Third-party Reproduction Research Articles

The Inaccessible Road to Motherhood — The Tragic Consequence of not having Reproductive Policies for Israelis with Disabilities

INTRODUCTION The desire of an individual to become a parent can be very strong, especially in child-centric societies, where the idea of having children and raising a family is highly valued. In those societies, the prominent pro-natal nature translates into policies and laws regulating reproduction. The Jewish-Israeli society is a prime example of such a society where the use of state-funded Assisted Reproduction Technologies (ARTs) is the highest in the world--eight times higher than the international average. (1) However, the road to becoming a parent is not as smooth for all members of Israeli society. A recent case that went all the way to the Israeli Supreme Court proved how the current Israeli reproductive policies, particularly surrounding third-party reproduction methods such as adoption or surrogacy, are inaccessible to people with disabilities (among other minority groups) who share the same great desire to become parents. (2) The Ora Mor Yosef case revolves around a Jewish-Israeli woman with muscular dystrophy who could not bear a child because of her impairment. Her dream of becoming a mother was so powerful that after exhausting all of her other options, she used a surrogate, sperm donation, and egg donation to bring a baby into the world. However, the lack of genetic-biological connection to the baby led the courts to decide not to recognize Ora as the mother, meaning that she never had the chance to even see the baby. This Article will examine the exceptional case of Ora Mor Yosef in a broad context and from a Legal perspective. It will compare Israeli socio-legal treatment of what I refer to as the right to become a parent with the United States legal system and will show how Israeli law makes it more difficult for women with disabilities to have children. It will continue with a discussion on the concept of disabled motherhood from a comparative Israeli-American perspective. This discussion will illuminate that there are still universal struggles and hardships for people with disabilities, specifically women, as they endeavor to become mothers and in raising their children. By using a Disability Legal Studies framework and a socio-legal analysis, this interdisciplinary Article will bring to the foreground issues and ramifications that were not found in the original reasoning of the Israeli courts' rulings on the Ora Mor Yosef case and will demonstrate the crucial role legal institutions play in the social construction of disability and its treatment by society. It is my hope that this paper will therefore help bring more attention to the issue of disabled parents and prevent tragic instances like the one standing in the heart of this paper from recurring. It is important to conduct a comparative analysis of the American and Israeli legal systems on this issue since the Israeli legal treatment of people with disabilities has been influenced by American disability rights academia, legislation, and activism. The Americans with Disabilities Act (ADA) was used as the model for the Equal Rights for People with Disabilities Law, which is the main Israeli legislation governing this population, and American legal scholars were even involved in its enactment. (3) Furthermore, the work of Bizchut--the Human Rights Center for People with Disabilities, the leading organization on promoting the rights of Israelis with disabilities--was influenced by the work of American civil rights organizations. (4) The two systems differ, however, as Israel has signed and ratified (5) the United Nations Convention on the Rights of Persons with Disabilities (UN CRPD), (6) while the United States has declined to do so. (7) This is the first time that such a comparative analysis has been conducted on the issue of parents living with disabilities, and it helps shed light on the broader relationship between disability and law. Part I introduces the socio-legal landscape regarding access to reproduction in Israel and the United States. …

Psychological Counseling of Female Fertility Preservation Patients

Young cancer patients are increasingly interested in preserving their fertility prior to undergoing gonadotoxic therapies. Although the medical safety and treatment protocols for fertility preservation have been well documented, limited research has addressed the emotional issues that arise in fertility preservation patients. We briefly review the literature on the psychosocial issues in adult female fertility preservation treatment and describe our experiences within this patient population. Our findings suggest that several important issues to be addressed during the psychological counseling of adult female fertility preservation patients include: (1) preexisting psychological distress in patients undergoing treatment, (2) choice of fertility preservation strategy in the face of an uncertain relationship future, (3) decision making regarding use of third-party reproduction (e.g., sperm/egg donation, gestational surrogacy), (4) treatment expectations regarding pregnancy and miscarriage, (5) ethical issues related to treatment including the creation, cryopreservation, and disposition of embryos/oocytes, and (6) decision regret from patients who declined fertility preservation.

From Infertility to Successful Third-Party Reproduction: The Trajectory of Greek Women.

The purpose of our phenomenological hermeneutic study was to explore the lived experiences of Greek infertile women who achieve a pregnancy through the use of sperm, oocyte, or embryo donation or surrogate motherhood. Semistructured interviews were conducted with 15 infertile women. Findings suggest that conceiving a child through assisted reproductive technologies (ART) is lived as a highly distressing experience, comprising long waiting periods for medical results, several failed attempts, and treatment options with uncertain outcomes. The analysis of women's accounts revealed a constitutive pattern, journeying between hope and despair, and three associated themes: (a) coping with uncertainty and treatment failures, (b) exploring options and decision making, and (c) being supported by spouse and professionals. Findings illuminate the specific meaning-based coping processes, decision-making patterns, and sources of support that help women who pursue treatment until they give birth to a child, to manage highly stressful situations and critical decisions.

