Third-party Assisted Reproduction Research Articles

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 longitudinal study of families formed through third-party assisted reproduction: Mother-child relationships and child adjustment from infancy to adulthood.

The seventh phase of this longitudinal study investigated whether children born through third-party assisted reproduction experienced psychological problems, or difficulties in their relationship with their mothers, in early adulthood. The impact of disclosure of their biological origins, and quality of mother-child relationships from age 3 onward, were also examined. Sixty-five assisted reproduction families, including 22 surrogacy families, 17 egg donation families, and 26 sperm donation families, were compared with 52 unassisted conception families when the children were aged 20. Less than half of the mothers had completed tertiary education and less than 5% were from ethnic minority backgrounds. Standardized interviews and questionnaires were administered to mothers and young adults. There were no differences between assisted reproduction and unassisted conception families in mothers' or young adults' psychological well-being, or the quality of family relationships. However, within the gamete donation families, egg donation mothers reported less positive family relationships than sperm donation mothers, and young adults conceived by sperm donation reported poorer family communication than those conceived by egg donation. Young adults who learned about their biological origins before age 7 had less negative relationships with their mothers, and their mothers showed lower levels of anxiety and depression. Associations between parenting and child adjustment did not differ between assisted and unassisted reproduction families from ages 3 to 20. The findings suggest that the absence of a biological connection between children and their parents in assisted reproduction families does not interfere with the development of positive mother-child relationships or psychological adjustment in adulthood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Islamic beliefs on gamete donation: The impact on reproductive tourism in the Middle East and the United Kingdom

Approximately 15% of couples are affected by infertility worldwide. Subsequently, the use of assisted reproductive technologies is becoming increasingly popular, including the use of donor eggs, sperm and embryos. Despite ongoing ethical debate surrounding gamete donation, this is now a widely accepted practice in Western countries. Assisted reproductive technology is becoming more commonly utilised within the Muslim population; however, gamete donation remains a relatively controversial and taboo topic within this religion. Interestingly, there are significant differences in beliefs between Sunni and Shi’a Muslims. Whilst Sunni Islam absolutely forbids the use of third-party reproductive assistance, Shi’a Islam is somewhat more lenient towards this practice. Reproductive tourism has therefore become prevalent in Shi’a Middle Eastern countries that permit the use of donor gametes in assisted reproductive technologies; however, this continues to evoke a strong bioethical debate, particularly around sperm donation. With the increased influx of reproductive tourism, this is beginning to weaken the regional Sunni Islam ban on the use of donor technologies, questioning the morality of their current beliefs. Consideration of religious beliefs is also crucial for patient-centred care in UK patients treated by the National Health Service for fertility issues. Of note, there is a lack of non-Caucasian donors in the United Kingdom. Reproductive tourism is also becoming increasingly common in the United Kingdom and needs to be considered in terms of future patient management in delivering good obstetric care.

Stakeholders views on the ethical aspects of oocyte banking for third-party assisted reproduction: a qualitative interview study with donors, recipients and professionals.

