Gamete Donation Research Articles

Disciplined parents and autonomous children: information sharing as governing device in Swedish identity-release gamete donation

Abstract This article analyses shifts and continuities in Swedish regulation of information sharing in identity-release donor conception. At a time when families include both solo and same-sex parenting, I draw on a practice-oriented method to compare legal and pre-legislative documents from the early 1980s with those of the late 2010s as developed in a Swedish national context. Following the turn to openness in donor conception, I discuss the practical implications of framing access to information from the hospitals’ so-called ‘special medical record’ as a children’s right, when information is in fact only available after ‘maturity’ is reached. Furthermore, I show how a significant change in the understanding of child–parent relationships in donor-conceived families is articulated in the 2019 legislation. If early policy documents portrayed donor-conceived children as potentially problematic for not ‘knowing their origin’, I argue that now it is parents in donor-conceived families who are constructed as potentially problematic. Drawing on critical kinship theory, I conclude that Swedish policy-making on information sharing in donor conception relies on a symbolic rather than material understanding of genetic relatedness that fails to acknowledge how different family forms might have different needs. Based on these findings, I suggest that policymakers take into account the implications a changing view on family life and genetics have for children and parents following donor conception.

484 Donor gamete status and hypertensive disorders of pregnancy in pregnancies conceived with assisted reproductive technologies

484 Donor gamete status and hypertensive disorders of pregnancy in pregnancies conceived with assisted reproductive technologies

Perceptions of social support of solo women after gamete donation and of women in heterosexual partnerships after in vitro fertilization

Perceptions of social support of solo women after gamete donation and of women in heterosexual partnerships after in vitro fertilization

Embryological Perspectives on Gamete and Embryo Donation

This article addresses the issue of gamete and embryo donation from the perspective of the assisted reproduction laboratory, where the so-called "clinical" embryologists work making all the current variants of in vitro fertilization including the andrology laboratory, oocyte collection, conventional insemination or through ICSI, embryo culture, gamete and embryo quality evaluation, embryo transfer, cryopreservation of gametes and embryos, preimplantation genetic studies, results analyses and quality control, assessment and improvement. To think that the responsibility of an ART laboratory only attains the strictly technical or logistical areas is an error or a simplification that excludes embryologists from other important matters. Clinical embryologists have the obligation to ensure that procedures follow strict ethical rules, highlight deviations or errors from these canons, and refuse to act in cases of violation of said standards. Donating embryos to assist in others´ efforts on building a family is an important option for patients who are considering the disposal of cryopreserved embryos, in excess those needed to meet their own fertility goals.
 Gamete donation, a more widespread procedure, can help us to better understand certain aspects of embryo donation. Donation must be a free transaction, not influenced by guilt or any other type of pressure or coercion of any kind.
 We are facing a totally new issue because we are the only species on the planet that can manipulate our own gametes and embryos in a context where assisted reproduction represents a dramatic challenge to the social values that govern our way of being born, without precedent in human history.
 
 

Genetic counseling for pre-implantation genetic testing of monogenic disorders (PGT-M).

Pre-implantation genetic testing (PGT) is a vital tool in preventing chromosomal aneuploidies and other genetic disorders including those that are monogenic in origin. It is performed on embryos created by intracytoplasmic sperm injection (ICSI). Genetic counseling in the area of assisted reproductive technology (ART) has also evolved along with PGT and is considered an essential and integral part of Reproductive Medicine. While PGT has the potential to prevent future progeny from being affected by genetic conditions, genetic counseling helps couples understand and adapt to the medical, psychological, familial and social implications of the genetic contribution to disease. Genetic counseling is particularly helpful for couples with recurrent miscarriages, advanced maternal age, a partner with a chromosome translocation or inversion, those in a consanguineous marriage, and those using donor gametes. Partners with a family history of genetic conditions including hereditary cancer, late onset neurological diseases and with a carrier status for monogenic disorders can benefit from genetic counseling when undergoing PGT for monogenic disorders (PGT-M). Genetic counseling for PGT is useful in cases of Mendelian disorders, autosomal dominant and recessive conditions and sex chromosome linked disorders and for the purposes of utilizing HLA matching technology for creating a savior sibling. It also helps in understanding the importance of PGT in cases of variants of uncertain significance (VUS) and variable penetrance. The possibilities and limitations are discussed in detail during the sessions of genetic counseling.