Lesbian couples' views about and experiences of not being able to choose their sperm donor

In this qualitative study, we explore how lesbian recipients view and experience the selection of their anonymous sperm donor. The study was conducted in Belgium, where fertility centres follow a legal protocol that severely restricts personal choice in donor selection. While previous studies have shown that recipients want greater control and input in the selection of their sperm donor, this was not a main concern for most women in the present study. They generally acknowledged their lack of control on the selection outcome and accepted this as part and parcel of an anonymous donation policy that provides an opportunity to have a child. They actively and passively downplayed initial concerns about the donor selection procedure and felt they did not have or need a right to further control over the donor selection. In adopting this ‘subordinate’ position, they felt they should trust the hospital, which they hoped would fulfil rather high screening standards. Those who did want more choice were nuanced and careful about their motivations: they focused on selecting traits that would facilitate normal child development or increase family coherence. The findings shed light on how these patients perceive their position in this third-party reproduction setting.

Third-party reproduction and the internet: an assessment of society for assisted reproductive technology (SART) fertility clinic websites

Third-party reproduction and the internet: an assessment of society for assisted reproductive technology (SART) fertility clinic websites

Screening and treatment for hypothyroidism in donor oocyte recipients: a practice survey

Guidelines for treatment of mild hypothyroidism prior to conception have recently become more inclusive. The objective of this study was to examine practice patterns among donor oocyte programs in regard to screening and treatment of donor-oocyte recipients for hypothyroidism. Cross-sectional survey. A one-page questionnaire was offered to attendees at a 2014 national symposium on third-party reproduction. Descriptive statistics were compiled. There were 46 responses from practices in 22 states; 6 (13%) were academic programs and the remainder were from private practices. The majority of respondents (65%) were nurses. Programs performed 35 donor egg cycles (median; range 4-1093) per year. Only four programs (9%) denied routinely screening prospective recipients for hypothyroidism; the majority of programs (57%) screen with TSH level only at the initial visit, while 35% screen annually. In early pregnancy, 29 programs (71%) screen recipients again: at the time of the first or second beta-hCG in 17 of programs (37%), and with the first ultrasound scan in 8 programs (17%). The TSH level at or above which programs treat with levothyroxine is 2.5 mIU/L in 26 programs (56%), 2.6–3.0 mIU/L in 9 programs (20%), and 3.1–4.5 mIU/L in 4 programs (9%). The frequency of TSH retesting is every 4 weeks in 15 programs (33%), every 4.5–5 weeks in 9 programs (20%) , and every 6 weeks in 13 programs (28%). The choice of levothyroxine was brand-name in 8 programs (17%) and generic in 38 (83%). Of the latter, 17 (45%) stated they require the same generic to be dispensed with refills, while 16 (42%) said they do not. Screening of planned donor-egg recipients for hypothyroidism, treatment with levothyroxine, and TSH re-testing generally follow recommended guidelines, with early-pregnancy TSH measurement often deferred to the time of first ultrasound. The majority of programs seek consistent daily levothyroxine dosing through either branded or same-generic prescription.

Gab Kovacs, The Subfertility Handbook: A Clinician’s Guide

This, the second edition of The Subfertility handbook: A Clinician’s Guide has been published 14 years after the First Edition that had appeared in print in 1997. This new edition takes an international view, with contributions from experts from around the world. The fully revised and updated second edition of this practical handbook provides comprehensive coverage of all the aspects of subfertility, including treatment and diagnosis. A recognized world expert in the field writes each chapter and, together, they aim to provide the state-of-the-art answers to all the problems of subfertility in a single volume. The introductory chapter provides a flow-chart approach to systematic diagnosis and treatment. Clearly written and easy to read, the subsequent chapters describe what questions to ask, how to investigate, and what each treatment requires. With an expanded international team of authors, this new edition also offers new chapters devoted to the third-party reproduction and in vitro maturation of oocytes.

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.