STUDY QUESTIONWhat are the moral considerations held by donors, recipients and professionals towards the ethical aspects of the intake and distribution of donor bank oocytes for third-party assisted reproduction?SUMMARY ANSWERInterviews with oocyte donors, oocyte recipients and professionals demonstrate a protective attitude towards the welfare of the donor and the future child.WHAT IS KNOWN ALREADYThe scarcity of donor oocytes challenges the approach towards the many ethical aspects that arise in establishing and operating an oocyte bank for third-party assisted reproduction. Including experiences and moral considerations originating from practice provides useful insight on how to overcome these challenges.STUDY DESIGN, SIZE, DURATIONThe project was set-up as a qualitative interview study and took place between October 2016 and August 2017.PARTICIPANTS/MATERIALS, SETTING, METHODSWe conducted 25 semi-structured interviews with professionals engaged in the practice of oocyte banking (n = 10), recipients of donor oocytes (n = 7) and oocyte donors (n = 8). Key themes were formulated by means of a thematic analysis.MAIN RESULTS AND THE ROLE OF CHANCEBased on the interviews, we formulated four main themes describing stakeholders’ views regarding the ethical aspects of the intake and distribution of donor bank oocytes. First, respondents articulated that when selecting donors and recipients, healthcare workers should prevent donors from making a wrong decision and safeguard the future child’s well-being by minimizing health risks and selecting recipients based on their parental capabilities. Second, they proposed to provide a reasonable compensation and to increase societal awareness on the scarcity of donor oocytes to diminish barriers for donors. Third, respondents considered the prioritization of recipients in case of scarcity a difficult choice, because they are all dependent on donor oocytes to fulfil their wish for a child. They emphasized that treatment attempts should be limited, but at least include one embryo transfer. Fourth and finally, the importance of good governance of oocyte banks was mentioned, including a homogenous policy and the facilitation of exchange of experiences between oocyte banks.LIMITATIONS, REASONS FOR CAUTIONThe possibility of selection bias exists, because we interviewed donors and recipients who were selected according to the criteria currently employed in the clinics.WIDER IMPLICATIONS OF THE FINDINGSRespondents’ moral considerations regarding the ethical aspects of the intake and distribution of donor oocytes demonstrate a protective attitude towards the welfare of the donor and the future child. At the same time, respondents also questioned whether such a (highly) protective attitude was justified. This finding may indicate there is room for reconsidering strategies for the collection and distribution of donor bank oocytes.STUDY FUNDING/COMPETING INTEREST(s)This study was funded by ZonMw: The Dutch Organization for Health Research and Development (Grant number 70-73000-98-200). A.M.E.B. and B.C.J.M.F. are the initiators of the UMC Utrecht oocyte bank. J.J.P.M.P. is the director of the MCK Fertility Centre. IMC is working as a gynaecologist at the AMC Amsterdam oocyte bank. During the most recent 5-year period, BCJM Fauser has received fees or grant support from the following organizations (in alphabetic order): Actavis/Watson/Uteron, Controversies in Obstetrics & Gynaecologist (COGI), Dutch Heart Foundation, Dutch Medical Research Counsel (ZonMW), Euroscreen/Ogeda, Ferring, London Womens Clinic (LWC), Merck Serono (GFI), Myovant, Netherland Genomic Initiative (NGI), OvaScience, Pantharei Bioscience, PregLem/Gedeon Richter/Finox, Reproductive Biomedicine Online (RBMO), Roche, Teva and World Health Organization (WHO). The authors have no further competing interests to declare.TRIAL REGISTRATION NUMBERN/A.

Misconduct in third-party assisted reproduction: an Ethics Committee opinion

Professionals who discover misconduct or other undisclosed information that would be material to the participation of another party (such as a donor, gestational carrier, intended parent, or lawyer) in an assisted reproductive technology arrangement should encourage disclosure to that party. In some instances, it is ethically permissible for the physician either to disclose material information to the affected party or to decline to provide care. In all cases involving the legal status or rights of the parties, referral to legal professionals is advised. This document replaces the document of the same name, last published in 2014 (Fertil Steril 2014;101:38-42).

Ethics of oocyte banking for third-party assisted reproduction: a systematic review.

The demand for donor oocytes has increased dramatically over the years. Today people in need of ART with the use of donor oocytes can appeal to commercial or public donor oocyte banks. The introduction of oocyte banks has shed a new light on the practice of ART using donor oocytes. The establishment and maintenance of oocyte banks should be sensitive to the ethical considerations. However, it is currently unclear which ethical aspects have to be taken into account. The aim of this article is to identify the ethical aspects of establishing and maintaining oocyte banks for third-party ART. A systematic search was performed in July 2016 and February 2017 in both PubMed and Embase using a search string that combined synonyms for oocytes, donation or banking, reproductive care and ethics. We included a wide variety of English-language articles with a reasoned description of ethical aspects or moral considerations on oocyte donation or banking for third-party ART. The practice of oocyte banking consists of three components, namely, the intake, storage and distribution of donor oocytes, and each is associated with multiple ethical challenges. The majority of the literature discusses ethical aspects with regard to the intake of donor oocytes, taking into account both the interests of the donor and those of the potential child. Ethical aspects related to the donor are the risks and psychosocial impact of donation, motivations and compensation in donor recruitment, and requirements for informed consent. Ethical aspects related to the potential child are 2-fold: first, the welfare standard and the selection of donors, and second, anonymity and disclosure. Ethical aspects of storing donor oocytes for ART are quality standards, confidentiality, issues of ownership and control, and international transport of donor oocytes. Ethical aspects of the distribution of donor oocytes concern the selection of recipients and the acceptability of treatment of 'non-traditional' families in particular, prioritization of recipients in case of scarcity, cross-border reproductive care, matching of recipients and donor oocytes, informed consent and counselling for recipients. Our review demonstrates that multiple ethical aspects have to be taken into account when establishing and maintaining an oocyte bank. Yet, for many of these aspects there is no consensus regarding what approach should be employed. Remarkably, the existing literature focuses mainly on ethical aspects related to the intake of donor oocytes, while aspects related to storage and distribution of donor oocytes are less often addressed. An important gap in the existing literature should therefore be acknowledged. To conclude, our findings can serve as a starting point for clinicians in the field of ART, to conceptualize what challenges arise when establishing and maintaining oocyte banks for third-party ART. The review may also stimulate policy makers to set up a trustworthy and adaptive governance structure for the intake, storage and distribution of donor oocytes.