The revision of the Bioethics Act, two years on: major principles and consequences for practice in the reproductive biology laboratory

Since 1994, in France, bioethics law has set the regulatory framework for Medically Assisted Reproduction (MAR). The latest revision of the law of August 2, 2021, is characterized by major upheavals in the field of MAR and intervenes in several areas: the purpose and conditions to access to MAR, access to origins in the case of gamete or embryo donation, and gametes cryopreservation without medical indication. Indeed, the law authorizes, because of a strong societal demand, the extension of sperm donation to couples of women and unmarried women, as well as the possibility for any person to preserve his/her gametes if he/she meets the age criteria defined by decree. Finally, the law opens the possibility for people born following gamete or embryo donation to have access, from their 18th anniversary, to identifying and/or non-identifying data. These new measures have led to a very important number of MAR requests to fertility and donation centers, and have required the implementation of new circuits in order to harmonize care, without discrimination or prioritization.

Parenting, dyadic coping, and child emotion regulation in lesbian, gay, and heterosexual parent families through assisted reproduction

ABSTRACT Aims The present study examined the associations between family structure, parenting, and dyadic coping and children’s emotion regulation in lesbian, gay, and heterosexual parent families through assisted reproduction. It also explored differences in parenting dimensions and dyadic coping, based on parents’ sexual orientation. Methods Participants were 60 lesbian mothers through donor insemination, 50 gay fathers through surrogacy, and 42 heterosexual parents through gamete donation, all with a child aged 6–12 years (M = 8.67; SD = 2.16; 48.68% females) and residing in Italy. In each family, both parents reported parenting stress, parent – child relational self-efficacy, parental control, dyadic coping, and their perception of the child’s emotion regulation. Results Mixed models indicated no significant differences between family types in parenting stress and use of a controlling parenting style. However, lesbian mothers reported higher parent – child relational self-efficacy than heterosexual parents, and higher dyadic coping strategies than gay fathers. Also, children of gay fathers showed greater emotion regulation than children of heterosexual parents. Across family types, higher levels of parenting stress and dyadic coping, and lower levels of parent – child relational self-efficacy were associated with lower child emotion regulation. Conclusion Given that in middle childhood, across family types, better emotional regulation was associated with lower parenting stress and dyadic coping, and greater effectiveness in the parent – child relationship clinical work should focus on the parent’s and couple’s ability to cooperatively manage stressors while maintaining a balanced focus on their children’s resources and autonomy.

#169 : The Use of PIEZO-ICSI Increases Fertilisation and Lowers Degeneration Rates when Compared to Conventional ICSI: In a Singapore Setting

Background and Aims: PIEZO-ICSI was first introduced by Kimura & Yanagimachi in 1995 on mouse oocytes (1). It is a modified version of microinjection that uses piezoelectric pulses to enable fine movement of the needle. Further studies of PIEZO-ICSI on human oocytes showed improved outcomes in Japanese clinics (2-6) and similar findings were also reported by an Australian IVF group (7,8). In this study, we reflect on our experience using PIEZO-ICSI in a Singapore-based IVF clinic. Method: A retrospective study of 535 ICSI cycles was performed from January 2020 to December 2022, comprising of 157 cycles using Conventional ICSI and 378 cycles using PIEZO-ICSI. Primary outcomes were fertilisation, degeneration, blastulation and blastocyst usable rates. Secondary outcomes include clinical pregnancy, implantation and miscarriage rates. Patients who used donor gametes, surgically retrieved sperm or utilised cleavage-staged embryos were excluded. Two senior embryologists were responsible for the microinjections and had no prior experience with PIEZO-ICSI. Statistical significance for laboratory and clinical outcomes were determined using Mann-Whitney U Test and chi-square contingency tables, respectively. Results: The PIEZO-ICSI group showed significantly higher fertilisation (83.09% vs 69.62%, p<0.0001) and lower degeneration rates (3.17% vs 7.33%, p<0.0001) when compared to Conventional ICSI (Table 1). Blastulation (69.51% vs 64.86%, p=0.26) and blastocyst usable rates per 2PN (54.36% vs 51.26%, p=0.67) showed a higher trend in the PIEZO-ICSI group but did not meet statistical significance. The estimated time-to-competency for embryologists to achieve consistent outcomes with PIEZO-ICSI was three months (Figure 1). In terms of clinical outcomes, no significant differences were observed for clinical pregnancy (61.57% vs 56.97%, p=0.39), implantation (48.57% vs 43.59%, p=0.23) and miscarriage rates (23.70% vs 23.40%, p=0.96) between the PIEZO-ICSI and Conventional ICSI groups (Table 2). Conclusion: The use of PIEZO-ICSI improves fertilisation and degeneration outcomes when compared to Conventional ICSI in a Singapore-based IVF clinic.