A survey of current oocyte cryopreservation (OC) practice and utilization in the USA

OBJECTIVE: To learn about the current practice and utilization of oocyte cryopreservation (OC) among US ART programs. DESIGN: Cross-sectional survey. MATERIALS AND METHODS: A national conference on third-party reproduction in early 2013, a 1-page survey questionnaire was offered to all attendees. Descriptive statistics were compiled. RESULTS: Of the 74 ART programs with representatives attending the conference, 32 (43%) completed the survey, from 19 states with broad geographic and program size representation. 24 (75%) of these programs currently offer OC; 5 plan to do so in the next year. Over 90% stated they offer OC for elective fertility preservation and for cancer patients; 58% offer OC for donor eggs and at retrieval for IVF. The majority had no age limits for OC in cancer patients; for elective OC, 88% had no upper age limit or a limit of 40 yr or older. Most programs reported very low OC volume, with interquartile ranges of 0-10 annual retrievals with OC and 0-2 embryo transfers (ET) after prior OC. Only 3 programs had experience of bothR 25 retrievals with OC andR 10 ETafter OC. 87% of programs have onsite cryostorage for oocytes; only 12% reported that their storage consents are time-limited. Only 36% reported a pregnancy with ET after non-donor cryopreserved oocytes; 85% had a pregnancy with cryopreserved donor oocytes. The majority have contracted with an outside donor egg bank. 72% (100% of responses) stated they require STD screening before non-donor OC. 50% of programs advertise elective OC on their website. Insurance plans in mandated states do not cover OC even for cancer patients. CONCLUSION: Declared no longer experimental by ASRM in 2012, OC practice and utilization in the USA are still in their infancy despite high adoption rate. Common age limits set by programs for elective OC do not appropriately reflect oocyte biology.

Attitudes towards cross-border reproductive care among infertile Japanese patients

The attitudes towards cross-border reproductive care (CBRC) held by infertile Japanese patients have not been explored. The objective of the present study was to examine interest levels, preferred destinations, motivations, and sources of information related to CBRC. Our findings provide a general outline of CBRC and the future of reproduction and assisted reproductive technology (ART) in Japan. The study used a cross-sectional design. Data were collected from 2,007 infertile Japanese patients from 65 accredited ART clinics in Japan (response rate, 27.4%) via anonymous questionnaires. Most of the infertile Japanese patients who responded denied using CBRC. However, by group, 171 (8.5%) patients in non-donor in vitro fertilization, 150 (7.5%) in egg donation, 145 (7.2%) in pre-implantation genetic diagnosis, and 129 (6.4%) in surrogacy said that, depending on the situation, they might travel abroad in the future. Older respondents were more likely to express an intention to travel overseas for egg donation in the future. The most popular destination for CBRC was the United States. Popular reasons for interest in CBRC among those considering or planning using this approach to third-party reproduction were that egg donation or surrogacy was unavailable or that obtaining ethical approval takes too long in Japan, whereas these processes are legal and affordable overseas. However, high cost was the most common reason for hesitancy regarding CBRC. Among the participants who were considering or planning to travel abroad for this purpose, TV, medical agencies, print media, and message boards on websites were popular sources of information, whereas doctors, friends, and patient self-help groups were not. Although CBRC among infertile Japanese patients is not at present common, the demand for and use of this approach may increase in the future in the context of the increasingly aging population. Lack of regulation and unavailability of third-party reproduction is a major cause of CBRC among Japanese patients. Health care provider faces an urgent need for giving useful information for patients regarding CBRC.

Psychometric Properties and Norms for the Personality Assessment Inventory in Egg Donors and Gestational Carriers

Although psychological evaluations are an integral element of screening for third-party reproduction and the Personality Assessment Inventory (PAI) is commonly used for these evaluations, little is known about the psychometric properties or normative scores on the PAI among egg donors and carriers. We evaluated the PAI among 1,044 egg donors and gestational carriers from various fertility clinics across the United States. PAI scales were generally internally consistent in this population, although range restriction appeared to attenuate reliability on several scales. The PAI profiles of egg donors and carriers had elevated positive impression management and suppressed clinical scale scores relative to the community standardization sample, as would be expected given the contingencies of this assessment context. Scores were similar across egg donors and carriers and were similar whether the carrier or donor was known or not known to the prospective parents. Sample-specific norms are provided for the use of the PAI in this setting.

