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Ishii T, de Miguel Beriain I. Shifting to a model of donor conception that entails a communication agreement among the parents, donor, and offspring. BMC Med Ethics 2022; 23:18. [PMID: 35246130 PMCID: PMC8895777 DOI: 10.1186/s12910-022-00756-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background Some persons conceived with donor gametes react negatively when they found their birth via donor conception. They request access to information about and seek to communicate with the donor. However, some countries mandate donor anonymity. Other countries allow donor-conceived persons to access donor information, but they can only use this access if their parents have disclosed donor conception to them. We investigated a thorny issue of donor conception: whether donor conception should be shifted from an anonymous basis to a non-anonymous basis. Methods We review the issues and concerns regarding donor conception. We then consider the impact of direct-to-consumer genetic testing on donor conception, as well as the influence of donor conception on offspring’s identity and the potential of different types of donors. To discuss the future policy of donor conception, the policies on the anonymity of gamete donors were investigated using publicly-available documents in 15 countries. Results The aim of mandating donor anonymity is to protect the privacy of the donor and intended parents. However, the diffusion of direct-to-consumer genetic testing may make it impossible to maintain anonymity. Birth via donor conception shapes the offspring’s identity, and the donor may further influence the development of offspring’s identity through communications. It remains important to disclose donor conception to donor-conceived offspring and to provide them with donor information. However, that information might be insufficient for some donor-conceived persons. Here are benefits to having open-identity donors and known donors. Such donors can make an agreement with the parents regarding future communication with the offspring, although both sides should respect privacy. Subsequent counseling for all parties involved can result in better tripartite communication agreements. Conclusions In sum, ethical and practical issues that complicate donor anonymity are driving a shift to non-anonymous donor conception, in which all parties come to a communication agreement. To pave the way for such a donor conception system, transitional measures can be put into place. For countries that already adopted non-anonymous donor conception, ensuring the communication agreements is important to protect the rights of parents, donor, and offspring. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00756-1.
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Affiliation(s)
- Tetsuya Ishii
- Office of Health and Safety, Hokkaido University, Sapporo, 0600808, Japan.
| | - Iñigo de Miguel Beriain
- Law and the Human Genome RG, University of the Basque Country UPV/EHU, Faculty of Law, Library Building, 6th-Floor, Leioa Campus, Barrio Sarriena S/N, 48940, Leioa, Spain
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Cabar FR, de Oliveira MA, Machado ANC. Critical Analysis of The Changes in CFM Resolution 2294/21 And Its Impacts on Assisted Human Reproduction. JBRA Assist Reprod 2022; 26:659-665. [PMID: 35416023 PMCID: PMC9635607 DOI: 10.5935/1518-0557.20220007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The Brazilian Federal Board of Medicine (CFM) issued resolution number 2294/21, which regulates human reproduction procedures in Brazil, bringing significant changes to clinical practice in assisted human reproduction, and it raised ethical, bioethical, and legal discussions between professionals and patients. This study aims to analyze these changes in different aspects, especially because some of them are controversial. Evidence-based knowledge resources were used to support the analyses of crucial points that were impacted by this change. A literature review was carried out to obtain information about guidelines and laws, as well as articles that contemplate ethical discussions on assisted reproduction. The search sites used were BVS, Pub Med, LILACS and Google Scholar. The keywords used were law, legislation, bioethics, reference guide and assisted human reproduction. Relevant official documents from the Brazilian State were also found and included in the survey. The new resolution regarding the use of assisted reproduction techniques brought important changes, with clinical implications for couples who wish to become pregnant, and there is a need for a broad discussion concerning these repercussions from clinical, ethical, bioethical, and legal points of view.