Australian intended parents’ decision-making and characteristics and outcomes of surrogacy arrangements completed in Australia and overseas

Markets for international surrogacy often arise in jurisdictions with limited regulations regarding assisted reproductive technologies. In some countries, like Australia, regulated domestic surrogacy services are often sidestepped for international providers. This study describes how Australian intended parents decide where to pursue surrogacy and compares the characteristics and outcomes of arrangements completed within and outside of Australia. The findings show that, although intended parents preferred undergoing surrogacy in Australia, perceiving the process as too long and complicated was a common reason to pursue an international arrangement. Multiple embryo transfer, anonymous gamete donation, and a lack of counselling were common in international surrogacy arrangements. When compared to surrogacy arrangements completed in Australia, where single embryo transfer is mandatory for surrogacy cycles, the rates of multiple birth, preterm birth and neonatal intensive care in international surrogacy were higher. These findings raise concerns about the health and welfare of international surrogacy participants, particularly the surrogates and children. In lieu of any international instrument regulating surrogacy, improving access to surrogacy at a domestic level would reduce the number of people engaging with international arrangements and in turn, reduce the potential for harm.

Deontological Guilt and Moral Distress as Diametrically Opposite Phenomena: A Case Study of Three Clinicians.

Feelings of guilt are human emotions that may arise if a person committed an action that contradicts basic moral mores or failed to commit an action that is considered moral according to their ethical standards and values. Psychological scholarship distinguishes between altruistic guilt (AG) and deontological guilt (DG). AG results from having caused harm to an innocent victim, either by acting or failing to act, whereas DG is caused by violating a moral principle. Although physicians may be expected to experience frequent feelings of guilt in their demanding and intensive work, it is surprising to find that this issue has not been explored in the professional literature on medical ethics. To that end, we conducted a qualitative study that included personal in-depth interviews with Sunni Muslim gynaecologists. These doctors provide underground infertility care and perform religiously forbidden treatments involving sex selection and gamete donation. They opened their hearts and spoke about the emotionally taxing pangs of conscience they suffer. Analysing their narratives led us to characterize their feelings of guilt as DG. We discuss the causes for their plight and the way they cope with it, compare DG to the concept of moral distress, and call for future research on clinicians' feelings of guilt and pangs of conscience.

Obstetrical and neonatal outcomes after single and double gamete donation

Introduction: An increasing number of women and couples need oocyte donation to help achieve pregnancy. Several studies have found a correlation between the use of oocyte donation and adverse obstetrical outcomes such as gestational hypertension and preeclampsia. A possible additive risk in using double donation (oocyte and sperm donation) compared to the use solely of oocyte donation has been suggested but only sparsely investigated. The aim of this study is to investigate the differences in obstetric and neonatal outcomes after double donation compared to oocyte donation.Methods: This is a retrospective cohort study of 197 women, who achieved pregnancy after oocyte donation between 2015 and 2022. The primary outcomes investigated were gestational hypertension and preeclampsia. Secondary outcomes were early pregnancy loss, HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome, fetal growth restriction, and gestational diabetes mellitus.Results: No significant differences between the use of oocyte and double donation were observed, when looking at the risk of developing gestational hypertension (AOR = 1.02, 95%CI = [0.33;3.15], P = 0.97) or preeclampsia (AOR = 2.4, 95%CI = [0.68;8.41], P = 0.17). We observed no significant differences between the two groups regarding any of the secondary outcomes.Conclusion: This study did not find an increased risk of obstetrical or neonatal complications such as preeclampsia, gestational diabetes mellitus, or fetal growth restriction after double donation compared to oocyte donation.