Marital stability and quality in families created by assisted reproduction techniques: a follow-up study

An increasing number of children are being born with the use of assisted reproduction techniques such as donor insemination, egg donation and surrogacy. There have been concerns that the use of these third-party reproduction techniques may have a negative effect on the quality of the relationship between the mother and father. Marital stability and quality was examined in a UK sample of donor insemination, egg donation and surrogacy families and families in which children were naturally conceived. Interview and questionnaire assessments of marital stability and quality were collected from mothers and fathers over five time points, when the children in the families were aged 1, 2, 3, 7 and 10. Of those families who participated when children were 10years old, a minority of couples in each family type had divorced/separated and few differences emerged between the different family types in terms of mothers’ or fathers’ marital quality. Despite concerns, couples in families created by donor insemination, egg donation and surrogacy were found to be functioning well.An increasing number of children are being born with the use of assisted reproduction techniques such as donor insemination, egg donation and surrogacy. There have been concerns that the use of these third-party reproduction techniques may have a negative effect on the quality of the relationship between the mother and father. Marital stability and quality was examined in a UK sample of donor insemination, egg donation, and surrogacy families and families in which children were naturally conceived. Interview and questionnaire assessments of marital stability and quality were collected from mothers and fathers over five time points, when the children in the families were aged 1, 2, 3, 7 and 10. Of those families who participated when children were 10years old, a minority of couples in each family type had divorced/separated and few differences emerged between the different family types in terms of mothers’ or fathers’ marital quality. Despite concerns, couples in families created by donor insemination, egg donation and surrogacy were found to be functioning well.

Analysis of a cohort of gay men seeking help with third-party reproduction

Historically, adoption or foster parenting were the only options for gay men seeking to have children. Lack of knowledge with regards to third-party reproduction, societal attitudes and physicians' willingness to treat gay men, may have contributed to fewer gay men becoming parents using fertility treatment. There is a lot research on the needs and options of lesbians seeking parenthood; however, data is limited on the needs and challenges that gay men face. The objective of this study is to better understand the needs, treatment considerations and support system of gay men choosing to have children with the help of fertility treatment.

An Ethic of Care and Responsibility: Reflections on Third-Party Reproduction

The rapid development of assisted reproduction technologies for the treatment of infertility appears to empower women through expanding their individual choice, but it is also creating new forms of suffering for them and their collaborators, especially in the context of transnational third-party reproduction. This paper explores the possibility of framing the ethical discourse around third-party reproduction by bringing attention to concerns of altruistic empathy for women who collaborate in the reproductive process, in addition to those of individualistic choice. This would entail moving beyond an ethic of liberty that is based on self-interest and the language of rights, to an alternative ethic of care that is based on self-restraint and the language of responsibilities. An ethic of care and responsibility would cultivate the empathetic self-reflection of the autonomous actor in relation to those others who are part of the enterprise of bringing a child into the world.

Ethics of intergenerational (father-to-son) sperm donation

In the ever changing field of reproductive medicine, clinics are regularly confronted with requests for novel variants of medically assisted reproduction. Particularly third-party (assisted) reproduction, which requires the involvement of an oocyte or sperm donor, is ethically and psychologically complex due to the parties involved, but nevertheless widely accepted. A particular type of third party reproduction concerns intrafamilial medically assisted reproduction (IMAR), where the donor is a family member of the recipients. In IMAR, some of the ethical and psychological issues associated with third party reproduction are intensified. The precise impact and consequences, however, remain speculative due to the lack of information regarding IMAR. Both the ESHRE Task Force on Ethics and Law and the Human Fertilization and Embryology Authority have recently highlighted the lack of information and the need for debate. In order to contribute to the discussion and knowledge on IMAR, we present a couple that recently visited our academic clinic with a request for a very particular variant of IMAR: first degree, intergenerational father-to-son sperm donation. As our academic hospital did not have experience with this variant of IMAR, our interdisciplinary Ethics Committee for Reproductive Medicine extensively discussed the request, resulting in an advisory report on the ethics of IMAR in general and father-to-son sperm donation in particular. Here, we will first present the andrological and social background of the couple and subsequently discuss the ethical considerations that led to the approval of their request. We will conclude the paper with recommendations for a morally sound practice of IMAR.

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.

Mating by proxy: a novel perspective to donor conception

How single, partnered lesbian, and partnered heterosexual women undertaking donor insemination rate the importance of donor characteristics is explored in the context of Trivers's parental investment theory. Consistent with this theory, single women placed higher value on biographical traits reflective of the donor's level of potential resources (occupation, hobbies, age) and good character compared with either partnered lesbian or heterosexual women.

More for the Fit: Gender and Class in the Representation of Designated Adoption in a Selection of U.S. Television Series

No abstract available.

Egg Donation

There is an increasing trend in the use of donor eggs by women unable to otherwise conceive. Third-party reproduction, specifically in vitro fertilization (IVF) with donor eggs, has particular ethical issues including possible conflict of interest between provider, donor, and recipient; completeness of informed consent; whether the donor has legal representation; and follow-up support. Nurses working with women who might have IVF are in a position to positively affect the egg donor's experience by making sure that donors understand the risks as well as the benefits of egg donation.

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.