Third-party Reproduction Research Articles

Propozycje w zakresie wprowadzenia do polskiego prawa dawstwa identyfikowalnego komórek rozrodczych i zarodków

The purpose of this paper is to present proposals for implementation of identifiable donation of gametes and embryos into the Polish law. The analysis is divided into three parts. The first part examines arguments for the abolition of a donor’s anonymity and the practical consequences of using direct-to-consumer genetic testing to track an anonymous donor. The second part deals with international documents regarding the child’s right to know their genetic origins; attempts to standardize the model of gamete and embryo donation within the member states of the Council of Europe, analysis of national jurisdictions, and debate on the retrospective amendments of law. The third part moves to analysis of how the identifiable donation should be implemented into the Polish law, assuming that the law should be changed only prospectively. Therefore, differentiation of donors who decide on donation before changing the law and after amendment of law is taken into consideration. Moreover, the third part examines which potential changes to law may be taken into consideration, assuming that it is justified to indicate the circumstances of third-party reproduction in documents related to the Polish Registry of Births, Marriages and Deaths.

Are donor-conceived people willing to use donors themselves? Insights from individuals conceived via donor-assisted reproduction.

Are donor-conceived people (DCP) willing to utilize donor gametes themselves if unable to conceive spontaneously? The majority of DCP would consider or are undecided about utilizing donor gametes and those who would consider the utilization are more likely to have been told about their donor-conceived origins at a young age by a family member and have overall positive experiences as a DCP. DCP view their donor conception as an important part of their self-identity and many desire contact with genetically related individuals. Additionally, many believe that sperm donation should only be practiced if identifying information on the donor is provided. This was a cross-sectional study using a Web-based survey that was disseminated from 6 March to 15 August 2021. A total of 528 participants completed the questionnaire. The researcher-created survey was sent to registered users of the Donor Sibling Registry (DSR) who were conceived via donor-assisted reproduction and were 18 years of age or older. The survey was optional and anonymous, and the main outcome measure was the willingness to use donated gametes if unable to spontaneously conceive. Of the 528 participants who completed the survey, 40.2% (212/528) have or would consider using donor gametes themselves if unable to conceive spontaneously and 24.6% (130/528) were undecided. Those who had used or were undecided about the utilization were significantly younger (26 years vs. 31 years, P < 0.001) and less likely to be married (32.7% vs. 47.3%, P < 0.001) than those who would not consider using donor gametes. They were also less likely to self-identify as female (78.9% vs. 86.6%, P = 0.03) but had no difference in sexual orientation (P = 0.13). Additionally, they were more likely to have known about their donor-conceived origins for more years (18 (0-50) vs. 11 (0-61), P = 0.004), be informed by a family member (75.5% vs. 65.6%, P = 0.001) and have overall positive feelings about being conceived using a donor (93.0% vs. 52.5%, P < 0.001). A major limitation is that DSR participants may not be representative of all DCP. Additionally, analyzing the DCP who stated that they were undecided about using donor gametes into the 'would consider' group may be overestimating the openness to utilization in this group. The findings from this study give new insight for health care workers to further counsel patients who are considering using third-party reproduction by providing reassurance that the majority of their future children would consider similar means, if needed, to achieve their family-building goals. Funding for this study was received from the Department of Obstetrics and Gynecology Division of Reproductive Endocrinology and Infertility, University of Colorado. All authors declare that there are no conflicts of interest to disclose. N/A.

P-488 Perceptions of gamete and embryo donation recipient parents about the online experimental and control programs in the TELL Tool feasibility clinical trial at immediate post-test