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Affiliation(s)
- Fabio Roberto Cabar
- Faculdade de Medicina da Universidade de São Paulo -
Departamento de Obstetrícia e Ginecologia. São Paulo, SP, Brazil ,Corresponding Author: Fábio Roberto Cabar,
Secretaria da Divisão de Clínica Obstétrica, University of
Sao Paulo School of Medicine, São Paulo, SP, Brazil,
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Kirkman-Brown J, Calhaz-Jorge C, Dancet EAF, Lundin K, Martins M, Tilleman K, Thorn P, Vermeulen N, Frith L. OUP accepted manuscript. Hum Reprod Open 2022; 2022:hoac001. [PMID: 35178481 PMCID: PMC8847071 DOI: 10.1093/hropen/hoac001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/14/2021] [Indexed: 11/26/2022] Open
Abstract
STUDY QUESTION What information and support should be offered to donors, intended parents and donor-conceived people, in general and in consideration of the availability of direct-to-consumer genetic testing and matching services? SUMMARY ANSWER For donors, intended parents and donor-conceived offspring, recommendations are made that cover information needs and informed consent, psychosocial implications and disclosure. WHAT IS KNOWN ALREADY Trends indicate that the use of donor-assisted conception is growing and guidance is needed to help these recipients/intended parents, the donors and offspring, navigate the rapidly changing environment in which donor-assisted conception takes place. STUDY DESIGN, SIZE, DURATION A working group (WG) collaborated on writing recommendations based, where available, on evidence collected from a literature search and expert opinion. Draft recommendations were published for stakeholder review and adapted where relevant based on the comments received. PARTICIPANTS/MATERIALS, SETTING, METHODS Papers retrieved from PUBMED were included from 1 January 2014 up to 31 August 2020, focusing on studies published since direct-to-consumer genetic testing has become more widespread and accessible. The current paper is limited to reproductive donation performed in medically assisted reproduction (MAR) centres (and gamete banks): donation outside the medical context was not considered. MAIN RESULTS AND THE ROLE OF CHANCE In total, 32 recommendations were made for information provision and support to donors, 32 for intended parents and 27 for donor-conceived offspring requesting information/support. LIMITATIONS, REASONS FOR CAUTION The available evidence in the area of reproductive donation is limited and diverse with regards to the context and types of donation. General conclusions and recommendations are largely based on expert opinion and may need to be adapted in light of future research. WIDER IMPLICATIONS OF THE FINDINGS These recommendations provide guidance to MAR centres and gamete banks on good practice in information provision and support but should also be considered by regulatory bodies and policymakers at a national and international level to guide regulatory and legislative efforts towards the protection of donors and donor-conceived offspring. STUDY FUNDING/COMPETING INTEREST(S) The development of this good practice paper was funded by European Society of Human Reproduction and Embryology (ESHRE), covering expenses associated with the WG meetings, the literature searches and dissemination. The WG members did not receive any payment. The authors have no conflicts of interest to declare. DISCLAIMER This document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation. The recommendations should be used for informational and educational purposes. They should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. †ESHRE pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.
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Affiliation(s)
| | - Jackson Kirkman-Brown
- Centre for Human Reproductive Science, University of Birmingham, IMSR, Birmingham, UK
- Correspondence address. University of Birmingham, IMSR, Birmingham B15 2TT, UK. E-mail: ;
| | | | - Eline A F Dancet
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - Kersti Lundin
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mariana Martins
- University of Porto, Faculty of Psychology and Education Sciences, Porto, Portugal
| | - Kelly Tilleman
- Department for Reproductive Medicine, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Petra Thorn
- Private Practice, Couple and Family Therapy, Infertility Counseling, Mörfelden, Germany
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology (ESHRE) Central Office, Strombeek-Bever, Belgium
| | - Lucy Frith
- Centre for Social Ethics and Policy, University of Manchester, Manchester, UK
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Bonan S, Chapel-Lardic E, Rosenblum O, Dudkiewicz-Sibony C, Chamouard L, Wolf JP, Thiounn N, Condat A, Chalas C, Patrat C, Mendes N, Drouineaud V. Characteristics and intentions of heterosexual couples comprising a transgender man awaiting sperm donation to conceive a child. Andrology 2021; 9:1799-1807. [PMID: 34467677 DOI: 10.1111/andr.13103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 08/08/2021] [Accepted: 08/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND More than half of transgender (TG) men wish to have children. Until recently, TG people in France were rarely offered gamete donation, mainly because the Bioethics Law allows the use of assisted reproductive technologies (ART) only in infertile couples. The only option currently available for heterosexual couples with a TG man is ART with sperm donation. The Center for Study and Preservation of Eggs and Sperm (CECOS) of the Cochin Hospital is the first French center to propose sperm donation to such couples, and has done so since 1999. OBJECTIVES To determine the main characteristics and intentions of 43 couples, including a TG man and his cisgender female partner awaiting sperm donation. MATERIALS AND METHODS A retrospective analysis was carried out on the records from October 2010 to December 2019, of 43 couples with a TG man who applied for sperm donation at the CECOS of the Cochin Hospital (Paris, France). RESULTS The mean age of TG men and cisgender women was 32 ± 6.6 and 29.7 ± 4.6 years, respectively. In 77% of cases, the couple met before the man's transition. Eighty-one percent of the couples were in a stable relationship for at least 3 years, and 94% wished to have a child for no more than 5 years. Almost all of the couples (95%) intended to inform their child of their conception by sperm donation and the father's transidentity (92%). DISCUSSION Due to restrictive French legislation, the profile of our couples probably does not reflect that of all couples consisting of a TG man and a cisgender woman. The study took place over a long period of time and the characteristics of the couples could probably change over time. CONCLUSION The couples often met before the man's transition, cohabited for several years, intended to inform their child of sperm donation and the father's transidentity.