Steps forward in embryo transfer technique: a retrospective study comparing direct versus afterload catheters at different time frames.

To assess whether embryo transfer (ET) technique can influence the clinical pregnancy rate (CPR) and its correlation with the embryo transfer difficulty. This single center retrospective cohort analysis of fresh and frozen single blastocyst transfers performed between January 2016 and December 2021 included fresh and frozen single blastocyst transfers performed during the study timeframe. Direct technique was the only one used from January 2016 to September 2017. From September 2017 to March 2019, the choice between the two techniques was given by randomization, due to a clinical trial recruitment. From April 2019, only the afterload technique was used. Preimplantation genetic testing cycles and gamete donation procedures and cycles performed with external gametes or embryos were excluded. CPR was the primary outcome, while difficult transfer rate the secondary one. Univariate and multivariate logistic regressions were performed. During the period, 8,189 transfers were performed. CPR of the afterload group resulted significantly higher compared to the direct group (44.69% versus 41.65%, OR 1.13, 95% CI 1.02-1.25, p = 0.017) and the rate of difficult transfers two-thirds lower (9.06% versus 26.85%, OR 0.27, 95% CI 0.24-0.31, p < 0.001). Our study demonstrated that CPR is significantly affected by the ET technique. In particular, with the afterload protocol, both CPR and easy transfer rates increased. http://clinicaltrials.gov registration number: NCT05364528, retrospectively registered on 3rd of May 2022.

Direct-to-consumer genetic testing and the changing landscape of gamete donor conception: key issues for practitioners and stakeholders

Research questionWhat effect does direct-to-consumer genetic testing (DTCGT) have on information finding and sharing in relation to gamete donor conception? DesignThis study used in-depth qualitative interviews with parents through donor conception, donors, the relatives of donors and donor-conceived people who have used, or considered using, DTCGT. Interviews were conducted between September 2021 and February 2023. Sixty people defined themselves as having been affected by donor conception and DTCGT. Fifty-seven of these were resident in the UK at the time of interview. The final sample included 19 (spermatozoa, egg or embryo) donors, 25 donor-conceived people, 20 parents through donor conception and two relatives of donors. Five participants occupied more than one of these roles. ResultsThe rise of DTCGT is affecting how information about donor conception is managed: it shifts patterns of knowledge about donor conception; increases flexibility regarding the age of access to information about donor relatives; can lead to a growing role for non-professionals, including wider family members, in gatekeeping information about donor conception; accentuates the effect of donor conception for donors’ and the relatives of donor-conceived people; and shapes, and is shaped, by the formal regulatory donor information management systems. ConclusionFertility professionals should inform people using, or considering, donor conception, or (potential) donors, about the different ways DTCGT can affect sharing information about donor conception. Support is needed for those affected by these changes.

Long-term follow-up of mental health and satisfaction in a Swedish sample of sperm and egg donors after open-identity donation

How is the mental health of open-identity gamete donors and their satisfaction with their contributions 14-17 years after acceptance as a donor? The Swedish Study on Gamete Donation is a longitudinal study comprising women and men who were accepted as donors at seven Swedish university clinics between 2005 and 2008. The latest (fifth) follow-up included 215 open-identity donors (response rate 87%): 123 oocyte donors and 92 sperm donors. The donors answered a questionnaire regarding their perceptions, experiences and expectations after gamete donation 14-17 years previously. The donors were satisfied with the experience of donating, and no differences were detected between sperm and oocyte donors. Oocyte donors were more than twice as likely to feel that family and friends were proud of their donation compared with sperm donors (51% versus 23%, P < 0.001). In total, six donors regretted their donation: four oocyte donors and two sperm donors. Sperm donors were more frequently satisfied with the financial compensation compared with oocyte donors (P = 0.005). No difference in the development of symptoms of anxiety or depression was detected 14-17 years post-donation. Long-term follow-up studies on donors are important for recruiting donors, and for recipients and the children who will be conceived with donated gametes. The results from the current study indicate that donors, generally, have good mental health and do not regret their decision to donate gametes. These findings are reassuring for all parties involved.