Is Lower Quality Clinical Care Ethically Justifiable for Patients Residing in Areas with Infrastructure Deficits?

Reproductive health services, including infertility care, are important in countries with infrastructure deficits, such as Lebanon, which now hosts more than one million Syrian refugees. Islamic prohibitions on child adoption and third-party reproductive assistance (donor eggs, sperm, embryos, and surrogacy) mean that most Muslim couples must turn to in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) to overcome their childlessness. Attempts to bring low-cost IVF-ICSI to underserved populations might help infertile couples where no other services are available. However, a low-cost IVF-ICSI protocol for male infertility remains technically challenging and thus may result in two standards of clinical care. Nonetheless, low-cost IVF-ICSI represents a form of reproductive justice in settings with infrastructure deficits and is clearly better than no treatment at all.

International Solidarity in reproductive justice: surrogacy and gender-inclusive polymaternalism

Reproductive justice and gestational surrogacy are often implicitly treated as antonyms. Yet the former represents a theoretic approach that enables the long and racialised history of surrogacy (far from a new or ‘exceptional’ practice) to be appreciated as part of a struggle for ‘radical kinship’ and gender-inclusive polymaternalism. Recasting surrogacy as a dynamic contradiction in itself, full of latent possibilities relevant to early Reproductive Justice militants’ family-abolitionist aims, this article invites scholars in human geography and cognate disciplines to re-think the boundaries of surrogacy politics. As ethnographies of formal gestational workplaces, accounts of gestational workers’ self-organised resistance, and readings of the attendant public media scandals show (taking examples from India, Thailand, and New Jersey), there is no good reason to place these new economies of ‘third-party reproductive assistance’ in a ‘realm apart’ from conversations about social reproduction more generally. Surrogacy, I argue, potentially names a practice of commoning at the same time as it names a new wave of accumulation in which clinicians are capitalising on the contemporary – biogenetic-propertarian, white-supremacist – logic of kinmaking in the Global North. Ongoing experiments in the redistribution of mothering labour (‘othermothering’ in the Black feminist tradition) suggest that ‘another surrogacy is possible’, animated by what Kathi Weeks and the 1970s intervention ‘Wages Against Housework’ conceive as anti-work politics. In making this argument, the article revives the concept ‘gestational labour’ as a means of keeping the process of ‘literal’ reproduction open to transformation.

Embryo donation and counselling for the welfare of donors, recipients, their families and children.

How do counsellors facilitating known 'open' embryo donation (ED) experience their roles and responsibilities? Counsellors regard counselling for ED as entailing significant responsibility to ensure that the longer-term implications of the practice are understood and that positive relationships are established that will promote the well-being of donors, recipients, their families and the children involved. While counselling is frequently recommended in third-party assisted reproduction, there has been little research into the experiences of counsellors and their perceptions of their roles and responsibilities. Fertility counsellors were interviewed between March and October 2012 as to their experiences and perceptions of their roles and responsibilities. Fertility counsellors were recruited from across New Zealand and interviews were conducted with all nine counsellors involved in ED counselling. Interview data were analysed thematically to identify main themes. Counsellors regard ED as a complex practice with enduring implications arising from the genetic link between donors and offspring, which is seen to bestow immutable social ties. They see their role as the provision of implications counselling and the facilitation of ongoing positive relationships between donors and recipients in an 'open' context. Counsellors express concern about their responsibility for promoting the welfare of all parties--including that of the child--the limitations of counselling, and the conflation of assessment and counselling roles. Experiences of counselling for ED may change over time as longer-term outcomes become more apparent. Further consideration needs to be given as to how the welfare principle may best be operationalised in counselling practice, particularly in contexts of 'open' donation. This study was funded by an AUT University Faculty of Health and Environmental Sciences research grant. The authors have no conflicts of interest to declare.

Islam, Assisted Reproduction, and the Bioethical Aftermath.

