Fund, Hong Kong Matching Fund.

Gender differences in behaviors toward acceptance of donor egg, sperm, and embryo in Northern Thai infertile couples.

This study aimed to examine the behavior towards the acceptance of donor egg, donor sperm, and donor embryo of Northern Thai infertile couples, separated between men and women. A cross-sectional study was conducted at the CMEx Fertility Center, Chiang Mai, Thailand. The questionnaires consisted of sociodemographic questions and the acceptance of couples toward donor egg, sperm and embryo. The couples filled in the answers separately. A total of 250 infertile couples were assessed. There were no differences in the acceptance rate of donor egg, sperm and embryo between the men and the women. Male acceptance rates were 25.6%, 18.8%, and 18.8%, respectively; while female acceptance rates were 24.4%, 18.4%, and 19.2%, respectively. Most couples (over 70%) concordantly rejected the donation program. Around 10% of couples had discordant answers. The concordance accepted for couples for donor egg, sperm and embryo was only 20%, 13.2%, and 14.8%. Older people and those who had been infertile for a longer period were significantly more likely to accept donation programs. There is no difference concerning the acceptance of donor gametes and embryo among men and women. Most participants reject the utilization of donor programs, the overall acceptance rate is relatively low. This may indicate the need for more adequate information and education for the community to enhance prevention programs rather than focus on the treatment with donor gametes or embryos.

O-179 From secrecy to transparency: The journey of donor identity in reproductive medicine in Portugal

Abstract Thanks to significant medical advancements in reproductive medicine, people have more opportunities to achieve their parenthood goals. Third-party reproduction allows individuals and couples who might not otherwise be able to conceive to have the chance to build their family, thanks to the availability of donor gametes and gestational surrogacy. Gamete donation policy in Europe varies by country, raising ethical and legal concerns. In recent years, shifts from anonymity towards openness in donor legislation have occurred in several countries. Globally, in the last decade, there has been an increase in the number of families created using egg, sperm or embryo donation. The number of IVF/ICSI cycles using donor eggs or sperm in Portugal totalled 1890 in 2019 and 54 in 2020 (an unusual year due to the Covid-19 pandemic). In Portugal, the first medically assisted reproduction (MAR) law was approved in 2006, and gamete donations were anonymous. Ten years later, in 2016, Portugal’s MAR legal framework changed, and access to MAR was broadened to all women, independent of their marital status and sexual orientation. Therefore, treatment with donor sperm, oocytes, and embryos became available to recipients, including heterosexual couples, lesbian couples, and single women. In 2018, there was another change in the law and gamete donations became non-anonymous. In Portugal, identity-release donation allows the donor to remain anonymous to the intended parents during treatment (although they may have access to some non-identifying information about the donor). Nevertheless, the child can request the National Council for Medically Assisted Reproduction access to the donor’s personal information (full name) once they turn 18. Considering this legal framework, the number of previous donors who were contacted and asked whether they would maintain their donation despite the non-anonymity was residual. The identity-release framework did not seem to have affected the number of donations either. Donations are more frequent in private clinics than in the Portuguese public gamete bank, and this leads to waiting lists that can reach two years for a treatment involving oocytes or sperm donation. In this context, efforts to increase gamete donation, particularly in the National Health Service, are crucial. A study is currently being conducted in Portugal to pinpoint the main reasons why people do not consider being gamete donors. Preliminary results in a sample comprising 297 participants (82.2% females), with a mean age of 25.43 (SD = 7.88) years old and a mean of 14.09 (SD = 2.06) years of education, revealed that 73 (24.6%) stated that they would not consider being a donor because of the non-anonymity and 39 (13.2%) indicated that they would not consider becoming a donor due to concerns about being contacted in the future and requested responsibilities. These results may contribute to informing future initiatives aiming at promoting awareness on the topic of gamete donation. Another relevant topic is secrecy, which refers to parents not disclosing information to their offspring or their social group about donated gametes’ conception. Disclosing is recommended as an ongoing process, preferably when the child is young. This disclosure process may benefit from counselling or other support resources (e.g., children’s books, patients’ associations).