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Affiliation(s)
- Sarah Bonan
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Emeline Chapel-Lardic
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Ouriel Rosenblum
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France.,Service de Psychiatrie de l'enfant et de l'adolescent, Hôpital Universitaire La Pitié - Salpétrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Charlotte Dudkiewicz-Sibony
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Laura Chamouard
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Jean-Philippe Wolf
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France.,Inserm U1016, Institut Cochin, Université de Paris, Paris, France
| | - Nicolas Thiounn
- Inserm U1016, Institut Cochin, Université de Paris, Paris, France.,Service d'Urologie, Centre Hospitalier Georges Pompidou, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Agnès Condat
- Service de Psychiatrie de l'enfant et de l'adolescent, Hôpital Universitaire La Pitié - Salpétrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Céline Chalas
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Catherine Patrat
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France.,Inserm U1016, Institut Cochin, Université de Paris, Paris, France
| | - Nicolas Mendes
- Service de Psychiatrie de l'enfant et de l'adolescent, Hôpital Universitaire La Pitié - Salpétrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Véronique Drouineaud
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
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Metzler-Guillemain C, Saias-Magnan J, Carez S, Perrin J, Capelle M, Gnisci A, Bottin P, Daoud-Deveze C. [Disclosure to donor conceived offsprings after gamete donation or embryo donation: A major challenge for the future]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:220-222. [PMID: 32992054 DOI: 10.1016/j.gofs.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Indexed: 06/11/2023]
Affiliation(s)
- C Metzler-Guillemain
- Pôle femmes-parents-enfants, centre clinico-biologique d'assistance médicale à la procréation-CECOS, APHM, hôpital La Conception, 13385 Marseille cedex 5, France; Inserm, MMG, U1251, Marseille Medical Genetics, Aix-Marseille Université, 13385 Marseille, France.
| | - J Saias-Magnan
- Pôle femmes-parents-enfants, centre clinico-biologique d'assistance médicale à la procréation-CECOS, APHM, hôpital La Conception, 13385 Marseille cedex 5, France
| | - S Carez
- Pôle femmes-parents-enfants, centre clinico-biologique d'assistance médicale à la procréation-CECOS, APHM, hôpital La Conception, 13385 Marseille cedex 5, France; Pôle psychiatrie centre, APHM, Hôpital La Conception, 13385 Marseille, France
| | - J Perrin
- Pôle femmes-parents-enfants, centre clinico-biologique d'assistance médicale à la procréation-CECOS, APHM, hôpital La Conception, 13385 Marseille cedex 5, France; Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE) UMR CNRS 7263 - IRD 237, Aix-Marseille Université, Marseille, France
| | - M Capelle
- Pôle femmes-parents-enfants, centre clinico-biologique d'assistance médicale à la procréation-CECOS, APHM, hôpital La Conception, 13385 Marseille cedex 5, France
| | - A Gnisci
- Pôle femmes-parents-enfants, centre clinico-biologique d'assistance médicale à la procréation-CECOS, APHM, hôpital La Conception, 13385 Marseille cedex 5, France
| | - P Bottin
- Pôle femmes-parents-enfants, centre clinico-biologique d'assistance médicale à la procréation-CECOS, APHM, hôpital La Conception, 13385 Marseille cedex 5, France
| | - C Daoud-Deveze
- Pôle femmes-parents-enfants, centre clinico-biologique d'assistance médicale à la procréation-CECOS, APHM, hôpital La Conception, 13385 Marseille cedex 5, France
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Neyroud AS, Roche M, Domin M, Jaillard S, Ravel C. [Anonymity of gamete donation and genetic testing]. ACTA ACUST UNITED AC 2020; 48:820-826. [PMID: 32565387 DOI: 10.1016/j.gofs.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Indexed: 11/18/2022]
Abstract
Development of genetic testing direct-to-consumer (DTC) for recreational purposes, although prohibited in France, is a real challenge to the current practice of gamete donation. Indeed, anonymity is a fundamental principle contributing to the ethics of donation. This principle is weakened due to the availability to the general public of these tests on the Internet. Several thousands of people are conceived by gamete donation worldwide, some of whom do not know how they were conceived. Gamete donors should be informed that their anonymity is no longer guaranteed, as they can be found by homologies of their DNA, or that of a parent or a child, potentially available in databases. Thus, adults conceived by gamete donation but not informed by their parents can discover their way of conception. Recipients of gamete donation should also be informed that their child's DNA will establish the biological discrepancy and they should be encouraged to disclose the conception to their child. Several countries now allow children conceived by donation to obtain donor's identity. In France, the Bioethics Law is currently being finalized and will now allow access to donor's identity for people conceived by gamete donation.