Abstract Study question What are parents’ initial perceptions about the online experimental and control programs at immediate post-test? Summary answer Parents reported overall acceptability of the online instructions, technological navigation, length, and quality of videos, as well as suggestions for further improvement. What is known already Multiple investigations have examined the reasons why parents who used donated gametes or embryos, decide to inform their children that they were conceived through third-party reproduction. A consistent theme in this research is parental calls for strategies and tools to aid parents with disclosure to their children. Despite these calls from parents, little research has focused on developing new methods of delivering parent-focused materials that aim to assist parents in their disclosure process. To address this concern, we developed an online experimental program called the Tool to Empower Parental TeLling and TaLking (TELL Tool) and completed alpha testing. Study design, size, duration A 3-month feasibility clinical trial. Participants/materials, setting, methods Donor sperm, egg, and embryo recipient parents were randomized to either an experimental TELL Tool program or a control program focused on good parenting practices. Both the TELL Tool and the control programs are administered online. To date 13 parents have completed the experimental or control program and each participant has answered an immediate post-test survey about the acceptability of the program. Descriptive statistics and qualitative content analysis guided the analysis. Main results and the role of chance The sample consists of 13 U.S. parents between 35 to 53 years (M = 41.3 years). The parents used donated sperm (n = 5), eggs (n = 2), sperm and eggs (n = 2) or embryos (n = 4) and their children were between 1 to 12 years (M = 5.7 years). Most parents were female (n = 11) and White (n = 10). Parents were asked to rate the level of truthfulness about the acceptability of the online programs (ratings: 1 to 5, with 1 being “not at all true” to 5 being “very true”). Responses about the: (1) instructions provided for accessing the program were easy, were: range 3 to 5, M = 3.9; (2) technological navigation within the program was problematic, were: range 1 to 5, M = 2.7; (3) length of the program was too long, were: range 1 to 5, M = 3; and (4) videos within the program were helpful, were: range 3 to 5, M = 3.69. Responses to the open-ended questions provided insights to the ratings, such as parents’ statements about specific technological issues (e.g., ability to print resources, ease of navigating in-and-out of the program). Limitations, reasons for caution Preliminary data are reported for the feasibility trial at the immediate post-test timepoint as recruitment is ongoing. As the 3-month study unfolds, additional data will be obtained to allow for more in-depth understanding of parents’ perceptions about the acceptability of the experimental TELL Tool and control programs. Wider implications of the findings The acceptability of the online research for donor gamete and embryo recipient parents may illuminate access issues to these often hidden and dispersed parents and their families across the lifespan. Parents’ responses can provide a window of understanding for other decision aids that target health promotion among parents and children. Trial registration number NCT04841967

The limitations of liberal reproductive autonomy.

The common liberal understanding of reproductive autonomy - characterized by free choice and a principle of non-interference - serves as a useful way to analyse the normative appeal of having certain choices open to people in the reproductive realm, especially for issues like abortion rights. However, this liberal reading of reproductive autonomy only offers us a limited ethical understanding of what is at stake in many kinds of reproductive choices, particularly when it comes to different uses of reproductive technologies and third-party reproduction. This is because the liberal framework does not fully capture who benefits from which reproductive options, the extent of the risks and harms involved in various reproductive interventions, and the reasons for why people are driven to make certain reproductive choices.

GENType: all-in-one preimplantation genetic testing by pedigree haplotyping and copy number profiling suitable for third-party reproduction.