Assisted reproductive technologies (ARTs), including in vitro fertilization to overcome infertility, are now widely available across the Middle East. Islamic fatwas emerging from the Sunni Islamic countries have permitted many ARTs, while prohibiting others. However, recent religious rulings emanating from Shia Muslim-dominant Iran have created unique avenues for infertile Muslim couples to obtain donor gametes through third-party reproductive assistance. The opening of Iran to gamete donation has had major impacts in Shia-dominant Lebanon and has led to so-called reproductive tourism of Sunni Muslim couples who are searching for donor gametes across national and international borders. This paper explores the "bioethical aftermath" of donor technologies in the Muslim Middle East. Other unexpected outcomes include new forms of sex selection and fetal "reduction." In general, assisted reproduction in the Muslim world has been a key site for understanding how emerging biomedical technologies are generating new Islamic bioethical discourses and local moral responses, as ARTs are used in novel and unexpected ways.

Misconduct in third-party assisted reproduction: a committee opinion

Physicians who are told or discover information that would be material to another party's participation in an assisted reproductive technology (ART) arrangement (such as lawyer's, donor's, gestational carrier's, or intended parent's) should encourage disclosure to that party. In some instances, it is ethically and legally permissive for the physician to either disclose material information to an affected party or to transfer care of a patient to another willing provider. In all cases involving the legal status or rights of the parties, referral to legal professionals is advised.

Banning reproductive travel: Turkey’s ART legislation and third-party assisted reproduction

In March 2010, Turkey became the first country to legislate against the cross-border travel of its citizens seeking third-party reproductive assistance. Although the use of donor eggs, donor spermatozoa and surrogacy had been illegal in Turkey since the introduction of a regulatory framework for assisted reproductive treatment in 1987, men and women were free to access these treatments in other jurisdictions. In some cases, such travel for cross-border reproductive care (CBRC) was even facilitated by sophisticated arrangements between IVF clinics in Turkey and in other countries, particularly in Cyprus. However, new amendments to Turkey’s assisted reproduction legislation specifically forbid travel for the purposes of third-party assisted reproduction. This article outlines the cultural context of assisted reproductive treatment in Turkey; details the Turkish assisted reproduction legislation, particularly as it pertains to third-party reproductive assistance; explores Turkish attitudes towards donor gametes and surrogacy; assesses the existence and extent of CBRC prior to March 2010; and discusses some of the legal, ethical and practical implications of the new legislation. As CBRC becomes an increasingly pertinent issue, eliciting debate and discussion at both national and international levels, it is important to carefully consider the particular circumstances and potential consequences of this unique example. Recently, Turkey became the first country to legislate the cross-border reproductive travel of its citizens seeking third-party reproductive assistance. Although the use of donor eggs, donor spermatozoa and surrogacy had been illegal in Turkey since the introduction of a regulatory framework for assisted reproductive technology in 1987, men and women were free to access these treatments in other jurisdictions. In some cases, such travel for cross-border reproductive care (CBRC) was even facilitated by sophisticated arrangements between IVF clinics in Turkey and in other countries, particularly in Cyprus. However, new amendments to Turkey’s assisted reproduction legislation, introduced in March 2010, specifically forbid reproductive travel for the purposes of third-party assisted reproduction. This article outlines the cultural context of assisted reproductive treatment in Turkey; details the Turkish assisted reproduction legislation, particularly as it pertains to third-party reproductive assistance; explores Turkish attitudes towards donor gametes and surrogacy; assesses the existence and extent of CBRC prior to March 2010; and discusses some of the legal, ethical and practical implications of the new legislation. As CBRC becomes an increasingly pertinent issue, eliciting debate and discussion at both national and international levels, it is important to carefully consider the particular circumstances and potential consequences of this unique example.

Third-party reproductive assistance around the Mediterranean: comparing Sunni Egypt, Catholic Italy and multisectarian Lebanon

The article examines religious and legal restrictions on third-party reproductive assistance in three Mediterranean countries: Sunni Egypt, Catholic Italy and multisectarian Lebanon. In Egypt, assisted reproduction treatments are permitted, but third parties are banned, as in the rest of the Sunni Islamic world. Italy became similar to Egypt with a 2004 law ending third-party reproductive assistance. In multisectarian Lebanon, however, the Sunni/Catholic ban on third-party reproductive assistance has been lifted, because of Shia rulings emanating from Iran. Today, third-party reproductive assistance is provided in Lebanon to both Muslims and Christians, unlike in neighbouring Egypt and Italy. Such comparisons point to the need for understanding the complex interactions between law, religion, local moralities and reproductive practices for global bioethics.