P-783 Factors associated with donor-conceived adolescents’ intention to request information about their open-identity oocyte or sperm donor

Abstract Study question Is adolescents’ intention to request information about their open-identity donor associated with donor type, family form, or adolescent gender? Summary answer Adolescent girls were less likely than boys to intend requesting information about their open-identity donor, irrespective of donor type (oocyte/sperm) and family form. What is known already Individuals conceived by open-identity gamete donation have the right to obtain identifying information about their donor. However, there is little knowledge about the level of interest in requesting such information as donor conceived (DC) persons approach the age when they can obtain this information, as well as their interest in contact with the donor and persons who share the same donor. The present study aims to investigate factors associated with adolescentś intention to request information about their open-identity donor and their interest in contact with the donor and donor-siblings. Study design, size, duration The study is based on the fifth wave of data collection in the prospective, longitudinal Swedish Study on Gamete Donation, conducted in 2022-2023. Participating parents provided consent to contact their donor conceived children (ages 13-16), who were approached with a postal/web-survey. A total of 98 adolescents participated (77% response rate): adolescents conceived with sperm donation in lesbian-couple (SD-lesb, n = 48) and heterosexual-couple families (SD-het, n = 27), and those conceived with oocyte-donation in heterosexual-couple families (OD-het, n = 23). Participants/materials, setting, methods The study was part of the longitudinal Swedish Study on Gamete Donation, including couples starting gamete donation treatment at university hospitals between 2005-2008. The current fifth wave of data collection is the first to include children self-report. Participating adolescents included 48 girls and 50 boys with a mean age of 14.44 for girls and 14.28 for boys. The survey comprised of socio-demographics, study-specific items and validated instruments. Data was analyzed with multinominal regression analysis. Main results and the role of chance Roughly half (56%) of the adolescents intended to request information about their open-identity donor, while 12% planned not to and 32% were unsure. Multinominal regression analysis showed a significant effect for gender, but not for family/donation type (SD-lesb, SD-het, OD-het). Girls were significantly more likely than boys to state that they did not intend to request donor information (OR = 4.66, 95% CI [1.13, 19.34]). Among those adolescents who planned to request identifying donor information, a subset stated that they intended to contact the donor (30% boys, 15% girls). Concerning interest in contact with persons who share the same donor, participants were evenly divided between an interest (29%) or no interest (27%) and remaining were unsure (44%). No differences were found with regard to groups or gender. Limitations, reasons for caution The relatively small sample size could affect the results of the statistical analysis, making it harder to get significant results and creating large confidence intervals. There is a possible attrition bias with less well-functioning families not participating. The study was conducted within the Swedish context of identity-release gamete donation. Wider implications of the findings Approaching adulthood, about half of donor-conceived individuals plan to request information about their open-identity donor, highlighting that many DC people want this possibility. The gender difference found contrasts with earlier research findings and points to the need to understand the specific motivations of different groups of DC adolescents. Trial registration number not applicable

P-569 Reciprocal expanded carrier screening for intended parents and gamete donors: experience of a global surrogacy support network