Is it possible to develop a comprehensive pipeline for all-in-one preimplantation genetic testing (PGT), also suitable for parents-only haplotyping and, for the first time, third-party reproduction? Optimized reduced representation sequencing (RRS) by GENType, along with a novel analysis platform (Hopla), enables cheap, accurate and comprehensive PGT of blastocysts, even without the inclusion of additional family members or both biological parents for genome-wide embryo haplotyping. Several haplotyping strategies have proven to be effective for comprehensive PGT. However, these methods often rely on microarray technology, whole-genome sequencing (WGS) or a combination of strategies, hindering sample throughput and cost-efficiency. Moreover, existing tools (including other RRS-based strategies) require both prospective biological parents for embryo haplotyping, impeding application in a third-party reproduction setting. This study included a total of 257 samples. Preliminary technical validation was performed on 81 samples handpicked from commercially available cell lines. Subsequently, a clinical validation was performed on a total of 72 trophectoderm biopsies from 24 blastocysts, tested for a monogenic disorder (PGT-M) (n = 15) and/or (sub)chromosomal aneuploidy (PGT-SR/PGT-A) (n = 9). Once validated, our pipeline was implemented in a diagnostic setting on 104 blastocysts for comprehensive PGT. Samples were whole-genome amplified (WGA) and processed by GENType. Quality metrics, genome-wide haplotypes, b-allele frequencies (BAFs) and copy number profiles were generated by Hopla. PGT-M results were deduced from relative haplotypes, while PGT-SR/PGT-A results were inferred from read-count analysis and BAF profiles. Parents-only haplotyping was assessed by excluding additional family members from analysis and using an independently diagnosed embryo as phasing reference. Suitability for third-party reproduction through single-parent haplotyping was evaluated by excluding one biological parent from analysis. Results were validated against reference PGT methods. Genome-wide haplotypes of single cells were highly accurate (mean > 99%) compared to bulk DNA. Unbalanced chromosomal abnormalities (>5 Mb) were detected by GENType. For both PGT-M as well as PGT-SR/PGT-A, our technology demonstrated 100% concordance with reference PGT methods for diverse WGA methods. Equally, for parents-only haplotyping and single-parent haplotyping (of autosomal dominant disorders and X-linked disorders), PGT-M results were fully concordant. Furthermore, the origin of trisomies in PGT-M embryos was correctly deciphered by Hopla. Intrinsic to linkage-analysis strategies, de novo single-nucleotide variants remain elusive. Moreover, parents-only haplotyping is not a stand-alone approach and requires prior diagnosis of at least one reference embryo by an independent technology (i.e. direct mutation analysis) for haplotype phasing. Using a haplotyping approach, the presence of a homologous recombination site across the chromosome is biologically required to distinguish meiotic II errors from mitotic errors during trisomy origin investigation. We offer a generic, fully automatable and accurate pipeline for PGT-M, PGT-A and PGT-SR as well as trisomy origin investigation without the need for personalized assays, microarray technology or WGS. The unique ability to perform single-parent assisted haplotyping of embryos paves the way for cost-effective PGT in a third-party reproduction setting. L.D.W. is supported by the Research Foundation Flanders (FWO; 1S74619N). L.R. and B.M. are funded by Ghent University and M.B., S.S., K.T., F.V.M. and A.D. are supported by Ghent University Hospital. Research in the N.C. lab was funded by Ghent University, VIB and Kom op Tegen Kanker. A.D.K and N.C. are co-inventors of patent WO2017162754A1. The other authors have no conflicts of interest. N/A.

‘Donor-matching’ in Third-party Reproduction: a Comparative Analysis of Law and Practice in Europe

Abstract Medically assisted reproduction is of significant public and policy interest across Europe. Where use of donor gametes (eggs, sperm, or embryos) is required, some people may employ ‘donor-matching’, which seeks to establish phenotypic similarity between gamete donors and recipient(s). This article examines donor-matching focusing on methods used to match donors and recipients, reasons for its use, and laws and practices across several European jurisdictions. The discussion is informed by examination of relevant literature, regulatory instruments, and consultation with practitioners and experts, and aims to inform wider theoretical and policy debates. Differences in practice and issues that arise across jurisdictions are highlighted. That donor-matching has the potential to be used by people born as a result of third-party reproduction to identify their donor is also discussed. The authors conclude that the use of donor-matching raises complex issues for recipients and donor-conceived people alike, which must be considered when contemplating its use and regulation.

Primary ovarian insufficiency: a glimpse into the racial and socioeconomic disparities found within third-party reproduction

ObjectiveTo describe a unique case of primary ovarian insufficiency and review the systemic barriers in place that hinder reproductive autonomy for Black women who require third-party reproduction.DesignCase report and review of the literature.SettingSafety-net hospital in an urban community.Patient(s)A 36-year-old Black woman, gravida 0, with primary ovarian insufficiency who desires future fertility but is restricted by systemic barriers.Intervention(s)Chromosome analysis.Main Outcome Measure(s)Not applicable.Result(s)Balanced reciprocal translocation between chromosomes 1 and 13: 46,XX,t(1;13)(q25;q14.1).Conclusion(s)The field of assisted reproductive technology has evolved at an exponential rate, yet it unfortunately benefits some and not all. It is imperative that when we advocate for full spectrum infertility care, that this encompasses everyone. As we continue to further study and develop assisted reproductive technology, we must not forget to consider the factors leading to racial and socioeconomic disparities in reproductive care access, utilization, and outcomes.

STATE INSURANCE MANDATES AND MULTIPLE BIRTH RATES AMONG WOMEN UNDERGOING DONOR FROZEN EMBRYO TRANSFER

Previous studies have shown that the cost of IVF is a barrier to adoption of elective single embryo transfer (eSET) and that this barrier is reduced in states with mandated insurance coverage (1, 2). The use of donated excess embryos is an increasingly common mechanism for family building that is of particular interest to patients who may not otherwise be able to afford IVF. However, it is not known whether the multiple birth rate with donor frozen embryo transfer differs between mandated and non-mandated states, particularly since third-party reproduction is often excluded from coverage.