A comparative study of sperm and egg donors' personal descriptions and goodwill messages

Research questionWhat information do sperm donors and egg donors include in their personal descriptions and goodwill messages? DesignA total of 131 (76 egg, 55 sperm) donor information forms from 2011 to 2021 were analysed using qualitative content analysis for personal descriptions and goodwill messages written to recipients of donor gametes. Categorical data were analysed statistically to examine differences between egg and sperm donors. ResultsEgg donors wrote longer goodwill messages than sperm donors (X2 (1) = 6.18, P = 0.013), although they were less likely to provide a personal description (X2(1) = 4.53, P = 0.033). Sperm donors were more likely than egg donors to describe themselves through their athleticism (X2 (1) = 12.10, P < 0.001) and their personality traits (X2 (1) = 5.29, P = 0.021), such as being laid back or goal driven. Both sperm donors and egg donors included messages that wished the family and the child well, with sperm donors more likely than egg donors to include advice in their goodwill message (X2 (1) = 6.39, P = 0.012). Egg donors were more likely than sperm donors to mention motivations that involved helping others (X2 (1) = 4.59, P = 0.032). ConclusionGiven the differences found between the content of egg and sperm donor information forms, there is a need for better information and support to be provided to gamete donors to improve the amount of information provided and ensure consistency. More specific and guided questions on the forms may help donors complete them.

Donor sibling relations among adult offspring conceived via insemination by lesbian parents.

How do adult offspring in planned lesbian-parent families feel about and relate to their donor (half) sibling(s) (DS)? A majority of offspring had found DS and maintained good ongoing relationships, and all offspring (regardless of whether a DS had been identified) were satisfied with their knowledge of and contact level with the DS. The first generation of donor insemination offspring of intended lesbian-parent families is now in their 30s. Coincident with this is an increased use of DNA testing and genetic ancestry websites, facilitating the discovery of donor siblings from a common sperm donor. Few studies of offspring and their DS include sexual minority parent (SMP) families, and only sparse data separately analyze the offspring of SMP families or extend the analyses to established adult offspring. This cohort study included 75 adult offspring, longitudinally followed since conception in lesbian-parent families. Quantitative analyses were performed from online surveys of the offspring in the seventh wave of the 36-year study, with a 90% family retention rate. The data were collected from March 2021 to November 2022. Participants were 30- to 33-year-old donor insemination offspring whose lesbian parents enrolled in a US prospective longitudinal study when these offspring were conceived. Offspring who knew of a DS were asked about their numbers found, characteristics or motivations for meeting, DS terminology, relationship quality and maintenance, and impact of the DS contact on others. All offspring (with or without known DS) were asked about the importance of knowing if they have DS and their terminology, satisfaction with information about DS, and feelings about future contact. Of offspring, 53% (n = 40) had found DS in modest numbers, via a DS or sperm bank registry in 45% of cases, and most of these offspring had made contact. The offspring had their meeting motivations fulfilled, viewed the DS as acquaintances more often than siblings or friends, and maintained good relationships via meetings, social media, and cell phone communication. They disclosed their DS meetings to most relatives with neutral impact. The offspring, whether with known or unknown DS, felt neutral about the importance of knowing if they had DS, were satisfied with what they knew (or did not know) of the DS, and were satisfied with their current level of DS contact. This study is the largest, longest-running longitudinal study of intended lesbian-parent families and their offspring, and due to its prospective nature, is not biased by over-sampling offspring who were already satisfied with their DS. The sample was from the USA, and mostly White, highly educated individuals, not representative of the diversity of donor insemination offspring of lesbian-parent families. While about half of the offspring found out about DS, the other half did not. Regardless of knowing of a DS, these adult offspring of lesbian parents were satisfied with their level of DS contact. Early disclosure and identity formation about being donor-conceived in a lesbian-parent family may distinguish these study participants from donor insemination offspring and adoptees in the general population, who may be more compelled to seek genetic relatives. The study participants who sought DS mostly found a modest number of them, in contrast to reports in studies that have found large numbers of DS. This may be because one-third of study offspring had donors known to the families since conception, who may have been less likely to participate in commercial sperm banking or internet donation sites, where quotas are difficult to enforce or nonexistent. The study results have implications for anyone considering gamete donation, gamete donors, donor-conceived offspring, and/or gamete banks, as well as the medical and public policy professionals who advise them. No funding was provided for this project. The authors have no competing interests. N/A.