Abstract Study question Is expanded carrier screening an effective tool to identify carriers of clinically relevant genes and determine the reproductive risk between a donor and recipient pair? Summary answer This study has determined that there is a strong rationale for performing matching according to expanded carrier screening results, especially for gamete donor programs. What is known already Carrier screening (CS) identifies carriers of autosomal recessive (AR) and/or X-linked (XL) genetic conditions to establish reproductive risk. If both partners (egg and sperm providers) carry a pathogenic variant in the same gene (co-carriage), there is 25% risk that offspring will be affected. The same risk is present for egg providers who carry an XL disorder. In expanded carrier screening (ECS), many clinically relevant conditions are screened simultaneously using a single-panel approach. The implementation of ECS is becoming commonplace across gamete donor banks. Providing recipients with a matching panel is key in determining reproductive risk and suitable treatment options. Study design, size, duration In this retrospective review, data was collected for 104 gamete recipients and 31 gamete donors who underwent ECS between March 2021-January 2024. ECS was provided through a single genetic testing laboratory, using a whole exome sequencing (WES) platform. The panel used for the gamete donors/recipients consisted of approximately 500 AR genes; optional analysis of 66 X-Linked genes was available for biologically female donors/recipients. Participants/materials, setting, methods In total, 104 gamete recipients were screened against one or more donor(s) using the same ECS panel. All donors/recipients underwent testing in a clinical setting and received pre/post-test genetic counselling, where required. The testing laboratory provided the referring clinician with the results for each individual. Matching was overseen by My Surrogacy Journey and the relevant donor bank. Donor-recipient match reports were requested from the testing laboratory. Individual and matched reports were used for this review. Main results and the role of chance In total, 76.9% (80/104) of gamete recipients presented with a positive result in at least one clinically relevant gene that could have an impact on reproductive planning. Between the 80 positive gamete recipients, 177 gene variants were carried; variant classification was available for 132 variants (74.6%). The majority of gene variants carried were classified as pathogenic (59.9%), meaning that these variants are associated with causing disease. Most frequently, recipients were carriers of a variant in 1-3 genes (1 gene: 36.3%; 2 genes: 27.5%; 3 genes: 22.5%). In addition to this, 77.4% (24/31) of gamete donors were identified to carry a variant in at least one clinically relevant gene, which includes one egg donor (3.2%; 1/24) who was a carrier of an XL condition. This meant that despite the lack of co-carriage in the AR gene(s) of interest, the recipient could not proceed with this donor due to the associated risk (25%). Of the 43 recipients matched with a donor, 9.3% (4/43) showed a high reproductive risk (25%) due to their reciprocal matching results. This expanded carrier screening strategy demonstrates significant utility in identifying positive carrier status and supporting donor-recipient matching programmes by determining high risk reproductive pairs. Limitations, reasons for caution This study was retrospective in nature. The majority of recipients were Caucasian (∼80% of cases). Ethnic groups are not homogenous; there can be significant genetic, cultural, and environmental diversity between/within ethnic groups. Decision outcome data should be collected to improve this work. Wider implications of the findings The findings from this analysis suggest that there is a strong rationale for performing donor-recipient matching using an ECS approach. Increasing awareness and accessibility of ECS in this setting should be a global initiative, with the ultimate aim of reducing the burden of genetic disease in donor-conceived offspring. Trial registration number N/A

P-489 Examining information, willingness to donate and beliefs regarding gamete donation among people of reproductive age

Abstract Study question Which beliefs, motives and psychosocial characteristics distinguish people who are willing to donate their gametes from those who are not? Summary answer Willingness to donate does not differ between men and women, but there are differences in beliefs surrounding its risks, motivations and psychological characteristics. What is known already Previous studies have examined the main psychological characteristics of donors and their motivation to donate. Literature shows that donation is motivated by altruism, with donors being autonomous, self-confident, self-acceptant, and goal-orientated people, guided by meaningful values. Gender differences showed that egg donors often have close contact with infertility situations and motherhood and would like to provide this joy to other women. Sperm donors are more motivated by curiosity about their own fertility and want to spread their “good” genes. However, here is still much to know about what distinguish those who are willing to donate from those who are not. Study design, size, duration This is a cross-sectional study. Data was collected through an online questionnaire, which was disseminated using social media. Inclusion criteria were being adult, within a reproductive age range (between 18 and 35 years old), and fluent in Portuguese. Participants/materials, setting, methods A total of 405 participants completed the survey (305 women and 99 men). The questionnaire included sociodemographic data, beliefs towards gamete donation, reasons that might impact the likelihood of donating, and psychological characteristics through self-administered instruments: Experiences in Close Relationships (ECR), Self-Compassion Scale (SELFCS), Self-Report Altruism Scale (SRAS), NEO Five-Factor Inventory (NEO-FFI). Independent t-test was performed to compare men and women and participants willing or not to donate gametes. Main results and the role of chance Women were 22.86 (±.23) years old and men 24.34 (±.43). A total of 24.2% of participants were willing to donate gametes. There were no gender differences regarding willingness. Significantly more women than men believed that donating gametes might imply psychological risks (p=.001). There were gender differences in motivations to donate. Women were more likely to donate if they could receive fertility counselling (p=.005) and information about infertility (p=.037), and if they could talk with other donors (p&amp;lt;.001) than man. Among women, those willing to donate believed donating would not cause psychological damage (p=.004), would be supported by their social network (p =.006) and would not be criticized by family and friends if they did so (p=.011) compared to those not willing. Psychological differences revealed that women willing to donate presented higher levels of common humanity (p=.003), self-kindness (p=.046), were more altruistic (p&amp;lt;.001) and extroverted (p=.027) than those who were not. No differences were found regarding their attachment orientation. Among men, the only differences distinguishing those who considered donating sperm and those who did not was their altruism levels (p=.047). No differences were found regarding their beliefs towards gamete donation, perceived support regarding the decision, attachment style, self-compassion, and personality traits. Limitations, reasons for caution This study included a convenience sample, and participants lacked adequate information about the legal context and implications of donating gametes in Portugal. The sample size of participants considering donating was small, which may affect our conclusion. Wider implications of the findings Women who consider donating seem to present more salient psychological characteristics than men. Stigma and misinformation might prevent women from considering donating eggs. The possibility of receiving fertility counselling and share their experiences with other donors are valued in the process, which should be considered when recruiting donors. Trial registration number NA