Stuck under the Rainbow? Gay Parents' Experiences with Transnational Surrogacy and Family Formation in Times of COVID-19 Lockdown

Scientific progress in the medical field has contributed to the realisation of becoming parents by people who have previously been naturally excluded from procreation and parenthood, such as older, non-fertile, and homosexual persons and couples. However, depending on specific national regulations, possible pathways to becoming parents are different and often reserved only for some categories of people. This is the case, for example, in Italy, where it is more difficult for homosexual people to have a family than it is for others, since national legislation prohibits homosexuals from using any form of third-party reproduction. Consequently, many Italian same-sex couples turn to agencies abroad to realise their desire to have children, giving rise to transnational practices of family formation. The COVID-19 pandemic and severe lockdown policies have exacerbated some critical aspects of this transnational system of access to parenting. To fight the spread of coronavirus, national governments have placed limits on mobility and, consequently, also placed limits on transnational practices and trajectories of family formation. The specific aim of this paper is to provide insights into the experiences of some gay Italian fathers-to-be who have been blocked in their transnational family formation projects because of coronavirus lockdown measures. The focus lies on how these men reacted to feeling “stuck” and seeing their plans of receiving and/or bringing home their children suddenly foiled by the lockdown measures. Particular attention is paid to how these men coped with exacerbated challenges in the transnational practices of reproduction and family formation.

Obesity and IVF: weighing in on the evidence.

Obesity is associated with serious health risks, and its rising prevalence represents a growing public health emergency. Ongoing research into the association of obesity and assisted reproductive technology (ART) outcomes aims to disentangle selective detrimental effects of obesity on the oocyte and the endometrium. More translational studies involving women with severe obesity and in the third-party reproduction setting will help improve the standard of care in the provision of ART services for obese patients.

Imagined and unimagined relatedness: a child of ‘one’s own’ in third-party reproduction in India

ABSTRACT This paper examines the ways in which egg donors, surrogate mothers, and intended parents in India imagine and unimagine their relationship with children born through third-party reproduction. Third-party reproduction is inseparable from plural parenthood and the question of who the ‘real’ parents are. In a legal and medical context, gestational surrogacy in India treats surrogates as not ‘real’ mothers, in favour of the ‘natural’ relationship between the intended mother and child. Here, the ‘genetic tie’ may ignore gestation in giving predominance to ‘genes’, but this logic is inverted in the case of egg donation, in which it is not uncommon for people to regard egg donors as ‘real’ mothers. Who is regarded as a ‘real’ parent, and who is not, is deeply embedded in the social process of creating kinship, shared notions of bodily substances, corporeal reality, and social recognition of ‘one’s own child’. The elements of gestation, genetic relations, and nurturing compete and coexist in the practice of third-party reproduction. This paper explores the multiple aspects of ‘real’ and ‘fictive’ kinship and its entanglement in making ‘a child of one’s own’ in third-party reproduction in India.

Some preliminary questions regarding third-party reproduction

Some preliminary questions regarding third-party reproduction

Third-party reproduction

ABSTRACT IS AVAILABLE IN THE PDF

Independent Third-party Reproduction of Infringing Signs Does Not Constitute Trade Mark Use

Independent Third-party Reproduction of Infringing Signs Does Not Constitute Trade Mark Use

Step-by-step decision-making process in third party assisted reproduction: a qualitative study

This study explores the experience of decision-making about the third party assisted reproduction in Iranian infertile patients using a qualitative approach. Data were collected in 2017–2019 through in-depth interviews of 20 infertile participants (3 couples and 14 individuals) who became pregnant or had children through third-party reproduction and 12 specialists. The interviews were transcribed verbatim, the data were managed using the MAXQDA 10 and analysed using a conventional content analysis approach. The main category that emerged was ‘step-by-step process of adjustment to third party assisted reproduction’. From this, five sub-categories were extracted: (i) ‘parental preference for biological children over non-biological children’; (ii) ‘parental preference for non-biological children over childlessness threats’; (iii) ‘strong preference for having partial genetic link with children’; (iv) ‘flexibility in removing or overcoming barriers to third party reproduction’; and (v) ‘parental preference for adopted children over childlessness’. The findings in the present study suggest the importance of lineage and biological relatedness in Iranian culture. Patients adjusted to non-biological parenting as a treatment option only if they have to. Using a step-by-step decision-making process helped participants make more thoughtful decisions by organising relevant information and defining alternatives. The results of the present study can help healthcare providers with counselling regarding parenting with or without genetic ties.