Why it is important that we understand the information that gamete donors provide about themselves to recipients

A personal description and goodwill message is often the only form of communication a gamete recipient receives from the donor. However, the nature of the information gamete donors leave for recipients is not well understood. This Viewpoint article discusses a recent study published in this journal that makes a significant contribution to our understanding of this area of research and raises important questions for research going forward.

Misconduct in third-party assisted reproductive technology by participants and nonmedical professionals or entities: an Ethics Committee opinion

Physicians involved in third-party assisted reproductive technology arrangements who discover material misconduct or other undisclosed information by a party to the arrangement (such as a gamete or embryo donor, gestational carrier, or intended parent) or by a nonmedical professional participant or entity (such as a recruiting program, gamete or embryo bank, or lawyer) should encourage that party or professional participant to disclose such misconduct or information. In some instances, it is ethically permissible for the physician to either disclose material information to the affected party or to decline to provide or continue to provide care. In all cases involving the legal status or rights of the parties, physicians should recommend that patients seek independent legal professional advice. This document replaces the document "Misconduct in third-party assisted reproduction," last published in 2018. The use of a physician's own gametes for the purpose of reproduction without the informed consent of the recipient(s) is unethical and illegal, as well as never permissible.

A Sense of Connectedness in Reproductive Donation. Contrasting Policy With Donor and Donor Kin Lived Experience

This article asks how well new developments in family life are reflected in law and policy, with a particular focus on donor conception. There has been an unprecedented ‘opening up’ of family life in recent decades; this increased diversity is, at least in part, linked to developments in reproductive technologies, including gamete donation. In family lives touched by donation, genetic relations with ‘donor connections’ take genetic connectedness beyond traditional notions of kinship. There is not yet an established social script for how to understand what constitutes meaningful connectedness in reproductive donation. Focussing on the UK context specifically, where assisted conception is highly regulated, this article examines on the one hand, how UK law and policy portray meaningful connectedness in the context of donation, and, on the other hand, how well this fits with connectedness as experienced within egg and sperm donor communities. Drawing on original data from UK law and policy analysis, and empirical interview data with egg and sperm donors and their kin, our analysis shows important disparities between law and policy, and the empirical evidence, suggesting a need for an overhaul of UK donor conception law and policy.

Embryo Donation and the Conditions of Children’s Inheritance: A Shiite Perspective

This study explains the lineage in embryo donation and the inheritance of born children. This study was conducted with a library, descriptive and analytical design, relying on books of jurisprudence and laws of Shia and other Islamic religions, as well as citing some legal studies. Under Ayatollah Khamenei’s original fatwa in 1990, which permitted gamete donation by third parties. This legal approach paved the way for the adoption of the Embryo Donation to Infertile Spouses Act in 2003. The embryos formed from a man’s sperm and the ovum of his legitimate wife, with any methods of embryo formation and its transfer to the aforementioned man and woman, have a legitimate lineage and there will be no problem in the inheritance for the baby. However, the embryos formed from the sperm of another man (other than a legal husband) or the egg of another woman (other than a legal wife) regardless of the method (natural or artificial) will not have legitimate lineage, and as a result, donated children are deprived of inheritance. To ensure the financial future of children born through embryo donation, solutions such as an official will or using the life insurance industry can be considered as a temporary solution. However, it is necessary to review the embryo donation law by religious and legislative authorities.