P-508 Management of incidental findings after preconception expanded carrier screening: identifying genetic predispositions to cancer and metabolic conditions in 8010 screened ART patients

Abstract Study question How do individuals and fertility clinics navigate incidental findings from Expanded Carrier Screening (ECS) in reproductive decision-making? Summary answer Incidental ECS findings prompted varied responses from patients and gamete donors, influencing diverse reproductive choices and underscoring the pivotal role of pre-test genetic counseling. What is known already ECS aims to assess reproductive risk in the general population for specific autosomal recessive and X-linked conditions. These manifest in infancy or early childhood and impact life expectancy or the quality of life. ECS results may guide interventions to avoid affected pregnancies, such as the implementation of preimplantation genetic testing of embryos (PGT-M). Additionally, ECS has the potential to uncover incidental findings with significant health implications, such as an elevated cancer risk or diagnosis. However, the lack of comprehensive reporting guidelines necessitates meticulous analysis to ensure effective clinical guidance for these individual findings. Study design, size, duration This retrospective descriptive study assessed the results of ECS tests performed in 5475 patients and 2535 oocyte and semen donors from four different fertility clinics between July 2017 and December 2023. ECS reports with incidental findings in the ATM, FH or LDLR genes were identified and further examined. We calculated individual and reproductive risks for affected individuals and recorded the subsequent clinical management pertaining to each case. Participants/materials, setting, methods Pre-test counselling was offered to both patients and gamete donors before consenting to ECS. Testing was outsourced to an external genetics laboratory using a panel of 309 genes analyzed through next generation sequencing and complementary molecular techniques. The laboratory reported pathogenic and likely pathogenic variants that were subsequently manually reviewed by an internal genetics committee. Personal and reproductive risks were assessed for each case and genetic counseling was provided in a subsequent meeting. Main results and the role of chance Genetic variants in ATM, FH, or LDLR genes were reported in 134 out of 8010 individuals undergoing ECS (1.67%). Among these, 108 variants were identified in patients: 53.7% (n = 58) in ATM, 19.4% in FH (n = 21), and 26.8% (n = 29) in LDLR. Out of the variants identified as incidental findings, 20/108 were actionable and eligible for PGT-M: 19 were associated with an increased risk for breast cancer and 1 for renal cancer. After being informed of the findings and their implications, 7/20 couples opted to revoke treatment as, according to internal policies, PGT-M was mandatory in such cases; 6/20 couples chose to undergo double gamete donation; 6/20 couples opted for PGT-M. Patients with pathogenic variants in LDLR linked to autosomal dominant inheritance for familial hypercholesterolemia (20/108, 18.5%), received follow-up guidelines and family genetic counseling. Pathogenic variants in ATM, FH, and LDLR were also identified in 26 gamete donors (24 oocyte donors and 2 sperm donors). Following internal review, 14 of these variants were considered incidental findings with an increased risk for breast cancer (13/14) or familial hypercholesterolemia (1/14), leading to the exclusion of these potential donors from the donation program. Limitations, reasons for caution The reproductive handling of incidental findings in our population relies on subjective decisions by the internal genetics committee, which may evolve with scientific advancements and recommendations from professional societies. Follow-up data on long-term reproductive outcomes are lacking. Wider implications of the findings This study reveals the diverse reproductive decisions made in response to incidental findings, underscoring the importance of pre-test genetic counseling. Our findings also highlight the subsequent impact on fertility programs, which may lead to the exclusion of gamete donors or patients choosing to revoke treatment. Trial registration number Not Applicable