A cross-sectional study of the psychosexual impact of cancer-related infertility in women: third-party reproductive assistance

This study empirically assessed emotional and sexual functioning, reproductive concerns, and quality of life (QOL) of cancer-related infertile women in comparison to those without a cancer history and explored awareness of third-party reproduction options in cancer survivors. One hundred twenty-two cancer survivors (Gynecologic and Bone Marrow/Stem Cell Transplant) with cancer-related infertility and 50 non-cancer infertile women completed a self-report survey assessing: reproductive concerns (RCS), mood (CES D), distress (IES), sexual function (FSFI), menopause (SCL), QOL (SF 12), relationships (ADAS), and exploratory (reproductive options) items. Cancer survivors exhibited greater sexual dysfunction and lower physical QOL than non-cancer infertile women (P < 0.001). No significant group differences were identified for mood (CES-D), mental health QOL (SF-12), reproductive concerns (RCS), and relationship satisfaction (ADAS). All groups scored in the FSFI range of sexual dysfunction, and with RCS scores above published means. Multivariate comparisons showed comparable depression and distress levels for all groups, but cancer survivors had poorer physical QOL [F(5,146)=4.22, P < 0.01]. A significant effect was also found for knowledge of third-party reproductive options on depression and distress levels [F(3,97)=4.62,P < 0.01]. Adjusted means demonstrated higher depression and distress scores for women with perceived unmet informational needs. Overall, loss of fertility was an emotionally challenging experience for women regardless of its cause. Cancer survivors were found to have lower scores of physical QOL and sexual function than non-cancer infertile women. Unmet informational needs about reproductive options appeared to be associated with negative mood and increased distress in cancer survivors. Targeted interventions to increase knowledge about reproductive options could be of great assistance to women pursuing parenthood in cancer survivorship. Additionally, intervention studies to improve sexual functioning and QOL in women with cancer-related infertility should be a priority of future research.

Surrogate obesity negatively impacts pregnancy rates in third-party reproduction

In a retrospective cohort review of third-party reproduction, we observed that surrogate body mass index (BMI) negatively impacts implantation rates in oocyte-donor in vitro fertilization cycles. A BMI > or =35 kg/m(2) cutoff is associated with a statistically significant decrease in pregnancy rates but not miscarriage rates.

The potential applicability of neuropsychological evaluation for oocyte donors

The aim of this study was to investigate the applicability of neuropsychological testing identifying cognitive factors of candidates for the anonymous oocyte sharing donation program. Prospective study evaluating testing applicability 24 subfertile women applied for IVF treatment (group A) and were willing to share their oocytes as part of the compensation agreement for assisted conception treatment. Besides good health and women's chronology (<32 yr), all volunteers suffered from either tubal or male factor infertility. Neuropsychological tests focused on the investigation of attention, learning abilities, memory, visual-spatial organization, mental flexibility, and intelligence (IQ). Neuropsychological results of these women were compared to a sample of 25 healthy fertile female volunteers (group B) using Student's t test and p<0.05 was considered significant. There were no significant differences between group responses regarding learning abilities, memory and visual-spatial organization. Women who were candidates for oocyte donation exhibited a significantly higher incidence of attention deficits (12.6 ± 2.4 vs 16.5 ± 2.2; p<0.02), although they had significantly greater scores on mental flexibility (3.2 ± 1.1 vs 2.1 ± 0.7; p<0.02) and IQ (111.05 ± 10.5 vs 98.3 ± 9.4; p<0.01). Two patients were considered not suitable for oocyte donation because neuropsychological testing revealed signs of attention-deficit hyperactivity disorder (ADHD) and epilepsy, which were latter confirmed. None of these diagnoses had been previously informed by the patients to the infertility specialist during the history and work-up procedures. The attention deficit presented in the oocyte donor candidates could be resulting from the interference of circumstantial anxiety. These prospective patients depend upon the results of an infertility treatment to remain in the program which is in itself highly stressful. The findings regarding greater mental flexibility in this sample suggest that this could be an essential feature for these women to endure this combined treatment (infertility treatment and the simultaneous oocyte donation). These findings reveal that neuropsychological testing can be a useful complementary instrument in the evaluation of candidates for oocyte donation and third-party assisted reproduction. Additional data should provide evidence to make neuropsychological testing as an integral part of the evaluation protocol to third-party reproductive candidates.