Gestational surrogacy: medical, psychosocial, and legal considerations

Gestational surrogacy can provide an effective family-building method for women whose uterus is absent or dysfunctional and with contraindications to pregnancy, single men, and same-sex male couples. Over the past 30 years, gestational surrogacy cases have represented a growing percentage of third-party reproduction cases, both in the United States and internationally. The following series of articles provides a summary of current topics in optimizing GS arrangements. They focus on medical and psychological screening; psychosocial adjustment of carriers, children, and their families; legal considerations with precedent-setting cases that every clinician should know; and an international overview of cross-border surrogacy.

Survey of Third-Party Parenting Options Associated With Fertility Preservation Available to Patients With Cancer Around the Globe.

PurposeIn the accompanying article, “Survey of Fertility Preservation Options Available to Patients With Cancer Around the Globe,” we showed that specific fertility preservation services may not be offered at various sites around the world because of cultural and legal barriers. We assessed global and regional experiences as well as the legal status of third-party reproduction and adoption to serve as a comprehensive international data set and resource for groups that wish to begin oncofertility interventions.MethodsWe provide data on the legalities of third-party assisted reproductive technologies and other family-building options in the 28 oncofertility-practicing countries surveyed.ResultsWe found regional and country differences that will be important in the development of tailored resources for physicians and for patient brochures that are sensitive to these local restrictions and cultural norms.ConclusionBecause many patients first consult Web-based materials, the formal assessment of the availability of these options provides members of the global oncofertility community with data to which they might otherwise not have ready access to better serve their patients.

Biblical Lessons on Third-Party Reproduction

Third-party reproduction uses ovum donors, sperm donors, embryo donors, and gestational surrogates in various combinations to create a child for heterosexual couples, same-sex couples, and individuals to raise. Its use is increasing in the United States and around the world, and it is increasingly the subject of legislation. But third-party reproduction tells the individuals who provide the ovum, sperm, and gestation required to create a child that they are reproductive mechanisms, not reproductive persons. By contrast, multiple stories in the Bible involving third-party reproduction recognize the motherhood and fatherhood, and thus the reproductive personhood, of those whose sexual union brings forth a new child. This is an important point for people of faith and the public to be mindful of.

Acceptance of Third-Party Reproduction in Assisted Reproduction Technology: Perception of Nurses in Osun State

Acceptance of Third-Party Reproduction in Assisted Reproduction Technology: Perception of Nurses in Osun State

Dilemmatic tensions around parenthood: the ambiguous third-party role in Assisted Reproductive Technologies and Surrogacy in France and Portugal

This article analyzes couples’ attitudes towards the third-party role in Assisted Reproductive Technologies with gamete donation, and problematizes parenthood and kinship. I base my analysis on 66 in-depth interviews with different ART actors (from beneficiaries to professionals) in France and Portugal, conducted as part of a research project already completed. Special focus is given to 19 interviews with heterosexual and homosexual couples who used third-party reproduction in Europe and the United States. I found a physical and moral detachment operation among heterosexual and lesbian couples vis-a-vis the donor of reproductive potential, who is depersonalized and reduced to a functionality. The objective is to preserve the intimacy of the couple and the autonomy of the parental project. This contrasts with innovative and enlarged family dynamics developed by gay couples, who integrate both female figures (surrogate and oocyte donor) in their children’s family history, through bonding efforts in a logic of reciprocity (gift and counter-gift). The purpose is to reject the negative image of a woman’s body being commodified while preserving the natural appearance of procreation. I conclude that a naturalist conception of kinship persists —one based on shared biogenetic substances that bind together one parent and the donor-conceived child— along with the centrality of biological processes such as pregnancy and childbirth. There are different ways of easing tensions inherent to the contractual intervention of third parties in the reproductive process. ART re-elaborates the line of demarcation between commodities and gifts and between living things and human beings, while reconfiguring family concepts.