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Affiliation(s)
- A-S Neyroud
- CHU Rennes, service de biologie de la reproduction-CECOS, 35000 Rennes, France; Univ Rennes, Inserm, EHESP, Irset (institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France
| | - M Roche
- CHU Rennes, service de biologie de la reproduction-CECOS, 35000 Rennes, France
| | - M Domin
- CHU Rennes, service de gynécologie, 35000 Rennes, France
| | - S Jaillard
- Univ Rennes, Inserm, EHESP, Irset (institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France; CHU Rennes, laboratoire de cytogénétique, 35000 Rennes, France
| | - C Ravel
- CHU Rennes, service de biologie de la reproduction-CECOS, 35000 Rennes, France; Univ Rennes, Inserm, EHESP, Irset (institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France.
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Silva SPD, Freitas CD, Baía I, Samorinha C, Machado H, Silva S. Doação de gametas: questões sociais e éticas (não) respondidas em Portugal. CAD SAUDE PUBLICA 2019; 35:e00122918. [DOI: 10.1590/0102-311x00122918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/25/2018] [Indexed: 12/12/2022] Open
Abstract
Resumo: Conhecer a discussão em torno dos desafios sociais e éticos da doação de gametas é fundamental para a boa governança das técnicas de reprodução assistida. Neste artigo, analisam-se os tópicos que orientaram o debate nas organizações de ética portuguesas, discutindo as suas conexões com os temas abordados internacionalmente. Para tal, em março de 2018, pesquisamos sistematicamente os websites do Conselho Nacional de Procriação Medicamente Assistida e do Conselho Nacional de Ética para as Ciências da Vida. Procedemos à análise de conteúdo temática de 25 documentos. Os resultados indicam que o debate se centrou na acessibilidade, no anonimato e na compensação de doadores e, em menor extensão, nas responsabilidades profissionais. Observaram-se posicionamentos heterogêneos e tensões entre múltiplos direitos e princípios éticos associados a receptores, a pessoas nascidas com recurso à doação de gametas e a doadores. Esses têm em comum três alegações: a escassez de evidência científica; as experiências de outros países; e regulamentações oriundas de entidades internacionais. Na literatura abordam-se tópicos adicionais, nomeadamente: uma via dupla que conjugue anonimato/identificação de doadores; implementação de sistemas de registo reprodutivo para receptores e doadores; limites do rastreio genético a doadores; doação por familiares/conhecidos; e o papel dos doadores na decisão quanto ao destino de embriões criopreservados e na escolha das características dos receptores dos seus gametas. Há espaço para expandir o debate e promover a pesquisa em torno das implicações sociais e éticas da doação de gametas, considerando a participação de todos os cidadãos.
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Affiliation(s)
| | - Cláudia De Freitas
- Universidade do Porto, Portugal; Universidade do Porto, Portugal; ISCT-Instituto Universitário de Lisboa, Portugal
| | - Inês Baía
- Universidade do Porto, Portugal; Universidade do Porto, Portugal
| | | | | | - Susana Silva
- Universidade do Porto, Portugal; Universidade do Porto, Portugal
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